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Lim SH, Gros B, Sharma E, Lehmann A, Lindsay JO, Caulfield L, Gaya DR, Taylor J, Limdi J, Kwok J, Shuttleworth E, Dhar A, Burdge G, Selinger C, Cococcia S, Murray C, Balendran K, Raine T, George B, Walker G, Aldridge R, Irving P, Lees CW, Samaan M. Safety, Effectiveness, and Treatment Persistence of Subcutaneous Vedolizumab in IBD: A Multicenter Study From the United Kingdom. Inflamm Bowel Dis 2023:izad166. [PMID: 37603730 DOI: 10.1093/ibd/izad166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Indexed: 08/23/2023]
Abstract
BACKGROUND AND AIMS Despite intravenous (IV) vedolizumab being established for treatment of inflammatory bowel disease (IBD), the novel subcutaneous (SC) route of administration may provide numerous incentives to switch. However, large-scale real-world data regarding the long-term safety and effectiveness of this strategy are lacking. METHODS IBD patients on IV vedolizumab across 11 UK sites agreed to transition to SC injections or otherwise continued IV treatment. Data regarding clinical disease activity (Simple Clinical Colitis Activity Index, partial Mayo score, and modified Harvey-Bradshaw Index), biochemical markers (C-reactive protein and calprotectin), quality of life (IBD control), adverse events, treatment persistence, and disease-related outcomes (namely corticosteroid use, IBD-related hospitalization, and IBD-related surgery) were retrospectively collected from prospectively maintained clinical records at baseline and weeks 8, 24, and 52. RESULTS Data from 563 patients (187 [33.2%] Crohn's disease, 376 [66.8%] ulcerative colitis; 410 [72.8%] SC, 153 [27.2%] IV) demonstrated no differences in disease activity, remission rates, and quality of life between the SC and IV groups at all time points. Drug persistence at week 52 was similar (81.1% vs 81.2%; P = .98), as were rates of treatment alteration due to either active disease (12.2% vs 8.9%; P = .38) or adverse events (3.3% vs 6.3%; P = .41). At week 52, there were equivalent rates of adverse events (9.8% vs 7.8%; P = .572) and disease-related outcomes. IBD control scores were equivalent in both IV-IV and IV-SC groups. CONCLUSIONS Switching to SC vedolizumab appears as effective, safe, and well tolerated as continued IV treatment and maintains comparable disease control and quality of life as IV treatment at 52 weeks.
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Affiliation(s)
- Samuel Hsiang Lim
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Beatriz Gros
- Edinburgh IBD Unit, NHS Lothian, Edinburgh, United Kingdom
| | - Esha Sharma
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anouk Lehmann
- Department of Gastroenterology, Royal London Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - James O Lindsay
- Department of Gastroenterology, Royal London Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - Louise Caulfield
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Jo Taylor
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Jimmy Limdi
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Jon Kwok
- Department of Gastroenterology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Elinor Shuttleworth
- Department of Gastroenterology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Anjan Dhar
- Department of Gastroenterology, Country Durham and Darlington NHS Foundation Trust, United Kingdom
| | - Gemma Burdge
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Christian Selinger
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Sara Cococcia
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Charles Murray
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Karthiha Balendran
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Becky George
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Gareth Walker
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Robin Aldridge
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Peter Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Charlie W Lees
- Edinburgh IBD Unit, NHS Lothian, Edinburgh, United Kingdom
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Samaan
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Carbery I, Burdge G, Clark T, Broglio G, Greer D, Alakkari A, Selinger CP. Impact on direct and indirect costs of switching patients with inflammatory bowel disease from intravenous to subcutaneous infliximab (CT-P13). BMJ Open Gastroenterol 2023; 10:bmjgast-2023-001105. [PMID: 36813298 PMCID: PMC9950917 DOI: 10.1136/bmjgast-2023-001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND We aim to compare the real-life direct and indirect costs of switching patients from intravenous to subcutaneous (SC) CT-P13, an infliximab biosimilar, in a tertiary UK Inflammatory Bowel Disease (IBD) centre. METHODS All adult patients with IBD on standard dosing CT-P13 (5 mg/kg 8 weekly) were eligible to switch. Of 169 patients eligible to switch to SC CT-P13, 98 (58%) switched within 3 months and one moved out of area. RESULTS Total annual intravenous cost for 168 patients was £689 507.04 (direct=£653 671.20, indirect=£35 835.84). After the switch, as-treated analysis demonstrated total annual cost for 168 patients (70 intravenous and 98 SC) was £674 922.83 (direct = £654 563, indirect = £20 359.83) resulting in £891.80 higher cost to healthcare providers. Intention to treat analysis showed a total annual cost of £665 961.01 (direct = £655 200, indirect = £10 761.01) resulting in £1528.80 higher cost to healthcare providers. However, in each scenario, the significant decrease in indirect costs resulted in lower total costs after switching to SC CT-P13. CONCLUSIONS Our real-world analysis demonstrates switching from intravenous to SC CT-P13 is broadly cost neutral to healthcare providers. SC preparations have marginally higher direct costs, switching allows for efficient use of intravenous infusion units and reduces costs to patients.
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Affiliation(s)
| | | | - Tanya Clark
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Giacomo Broglio
- IRCCS Fondazione Policlinico San Matteo Internal Medicine, Pavia, Italy
| | - Dan Greer
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Barton SJ, Ngo S, Costello P, Garratt E, El-Heis S, Antoun E, Clarke-Harris R, Murray R, Bhatt T, Burdge G, Cooper C, Inskip H, van der Beek EM, Sheppard A, Godfrey KM, Lillycrop KA. DNA methylation of Th2 lineage determination genes at birth is associated with allergic outcomes in childhood. Clin Exp Allergy 2017; 47:1599-1608. [PMID: 28756630 DOI: 10.1111/cea.12988] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/08/2017] [Accepted: 07/12/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is now increasing evidence that asthma and atopy originate in part in utero, with disease risk being associated with the altered epigenetic regulation of genes. OBJECTIVE AND METHODS To determine the relationship between variations in DNA methylation at birth and the development of allergic disease, we examined the methylation status of CpG loci within the promoter regions of Th1/2 lineage commitment genes (GATA3, IL-4, IL-4R, STAT4 and TBET) in umbilical cord DNA at birth in a cohort of infants from the Southampton Women's Survey (n = 696) who were later assessed for asthma, atopic eczema and atopy. RESULTS We found that higher methylation of GATA3 CpGs -2211/-2209 at birth was associated with a reduced risk of asthma at ages 3 (median ratio [median methylation in asthma group/median methylation in non-asthma group] = 0.74, P = .006) and 6-7 (median ratio 0.90, P = .048) years. Furthermore, we demonstrated that the GATA3 CpG loci associated with later risk of asthma lie within a NF-κB binding site and that methylation here blocks transcription factor binding to the GATA3 promoter in the human Jurkat T-cell line. Associations between umbilical cord methylation of CpG loci within IL-4R with atopic eczema at 12 months (median ratio 1.02, P = .028), and TBET with atopy (median ratio 0.98, P = .017) at 6-7 years of age were also observed. CONCLUSIONS AND CLINICAL RELEVANCE Our findings provide further evidence of a developmental contribution to the risk of later allergic disorders and suggest that involvement of epigenetic mechanisms in childhood asthma is already demonstrable at birth.
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Affiliation(s)
- S J Barton
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S Ngo
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - P Costello
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - E Garratt
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - S El-Heis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E Antoun
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - R Clarke-Harris
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - R Murray
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - T Bhatt
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - G Burdge
- Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - E M van der Beek
- Nutricia Research, Danone Nutricia Early Life Nutrition, Utrecht, The Netherlands.,Department of Pediatrics, University medical Centre Groningen, Groningen, The Netherlands
| | - A Sheppard
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Human Development and Health Academic Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - K A Lillycrop
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.,Centre for Biological Sciences, University of Southampton, Southampton, UK
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Raffa RB, Burdge G, Gambrah J, Kinecki HE, Lin F, Lu B, Nguyen JT, Phan V, Ruan A, Sesay MA, Watkins TN. Cebranopadol: novel dual opioid/NOP receptor agonist analgesic. J Clin Pharm Ther 2016; 42:8-17. [DOI: 10.1111/jcpt.12461] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- R. B. Raffa
- Temple University School of Pharmacy; Philadelphia PA USA
- University of Arizona College of Pharmacy; Tucson AZ USA
| | - G. Burdge
- Temple University School of Pharmacy; Philadelphia PA USA
| | - J. Gambrah
- Temple University School of Pharmacy; Philadelphia PA USA
| | - H. E. Kinecki
- Temple University School of Pharmacy; Philadelphia PA USA
| | - F. Lin
- Temple University School of Pharmacy; Philadelphia PA USA
| | - B. Lu
- Temple University School of Pharmacy; Philadelphia PA USA
| | - J. T. Nguyen
- Temple University School of Pharmacy; Philadelphia PA USA
| | - V. Phan
- Temple University School of Pharmacy; Philadelphia PA USA
| | - A. Ruan
- Temple University School of Pharmacy; Philadelphia PA USA
| | - M. A. Sesay
- Temple University School of Pharmacy; Philadelphia PA USA
| | - T. N. Watkins
- Temple University School of Pharmacy; Philadelphia PA USA
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Vagadia V, Bartholomew P, Kelly M, Handley G, Kelly C, Bridges M, Ruddick S, Malik R, Gilleece Y, Fisher M, Walker-Bone K, Selvan S, Collins DA, Meryon I, Pattle J, Scurr C, Davies G, Callan M, Mercieca C, Down M, Webb J, Shipley J, Bhalla AK, Poole KE, Treece GM, Ridgway GR, Mayhew PM, Borggrefe J, Gee AH, Mehta P, Nelson M, Boag F, Oldroyd AG, Halsey J, Goodson NJ, Greenbank C, Evans B, Bukhari M, Azagra R, Roca G, Encabo G, Aguye A, Zwart M, Casado E, Iglesias M, Puchol N, Sola S, Guell S, Harvey NC, Garrett E, Sheppard A, McLean C, Lillycrop K, Burdge G, Slater-Jefferies J, Rodford J, Crozier S, Inskip H, Starling Emerald B, Gale C, Hanson M, Gluckman P, Godfrey K, Cooper C, Edwards MH, Jameson K, Denison H, Aihie Sayer A, Cooper C, Dennison E, Cole Z, Harvey NC, Kim M, Robinson S, Inskip H, Godfrey KM, Cooper C, Dennison E, Clark EM, Morrison L, Gould V, Cuming M, Tobias J. Osteoporosis and metabolic bone disease: 73. Do Low Vitamin D Levels Predict Osteoporosis? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Burdge G, Alam SU, Grudinin A, Durkin M, Ibsen M, Khrushchev I, White I. Ultrafast intensity modulation by Raman gain for all-optical in-fiber processing. Opt Lett 1998; 23:606-608. [PMID: 18084591 DOI: 10.1364/ol.23.000606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We present experimental results on ultrafast intensity modulation using the Raman effect and demonstrate 10-Gbit/s selective pulse erasure. The technique is both broadband and polarization insensitive and has a potential speed in excess of 500 Gbits/s. In addition to performing pulse erasure, this all-optical modulator can shape pulses as a precise, soft aperture scalpel and create short, dark pulses.
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Abstract
The development or maturation of intercellular adhesions following their initiation has received very little attention even though this is an area of significance for a variety of in vivo processes. Using Ca2(+)-induced desmosome formation in MDCK cells as a study system it is shown that, following its initiation, desmosome formation continues for many hours. Following Ca2+ switching the major desmosomal glycoproteins, dg2/3a,b (desmocollins), accumulate progressively at the cell surface. Accumulation is first detectable within 45 min, but continues linearly for approximately 16 h, reaching a plateau at 24-32 h at 15 times the amount present in low-Ca2+ medium (LCM). Desmosomes do not increase in size during this time, but appear to become more numerous. These results suggest that cells progressively increase their desmosome-mediated adhesion over this period of time. Cycloheximide treatment shows that approximately 93% of the total dg2/3a,b accumulation is dependent upon protein synthesis after Ca2+ switching and only approximately 7% on assembly of pre-synthesised material. Thus, although triggering of desmosome formation is rapid, protein synthesis makes a major contribution to the gradual development of desmosomal adhesion in these cells. The initial assembly phase itself can be inhibited by treating cells in LCM with chloroquine, which reduces the cell surface concentration of dg2/3a,b by 40-50%. However, slow dg2/3a,b accumulation does take place in chloroquine and, if protein synthesis is permitted, desmosome formation occurs. It is suggested that when cell contacts are formed in vivo, maximisation of intercellular adhesiveness may take many hours and is dependent on the synthesis and accumulation of adhesive components.
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Affiliation(s)
- D L Mattey
- Cancer Research Campaign Medical Oncology Unit, University of Southampton, Southampton General Hospital, UK
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