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Rodriguez-Valero N, Sarasola Balerdi L, Vera I, de Alba T, Saloni M, Camprubí-Ferrer D. A skin comet sign after a trip to the Gambia. J Travel Med 2024; 31:taad162. [PMID: 38127628 DOI: 10.1093/jtm/taad162] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
A comet-like skin lesion, observed post-travel to Western Africa, was diagnosed as a Pyemotes spp.-related condition, coincidentally following the reading of an old, dusty book.
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Affiliation(s)
- Natalia Rodriguez-Valero
- Department of International Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Leire Sarasola Balerdi
- Department of International Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- Department of International Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Teresa de Alba
- Department of International Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Saloni
- Department of International Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Camprubí-Ferrer
- Department of International Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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2
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Martínez-Lacalzada M, Vera I, Álvarez-Martínez MJ, Aylagas C, Rodriguez-Valero N. Scalp myiasis presenting as forehead edema in a returning traveller from Belize: A diagnostic challenge. Travel Med Infect Dis 2024; 58:102661. [PMID: 38008238 DOI: 10.1016/j.tmaid.2023.102661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Miguel Martínez-Lacalzada
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
| | - Isabel Vera
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Miriam José Álvarez-Martínez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Biomedical Diagnostic Center (CDB), Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Cristian Aylagas
- Department of Microbiology, Biomedical Diagnostic Center (CDB), Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rodriguez-Valero
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
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3
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Martínez-Lacalzada M, Cruz A, Subirà C, Vera I, Roldan M, De Alba T, Saloni M, Muñoz J, Rodríguez-Valero N. Lack of a non-specific protective effect of prior yellow fever vaccination against COVID-19. J Travel Med 2024:taae027. [PMID: 38366375 DOI: 10.1093/jtm/taae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/16/2024] [Indexed: 02/18/2024]
Abstract
Live-attenuated virus vaccines, such as yellow fever vaccine, exhibit non-specific immunomodulatory effects, prompting exploration of their potential impact on COVID-19 pandemic. In this retrospective study, we didn’t observe an association between prior yellow fever vaccination with SARS-CoV-2 infection incidence. In the multivariate model, no association was found with COVID-19 prognosis.
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Affiliation(s)
- Miguel Martínez-Lacalzada
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Carme Subirà
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Roldan
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Teresa De Alba
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Saloni
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rodríguez-Valero
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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4
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Rodriguez-Valero N, Ledesma-Carbayo MJ, Martí-Soler H, Cuadrado Sanchez D, Vladimirov A, Camprubí-Ferrer D, Pinazo MJ, Losada I, Almuedo-Riera A, Romero L, Roman A, Vera I, Roldan-Torralvo M, Ferrer E, de Alba T, Jimenez A, Gómez-Valverde JJ, Muñoz J, Luengo Oroz M. A Smartphone App for Real-Time Assessment of Malaria Prophylaxis Adverse Events. Telemed J E Health 2024. [PMID: 38215269 DOI: 10.1089/tmj.2023.0200] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Background: Growth of international travel to malarial areas over the last decades has contributed to more travelers taking malaria prophylaxis. Travel-related symptoms may be wrongly attributed to malaria prophylaxis and hinder compliance. Here, we aimed to assess the frequency of real-time reporting of symptoms by travelers following malaria prophylaxis using a smartphone app. Method: Adult international travelers included in this single-center study (Barcelona, Spain) used the smartphone Trip Doctor® app developed by our group for real-time tracking of symptoms and adherence to prophylaxis. Results: Six hundred four (n = 604) international travelers were included in the study; 74.3% (449) used the app daily, and for one-quarter of travelers, malaria prophylaxis was prescribed. Participants from the prophylaxis group traveled more to Africa (86.7% vs. 4.3%; p < 0.01) and to high travel medical risk countries (60.8% vs. 18%; p < 0.01) and reported more immunosuppression (30.8% vs. 23.1% p < 0.01). Regarding symptoms, no significant intergroup differences were observed, and no relationship was found between the total number of malarial pills taken and reported symptoms. Conclusions: In our cohort, the number of symptoms due to malaria prophylaxis was not significantly higher than in participants for whom prophylaxis was not prescribed, and the overall proportion of symptoms is higher compared with other studies.
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Affiliation(s)
- Natalia Rodriguez-Valero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesus Ledesma-Carbayo
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Helena Martí-Soler
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Cuadrado Sanchez
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | | | - Daniel Camprubí-Ferrer
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesus Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Irene Losada
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Lucia Romero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Anna Roman
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Roldan-Torralvo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Ferrer
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Teresa de Alba
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Alejandra Jimenez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Juan Jose Gómez-Valverde
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Jose Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Luengo Oroz
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
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5
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Calafat M, Torres P, Tosca-Cuquerella J, Sánchez-Aldehuelo R, Rivero M, Iborra M, González-Vivo M, Vera I, de Castro L, Bujanda L, Barreiro-de Acosta M, González-Muñoza C, Calvet X, Benítez JM, Llorente-Barrio M, Surís G, Cañete F, Arias-García L, Monfort D, Castaño-García A, Garcia-Alonso FJ, Huguet JM, Marín-Jímenez I, Lorente R, Martín-Cardona A, Ferrer JÁ, Camo P, Gisbert JP, Pajares R, Gomollón F, Castro-Poceiro J, Morales-Alvarado J, Llaó J, Rodríguez A, Rodríguez C, Pérez-Galindo P, Navarro M, Jiménez-García N, Carrillo-Palau M, Blázquez-Gómez I, Sesé E, Almela P, Ramírez de la Piscina P, Taxonera C, Rodríguez-Lago I, Cabrinety L, Vela M, Mínguez M, Mesonero F, García MJ, Aguas M, Márquez L, Silva Porto M, Pineda JR, García-Etxebarría K, Bertoletti F, Brunet E, Mañosa M, Domènech E. Clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in patients with ulcerative colitis treated with two consecutive anti-TNF agents: data from the ENEIDA registry. Therap Adv Gastroenterol 2024; 17:17562848231221713. [PMID: 38187926 PMCID: PMC10771049 DOI: 10.1177/17562848231221713] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC) but little is known when it is used as the second anti-TNF. Objectives To compare the clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients. Design Retrospective observational study. Methods Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially). Results Overall, 473 UC patients were included (330 IVi and 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4% in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission. Conclusion The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.
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Affiliation(s)
- Margalida Calafat
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Paola Torres
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joan Tosca-Cuquerella
- Gastroenterology Department, Hospital Clínic Universitari de València, València, Spain
| | | | - Montserrat Rivero
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de investigación IDIVAL, Santander, Spain
| | - Marisa Iborra
- Gastroenterology Department, Hospital Universitari i Politècnic La Fe, València, Spain
| | | | - Isabel Vera
- Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Luisa de Castro
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Luis Bujanda
- Biodonostia Health Research Institute, San Sebastián, Spain
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, San Sebastián, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Xavier Calvet
- Gastroenterology Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - José Manuel Benítez
- Gastroenterology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | - Gerard Surís
- Gastroenterology Department, Hospital Universitari de Bellvitge (L’ Hospitalet de Llobregat), Barcelona, Spain
| | - Fiorella Cañete
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Lara Arias-García
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - David Monfort
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Andrés Castaño-García
- Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - José M. Huguet
- Gastroenterology Department, Hospital General Universitari de València, València, Spain
| | | | - Rufo Lorente
- Gastroenterology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Albert Martín-Cardona
- Gastroenterology Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Juan Ángel Ferrer
- Gastroenterology Department, Hospital Universitario Fundación de Alcorcón (Madrid), Spain
| | - Patricia Camo
- Gastroenterology Department, Hospital General San Jorge, Huesca, Spain
| | - Javier P. Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, IIS Princesa and UAM, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Ramón Pajares
- Gastroenterology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Fernando Gomollón
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | | | | | - Jordina Llaó
- Gastroenterology Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Andrés Rodríguez
- Gastroenterology Department, Hospital General Universitari d’Alacant, Alacant, Spain
| | - Cristina Rodríguez
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Pablo Pérez-Galindo
- Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Mercè Navarro
- Gastroenterology Department, Hospital Moisès Broggi, Sant Joan Despí, Spain
| | | | - Marta Carrillo-Palau
- Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain
| | | | - Eva Sesé
- Gastroenterology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Pedro Almela
- Gastroenterology Department, Hospital General Universitari de Castelló, Castellón, Spain
| | | | - Carlos Taxonera
- Gastroenterology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, Biocruces Bizkaia HRI, Galdakao, Spain
| | - Lidia Cabrinety
- Gastroenterology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Milagros Vela
- Gastroenterology Department, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Miguel Mínguez
- Gastroenterology Department, Hospital Clínic Universitari de València, València, Spain
| | | | - María José García
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de investigación IDIVAL, Santander, Spain
| | - Mariam Aguas
- Gastroenterology Department, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | - Marisol Silva Porto
- Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Juan R. Pineda
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Koldo García-Etxebarría
- Biodonostia Health Research Institute, San Sebastián, Spain
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, San Sebastián, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Federico Bertoletti
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduard Brunet
- Gastroenterology Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Míriam Mañosa
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Eugeni Domènech
- Gastroenterology and Hepatology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, Catalonia 08916, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
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Laynez-Roldán P, Losada-Galván I, Posada E, de la Torre Ávila L, Casellas A, Sanz S, Subirà C, Rodriguez-Valero N, Camprubí-Ferrer D, Vera I, Roldán M, Aldasoro E, Oliveira-Souto I, Calvo-Cano A, Valls ME, Álvarez-Martínez MJ, Gállego M, Abras A, Ballart C, Muñoz J, Gascón J, Pinazo MJ. Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement. PLoS Negl Trop Dis 2023; 17:e0011330. [PMID: 37440480 DOI: 10.1371/journal.pntd.0011330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi causes Chagas disease (CD), a potentially fatal disease characterized by cardiac disorders and digestive, neurological or mixed alterations. T. cruzi is transmitted to humans by the bite of triatomine vectors; both the parasite and disease are endemic in Latin America and the United States. In the last decades, population migration has changed the classic epidemiology of T. cruzi, contributing to its global spread to traditionally non-endemic countries. Screening is recommended for Latin American populations residing in non-endemic countries. METHODS The present study analyzes the epidemiological characteristics of 2,820 Latin American individuals who attended the International Health Service (IHS) of the Hospital Clinic de Barcelona between 2002 and 2019. The initial assessment of organ damage among positive cases of T. cruzi infection was analyzed, including the results of electrocardiogram (ECG), echocardiogram, barium enema and esophagogram. RESULTS Among all the screened individuals attending the clinic, 2,441 (86.6%) were born in Bolivia and 1,993 (70.7%) were female. Of individuals, 1,517 (81.5%) reported previous exposure to the vector, which is a strong risk factor associated with T. cruzi infection; 1,382 individuals were positive for T. cruzi infection. The first evaluation of individuals with confirmed T. cruzi infection, showed 148 (17.1%) individuals with Chagasic cardiomyopathy, the main diagnostic method being an ECG and the right bundle branch block (RBBB) for the most frequent disorder; 16 (10.8%) individuals had a normal ECG and were diagnosed of Chagasic cardiomyopathy by echocardiogram. CONCLUSIONS We still observe many Latin American individuals who were at risk of T. cruzi infection in highly endemic areas in their countries of origin, and who have not been previously tested for T. cruzi infection. In fact, even in Spain, a country with one of the highest proportion of diagnosis of Latin American populations, T. cruzi infection remains underdiagnosed. The screening of Latin American populations presenting with a similar profile as reported here should be promoted. ECG is considered necessary to assess Chagasic cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach given that it can detect cardiac abnormalities when the ECG is normal.
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Affiliation(s)
- Pedro Laynez-Roldán
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Irene Losada-Galván
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elizabeth Posada
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Leonardo de la Torre Ávila
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Aina Casellas
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Sergi Sanz
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Carme Subirà
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rodriguez-Valero
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Camprubí-Ferrer
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Roldán
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Edelweiss Aldasoro
- The International Foundation for Integrated Care (IFIC), Schiphol, The Netherlands
| | - Inés Oliveira-Souto
- Department of Infectious Diseases, Tropical Medicine & International Health Unit Vall d'Hebron-Drassanes, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Antonia Calvo-Cano
- Department of Infectious Pathology, Badajoz University Hospital, Badajoz, Spain
| | - Maria-Eugenia Valls
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic, Barcelona, Spain
| | - Míriam J Álvarez-Martínez
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic, Barcelona, Spain
| | - Montserrat Gállego
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Parasitology section, Departament of Biology, Health and Environment, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
- Center for Network Biothecnological Research in Infectious Diseases (CIBERISCIII), Madridy, Spain
| | - Alba Abras
- Genetic Area, Department of Biology, Universitat de Girona, Campus Montilivi, Girona, Spain
| | - Cristina Ballart
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Parasitology section, Departament of Biology, Health and Environment, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
| | - José Muñoz
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Gascón
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Center for Network Biothecnological Research in Infectious Diseases (CIBERISCIII), Madridy, Spain
| | - Maria-Jesus Pinazo
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Center for Network Biothecnological Research in Infectious Diseases (CIBERISCIII), Madridy, Spain
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7
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Balerdi-Sarasola L, Parolo C, Fleitas P, Cruz A, Subirà C, Rodríguez-Valero N, Almuedo-Riera A, Letona L, Álvarez-Martínez MJ, Valls ME, Vera I, Mayor A, Muñoz J, Camprubí-Ferrer D. Host biomarkers for early identification of severe imported Plasmodium falciparum malaria. Travel Med Infect Dis 2023; 54:102608. [PMID: 37348666 DOI: 10.1016/j.tmaid.2023.102608] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Severe imported P. falciparum malaria is a source of morbi-mortality in non-endemic regions. WHO criteria don't accurately classify patients at risk of complications. There is a need to evaluate new tools such as biomarkers to better identify patients with severe imported malaria. METHODS A case-control study was conducted in Barcelona, from January 2011-January 2021. Adult patients with microbiologically confirmed P. falciparum malaria were classified according to WHO criteria. Patients with imported non-malarial fevers were included as controls. In each group, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble triggering receptor expressed on myeloid cells (sTREM-1), C-reactive protein (CRP) and platelets were measured and their concentrations were compared between groups. New groups were made with a modified WHO severity classification and biomarkers' performance was evaluated using multiple imputation models. RESULTS 131 participants were included: 52 severe malaria, 30 uncomplicated malaria and 49 non-malarial fever cases. All biomarkers except sTREM-1 showed significant differences between groups. Using the modified WHO severity classification, Ang-2 and CRP presented the best AUROC; 0.79 (95%CI 0.64-0.94) and 0.80(95%CI 0.67-0.93). A model combining CRP and Ang-2 showed the best AUROC, of 0.84(95%CI 0.68-0.99), with the highest sensitivity and specificity: 84.6%(95%CI 58.9-98.1) and 77.4% (95%CI 65.9-87.7), respectively. CONCLUSIONS The combination of Ang-2 and CRP may be a reliable tool for the early identification of severe imported malaria. The use of a rapid prognostic test including the mentioned biomarkers could optimize imported malaria management, with the potential to decrease the rate of complications and hospitalizations in patients with imported malaria.
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Affiliation(s)
| | - C Parolo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - P Fleitas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Cruz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - A Almuedo-Riera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - L Letona
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M J Álvarez-Martínez
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - M Eugenia Valls
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - I Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - D Camprubí-Ferrer
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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8
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Taxonera C, Fernández-Aceñero MJ, Olivares D, Calvo M, Casis B, Bermejo F, López Serrano P, Iborra M, Mesonero F, Boscá Watts M, Díaz Del Arco C, Vera I, Olivares S, Algaba A, Alba C. Association of golimumab trough concentrations during maintenance with clinical, biological, endoscopic and histologic remission in patients with ulcerative colitis. Aliment Pharmacol Ther 2022; 56:614-624. [PMID: 35509152 DOI: 10.1111/apt.16964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/21/2022] [Accepted: 04/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Optimal golimumab concentration thresholds for important outcomes during maintenance are lacking. AIMS To investigate the association of golimumab trough concentrations during maintenance with key outcomes, including endoscopic and histologic remission, and long-term event-free persistence with golimumab, in patients with UC. METHODS This multi-centre, cross-sectional study included patients with UC on golimumab maintenance recruited either in remission or during a flare. Colonoscopy was scheduled, and study-specific rectocolonic biopsies were taken for blind central histologic reading. Samples for golimumab trough concentrations were collected close to colonoscopy. RESULTS Fifty-two patients were included. Median golimumab trough concentrations (μg/ml) were significantly higher in patients who had clinical remission (2.01 vs. 0.72, p = 0.047), combined clinical-biochemical remission (PMS ≤2 + faecal calprotectin <250 μg/g) (2.21 vs. 1.47, p = 0.041), endoscopic healing (Mayo endoscopic subscore 0) (2.52 vs. 1.47, p = 0.003), histologic remission (Geboes index ≤2.0) (2.33 vs. 1.50, p = 0.02) and disease clearance (clinical remission endoscopic healing + histologic remission) (2.52 vs. 1.70, p = 0.009), compared with those not meeting these criteria. Golimumab concentrations were significantly higher in patients who avoided golimumab dose escalation/discontinuation during follow-up (2.24 vs. 0.98, p = 0.012). Receiver-operating characteristic analyses identified golimumab thresholds [area under the curve] of 0.85 [0.76], 1.90 [0.76], 2.29 [0.75], 1.79 [0.68], 2.29 [0.72] and 1.56 [0.71] μg/ml as associated with clinical remission, combined remission, endoscopic healing, histologic remission, disease clearance and long-term event-free persistence with golimumab, respectively. CONCLUSIONS Golimumab trough concentrations during maintenance are associated with favourable treatment outcomes including endoscopic healing, histologic remission and long-term persistence on golimumab. We identified the optimal golimumab thresholds most closely associated with key outcomes.
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Affiliation(s)
- Carlos Taxonera
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.,Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | | | - David Olivares
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.,Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Marta Calvo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Begoña Casis
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario Fuenlabrada, Madrid, Spain
| | - Pilar López Serrano
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Marisa Iborra
- Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain
| | - Francisco Mesonero
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Maia Boscá Watts
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Isabel Vera
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Sonsoles Olivares
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alicia Algaba
- Department of Gastroenterology, Hospital Universitario Fuenlabrada, Madrid, Spain
| | - Cristina Alba
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain.,Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
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9
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Calafat M, Mañosa M, Ricart E, Nos P, Iglesias-Flores E, Vera I, López-Sanromán A, Guardiola J, Taxonera C, Mínguez M, Martín-Arranz MD, de Castro L, de Francisco R, Rivero M, Garcia-Planella E, Calvet X, García-López S, Márquez L, Gomollón F, Barrio J, Esteve M, Muñoz F, Gisbert JP, Gutiérrez A, Hinojosa J, Argüelles-Arias F, Busquets D, Bujanda L, Pérez-Calle JL, Sicilia B, Merino O, Martínez P, Bermejo F, Lorente R, Barreiro-de Acosta M, Rodríguez C, Fe García-Sepulcre M, Monfort D, Cañete F, Domènech E. Risk of Immunomediated Adverse Events and Loss of Response to Infliximab in Elderly Patients with Inflammatory Bowel Disease: A Cohort Study of the ENEIDA Registry. J Crohns Colitis 2022; 16:946-953. [PMID: 34864947 DOI: 10.1093/ecco-jcc/jjab213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 12/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Immunomediated adverse events [IAEs] are the most frequently reported infliximab [IFX]-related adverse events. Combination therapy may reduce their incidence, although this strategy is not recommended in elderly patients. We aimed to compare the rates of IFX-related IAEs and loss of response [LOR] in elderly and younger patients. METHODS Adult patients in the ENEIDA registry who had received a first course of IFX therapy were identified and grouped into two cohorts regarding age at the beginning of treatment [over 60 years and between 18 and 50 years]. The rates of IAEs and LOR were compared. RESULTS In total, 939 patients [12%] who started IFX over 60 years of age and 6844 [88%] below 50 years of age were included. Elderly patients presented a higher proportion of AEs related to IFX [23.2% vs 19%; p = 0.002], infections [7.1% vs 4.3%; p < 0.001] and neoplasms [2.2% vs 0.5%; p < 0.001]. In contrast, the rates of IAEs [14.8% vs 14.8%; p = 0.999], infusion reactions [8.1% vs 8.1%; p = 0.989], late hypersensitivity [1.3% vs 1.2%; p = 0.895], paradoxical psoriasis [1% vs 1.5%; p = 0.187] and drug-induced lupus erythematosus [0.6% vs 0.7%; p = 0.947] were similar in elderly and younger patients. LOR rates were also similar between the two groups [20.5% vs 19.3%; p = 0.438]. In the logistic regression analysis, IFX monotherapy, extraintestinal manifestations and female gender were the only risk factors for IAEs, whereas IFX monotherapy, extraintestinal manifestations and Crohn's disease were risk factors for LOR. CONCLUSIONS Elderly patients with inflammatory bowel disease have a similar risk of developing IFX-related IAEs and LOR to that of younger patients.
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Affiliation(s)
- Margalida Calafat
- H.U. Germans Trias i Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Míriam Mañosa
- H.U. Germans Trias i Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,H. Clínic Barcelona, Barcelona; IDIBAPS, Barcelona, Spain
| | - Pilar Nos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,H. Universitari La Fe, València, Spain
| | | | - Isabel Vera
- H.U. Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | - Carlos Taxonera
- H.U. Clínico San Carlos, Madrid; Instituto de investigación del Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Mínguez
- H.U. Clínico de València, València; Universitat de València, València, Spain
| | | | | | - Ruth de Francisco
- H.U. Central de Asturias and Instituto de Investigación Biosanitaria del principado de Asturias (ISPA), Oviedo, Spain
| | | | | | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,H.U. Parc Taulí , Sabadell, Spain
| | | | - Lucía Márquez
- Servei de Digestiu, Hospital del Mar, Barcelona and IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Fernando Gomollón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,H. Clínico Lozano Blesa, Zaragoza; Instituto de Investigaciones Sanitarias de Aragón
| | - Jesús Barrio
- Servicio de Gastroenterología. Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Maria Esteve
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,H. Universitari Mútua Terrassa, Terrassa, Spain
| | | | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,H. U. de la Princesa, Madrid; Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM)
| | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,H.G.U.Alicante, Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) , Spain
| | | | - Federico Argüelles-Arias
- Servicio de Digestivo, Hospital Universitario Virgen Macarena, Sevilla; Profesor Facultad Medicina de la Universidad de Sevilla, Sevilla, Spain
| | | | - Luís Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.,Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | | | | | | | | | - Fernando Bermejo
- Hospital Universitario de Fuenlabrada and Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain
| | | | | | | | | | | | - Fiorella Cañete
- H.U. Germans Trias i Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Eugeni Domènech
- H.U. Germans Trias i Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
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10
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Rodriguez-Valero N, Carbayo ML, Camprubí-Ferrer D, Martí-Soler H, Sanchez DC, Vladimirov A, Pinazo MJ, Almuedo-Riera A, Roman A, Vera I, Roldan M, de Alba T, Jimenez A, Gómez-Valverde JJ, Oroz ML, Muñoz J. Telemedicine for international travelers through a Smartphone-based monitoring platform (Trip Doctor®). Travel Med Infect Dis 2022; 49:102356. [PMID: 35589007 DOI: 10.1016/j.tmaid.2022.102356] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/24/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Overall, more than 50% of international travelers develop symptoms while traveling and 55% of them seek medical assistance during the trip. We conducted a study to evaluate the usefulness of a Smartphone app called TRIP Doctor® to provide telemedicine to international travelers. METHODS Participants over 18 years old attending our travel clinic at Hospital Clinic in Barcelona were invited to participate during 2017-2019. After downloading the app, the health status of the traveler was monitored on a daily basis, providing specific medical advice and offering remote contact with specialized physicians through an integrated chat, if needed. RESULTS From 449 users, 59 (13%) contacted for medical assistance through the app during the trip. Main reasons for telemedicine were diarrhea (25.7%), skin conditions (19.7%) and fever (12.1%). Among patients who contacted, 90% of the travelers did not require to be referred to a local doctor. Symptomatic treatment was the main treatment prescribed (38%). In a 14.7% of the cases a follow-up was not required, a 63.2% recovered and 22.1% were loss of follow-up. After a multivariate analysis, duration of trip >14 days was found to be the only factor associated with the use of telemedicine (OR 2.2, CI 95% 1.1-4.5, p = 0.03). CONCLUSION In conclusion, travelers using telemedicine travelled for longer periods of time and mostly contacted for mild symptoms which could be solved successfully by remote assistance with our specialized doctors.
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Affiliation(s)
- N Rodriguez-Valero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain.
| | - Mj Ledesma Carbayo
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - D Camprubí-Ferrer
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - H Martí-Soler
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - D Cuadrado Sanchez
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - A Vladimirov
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - M J Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - A Almuedo-Riera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - A Roman
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - I Vera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - M Roldan
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - T de Alba
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - A Jimenez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - Juan J Gómez-Valverde
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - M Luengo Oroz
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - J Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
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11
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Hernández-Camba A, Arranz L, Vera I, Carpio D, Calafat M, Lucendo AJ, Taxonera C, Marín S, Garcia MJ, Marín GS, Rodríguez ES, Carbajo AY, De Castro ML, Iborra M, Martin-Cardona A, Rodríguez-Lago I, Busquets D, Bertoletti F, Ausín MS, Tardillo C, Malaves JH, Bujanda L, Castaño A, Domènech E, Ramos L. Real-world use of mycophenolate mofetil in inflammatory bowel disease: Results from the ENEIDA registry. Dig Liver Dis 2022; 54:635-641. [PMID: 34862115 DOI: 10.1016/j.dld.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments. AIMS Our primary objective was to evaluate the effectiveness and safety of MMF in IBD. METHODS IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented. RESULTS A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5). CONCLUSION Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.
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Affiliation(s)
- A Hernández-Camba
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain.
| | - L Arranz
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain
| | - I Vera
- Hospital Universitario Puerta de Hierro Majadahonda, Gastroenterology Dept., Madrid, Spain
| | - D Carpio
- Complexo Hospitalario Universitario de Pontevedra, Gastroenterology Dept., Pontevedra, Spain. Instituto de Investigación Sanitaria Galicia Sur
| | - M Calafat
- Hospital Universitario Germans Trias i Pujol, Gastroenterology Dept., Badalona, and CIBEREHD, Madrid, Spain
| | - A J Lucendo
- Hospital General de Tomelloso, Gastroenterology Dept., Tomelloso, and CIBEREHD, Spain
| | - C Taxonera
- Hospital Clínico Universitario San Carlos, Gastroenterology Dept., Madrid, Spain
| | - S Marín
- Hospital Reina Sofía, Gastroenterology Dept., Córdoba, Spain
| | - M J Garcia
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Gastroenterology Dept., Santander, Spain
| | - G Suris Marín
- Hospital Universitari de Bellvitge, Gastroenterology Dept., Barcelona, Spain
| | | | - A Y Carbajo
- Hospital Universitario Río Hortega, Gastroenterology Dept., Valladolid, Spain
| | - M L De Castro
- Complexo H. Universitario de Vigo, Gastroenterology Dept., Vigo, Spain
| | - M Iborra
- Hospital Universitari La Fe de Valencia and CIBEREHD, Gastroenterology Dept., Valencia, Spain
| | - A Martin-Cardona
- Hospital Universitari Mútua Terrassa and CIBEREHD, Gastroenterology Dept., Barcelona, Spain
| | - I Rodríguez-Lago
- Hospital General de Tomelloso, Gastroenterology Dept., Tomelloso, and CIBEREHD, Spain; Hospital de Galdakao, Gastroenterology Dept., and Biocruces Bizkaia Health Research Institute, Galdakao, Spain
| | - D Busquets
- Hospital Universitari Dr. Josep Trueta, Gastroenterology Dept., Girona, Spain
| | - F Bertoletti
- Hospital de la Santa Creu i Sant Pau, Gastroenterology Dept., Barcelona, Spain
| | - M Sierra Ausín
- Complejo Asistencial Universitario de León, Gastroenterology Dept., León, Spain
| | - C Tardillo
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain
| | - J Huguet Malaves
- Hospital General Universitario de Valencia, Gastroenterology Dept., Valencia, Spain
| | - L Bujanda
- Hospital Universitario de Donostia - Instituto Biodonostia - Universidad del País Vasco UPV/EHU- and CIBEREHD, Gastroenterology Dept., Donostia, Spain
| | - A Castaño
- Hospital Universitario Central de Asturias, Gastroenterology Dept., Oviedo, Spain
| | - E Domènech
- Hospital Universitario Germans Trias i Pujol, Gastroenterology Dept., Badalona, and CIBEREHD, Madrid, Spain
| | - L Ramos
- Hospital Universitario de Canarias, Gastroenterology Dept., La Laguna, Spain
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12
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Camprubí-Ferrer D, Cobuccio L, Van Den Broucke S, Genton B, Bottieau E, d'Acremont V, Rodriguez-Valero N, Almuedo-Riera A, Balerdi-Sarasola L, Subirà C, Fernandez-Pardos M, Martinez MJ, Navero-Castillejos J, Vera I, Llenas-Garcia J, Rothe C, Cadar D, Van Esbroeck M, Foque N, Muñoz J. Causes of fever in returning travelers: a European multicenter prospective cohort study. J Travel Med 2022; 29:6510556. [PMID: 35040473 DOI: 10.1093/jtm/taac002] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Etiological diagnosis of febrile illnesses in returning travelers is a great challenge, particularly when presenting with no focal symptoms [acute undifferentiated febrile illnesses (AUFI)], but is crucial to guide clinical decisions and public health policies. In this study, we describe the frequencies and predictors of the main causes of fever in travelers. METHODS Prospective European multicenter cohort study of febrile international travelers (November 2017-November 2019). A predefined diagnostic algorithm was used ensuring a systematic evaluation of all participants. After ruling out malaria, PCRs and serologies for dengue, chikungunya and Zika viruses were performed in all patients presenting with AUFI ≤ 14 days after return. Clinical suspicion guided further microbiological investigations. RESULTS Among 765 enrolled participants, 310/765 (40.5%) had a clear source of infection (mainly traveler's diarrhea or respiratory infections), and 455/765 (59.5%) were categorized as AUFI. AUFI presented longer duration of fever (p < 0.001), higher hospitalization (p < 0.001) and ICU admission rates (p < 0.001). Among travelers with AUFI, 132/455 (29.0%) had viral infections, including 108 arboviruses, 96/455 (21.1%) malaria and 82/455 (18.0%) bacterial infections. The majority of arboviral cases (80/108, 74.1%) was diagnosed between May and November. Dengue was the most frequent arbovirosis (92/108, 85.2%). After 1 month of follow-up, 136/455 (29.9%) patients with AUFI remained undiagnosed using standard diagnostic methods. No relevant differences in laboratory presentation were observed between undiagnosed and bacterial AUFI. CONCLUSIONS Over 40% of returning travelers with AUFI were diagnosed with malaria or dengue, infections that can be easily diagnosed by rapid diagnostic tests. Arboviruses were the most common cause of AUFI (above malaria) and most cases were diagnosed during Aedes spp. high season. This is particularly relevant for those areas at risk of introduction of these pathogens. Empirical antibiotic regimens including doxycycline or azithromycin should be considered in patients with AUFI, after ruling out malaria and arboviruses.
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Affiliation(s)
| | - Ludovico Cobuccio
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Valérie d'Acremont
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | | | | | - Carme Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Isabel Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jara Llenas-Garcia
- Internal Medicine - Infectious Diseases, Vega Baja Hospital, Orihuela, Alicante, Spain.,Clinical Medicine Department, University Miguel Hernández, Elche, Alicante, Spain
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital LMU, Munich, Germany
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Hamburg, Germany
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nikki Foque
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jose Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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13
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Gutiérrez A, Zapater P, Ricart E, González-Vivó M, Gordillo J, Olivares D, Vera I, Mañosa M, Gisbert JP, Aguas M, Sánchez-Rodríguez E, Bosca-Watts M, Laredo V, Camps B, Marín-Jiménez I, Zabana Y, Martín-Arranz MD, Muñoz R, Navarro M, Sierra E, Madero L, Vela M, Pérez-Calle JL, Sainz E, Calvet X, Arias L, Morales V, Bermejo F, Fernández-Salazar L, Van Domselaar M, De Castro L, Rodríguez C, Muñoz-Villafranca C, Lorente R, Rivero M, Iglesias E, Herreros B, Busquets D, Riera J, Martínez-Montiel MP, Roldón M, Roncero O, Hinojosa E, Sierra M, Barrio J, De Francisco R, Huguet J, Merino O, Carpio D, Ginard D, Muñoz F, Piqueras M, Almela P, Argüelles-Arias F, Alcaín G, Bujanda L, Manceñido N, Lucendo AJ, Varela P, Rodríguez-Lago I, Ramos L, Sempere L, Sesé E, Barreiro-de Acosta M, Domènech E, Francés R. Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients. Front Med (Lausanne) 2022; 9:823900. [PMID: 35178413 PMCID: PMC8844561 DOI: 10.3389/fmed.2022.823900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Previous studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. Methods Prospective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. Results We included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 ± 12 vs. 54 ± 16 years, p < 0.001), had been diagnosed younger (31 ± 12 vs. 36 ± 15 years, p < 0.001), and had a shorter disease duration (14 ± 7 vs. 18 ± 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92–2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0–1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. Conclusions Compared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe.
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Affiliation(s)
- Ana Gutiérrez
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain.,IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Zapater
- IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Unidad Farmacología Clínica, Hospital General Universitario Alicante, Alicante, Spain.,Instituto IDIBE, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Medicina Digestiva Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María González-Vivó
- Servicio Medicina Digestiva, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Gordillo
- Servicio Patología Digestiva, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - David Olivares
- Servicio Medicina Digestiva, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Isabel Vera
- Servicio Aparato Digestivo, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Míriam Mañosa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Aparato Digestivo, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Mariam Aguas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitario La Fé, Valencia, Spain
| | | | - Maia Bosca-Watts
- Servicio Medicina Digestiva, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Viviana Laredo
- Servicio Medicina Digestiva, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Blau Camps
- Servicio Medicina Digestiva, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Ignacio Marín-Jiménez
- Servicio Medicina Digestiva, Hospital Gregorio Marañón, Madrid, Spain.,Gastroenterology Department, Instituto de Investigación Biomédica Gregorio Marañón IiSGM, Madrid, Spain
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | - Roser Muñoz
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain
| | - Mercè Navarro
- Servicio Medicina Digestiva, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Eva Sierra
- Servicio Medicina Digestiva, Hospital Universitario Miguel Servert, Zaragoza, Spain
| | - Lucía Madero
- Servicio Medicina Digestiva, Hospital General Universitario de Elche, Elche, Spain
| | - Milagros Vela
- Servicio Medicina Digestiva, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Empar Sainz
- Servicio Medicina Digestiva, Hospital Sant Joan de Déu - Althaia, Manresa, Spain
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Unitat Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Tauli, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Lara Arias
- Servicio Medicina Digestiva, Hospital Universitario de Burgos, Burgos, Spain
| | - Victor Morales
- Servicio Medicina Digestiva, Hospital General de Granollers, Barcelona, Spain
| | - Fernando Bermejo
- Servicio Medicina Digestiva, Hospital de Fuenlabrada, Fuenlabrada, Spain.,IIS Hospital La Paz IdiPaz-Madrid, Madrid, Spain
| | | | | | - Luisa De Castro
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo- SERGAS. IIS Galicia Sur. SERGAS-UVIG, Vigo, Spain
| | - Cristina Rodríguez
- Servicio Medicina Digestiva, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Rufo Lorente
- Servicio Medicina Digestiva, Hospital General Ciudad Real, Ciudad Real, Spain
| | - Montserrat Rivero
- Servicio Medicina Digestiva, Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Eva Iglesias
- Servicio Medicina Digestiva, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Belén Herreros
- Servicio Medicina Digestiva, Hospital Marina Baixa, Villajoyosa, Spain
| | - David Busquets
- Servicio Medicina Digestiva, Hospital de Girona Dr. Trueta/ICO, Girona, Spain
| | - Joan Riera
- Servicio Medicina Digestiva, Hospital Universitario Son LLàtzer, Palma de Mallorca, Spain
| | | | - Marta Roldón
- Servicio Cirugía General y del Aparato Digestivo, Hospital San Jorge, Huesca, Spain
| | - Oscar Roncero
- Servicio Medicina Digestiva, Hospital General La Mancha Centro, Ciudad Real, Spain
| | - Esther Hinojosa
- Servicio Medicina Digestiva, Hospital de Manises, Valencia, Spain
| | - Mónica Sierra
- Servicio Medicina Digestiva, Complejo Asistencial Universitario de León, León, Spain
| | - Jesús Barrio
- Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - José Huguet
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Olga Merino
- Servicio Medicina Digestiva, Hospital de Cruces, Bilbao, Spain
| | - Daniel Carpio
- Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Daniel Ginard
- Servicio Medicina Digestiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Fernando Muñoz
- Servicio Medicina Digestiva, Hospital Clínico Universitario Salamanca, Salamanca, Spain
| | - Marta Piqueras
- Servicio Medicina Digestiva, Consorci Sanitari Terrasa, Barcelona, Spain
| | - Pedro Almela
- Servicio Medicina Digestiva, Hospital General Universitario Castellón, Castellón de la Plana, Spain
| | | | - Guillermo Alcaín
- Servicio Medicina Digestiva, Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitario Donostia, San Sebastián, Spain.,Instituto Biodonostia, Universidad Pais Vasco, San Sebastián, Spain
| | - Noemí Manceñido
- Servicio Medicina Digestiva, Hospital Infanta Sofía, Madrid, Spain
| | - Alfredo J Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital General Tomelloso, Ciudad Real, Spain
| | - Pilar Varela
- Servicio Medicina Digestiva, Hospital Cabueñes, Gijón, Spain
| | - Iago Rodríguez-Lago
- Servicio de Aparato Digestivo, Hospital Universitario de Galdakao, IIS Biocruces, Galdakao, Spain.,Facultad de Medicina, University of Deusto, Bilbao, Spain
| | - Laura Ramos
- Servicio Medicina Digestiva, Hospital Universitario La Laguna, Santa Cruz Tenerife, Spain
| | - Laura Sempere
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain.,IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain
| | - Eva Sesé
- Servicio Medicina Digestiva, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Aparato Digestivo, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Rubén Francés
- IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Hepatic and Intestinal Immunobiology Group, Dpto. Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Spain.,Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universidad Miguel Hernández, Elche, Spain
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14
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Zabana Y, Marín-Jiménez I, Rodríguez-Lago I, Vera I, Martín-Arranz MD, Guerra I, Gisbert JP, Mesonero F, Benítez O, Taxonera C, Ponferrada-Díaz Á, Piqueras M, Lucendo AJ, Caballol B, Mañosa M, Martínez-Montiel P, Bosca-Watts M, Gordillo J, Bujanda L, Manceñido N, Martínez-Pérez T, López A, Rodríguez-Gutiérrez C, García-López S, Vega P, Rivero M, Melcarne L, Calvo M, Iborra M, Barreiro de-Acosta M, Sicilia B, Barrio J, Pérez JL, Busquets D, Pérez-Martínez I, Navarro-Llavat M, Hernández V, Argüelles-Arias F, Ramírez Esteso F, Meijide S, Ramos L, Gomollón F, Muñoz F, Suris G, de Zarate JO, Huguet JM, Llaó J, García-Sepulcre MF, Sierra M, Durà M, Estrecha S, Fuentes Coronel A, Hinojosa E, Olivan L, Iglesias E, Gutiérrez A, Varela P, Rull N, Gilabert P, Hernández-Camba A, Brotons A, Ginard D, Sesé E, Carpio D, Aceituno M, Cabriada JL, González-Lama Y, Jiménez L, Chaparro M, López-San Román A, Alba C, Plaza-Santos R, Mena R, Tamarit-Sebastián S, Ricart E, Calafat M, Olivares S, Navarro P, Bertoletti F, Alonso-Galán H, Pajares R, Olcina P, Manzano P, Domènech E, Esteve M. Nationwide COVID-19-EII Study: Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry. J Clin Med 2022; 11:421. [PMID: 35054116 PMCID: PMC8781643 DOI: 10.3390/jcm11020421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/23/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD.
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Affiliation(s)
- Yamile Zabana
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
| | | | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, 48960 Galdakao, Spain; (I.R.-L.); (J.L.C.)
- Biocruces Bizkaia Health Research Institute, 48960 Galdakao, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.V.); (Y.G.-L.)
| | | | - Iván Guerra
- Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain; (I.G.); (L.J.)
- Instituto de Investigación Hospital Universitario La Paz (IdiPaz), 28046 Madrid, Spain
| | - Javier P. Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | - Francisco Mesonero
- Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (F.M.); (A.L.-S.R.)
| | - Olga Benítez
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
| | - Carlos Taxonera
- Hospital Clínico San Carlos, 28040 Madrid, Spain; (C.T.); (C.A.)
- Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], 28040 Madrid, Spain
| | | | - Marta Piqueras
- Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (M.P.); (R.M.)
| | - Alfredo J. Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
- Hospital General de Tomelloso, 13700 Tomelloso, Spain;
| | - Berta Caballol
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínic de Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Míriam Mañosa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Pilar Martínez-Montiel
- Fundación Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (P.M.-M.); (S.O.)
| | - Maia Bosca-Watts
- Hospital Clinic Universitari de Valencia, 46010 Valencia, Spain; (M.B.-W.); (P.N.)
| | - Jordi Gordillo
- Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.G.); (F.B.)
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitario Donostia, Instituto Biodonostia, 20014 San Sebastián, Spain;
- Universidad del País Vasco (UPV/EHU), 48940 Leioua, Spain
| | - Noemí Manceñido
- Hospital Universitario Infanta Sofía, 28703 San Sebastián de los Reyes, Spain; (N.M.); (R.P.)
| | | | - Alicia López
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain;
| | | | | | - Pablo Vega
- Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Montserrat Rivero
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Luigi Melcarne
- Hospital Universitari Parc Taulí, 08208 Sabadell, Spain;
| | - Maria Calvo
- Hospital San Pedro-Logroño, 26006 Logroño, Spain;
| | - Marisa Iborra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitario y Politécnico de la Fe de Valencia, 46026 Valencia, Spain
| | | | | | - Jesús Barrio
- Hospital Universitario Río Hortega (HURH), 47012 Valladolid, Spain;
| | - José Lázaro Pérez
- Hospital Universitario Fundación de Alcorcón, 28922 Alcorcón, Spain;
| | - David Busquets
- Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain;
| | - Isabel Pérez-Martínez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | | | | | | | | | - Susana Meijide
- Hospital Universitario de Cruces, 48903 Barakaldo, Spain;
| | - Laura Ramos
- Hospital Universitario de Canarias, 38320 San Cristobal de la Laguna, Spain;
| | - Fernando Gomollón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínico Universitario “Lozano Blesa” and IIS Aragón, 50009 Zaragoza, Spain
| | - Fernando Muñoz
- Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | - Gerard Suris
- Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Spain;
| | | | - José María Huguet
- Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain;
| | - Jordina Llaó
- Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain;
| | | | - Mónica Sierra
- Complejo Asistencial Universitario de León, 24071 León, Spain;
| | - Miguel Durà
- Hospital Clínico de Valladolid, 47003 Valladolid, Spain;
| | | | | | | | | | - Eva Iglesias
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, 14004 Cordoba, Spain;
| | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Pilar Varela
- Hospital Universitario de Cabueñes, 33394 Gijón, Spain;
| | - Núria Rull
- Hospital Universitario Son Llàtzer, 07198 Palma, Spain;
| | - Pau Gilabert
- Hospital de Viladecans, 08840 Viladecans, Spain;
| | | | | | - Daniel Ginard
- Hospital Universitario Son Espases, 07120 Palma, Spain;
| | - Eva Sesé
- Hospital Universitari Arnau de Vilanova de Lleida, 25198 Lleida, Spain;
| | - Daniel Carpio
- Complexo Hospitalario de Pontevedra, 36071 Pontevedra, Spain;
| | - Montserrat Aceituno
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
| | - José Luis Cabriada
- Gastroenterology Department, Hospital Universitario de Galdakao, 48960 Galdakao, Spain; (I.R.-L.); (J.L.C.)
- Biocruces Bizkaia Health Research Institute, 48960 Galdakao, Spain
| | - Yago González-Lama
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.V.); (Y.G.-L.)
| | - Laura Jiménez
- Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain; (I.G.); (L.J.)
- Instituto de Investigación Hospital Universitario La Paz (IdiPaz), 28046 Madrid, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | | | - Cristina Alba
- Hospital Clínico San Carlos, 28040 Madrid, Spain; (C.T.); (C.A.)
- Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], 28040 Madrid, Spain
| | - Rocío Plaza-Santos
- Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (Á.P.-D.); (R.P.-S.)
| | - Raquel Mena
- Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (M.P.); (R.M.)
| | | | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínic de Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Margalida Calafat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Sonsoles Olivares
- Fundación Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (P.M.-M.); (S.O.)
| | - Pablo Navarro
- Hospital Clinic Universitari de Valencia, 46010 Valencia, Spain; (M.B.-W.); (P.N.)
| | - Federico Bertoletti
- Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.G.); (F.B.)
| | - Horacio Alonso-Galán
- Hospital Universitario Donostia, Instituto Biodonostia, 20014 San Sebastián, Spain;
- Universidad del País Vasco (UPV/EHU), 48940 Leioua, Spain
| | - Ramón Pajares
- Hospital Universitario Infanta Sofía, 28703 San Sebastián de los Reyes, Spain; (N.M.); (R.P.)
| | - Pablo Olcina
- Hospital Virgen de la Luz, 16002 Cuenca, Spain; (T.M.-P.); (P.O.)
| | - Pamela Manzano
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
| | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Maria Esteve
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
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15
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Guijarro LG, Cano-Martínez D, Toledo-Lobo MV, Salinas PS, Chaparro M, Gómez-Lahoz AM, Zoullas S, Rodríguez-Torres R, Román ID, Monasor LS, Ruiz-Llorente L, Del Carmen Boyano-Adánez M, Guerra I, Iborra M, Cabriada JL, Bujanda L, Taxonera C, García-Sánchez V, Marín-Jiménez I, Acosta MBD, Vera I, Martín-Arranz MD, Mesonero F, Sempere L, Gomollón F, Hinojosa J, Alvarez-Mon M, Gisbert JP, Ortega MA, Hernández-Breijo B, On Behalf Of The Predicrohn Study Group From Geteccu. Relationship between IGF-1 and body weight in inflammatory bowel diseases: Cellular and molecular mechanisms involved. Biomed Pharmacother 2021; 144:112239. [PMID: 34601192 DOI: 10.1016/j.biopha.2021.112239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022] Open
Abstract
Inflammatory bowel diseases (IBD), represented by ulcerative colitis (UC) and Crohn's disease (CD), are characterized by chronic inflammation of the gastrointestinal tract, what leads to diarrhea, malnutrition, and weight loss. Depression of the growth hormone-insulin-like growth factor-1 axis (GH-IGF-1 axis) could be responsible of these symptoms. We demonstrate that long-term treatment (54 weeks) of adult CD patients with adalimumab (ADA) results in a decrease in serum IGF-1 without changes in serum IGF-1 binding protein (IGF1BP4). These results prompted us to conduct a preclinical study to test the efficiency of IGF-1 in the medication for experimental colitis. IGF-1 treatment of rats with DSS-induced colitis has a beneficial effect on the following circulating biochemical parameters: glucose, albumin, and total protein levels. In this experimental group we also observed healthy maintenance of colon size, body weight, and lean mass in comparison with the DSS-only group. Histological analysis revealed restoration of the mucosal barrier with the IGF-1 treatment, which was characterized by healthy quantities of mucin production, structural maintenance of adherers junctions (AJs), recuperation of E-cadherin and β-catenin levels and decrease in infiltrating immune cells and in metalloproteinase-2 levels. The experimentally induced colitis caused activation of apoptosis markers, including cleaved caspase 3, caspase 8, and PARP and decreases cell-cycle checkpoint activators including phosphorylated Rb, cyclin E, and E2F1. The IGF-1 treatment inhibited cyclin E depletion and partially protects PARP levels. The beneficial effects of IGF-1 in experimental colitis could be explained by a re-sensitization of the IGF-1/IRS-1/AKT cascade to exogenous IGF-1. Given these results, we postulate that IGF-1 treatment of IBD patients could prove to be successful in reducing disease pathology.
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Affiliation(s)
- Luis G Guijarro
- Department of System Biology, University of Alcalá, Alcalá de Henares, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - David Cano-Martínez
- Department of System Biology, University of Alcalá, Alcalá de Henares, Spain
| | - M Val Toledo-Lobo
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain; Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Spain
| | | | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Gastroenterology Unit Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Spain
| | - Ana M Gómez-Lahoz
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Sofía Zoullas
- Department of System Biology, University of Alcalá, Alcalá de Henares, Spain
| | - Rosa Rodríguez-Torres
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Irene D Román
- Department of System Biology, University of Alcalá, Alcalá de Henares, Spain
| | | | - Lidia Ruiz-Llorente
- Department of System Biology, University of Alcalá, Alcalá de Henares, Spain
| | | | - Iván Guerra
- Gastroenterology Department, Hospital Universitario de Fuenlabrada & Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Spain
| | - Marisa Iborra
- Gastroenterology Unit, Hospital Universitario de La Fe (CIBEREHD), Valencia, Spain
| | - José Luis Cabriada
- Gastroenterology Unit, Hospital Universitario de Galdakano, Vizcaya, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Department of Gastroenterology. Biodonostia Health Research Institute. Universidad del País Vasco (UPV/EHU). San Sebastián, Spain
| | - Carlos Taxonera
- Gastroenterology Unit, Hospital Universitario Clínico San Carlos and IdISSC, Madrid, Spain
| | - Valle García-Sánchez
- Gastroenterology Unit, Hospital Universitario Reina Sofía/Universidad de Córdoba, Spain
| | - Ignacio Marín-Jiménez
- Gastroenterology Unit, Hospital Universitario Gregorio Marañón e IiSGM, Madrid, Spain
| | | | - Isabel Vera
- Gastroenterology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Francisco Mesonero
- Gastroenterology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Laura Sempere
- Gastroenterology Unit, Hospital Universitario Alicante, Alicante, Spain
| | - Fernando Gomollón
- Gastroenterology Unit, Hospital Clínico Universitario, Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Joaquín Hinojosa
- Gastroenterology Unit, Hospital Universitario Manises, Valencia, Spain
| | - Melchor Alvarez-Mon
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Gastroenterology Unit Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Spain.
| | - Miguel A Ortega
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain; Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Spain.
| | - Borja Hernández-Breijo
- Department of System Biology, University of Alcalá, Alcalá de Henares, Spain; Immuno-Rheumatology Research Group. IdiPaz. Hospital Universitario La Paz, Madrid, Spain
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16
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Taxonera C, Martínez-Montiel MP, Barreiro-de-Acosta M, Vera I, Lorente R, Vega P, Diz-Lois MT, Fuentes Coronel AM, Pérez Calle JL, Casis B, Ferreiro-Iglesias R, Calvo M, Olivares D, Alba C. Preferences and satisfaction of IBD patients after switching from adalimumab 40 mg weekly to 80 mg every other week given as a single injection: the ADASCAL study. Therap Adv Gastroenterol 2021; 14:17562848211056157. [PMID: 35116079 PMCID: PMC8804976 DOI: 10.1177/17562848211056157] [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: 08/07/2021] [Accepted: 10/09/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A recently registered device containing 80 mg of adalimumab (ADA) allows an alternative dose escalation regimen with ADA 80 mg every other week (EOW) given as a single subcutaneous injection instead of 40 mg every week. The ADASCAL study evaluated the preferences and satisfaction of inflammatory bowel disease (IBD) patients after switching their ADA regimen from 40 mg weekly to 80 mg EOW given with a single-dose pen. METHODS In this multicentre cross-sectional study, patients in whom the ADA regimen was changed from 40 mg weekly to 80 mg EOW completed the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), a four-item questionnaire [a Likert-type 5-point scale for preferences, two closed questions for convenience and a 100-point visual analogue scale (VAS) to assess which escalated ADA regimen patients would prefer to continue] and two Health-Related Quality of Life (HRQoL) questionnaires: the generic European Quality of Life-5 Dimensions (EQ-5D) and disease-specific Spanish version of the Inflammatory Bowel Disease Questionnaire (SIBDQ-9). RESULTS In total, 77 patients (64 Crohn's disease and 13 ulcerative colitis) were included. The TSQM score showed a notably high global satisfaction [83.4, standard deviation (SD) = 14.1] of patients with ADA 80 mg EOW given with a single-dose pen, with high TSQM scores for individual components: effectiveness (77.6, SD = 16.9), convenience (83.7, SD = 14.5) and side effects (86.1, SD = 23.4). Most of the patients (74%) preferred the ADA EOW regimen (59.7% had strong preference, 14.3% slight preference). ADA EOW interferes less with daily activity (59.7%) and with travel plans (81.8%). Most patients (77%) would prefer to continue with ADA EOW (mean VAS score of 84.7, SD = 24.1, where 100 indicates a preference for ADA EOW). Patients reported high HRQoL scores on both the EQ-5D (72.3, SD = 20.1) and SIBDQ-9 (75.1, SD = 14.7). CONCLUSION IBD patients in whom the ADA regimen was changed from 40 mg weekly to 80 mg EOW reported a higher preference for the EOW regimen and therefore most decided to continue with a single self-injection EOW.
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Affiliation(s)
| | | | | | - Isabel Vera
- Gastroenterology Department, Hospital
Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Rufo Lorente
- Gastroenterology Department, Hospital General
Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Vega
- Gastroenterology Department, Complexo
Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | | | - Begoña Casis
- Gastroenterology Department, Hospital
Universitario 12 de Octubre, Madrid, Spain
| | | | - Marta Calvo
- Gastroenterology Department, Hospital
Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Olivares
- Gastroenterology Department, Hospital Clínico
Universitario San Carlos, Madrid, Spain
| | - Cristina Alba
- Gastroenterology Department, Hospital Clínico
Universitario San Carlos, Madrid, Spain
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17
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Grau-Pujol B, Camprubí-Ferrer D, Marti-Soler H, Fernández-Pardos M, Carreras-Abad C, Andrés MVD, Ferrer E, Muelas-Fernandez M, Jullien S, Barilaro G, Ajanovic S, Vera I, Moreno L, Gonzalez-Redondo E, Cortes-Serra N, Roldán M, Arcos AAD, Mur I, Domingo P, Garcia F, Guinovart C, Muñoz J. Pre-exposure prophylaxis with hydroxychloroquine for COVID-19: a double-blind, placebo-controlled randomized clinical trial. Trials 2021; 22:808. [PMID: 34781981 PMCID: PMC8591593 DOI: 10.1186/s13063-021-05758-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a promising strategy to break COVID-19 transmission. Although hydroxychloroquine was evaluated for treatment and post-exposure prophylaxis, it is not evaluated for COVID-19 PrEP yet. The aim of this study was to evaluate the efficacy and safety of PrEP with hydroxychloroquine against placebo in healthcare workers at high risk of SARS-CoV-2 infection during an epidemic period. METHODS We conducted a double-blind placebo-controlled randomized clinical trial in three hospitals in Barcelona, Spain. From 350 adult healthcare workers screened, we included 269 participants with no active or past SARS-CoV-2 infection (determined by a negative nasopharyngeal SARS-CoV-2 PCR and a negative serology against SARS-CoV-2). Participants allocated in the intervention arm (PrEP) received 400 mg of hydroxychloroquine daily for the first four consecutive days and subsequently, 400 mg weekly during the study period. Participants in the control group followed the same treatment schedule with placebo tablets. RESULTS 52.8% (142/269) of participants were in the hydroxychloroquine arm and 47.2% (127/269) in the placebo arm. Given the national epidemic incidence decay, only one participant in each group was diagnosed with COVID-19. The trial was stopped due to futility and our study design was deemed underpowered to evaluate any benefit regarding PrEP efficacy. Both groups showed a similar proportion of participants experiencing at least one adverse event (AE) (p=0.548). No serious AEs were reported. Almost all AEs (96.4%, 106/110) were mild. Only mild gastrointestinal symptoms were significantly higher in the hydroxychloroquine arm compared to the placebo arm (27.4% (39/142) vs 15.7% (20/127), p=0.041). CONCLUSIONS Although the efficacy of PrEP with hydroxychloroquine for preventing COVID-19 could not be evaluated, our study showed that PrEP with hydroxychloroquine at low doses is safe. TRIAL REGISTRATION ClinicalTrials.gov NCT04331834 . Registered on April 2, 2020.
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Affiliation(s)
- Berta Grau-Pujol
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain.
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
- Mundo Sano Foundation, Buenos Aires, Argentina.
| | - Daniel Camprubí-Ferrer
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Helena Marti-Soler
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Marc Fernández-Pardos
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Clara Carreras-Abad
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Maria Velasco-de Andrés
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Elisabet Ferrer
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Magdalena Muelas-Fernandez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Sophie Jullien
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Giuseppe Barilaro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Sara Ajanovic
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Isabel Vera
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Laura Moreno
- Infectious Diseases Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eva Gonzalez-Redondo
- Infectious Diseases Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Núria Cortes-Serra
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Montserrat Roldán
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Ana Artes-de Arcos
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Isabel Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, 08025, Barcelona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, 08025, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
- Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Caterina Guinovart
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - University of Barcelona, Rosselló 132 4rt 1a, 08036, Barcelona, Spain
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18
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Casellas F, Calvet X, Carpio D, Vera I, Saldaña R, Mínguez M, Marín L, Juliá B. Factors associated with quality of care in inflammatory bowel diseases: a view from patient's side using the IQCARO quality of care decalogue. BMC Gastroenterol 2021; 21:412. [PMID: 34715812 PMCID: PMC8555225 DOI: 10.1186/s12876-021-01968-2] [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: 12/28/2020] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Quality of care (QoC) is a highly important topic in inflammatory bowel disease (IBD). We recently elaborated a decalogue of QoC indicators (IQCARO-QoC) developed by IBD patients. The aim of the present study was to assess the factors associated with patients’ evaluation of QoC in Spain using the IQCARO-QoC Decalogue recently developed by IBD patients. Methods A survey including patients’ socio-demographic and clinical characteristics, and the IQCARO-QoC Decalogue, was completed by IBD patients. We described patients’ assessment of QoC across Spanish patients. A univariable and multivariable analysis was performed to explore the associations between patients’ characteristics and QoC. Results Questionnaires from 788 participant patients were analysed. Participants’ mean age was 43.4 years, 63% were females and 58% had Crohn’s disease. The mean QoC score was 8.1 (± 2.4 SD) points out of a maximum of 10. Items with the lowest score were related to the provision of information and the implication of the medical team throughout the entire patient care. Factors associated with better QoC scores included: being employed better disease control, fewer numbers of unscheduled visits, and being followed by a gastroenterologist specialized in IBD. Conclusions Spanish patients’ reported QoC seems to be globally good although there is room for improvement, especially in providing adequate information to patients. Care provided by specialized IBD gastroenterologists seems to be related with higher QoC scores.
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Affiliation(s)
- F Casellas
- Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Parc del Taulí, 1. 08208 Sabadell, Barcelona, Spain
| | - Xavier Calvet
- Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Parc del Taulí, 1. 08208 Sabadell, Barcelona, Spain. .,Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Sabadell, Barcelona, Spain. .,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. .,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.
| | - D Carpio
- Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Biomédica Galicia Sur (IBI), Pontevedra, Spain
| | - I Vera
- Servicio de Aparato Digestivo, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - M Mínguez
- Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - L Marín
- Servei de Malalties Digestives, Hospital Germans Trias I Pujol, Barcelona, Spain
| | - B Juliá
- Medical Department MSD, Madrid, Spain
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19
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Calvet X, Casellas F, Saldaña R, Carpio D, Mínguez M, Vera I, Marín L, Juliá B. Patient-Evaluated Quality of Care is Related to Better Inflammatory Bowel Disease Outcomes: The IQCARO II Project. Patient 2021; 14:625-634. [PMID: 33709214 DOI: 10.1007/s40271-021-00500-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Measuring quality of care (QoC) from a patient's perspective is becoming increasingly important in inflammatory bowel disease. OBJECTIVE The objective of this study was to determine whether patients' evaluations of QoC correlate with better inflammatory bowel disease outcomes. METHODS A survey including patients' characteristics, a decalogue of QoC indicators, and self-reported disease outcomes was completed by Spanish patients with inflammatory bowel disease. A QoC index (QoCI) was constructed with the sum of the "yes" answers in the decalogue. We evaluated the correlation of QoCI with outcomes. A sub-analysis comparing patients with high QoCI vs those with low QoCI was performed (QoCI = 10 or ≤ 7). RESULTS Seven hundred and eighty-eight questionnaires were analyzed. Mean age of participants was 43.4 years (63% women). Mean QoCI was 8.1 (± 2.4). The QoCI correlated significantly with activity of the disease, number of flares, emergency/unscheduled visits, and disease control. Patients scoring in the first QoCI quartile reported a decreased rate of moderate/severe disease (34.8% vs 55.3%, p < 0.001), fewer numbers of flares (p < 0.001), and fewer emergency/unscheduled visits (p < 0.001) compared with those in the lower QoCI quartile. The high QoC group also reported better disease control. CONCLUSIONS Patient-evaluated QoC correlates with better outcomes. Evaluation of QoC by patients may be useful to detect inadequate care and improve inflammatory bowel disease outcomes.
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Affiliation(s)
- Xavier Calvet
- Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Sabadell, Spain
| | - Fransesc Casellas
- Crohn-Colitis Care Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Biomédica Galicia Sur (IBI), Pontevedra, Spain
| | - Miguel Mínguez
- Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - Isabel Vera
- Servicio de Aparato Digestivo, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Laura Marín
- Servei de Malalties Digestives, Hospital Germans Trias I Pujol, Barcelona, Spain
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20
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Mesonero F, Castro-Poceiro J, Benítez JM, Camps B, Iborra M, López-García A, Torres P, Esteve M, Tosca J, Bertoletti F, Almela P, Calvet X, Vera I, Bujanda L, Gomollón F, Rodríguez C, Antolín B, Busquets D, Hernández A, Rivero M, Monfort I Miquel D, Castaño-García A, Gisbert JP, Domènech E, López-Sanromán A. Effectiveness and safety of methotrexate monotherapy in patients with Crohn's disease refractory to anti-TNF-α: results from the ENEIDA registry. Aliment Pharmacol Ther 2021; 53:1021-1029. [PMID: 33715177 DOI: 10.1111/apt.16315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/27/2021] [Accepted: 02/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Methotrexate can be used to maintain remission in Crohn's disease patients who are intolerant to thiopurines. Data on its use as monotherapy in other scenarios are limited. AIM To assess the effectiveness of methotrexate monotherapy in Crohn's disease patients after previous failure to anti-tumour necrosis factor (anti-TNFα) drugs. METHODS A retrospective, observational multicentre study of data from the Spanish ENEIDA registry. Participants were patients with active Crohn's disease and previous failure to anti-TNFα started on methotrexate monotherapy. Short-term effectiveness was assessed at 12-16 weeks based on Harvey-Bradshaw index (HBI): clinical remission as HBI ≤ 3 points and clinical response as HBI drop of ≥ 3 points over baseline. Long-term effectiveness was defined as steroid-free methotrexate persistence from 12 to 16 weeks until maximum follow up. Adverse events were recorded. RESULTS Data were compiled for 110 patients treated with methotrexate after a failed response to one (39%) or two (55.6%) anti-TNFα agents. Short-term clinical response and remission rates were 60% and 30.9% respectively. Of 74 patients who continued after week 16, long-term effectiveness was achieved in 82% and 74% at 12 and 24 months respectively. In the multivariate analysis, non-remission at short term (vs remission) was associated with long-term failure (HR 2.58, 95%CI 1.95-3.68, P = 0.028). Adverse events (evaluated in 100 patients) were recorded in 44%, and in 30.4% of these patients, they led to methotrexate discontinuation. CONCLUSIONS The benefits observed suggest methotrexate monotherapy could be a valid option in Crohn's disease patients with previous failure to anti-TNFα.
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21
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Chaparro M, Garre A, Iborra M, Sierra M, Barreiro-de Acosta M, Fernández-Clotet A, de Castro L, Boscá-Watts M, Casanova MJ, López-García A, Lorente R, Rodríguez C, Carbajo AY, Arroyo MT, Gutiérrez A, Hinojosa J, Martínez-Pérez T, Villoria A, Bermejo F, Busquets D, Camps B, Cañete F, Manceñido N, Monfort D, Navarro-Llavat M, Pérez-Calle JL, Ramos L, Rivero M, Angueira T, Camo P, Carpio D, García-de-la-Filia I, González-Muñoza C, Hernández L, Huguet JM, Morales VJ, Sicilia B, Vega P, Vera I, Zabana Y, Nos P, Suárez Álvarez P, Calviño-Suarez C, Ricart E, Hernández V, Mínguez M, Márquez L, Hervías Cruz D, Rubio Iturria S, Barrio J, Gargayo-Puyuelo C, Francés R, Hinojosa E, del Moral M, Calvet X, Algaba A, Aldeguer X, Guardiola J, Mañosa M, Pajares R, Piqueras M, García-Bosch O, Lopez Serrano P, Castro B, Lucendo AJ, Montoro M, Castro Ortiz E, Mesonero F, García-Planella E, Fuentes DA, Bort I, Delgado-Guillena P, Arias L, Iglesias A, Calvo M, Esteve M, Domènech E, Gisbert JP. Effectiveness and Safety of Ustekinumab in Ulcerative Colitis: Real-world Evidence from the ENEIDA Registry. J Crohns Colitis 2021; 15:1846-1851. [PMID: 33860795 PMCID: PMC8083263 DOI: 10.1093/ecco-jcc/jjab070] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. METHODS Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. RESULTS A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. CONCLUSIONS Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.
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Affiliation(s)
- María Chaparro
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain,CORRESPONDENCE: María Chaparro, M.D., Ph.D, Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Universitario de La Princesa, Diego de León, 62. 28006 Madrid, Spain, Tel.: 34-913093911; Fax: 34-915204013, e-mail:
| | - Ana Garre
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
| | - Marisa Iborra
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | - Mónica Sierra
- Complejo Asistencial Universitario de León, León, Spain
| | | | | | - Luisa de Castro
- Xerencia Xestion Integrada de Vigo, SERGAS. Vigo. Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO. Spain
| | - Maia Boscá-Watts
- Hospital Clinico de Valencia. Universitat de València, Valencia, Spain
| | - María José Casanova
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
| | - Alicia López-García
- Hospital del Mar and Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - Rufo Lorente
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Ana Y Carbajo
- Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | | | - Ana Gutiérrez
- Hospital General Universitario de Alicante and CIBERehd, IIS ISABIAL Alicante, Spain
| | | | | | - Albert Villoria
- Hospital Parc Taulí, Sabadell. Depàrtament de Medicina. Universitat Autònoma de Barcelona and CIBERehd, Spain
| | - Fernando Bermejo
- Hospital Universitario Fuenlabrada and Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain
| | - David Busquets
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
| | - Blau Camps
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fiorella Cañete
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | | | | | | | | | - Laura Ramos
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Montserrat Rivero
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Teresa Angueira
- Hospital General de Tomelloso and CIBERehd, Ciudad Real, Spain
| | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | | | - José M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Pablo Vega
- Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Yamile Zabana
- Hospital Universitario Mútua Terrassa and CIBERehd, Terrassa, Spain
| | - Pilar Nos
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | | | | | - Elena Ricart
- Hospital Clìnic i Provincial and CIBERehd, IDIBAPS, Barcelona, Spain
| | - Vicent Hernández
- Xerencia Xestion Integrada de Vigo, SERGAS. Vigo. Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO. Spain
| | - Miguel Mínguez
- Hospital Clinico de Valencia. Universitat de València, Valencia, Spain
| | - Lucía Márquez
- Hospital del Mar and Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | | | | | - Jesús Barrio
- Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | | | - Rubén Francés
- Hepatic and intestinal Immunobiology group Clinical Medicina, Department Miguel Hernández University, IIS ISABIAL, Hospital General Universitario de Alicante and CIBERehd, Alicante, Spain
| | | | | | - Xavier Calvet
- Hospital Parc Taulí, Sabadell. Depàrtament de Medicina. Universitat Autònoma de Barcelona and CIBERehd, Spain
| | - Alicia Algaba
- Hospital Universitario Fuenlabrada and Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain
| | - Xavier Aldeguer
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
| | | | - Miriam Mañosa
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | - Ramón Pajares
- Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | | | | | | | - Beatriz Castro
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | | | | | | | | | | | | | - Lara Arias
- Hospital Universitario de Burgos, Burgos, Spain
| | - Agueda Iglesias
- Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Marta Calvo
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Esteve
- Hospital Universitario Mútua Terrassa and CIBERehd, Terrassa, Spain
| | - Eugeni Domènech
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | - Javier P Gisbert
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
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22
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Guasch M, Cañete F, Ordás I, Iglesias-Flores E, Clos A, Gisbert JP, Taxonera C, Vera I, Mínguez M, Guardiola J, Rivero M, Nos P, Gomollón F, Barrio J, de Francisco R, López-Sanromán A, Martín-Arranz MD, Garcia-Planella E, Camargo R, García-López S, de Castro L, Calvet X, Esteve M, Mañosa M, Domènech E. Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents. J Gastroenterol Hepatol 2020; 35:2080-2087. [PMID: 32350906 DOI: 10.1111/jgh.15084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Biological therapies may be changing the natural history of inflammatory bowel diseases (IBDs), reducing the need for surgical intervention. We aimed to assess whether the availability of anti-TNF agents impacts the need for early surgery in Crohn's disease (CD) and ulcerative colitis (UC). METHODS Retrospective, cohort study of patients diagnosed within a 6-year period before and after the licensing of anti-TNFs (1990-1995 and 2007-2012 for CD; 1995-2000 and 2007-2012 for UC) were identified in the ENEIDA Registry. Surgery-free survival curves were compared between cohorts. RESULTS A total of 7370 CD patients (2022 in Cohort 1 and 5348 in Cohort 2) and 8069 UC patients (2938 in Cohort 1 and 5131 in Cohort 2) were included. Immunosuppressants were used significantly earlier and more frequently in both CD and UC post-biological cohorts. The cumulative probability of surgery was lower in CD following anti-TNF approval (16% and 11%, 22% and 16%, and 29% and 19%, at 1, 3, and 5 years, respectively P < 0.0001), although not in UC (3% and 2%, 4% and 4%, and 6% and 5% at 1, 3, and 5 years, respectively; P = 0.2). Ileal involvement, older age at diagnosis and active smoking in CD, and extensive disease in UC, were independent risk factors for surgery, whereas high-volume IBD centers (in both CD and UC) and immunosuppressant use (in CD) were protective factors. CONCLUSIONS Anti-TNF availability was associated with a reduction in early surgery for CD (driven mainly by earlier and more widespread immunosuppressant use) but not in UC.
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Affiliation(s)
- Montserrat Guasch
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Fiorella Cañete
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain
| | - Ingrid Ordás
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Clínic and IDIBAPS (Barcelona, Catalonia), Madrid, Spain
| | | | - Ariadna Clos
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (Madrid), Madrid, Spain
| | - Carlos Taxonera
- Hospital Clínico San Carlos, Instituto de Investigación del Hospital Clínico San Carlos (IdISSC) (Madrid), Madrid, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro (Madrid), Majadahonda, Spain
| | - Miguel Mínguez
- H. Clínico de Valencia i Universitat de València (València), Valencia, Spain
| | - Jordi Guardiola
- Hospital Universitari de Bellvitge IDIBELL and Universitat de Barcelona (L'Hospitalet del Llobregat, Catalonia), Llobregat, Spain
| | - Montserrat Rivero
- Hospital Marqués de Valdecilla and IDIVAL (Santander), Santander, Spain
| | - Pilar Nos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Universitari i Politècnic La Fe (Valencia), Valencia, Spain
| | - Fernando Gomollón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,IIS Aragón, Hospital Clínico Lozano Blesa (Zaragoza), Zaragoza, Spain
| | | | - Ruth de Francisco
- Hospital Universitario Central de Asturias e Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) (Oviedo), Spain
| | | | | | | | | | | | | | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Parc Taulí (Sabadell, Catalonia), Spain
| | - Maria Esteve
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Mútua Terrassa (Terrassa, Catalonia), Spain
| | - Míriam Mañosa
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain
| | - Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain
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23
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Iborra M, García-Morales N, Rubio S, Bertoletti F, Calvo M, Taxonera C, Boscá-Watts MM, Sierra M, Mancenido N, Beltrán B, Nantes Castillejo Ó, García-Planella E, Vera I, Alba C, Martí-Aguado D, Ballester MP, Cano-Sanz N, Pajares-Villarroya R, Cerrillo E, Cañada A, Nos P. Real-life experience with 4 years of golimumab persistence in ulcerative colitis patients. Sci Rep 2020; 10:17774. [PMID: 33082359 PMCID: PMC7576126 DOI: 10.1038/s41598-020-73577-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 02/08/2023] Open
Abstract
Golimumab has demonstrated its long-term efficacy and safety in ulcerative colitis in clinical trials, but no data of long-term persistence has been published from real world. To estimate long-term persistence of golimumab, as well as factors associated with longer persistence, in patients with ulcerative colitis in real life. Observational multicentre study including adult patients with ulcerative colitis treated with golimumab and with at least twelve months of follow-up. We included 190 patients, 105 (55.26%) naive to anti-TNF, with mean disease duration of 9.32 ± 8.09 years. Probability of persistence was 63%, 46%, 39% and 27% at 1, 2, 3 and 4 years, respectively. Persistence was lower in patients with primary failure to previous anti-TNF. Eighty-two (43.16%) patients needed dose intensification during follow-up, with a mean time until intensification of 8.03 ± 8.64 months. Dose intensification and lower disease duration predicted higher persistence with golimumab (p = 0.037 and p = 0.008, respectively). During a follow-up of 17.25 ± 15.83 months, 32 (16.5%) patients needed hospitalisation and 11 (6%) underwent colectomy. No unexpected adverse events were reported. Golimumab has demonstrated good persistence and safety profile for long treatment in ulcerative colitis patients.
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Affiliation(s)
- Marisa Iborra
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
| | - Natalia García-Morales
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Saoia Rubio
- Department of Digestive Diseases, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Federico Bertoletti
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Calvo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Carlos Taxonera
- Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Mónica Sierra
- Department of Gastroenterology, Complejo Asistencial Universitario de León, León, Spain
| | - Noemí Mancenido
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Belén Beltrán
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | | | - Isabel Vera
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Cristina Alba
- Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | - David Martí-Aguado
- Department of Gastroenterology, Hospital Clínico Universitario, Valencia, Spain
| | | | - Noelia Cano-Sanz
- Department of Gastroenterology, Complejo Asistencial Universitario de León, León, Spain
| | - Ramón Pajares-Villarroya
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Elena Cerrillo
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Antonio Cañada
- Deparment of Biostatistics and Bioinformatics, Instituto de Investigación Sanitaria Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Nos
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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24
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Calafat M, Mañosa M, Mesonero F, Guardiola J, Mínguez M, Nos P, Vera I, Taxonera C, Iglesias E, Ricart E, Gisbert JP, Calvet X, García-López S, Monfort D, Pérez Calle JL, Riestra S, Gomollón F, Garcia-Planella E, Bermejo F, Hernández V, Martín-Arranz MD, Gutiérrez A, Torres P, Cañete F, Domènech E. Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry. J Crohns Colitis 2020; 14:1290-1298. [PMID: 32201893 DOI: 10.1093/ecco-jcc/jjaa055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Although commonly used in inflammatory bowel disease [IBD], thiopurines frequently cause intolerance, and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort, and to assess the impact of age on tolerance. METHODS Adult IBD patients from the ENEIDA registry, who were switched to a second thiopurine due to adverse events [excluding malignancies and infections], were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance, and persistence with the second thiopurine were evaluated. RESULTS A total of 1278 patients [13% over 60 years of age] were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, and persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.07-2.07; p = 0.017) , previous gastrointestinal toxicity [OR 1.4; 95% CI 1.11-1.78; p = 0.005], previous acute pancreatitis [OR 6.78; 95% CI 2.55-18.05; p <0.001], and exposure to the first thiopurine <6 months [OR 1.59; 95% CI 1.14-2.23; p = 0.007]. CONCLUSIONS In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended.
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Affiliation(s)
- Margalida Calafat
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Míriam Mañosa
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
| | | | - Jordi Guardiola
- Hospital Universitari de Bellvitge, IDIBELL, [L'Hospitalet del Llobregat] Universitat de Barcelona, Barcelona, Spain
| | - Miguel Mínguez
- Hospital Clínico de Valencia, Universitat de València, Valencia, Spain
| | - Pilar Nos
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | | | - Elena Ricart
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
- Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP], Universidad Autónoma de Madrid, Madrid, Spain
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
- Hospital Parc Taulí, Sabadell, Spain
| | | | | | | | - Sabino Riestra
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias [ISPA], Oviedo, Spain
| | - Fernando Gomollón
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
- Hospital Clínico Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | | | - Fernando Bermejo
- Hospital Universitario Fuenlabrada [Fuenlabrada] and Instituto de Investigación Sanitaria Hospital La Paz [IdiPAZ], Spain
| | - Vicent Hernández
- Complexo Hospitalario Universitario de Vigo, Vigo and Gastrointestinal Diseases Research Group, Galicia Sur Health Research Institute [IIS Galicia Sur]. SERGAS-UVIGO, Spain
| | | | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Paola Torres
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Fiorella Cañete
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
| | - Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre enfermedades Hepáticas y Digestivas CIIBEREHD, Spain
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Merino Argumánez C, Espinosa M, Ramos Giráldez C, Rusinovich O, De la Torre N, Campos Esteban J, Gonzalez Lama Y, Matallana V, Calvo Moya M, Ruiz Antorán B, Vera I, Vázquez G, Andréu Sánchez JL, Sanz J. SAT0386 USEFULNESS OF THE FECAL CALPROTECTIN AS SCREENING TOOL FOR INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH SPONDYLOARTHRITIS AND NO DIGESTIVE SYMPTOMS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Fecal calprotectin (FC) is a biomarker of bowel inflammation widely spread in diagnosis and follow-up of inflammatory bowel disease (IBD). It is classically estimated that 5% of patients with axial spondyloarthritis (SpA) also have IBD; coexistence of both conditions has definite impact in clinical decisions. Proactive detection of both diseases should be advisable, though appropriate screening tools are still lacking.Objectives:To evaluate the usefulness of FC for the diagnosis of IBD in patients diagnosed with SpA with no clinical suggestive manifestations or previous diagnosis of IBD.Methods:Patients from a Rheumatology clinic diagnosed with SpA who met ASAS criteria and did not present digestive symptoms suggestive of IBD were consecutively included. Demographics, clinical and analytical data of SpA (uveitis, HLA B27, acute phase reactants) at the time of inclusion, and treatment history were collected. Patients with a positive FC (> 50 mg/Kg) underwent ileocolonoscopy with biopsies of colon and terminal ileum. Patients who were recommended to avoid NSAIDs 2-4 weeks before stool collection and endoscopy.Patients with no endoscopic findings underwent a second determination of fecal calprotectine. If persisted positive, capsule endoscopy was performed to evaluate small intestine.Results:98 patients included; 47% male, mean age 46.1 (20-74) years. BASDAI 3.6 ± 2.5. HLA B27 positive in 78% of patients, high ESR in 31.6%, high CRP in 9.2%. FC positive in 49 patients (50%): mean 147 mg/kg (range 0-3038).47 underwent ileocolonoscopy: In 13 cases (26.5%), endoscopic findings were suggestive of IBD (7 Crohn’s disease and 1 ulcerative colitis). Microscopic inflammation was found in 2 additional cases. Among those 34 patients with normal ileocolonoscopy, 16 patients refused further investigations; among the remining 18 patients, a second FC was positive in 16. Capsule endoscopy showed findings suggestive of small intestine IBD in 6 additional patients.In patients with high FC levels,those with high CRP and ESR were more likely to have IBD(29% v 16% and 29% v 12% respectively). Patients with a history ofuveitis(18% vs 12%) orpsoriasis(33% v 16%) also had a higher prevalence of IBD, although none of those differences reached statistical significance.FC was higher insmokers(72%v 44%; p=0.03). There were no significant differences regarding HLA B27. No statistically significant differences were found in FC between patients with high FC who were diagnosed with IBD and those who were not.Conclusion:In our study, patients with SpA and no clinical feature suggestive of IBD who showed FC> 50 mg/kg had high prevalence of IBD, which could indicate theusefulness of FC as screening tool for IBD in patients with SpA.Patients with SpA and other immune-mediated condition or elevated CRP, seem to be more likely to have subclinical IBD.Disclosure of Interests:None declared
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Rodriguez-Valero N, Vera I, Torralvo MR, De Alba T, Ferrer E, Camprubi D, Almuedo Riera A, Gallego RS, Muelas M, Pinazo MJ, Muñoz J. Malaria prophylaxis approach during COVID-19 pandemic. Travel Med Infect Dis 2020; 38:101716. [PMID: 32360423 PMCID: PMC7252065 DOI: 10.1016/j.tmaid.2020.101716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | - Isabel Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Teresa De Alba
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Ferrer
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Daniel Camprubi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | - Magdalena Muelas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Jose Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Calvet X, Saldaña R, Carpio D, Mínguez M, Vera I, Juliá B, Marín L, Casellas F. Improving Quality of Care in Inflammatory Bowel Disease Through Patients' Eyes: IQCARO Project. Inflamm Bowel Dis 2020; 26:782-791. [PMID: 31634907 DOI: 10.1093/ibd/izz126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Quality improvement is a major topic in inflammatory bowel disease (IBD) care, and measuring quality of care (QoC) is necessary for QoC improvement. Most QoC projects or consensus statements are designed from the health care professional point of view. Having QoC indicators designed for and fully evaluable by patients may provide a key tool for external evaluation of QoC improvement measures. The aim of the IQCARO project was to identify indicators to measure QoC from the IBD patient's point of view. METHODS An extensive review of the literature to identify indicators of QoC was performed; first the identified indicators were reviewed by a steering committee including patients, nurses, IBD specialists, and methodologists. Then 2 focus groups of IBD patients analyzed the QoC indicators to determine whether they could be understood and evaluated by patients. The final QoC indicators were selected by a group of IBD patients using a Delphi consensus methodology. RESULTS An initial list of 54 QoC indicators was selected by the steering committee. The QoC indicators were evaluated by 16 patients who participated in 2 focus groups. They identified 21 indicators that fulfilled the understandability and evaluability requirements. The 10 most relevant QoC indicators were selected by 26 patients with IBD using a Delphi consensus. The selected items covered important aspects of QoC, including professionalism, patients' autonomy, information, accessibility, and continuity of care. CONCLUSIONS The present Delphi consensus identified QoC indicators that are useful for developing and measuring improvement strategies in the management of IBD.
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Affiliation(s)
- Xavier Calvet
- Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Biomédica Galicia Sur (IBI), Pontevedra, Spain
| | - Miguel Mínguez
- Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - Isabel Vera
- Servicio de Aparato Digestivo, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Laura Marín
- Servei de Malalties Digestives, Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Fransesc Casellas
- Crohn-Colitis Care Unit, Hospital Universitari Valld`Hebron, Barcelona, Spain
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28
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Chaparro M, Aterido A, Guerra I, Iborra M, Cabriada JL, Bujanda L, Taxonera C, García-Sánchez V, Marín-Jiménez I, Barreiro-de Acosta M, Vera I, Martín-Arranz MD, Hernández-Breijo B, Mesonero F, Sempere L, Gomollón F, Hinojosa J, Bermejo F, Beltrán B, Rodríguez-Pescador A, Banales JM, Olivares D, Aguilar-Melero P, Menchén L, Ferreiro-Iglesias R, Blazquez Gómez I, Benitez García B, Guijarro LG, Marin AC, Bernardo D, Marsal S, Julia A, Gisbert JP. Functional rare variants influence the clinical response to anti-TNF therapy in Crohn's disease. Therap Adv Gastroenterol 2019; 12:1756284819867848. [PMID: 31598133 PMCID: PMC6764039 DOI: 10.1177/1756284819867848] [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: 04/10/2019] [Accepted: 06/28/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The effect of low-frequency functional variation on anti-tumor necrosis factor alpha (TNF) response in Crohn's disease (CD) patients remains unexplored. The objective of this study was to investigate the impact of functional rare variants in clinical response to anti-TNF therapy in CD. METHODS CD anti-TNF naïve patients starting anti-TNF treatment due to active disease [Crohn's Disease Activity Index (CDAI > 150)] were included. The whole genome was sequenced using the Illumina Hiseq4000 platform. Clinical response was defined as a CDAI score <150 at week 14 of anti-TNF treatment. Low-frequency variants were annotated and classified according to their damaging potential. The whole genome of CD patients was screened to identify homozygous loss-of-function (LoF) variants. The TNF signaling pathway was tested for overabundance of damaging variants using the SKAT-O method. Functional implication of the associated rare variation was evaluated using cell-type epigenetic enrichment analyses. RESULTS A total of 41 consecutive CD patients were included; 3250 functional rare variants were identified (2682 damaging and 568 LoF variants). Two homozygous LoF mutations were found in HLA-B and HLA-DRB1 genes associated with lack of response and remission, respectively. Genome-wide LoF variants were enriched in epigenetic marks specific for the gastrointestinal tissue (colon, p = 4.11e-4; duodenum, p = 0.011). The burden of damaging variation in the TNF signaling pathway was associated with response to anti-TNF therapy (p = 0.016); damaging variants were enriched in epigenetic marks from CD8+ (p = 6.01e-4) and CD4+ (p = 0.032) T cells. CONCLUSIONS Functional rare variants are involved in the response to anti-TNF therapy in CD. Cell-type enrichment analysis suggests that the gut mucosa and CD8+ T cells are the main mediators of this response.
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Affiliation(s)
| | | | - Iván Guerra
- Gastroenterology Unit, Hospital Universitario de
Fuenlabrada, Instituto de Investigación de Hospital La Paz (IdiPaz), Madrid,
Spain
| | | | - Jose Luis Cabriada
- Gastroenterology Unit, Hospital Universitario de
Galdakano, Vizcaya, Spain
| | | | - Carlos Taxonera
- Gastroenterology Unit, Hospital Universitario
Clínico San Carlos and IdISSC, Madrid, Spain
| | | | - Ignacio Marín-Jiménez
- Gastroenterology Unit, Hospital Universitario
Gregorio Marañón e IiSGM, Madrid, Spain
| | | | - Isabel Vera
- Gastroenterology Unit, Hospital Universitario
Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Borja Hernández-Breijo
- Universidad de Alcalá, Alcalá de Henares,
Spain,Immuno-Rheumatology Research Group. IdiPaz.
Hospital Universitario La Paz, Madrid, Spain
| | - Francisco Mesonero
- Gastroenterology Unit, Hospital Universitario
Ramón y Cajal, Madrid, Spain
| | - Laura Sempere
- Gastroenterology Unit, Hospital Universitario
Alicante, Alicante, Spain
| | | | - Joaquín Hinojosa
- Gastroenterology Unit, Hospital Universitario
Manises, Valencia, Spain
| | - Fernando Bermejo
- Gastroenterology Unit, Hospital Universitario
de Fuenlabrada, Instituto de Investigación de Hospital La Paz (IdiPaz),
Madrid, Spain
| | | | | | | | - David Olivares
- Gastroenterology Unit, Hospital Universitario
Clínico San Carlos and IdISSC, Madrid, Spain
| | - Patricia Aguilar-Melero
- Gastroenterology Unit, Instituto Maimónides de
Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina
Sofía/Universidad de Córdoba, Spain
| | - Luis Menchén
- Gastroenterology Unit, Hospital Universitario
Gregorio Marañón e IiSGM, Madrid, Spain
| | - Rocío Ferreiro-Iglesias
- Gastroenterology Unit, Hospital Universitario
Clínico de Santiago, Santiago de Compostela, Spain
| | - Isabel Blazquez Gómez
- Gastroenterology Unit, Hospital Universitario
Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | | | - Sara Marsal
- Rheumatology Research Group, Vall d’Hebron
Research Institute, Barcelona, Spain
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Echarri A, Vera I, Ollero V, Arajol C, Riestra S, Robledo P, Calvo M, Gallego F, Ceballos D, Castro B, Aguas M, García-López S, Marín-Jiménez I, Chaparro M, Mesonero P, Guerra I, Guardiola J, Nos P, Muñiz J. The Harvey-Bradshaw Index Adapted to a Mobile Application Compared with In-Clinic Assessment: The MediCrohn Study. Telemed J E Health 2019; 26:80-88. [PMID: 30848700 PMCID: PMC6948001 DOI: 10.1089/tmj.2018.0264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: Mobile apps are useful tools in e-health and self-management strategies in disease monitoring. We evaluated the Harvey–Bradshaw index (HBI) mobile app self-administered by the patient to see if its results agreed with HBI in-clinic assessed by a physician. Methods: Patients were enrolled in a 4-month prospective study with clinical assessments at months 1 and 4. Patients completed mobile app HBI and within 48 h, HBI was performed by a physician (gold standard). HBI scores characterized Crohn's disease (CD) as remission <5 or active ≥5. We determined agreement per item and total HBI score and intraclass correlation coefficients (ICCs). Bland–Altman plot was performed. HBI changes in disease activity from month 1 to month 4 were determined. Results: A total of 219 patients were enrolled. All scheduled assessments (385 pairs of the HBI questionnaire) showed a high percentage of agreement for remission/activity (92.4%, κ = 0.796), positive predictive value (PPV) for remission of 98.2%, and negative predictive value of 76.7%. High agreement was also found at month 1 (93.15%, κ = 0.82) and month 4 (91.5%, κ = 0.75). Bland–Altman plot was more uniform when the HBI mean values were <5 (remission). ICC values were 0.82, 0.897, and 0.879 in all scheduled assessments, 1 and 4 months, respectively. Conclusions: We found a high percentage of agreement between patients' self-administered mobile app HBI and in-clinic physician assessment to detect CD activity with a remarkably high PPV for remission. The mobile app HBI might allow a strict control of inflammation by remote monitoring and flexible follow-up of CD patients. Reduction of sanitary costs could be possible.
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Affiliation(s)
- Ana Echarri
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Isabel Vera
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Virginia Ollero
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Claudia Arajol
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Sabino Riestra
- Gastroenterology Department, Central University Hospital, Oviedo, Spain
| | - Pilar Robledo
- Gastroenterology Department, San Pedro de Alacantara University Hospital, Cáceres, Spain
| | - Marta Calvo
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Franscisco Gallego
- Gastroenterology Department, Poniente University Hospital, Almeria, Spain
| | - Daniel Ceballos
- Gastroenterology Department, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Beatriz Castro
- Gastroenterology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Mariam Aguas
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Instituto de Investigación Sanitaria Princesa and CIBERehd, La Princesa University Hospital, Madrid, Spain
| | - Paco Mesonero
- Gastroenterology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Fuenlabrada University Hospital, Madrid, Spain
| | - Jordi Guardiola
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | - Javier Muñiz
- Instituto Universitario de Ciencias de La Salud e INIBIC, La Coruña University, La Coruña, Spain
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Chaparro M, Garre A, Ricart E, Iborra M, Mesonero F, Vera I, Riestra S, García-Sánchez V, Luisa De Castro M, Martin-Cardona A, Aldeguer X, Mínguez M, de-Acosta MB, Rivero M, Muñoz F, Andreu M, Bargalló A, González-Muñoza C, Pérez Calle JL, García-Sepulcre MF, Bermejo F, Huguet JM, Cabriada JL, Gutiérrez A, Mañosa M, Villoria A, Carbajo AY, Lorente R, García-López S, Piqueras M, Hinojosa E, Arajol C, Sicilia B, Conesa AM, Sainz E, Almela P, Llaó J, Roncero O, Camo P, Taxonera C, Domselaar MV, Pajares R, Legido J, Madrigal R, Lucendo AJ, Alcaín G, Doménech E, Gisbert JP. Short and long-term effectiveness and safety of vedolizumab in inflammatory bowel disease: results from the ENEIDA registry. Aliment Pharmacol Ther 2018; 48:839-851. [PMID: 30281832 DOI: 10.1111/apt.14930] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/05/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Effectiveness of vedolizumab in real world clinical practice is unknown. AIM To evaluate the short and long-term effectiveness of vedolizumab in patients with inflammatory bowel disease (IBD). METHODS Patients who received at least 1 induction dose of vedolizumab were included. Effectiveness was defined based on Harvey-Bradshaw index (HBI) in Crohn's disease (CD) and Partial Mayo Score (PMS) in ulcerative colitis (UC). Short-term response was assessed at week 14. Variables associated with short-term remission were identified by logistic regression analysis. The Kaplan-Meier method was used to evaluate the long-term durability of vedolizumab treatment. Cox model was used to identify factors associated with discontinuation of treatment and loss of response. RESULTS 521 patients were included (median follow-up 10 months [interquartile range 5-18 months]). At week 14, 46.8% had remission and 15.7% clinical response. CD (vs UC), previous surgery, higher CRP concentration and disease severity at baseline were significantly associated with impaired response. The rate of vedolizumab discontinuation was 37% per patient-year of follow-up (27.6% in UC and 45.3% in CD, P < 0.01). CD (vs UC), anaemia at baseline, steroids during induction and CRP concentration were associated with lower durability of treatment. Seven per cent of patients developed adverse events, infections being the most frequent. CONCLUSIONS Over 60% of IBD patients respond to vedolizumab. Many patients discontinue treatment over time. CD and disease burden impair both short- and long-term response. Vedolizumab seems to be safe in clinical practice.
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Rodriguez-Valero N, Luengo Oroz M, Cuadrado Sanchez D, Vladimirov A, Espriu M, Vera I, Sanz S, Gonzalez Moreno JL, Muñoz J, Ledesma Carbayo MJ. Mobile based surveillance platform for detecting Zika virus among Spanish Delegates attending the Rio de Janeiro Olympic Games. PLoS One 2018; 13:e0201943. [PMID: 30133492 PMCID: PMC6104978 DOI: 10.1371/journal.pone.0201943] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Zika virus has created a major epidemic in Central and South America, especially in Brazil, during 2015-16. The infection is strongly associated with fetal malformations, mainly microcephaly, and neurological symptoms in adults. During the preparation of the Rio de Janeiro Olympic Games in 2016, members of Olympic Delegations worldwide expressed their concern about the health consequences of being infected with Zika virus. A major risk highlighted by the scientific community was the impact on the spreading of the virus into new territories immediately after the Games. OBJECTIVES To detect real-time incidence of symptoms compatible with arboviral diseases and other tropical imported diseases among the Spanish Olympic Delegation (SOD) attending the Rio Olympic Games in 2016. METHODS We developed a surveillance platform based on a mobile application installed in participant's smartphones that monitored the health status of the SOD through a daily interactive check of the user health status including geo-localization data. The results were evaluated by a study physician on-call through a web-based platform monitoring system. Participants presenting severe symptoms or those compatible with Zika infection prompted an alarm in the system triggering specialized medical assistance and allowing early detection and control of the introduction of arboviral diseases in Spain. SUMMARY OF THE RESULTS The system was downloaded by 189 participants and used by 143 of them (76%). Median age was 38 years (IQR 16), and 134 (71%) were male. Mean duration of travel was 19 days (+/-9SD). During the Games the highest accumulated incidence observed was for headache: 6.06% cough: 5.30% and conjunctivitis: 3.03%. The incidence rate of cough during the Olympic Games was 1.1% per day per person, followed by headache 0.8% and 0.4% conjunctivitis or diarrhea. In our cohort we observed that non-athletes experienced more incidence of symptoms, except for incidence of cough which was the same in the two groups (1.1%). No participants reported symptoms fulfilling Zika definition case. CONCLUSION Our system did not find cases fulfilling Zika definition amongst participants of the SOD during the Games, consistent with limited cases of Zika in Rio during the Games. The app showed good usability and the web based monitoring platform allowed to manage infectious cases in real-time. The overall system has proven to serve as a real-time surveillance platform for detecting symptoms that could be present in tropical imported diseases, especially arboviral diseases, contributing to the preparedness for the introduction of vector borne-diseases in non-endemic countries.
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Affiliation(s)
- Natalia Rodriguez-Valero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health)-Universitat de Barcelona, Barcelona, Spain
| | - Miguel Luengo Oroz
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Daniel Cuadrado Sanchez
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Alexander Vladimirov
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Marina Espriu
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health)-Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health)-Universitat de Barcelona, Barcelona, Spain
| | - Sergi Sanz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health)-Universitat de Barcelona, Barcelona, Spain
| | - Jose Luis Gonzalez Moreno
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Jose Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health)-Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesus Ledesma Carbayo
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
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32
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Rodriguez-Valero N, Carbayo MJL, Sanchez DC, Vladimirov A, Espriu M, Vera I, Roldan M, de Alba T, Sanz S, Moreno JLG, Oroz ML, Muñoz J. Real-time incidence of travel-related symptoms through a smartphone-based app remote monitoring system: a pilot study. J Travel Med 2018; 25:4999197. [PMID: 29788400 DOI: 10.1093/jtm/tay034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 04/25/2018] [Indexed: 11/13/2022]
Abstract
Trip Doctor®, a Smartphone-based app monitoring system, was developed to detect infections among travelers in real-time. For testing, 106 participants were recruited (62.2% male, mean age 36 years (SD = 11)). Majority of trips were for tourism and main destinations were in South East Asia. Mean travel duration was 14 days (SD = 10). Diarrhea was the most frequently reported symptom (15.5%). The system demonstrated adequate usability and is ready to be used on a larger scale.
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Affiliation(s)
- N Rodriguez-Valero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - M J Ledesma Carbayo
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - D Cuadrado Sanchez
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - A Vladimirov
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - M Espriu
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - I Vera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - M Roldan
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - T de Alba
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - S Sanz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - J L Gonzalez Moreno
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - M Luengo Oroz
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - J Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
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Fernández Rodríguez CM, Fernández Pérez C, Bernal JL, Vera I, Elola J, Júdez J, Carballo F. RECALAD. Patient care at National Health System Digestive Care Units - A pilot study, 2015. Rev Esp Enferm Dig 2017; 110:44-50. [PMID: 29284269 DOI: 10.17235/reed.2017.5316/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To reach a situation diagnosis on the status of patient management at digestive care units (DCUs) in Spain. MATERIAL AND METHODS A cross-sectional descriptive study across DCUs in general acute care hospitals within the Spanish National Health System (data referred to 2015). The study variables were collected with a questionnaire including items on structure, services portfolio, activity, education, research, and good practice. Hospital discharge rates for digestive diseases were also assessed using the minimum basic data set (2005-2014). RESULTS Two hundred and nine hospitals invited, 55 responders (26.3%). Average discharges from hospital were 1,139 ± 653 per DCU/year, and 100 ± 66 per year per dedicated gastroenterologist. In 2014, admission rate to DCUs per 1,000 population and year was 280, with a mean stay of 7.4 days. The analysis of the MBDS for 2005-2014 reveals a progressive increase in the number of discharges (37% more in 2014 versus 2005), with a 28% decrease in hospital gross mortality rate (3.7% in 2014) and a slightly reduced (14%) mean stay (7.6 days in 2014). Considerable variability may be seen in structure, activity, and results indicators. Mortality and readmission rates, as well as mean stay, vary more than 100% amongst DCUs, and major dispersions also exist in frequentation and results amongst autonomous communities. CONCLUSIONS The RECALAD 2015 survey unveiled relevant aspects related to DCUs organization, structure, and management. The notable variability encountered likely reflects relevant differences in efficiency and productivity, and thus points out there is ample room for improvement.
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Affiliation(s)
| | | | | | - Isabel Vera
- Hospital Universitario Puerta de Hierro Majadahonda
| | - Javier Elola
- Director, Fundacion Instituto para la Mejora de la Asistencia Sanitaria, España
| | - Javier Júdez
- Gestion del conocimiento, Fundacion SEPD, España
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Vera I, Júdez FJ. Eluxadoline in the treatment of diarrhea-predominant irritable bowel syndrome. The SEPD perspective. Rev Esp Enferm Dig 2017; 109:788-794. [PMID: 28747053 DOI: 10.17235/reed.2017.5078/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Functional gut disorders, including diarrhea-predominant irritable bowel syndrome, are highly prevalent conditions worldwide that significantly impact health economy and patient quality of life, yet lacking fully satisfactory therapeutic options. These circumstances fostered research on various molecules with more specific therapeutic targets, including opioid receptors. Eluxadoline (Allergan's Vibercy® in the USA, Truberzi® in Europe) is a locally-acting mixed mu- and kappa-opioid receptor agonist, and delta-opioid receptor antagonist, that was licensed in 2015 by the Food and Drug Administration (FDA) and in 2016 by the European Medicines Agency (EMA) for use in diarrhea-predominant irritable bowel syndrome. Eluxadoline provides, with advantage over the current standard of care, control of both stool consistency and abdominal pain, good tolerability in most cases, and improved quality of life, hence it deserves consideration when approaching a patient with this disorder. As with any recently approved therapy, adequate pharmacovigilance is to be expected, as well as studies to inform on different scenarios such as on-demand therapy, loss of response assessment, use as rescue therapy for other molecules, and cost-effectiveness, to further characterize and more accurately position eluxadoline within the therapeutic spectrum.
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Affiliation(s)
- Isabel Vera
- Hospital Universitario Puerta de Hierro Majadahonda
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González-Lama Y, Blázquez I, Suárez CJ, Oliva B, Matallana V, Calvo M, Vera I, Abreu L. Impact of endoscopic monitoring in postoperative Crohn's disease patients already receiving pharmacological prevention of recurrence. Rev Esp Enferm Dig 2017; 107:586-90. [PMID: 26437976 DOI: 10.17235/reed.2015.3836/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain. AIMS To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR. METHODS Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as "endoscopy-based management (EBM)" if treatment step-up after endoscopy, or "non EBM (N-EBM)". Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered. RESULTS One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR.
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Affiliation(s)
- Yago González-Lama
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, España
| | | | | | - Borja Oliva
- Hospital Universitario Puerta de Hierro Majadahond
| | | | - Marta Calvo
- Hospital Universitario Puerta de Hierro Majadahond
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro Majadahond
| | - Luis Abreu
- Hospital Universitario Puerta de Hierro Majadahond
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Hernández-Breijo B, Chaparro M, Cano-Martínez D, Guerra I, Iborra M, Cabriada JL, Bujanda L, Taxonera C, García-Sánchez V, Marín-Jiménez I, Barreiro-de Acosta M, Vera I, Martín-Arranz MD, Mesonero F, Sempere L, Gomollón F, Hinojosa J, Gisbert JP, Guijarro LG. Standardization of the homogeneous mobility shift assay protocol for evaluation of anti-infliximab antibodies. Application of the method to Crohn's disease patients treated with infliximab. Biochem Pharmacol 2016; 122:33-41. [PMID: 27664854 DOI: 10.1016/j.bcp.2016.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/20/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND The availability of a quantitative method to measure anti-infliximab (IFX) antibodies (ATI) would facilitate the implementation of therapeutic drug monitoring in clinical decision-making. Our aim was to standardize the homogeneous mobility shift assay (HMSA) used in the measure of ATI levels. METHODS In this prospective longitudinal multicenter study, 50 IFX-treated Crohn's disease (CD) patients were followed up for 54weeks. During this period 360 human serum samples were analysed. Monomeric ATI levels were measured by a quantitative HMSA-method using an anti-IFX calibrator. IFX trough levels measured by ELISA were correlated with ATI levels. RESULTS Using HMSA and a pure anti-idiotypic monoclonal antibody specific for IFX (anti-IFX calibrator), we measured the levels of monomeric ATI generated in Crohn's disease patients treated with IFX. Anti-IFX calibrator allowed to quantify monomeric antibodies against IFX with a low limit of quantification (3nM). The threshold level of ATI in order to classify the immunogenicity of the patients was 10nM. We observed that 24% (12/50) of IFX-treated patients developed ATI (>10nM) during the observation period (54weeks). Serum concentration of ATI higher than 10nM dramatically increased the probability (OR=51.1; 95% CI: 20.4-128.0; p<0.0001) of presenting low levels of IFX (⩽1.5nM) in serum, as observed in some CD patients treated with standard doses of the drug. CONCLUSIONS The HMSA-method described here allows an accurate quantification of ATI concentration in international units (IU) and therefore it could be useful in the study of the relationship between ATI concentration, infliximab level and the clinical response to the drug.
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Affiliation(s)
- B Hernández-Breijo
- Systems Biology Department, Universidad de Alcalá and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Alcalá de Henares, Spain
| | - M Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and CIBEREHD, Madrid, Spain
| | - D Cano-Martínez
- Systems Biology Department, Universidad de Alcalá and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Alcalá de Henares, Spain
| | - I Guerra
- Hospital de Fuenlabrada, Madrid, Spain
| | - M Iborra
- Hospital la Fe, Valencia and CIBEREHD, Spain
| | | | - L Bujanda
- Hospital de Donostia, Guipúzcoa, Instituto Biodonostia, UPV/EHU and CIBEREHD, Spain
| | - C Taxonera
- Hospital Clínico San Carlos, and IdISSC, Madrid, Spain
| | - V García-Sánchez
- Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - I Marín-Jiménez
- Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - I Vera
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - F Mesonero
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - L Sempere
- Hospital General de Alicante, Alicante, Spain
| | - F Gomollón
- Hospital Clínico Universitario "Lozano Blesa", IIS Aragón, Zaragoza and CIBEREHD, Spain
| | | | - J P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and CIBEREHD, Madrid, Spain
| | - L G Guijarro
- Systems Biology Department, Universidad de Alcalá and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Alcalá de Henares, Spain.
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Araya F, Vera I, Sáez K, Vidal G. Effects of aeration and natural zeolite on ammonium removal during the treatment of sewage by mesocosm-scale constructed wetlands. Environ Technol 2016; 37:1811-1820. [PMID: 26848982 DOI: 10.1080/09593330.2015.1133715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective was to evaluate the effects of intermittent artificial aeration cycles and natural zeolite as a support medium, in addition to the contribution of plants (Schoenoplectus californicus) on NH4(+)-N removal during sewage treatment by Constructed Wetlands (CW). Two lines of Mesocosm Constructed Wetland (MCW) were installed: (a) gravel line (i.e. G-Line) and (b) zeolite line (i.e. Z-Line). Aeration increased the NH4(+)-N removal efficiency by 20-45% in the G-Line. Natural zeolite increased the NH4(+)-N removal efficiency by up to 60% in the Z-Line. Plants contributed 15-30% of the NH4(+)-N removal efficiency and no difference between the G-Line and the Z-Line. Conversely, the NH4(+)-N removal rate was shown to only increase with the use of natural zeolite. However, the MCW with natural zeolite, the NH4(+)-N removal rate showed a direct relationship only with the NH4(+)-N influent concentration. Additionally, relationship between the oxygen, energy and area regarding the NH4(+)-N removal efficiency was established for 2.5-12.5 gO2/(kWh-m(2)) in the G-Line and 0.1-2.6 gO2/(kWh-m(2)) in the Z-Line. Finally, it was established that a combination of natural zeolite as a support medium and the aeration strategy in a single CW could regenerate the zeolite's adsorption sites and maintain a given NH4(+)-N removal efficiency over time.
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Affiliation(s)
- F Araya
- a Engineering and Environmental Biotechnology Group, Environmental Science Faculty and EULA-Chile Center , University of Concepción , Concepción , Chile
| | - I Vera
- a Engineering and Environmental Biotechnology Group, Environmental Science Faculty and EULA-Chile Center , University of Concepción , Concepción , Chile
- b Centro de Investigación y Desarrollo en Recursos Hídricos (CIDERH) , Iquique , Chile
- c Universidad Arturo Prat , Iquique , Chile
| | - K Sáez
- d Department of Statistics, Faculty of Mathematics and Physical Sciences , University of Concepción , Concepción , Chile
| | - G Vidal
- a Engineering and Environmental Biotechnology Group, Environmental Science Faculty and EULA-Chile Center , University of Concepción , Concepción , Chile
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Gordillo J, Cabré E, Garcia-Planella E, Ricart E, Ber-Nieto Y, Márquez L, Rodríguez-Moranta F, Ponferrada Á, Vera I, Gisbert JP, Barrio J, Esteve M, Merino O, Muñoz F, Domènech E. Thiopurine Therapy Reduces the Incidence of Colorectal Neoplasia in Patients with Ulcerative Colitis. Data from the ENEIDA Registry. J Crohns Colitis 2015; 9:1063-70. [PMID: 26351379 DOI: 10.1093/ecco-jcc/jjv145] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/06/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Patients with ulcerative colitis (UC) are at increased risk of developing colorectal cancer (CRC), but recent studies suggest a lower risk than previously reported. The aim was to evaluate the incidence of dysplasia, CRC and related risk factors in UC patients from a Spanish nationwide database. METHODS All UC patients were identified and retrospectively reviewed. Clinical-epidemiological data and the finding of dysplasia and/or CRC were collected. RESULTS A total of 831 UC patients were included. Twenty-six cases of CRC in 26 patients and 29 cases of high-grade dysplasia (HGD) in 24 patients were found, accounting for 55 diagnoses of advanced neoplasia (AN = CRC and/or HGD) in 45 patients (33% of them within the first 8 years after UC diagnosis). The cumulative risk of AN was 2, 5.3 and 14.7% at 10, 20 and 30 years, respectively. Concomitant primary sclerosing cholangitis (odds ratio [OR] 10.90; 95% confidence interval [CI] 3.75-31.76, p < 0.001), extensive UC (OR 2.10, 95% CI 1.01-4.38, p = 0.048), UC diagnosis at an older age (OR 2.23, 95% CI 1.03-4.83, p = 0.043) and appendectomy prior to UC diagnosis (OR 2.66, 95% CI 1.06-6.71, p = 0.038) were independent risk factors for AN. Use of thiopurines (OR 0.21, 95% CI 0.06-0.74, p = 0.015) and being in a surveillance colonoscopy programme (OR 0.33; 95% CI 0.16-0.67; p = 0.002) were independent protective factors for AN. CONCLUSIONS The risk of AN among UC patients is lower than previously reported but steadily increases from the time of UC diagnosis. The widespread use of thiopurines may have influenced this reduced incidence of UC-related neoplasias.
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Affiliation(s)
- Jordi Gordillo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduard Cabré
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Elena Ricart
- Hospital Clínic i Provincial, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Yolanda Ber-Nieto
- Hospital Universitario Lozano Blesa, Zaragoza, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | | | | | - Isabel Vera
- Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - Javier P Gisbert
- Hospital Universitario de la Princesa and Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Jesús Barrio
- Hospital Universitaro Rio Hortega, Valladolid, Spain
| | - Maria Esteve
- Hospital Mútua de Terrassa, Terrassa, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | | | - Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Vera I, Verdura Vizcaíno E, Sanz Fuentenebro J. Regional Variations in the Use of ECT in Europe. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31876-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Verdura Vizcaíno E, Vera I, Sanz Fuentenebro J. Temporal Trends in the Use of ECT in Europe. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30271-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Verdura E, Vera I, Sanz-Fuentenebro J. Regional Variations in ECT Use in Europe. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30655-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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González-Lama Y, Suárez CJ, Blázquez I, Calvo M, Matallana V, Vera I, Abreu L. Mucosal healing in Crohn's disease: relevance and controversies in real life clinical practice. Rev Esp Enferm Dig 2014; 106:459-466. [PMID: 25490165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mucosal healing is a recent and emerging concept in Crohn's disease management that has been associated to a good prognosis and therefore it has been also proposed to be a clinically relevant therapeutic endpoint. On the other hand, there are many controversial aspects about this concept, and some clinically relevant difficulties that may preclude clinicians from moving this concept from clinical trials to clinical practice in many cases. This review is focused on both aspects of mucosal healing in day-to-day real life clinical practice.
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Vera I, Araya F, Andrés E, Sáez K, Vidal G. Enhanced phosphorus removal from sewage in mesocosm-scale constructed wetland using zeolite as medium and artificial aeration. Environ Technol 2014; 35:1639-1649. [PMID: 24956754 DOI: 10.1080/09593330.2013.877984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Phosphorus (P) contained in sewage maybe removed by mesocosm-scale constructed wetlands (MCW), although removal efficiency is only between 20% and 60%. P removal can be enhanced by increasing wetland adsorption capacity using special media, like natural zeolite, operating under aerobic conditions (oxidation-reduction potential (ORP) above +300 mV). The objective of this study was to evaluate P removal in sewage treated by MCW with artificial aeration and natural zeolite as support medium for the plants. The study compared two parallel lines of MCW: gravel and zeolite. Each line consisted in two MCW in series, where the first MCW of each line has artificial aeration. Additionally, four aeration strategies were evaluated. During the operation, the following parameters were measured in each MCW: pH, temperature, dissolved oxygen and ORP. Phosphate (PO4(-3) - P) and chemical oxygen demand (COD), five-day biological oxygen demand (BOD5), total suspended solids (TSS) and ammonium. (NH4(+) - N) were evaluated in influents and effluents. Plant growth (biomass) and proximate analysis for P content into Schoenoplectus californicus were also performed. The results showed that PO4(-3) - P removal efficiency was 70% in the zeolite medium, presenting significant differences (p < .05) with the results obtained by the gravel medium. Additionally, aeration was found to have a significant effect (p < .05) only in the gravel medium with an increase in up to 30% for PO43 - P removal. Thus, S. californicus contributed to 10-20% of P removal efficiency.
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Chaparro M, Zanotti C, Burgueño P, Vera I, Bermejo F, Marín-Jiménez I, Yela C, López P, Martín MD, Taxonera C, Botella B, Pajares R, Ponferrada A, Calvo M, Algaba A, Pérez L, Casis B, Maté J, Orofino J, Lara N, García-Losa M, Badia X, Gisbert JP. Health care costs of complex perianal fistula in Crohn's disease. Dig Dis Sci 2013; 58:3400-6. [PMID: 24026400 DOI: 10.1007/s10620-013-2830-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/27/2013] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the use of health care resources and the associated costs of complex perianal Crohn's disease (CD) from the National Health System perspective. METHODS We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review. RESULTS We recorded 527 treatments: 73.1% pharmacological (32.3% antibiotic, 20.5% immunomodulator, 20.3% biological) and 26.9% surgical. Mean annual global cost was €8,289/patient, 75.3% (€6,242) of which was accounted for by pharmacological treatments (€13.44 antibiotics; €1,136 immunomodulators; €5,093 biological agents), 12.4% (€1,027) by hospitalizations and surgery, 7.7% (€640) by medical visits, 4.2% (€350) by laboratory/diagnostic tests, and 0.4% (€30) by emergency department visits. CONCLUSIONS Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.
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Affiliation(s)
- M Chaparro
- Servicio de Aparato Digestivo del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Playa de Mojácar 29. Urb Bonanza, 28669, Boadilla del Monte, Madrid, Spain,
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Casellas F, Ginard D, Vera I, Torrejón A. Satisfaction of health care professionals managing patients with inflammatory bowel disease. J Crohns Colitis 2013; 7:e249-55. [PMID: 23138131 DOI: 10.1016/j.crohns.2012.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The aim of the present study was to analyze the satisfaction of health care professionals who attend patients with inflammatory bowel disease (IBD) and to determine the variables more related with satisfaction/dissatisfaction. METHODS Cross-sectional, self-administered written 15-item questionnaire was evaluated using a Likert scale, completed by Spanish gastroenterologists and nurse practitioners specialized in IBD patient care. RESULTS A total of 202 surveys, 133 physicians (65.8%) and 69 nurses (34.2%) were conducted. Global scoring of satisfaction was 54.0 for physicians and 64.2 for nurses (p<0.001). In both groups the highest scores were achieved in those items related to their professional careers and management of personal and professional lives as well as those that refer to their interdisciplinary relationship with other medical units, management of patients within the hospital setting and finally communication with the patient. The items that attained the lowest score included those related to the length and staff available for the medical consult, work environment and the balance among health care provider needs for contribution, recognition and fulfillment. With regard to the variables involved with satisfaction, the results show that those physicians that only took care of IBD patients achieved a higher degree of satisfaction. This could be related with the fulfillment of their own professional expectations. CONCLUSIONS The level of satisfaction of health care professionals that take care of IBD patients is low and may impact on patient care. Therefore, new strategies to increase the degree of satisfaction of IBD health care providers should be implemented.
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Affiliation(s)
- Francesc Casellas
- Unitat Atenció Crohn-Colitis, University Hospital Vall d'Hebron, Pso. Vall d'Hebron 119, Barcelona, 08035, Spain.
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Casellas F, Vera I, Ginard D, Torrejón A. Inflammatory bowel disease patient's satisfaction with healthcare services received: physicians' and nurses' perceptions. Rev esp enferm dig 2013; 105:385-91. [DOI: 10.4321/s1130-01082013000700003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vera I, Sáez K, Vidal G. Performance of 14 full-scale sewage treatment plants: comparison between four aerobic technologies regarding effluent quality, sludge production and energy consumption. Environ Technol 2013; 34:2267-2275. [PMID: 24350481 DOI: 10.1080/09593330.2013.765921] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The performance of 14 Full-Scale Sewage Treatment Plants (STPs) was evaluated. STPs were divided into four aerobic technologies: a) Aerated Lagoon (AL), and three configurations of activated sludge technologies, b) conventional (CAS), c) Extended Aeration (EA), d) Sequencing Batch Reactor (SBR). Comparison between these configurations were made regarding: a) control parameters, organic loading rate (OLR), Mixed Liquor Volatile Suspended Solids (MLVSS) concentrations, Food to Microorganism ratio (F/M), sludge age (theta(c)), Hydraulic Retention Time (HRT) and return sludge ratio (R); b) effluent quality, through 5-day Biological Oxygen Demand (BOD5), Chemical Oxygen Demand (COD), Total Suspended Solids (TSS), Total Kjeldahl Nitrogen (TKN), Total Phosphorus (TP); and c) indicators related to sludge production (on a dry basis) and electrical energy consumption. Also, complementary costs analyses were made. The results show that in terms of effluent quality, for all configurations organic matter (BOD5 and COD) and TKN removal efficiency were up to 90%, while TSS and TP were up to 90% and 50%, respectively. However, CAS, EA, SBR, and AL had stability problems with effluent concentrations. The results of the electrical energy consumption and sludge production analyses show that SBRs reduce these indicators by 40%. Cost analysis showed that CAS, EA, SBR and AL had similar cost structures, with more than 50% of total operating and maintenance cost being related to electrical energy and sludge management. Therefore, SBR could be defined as the configuration with a more stable performance.
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Affiliation(s)
- I Vera
- Environmental Science Center EULA-Chile, University of Concepción, Concepción, Chile
| | - K Sáez
- Department of Statistics, Faculty of Mathematics and Physical Sciences, University of Concepción, Concepción, Chile
| | - G Vidal
- Environmental Science Center EULA-Chile, University of Concepción, Concepción, Chile
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Cabriada JL, Vera I, Domènech E, Barreiro-de Acosta M, Esteve M, Gisbert JP, Panés J, Gomollón F. [Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on the use of anti-tumor necrosis factor drugs in inflammatory bowel disease]. Gastroenterol Hepatol 2013; 36:127-46. [PMID: 23433780 DOI: 10.1016/j.gastrohep.2013.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/21/2013] [Indexed: 12/13/2022]
Affiliation(s)
- José Luis Cabriada
- Servicio de Aparato Digestivo, Hospital Galdakao-Usansolo, Galdakao, Vizcaya, España.
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Chaparro M, Panés J, García V, Merino O, Nos P, Domènech E, Peñalva M, García-Planella E, Esteve M, Hinojosa J, Andreu M, Muñoz F, Gutiérrez A, Mendoza JL, Barrio J, Barreiro-de M, Vera I, Vilar P, Cabriada JL, Montoro MA, Aldeguer X, Saro C, Gisbert JP. Long-term durability of response to adalimumab in Crohn's disease. Inflamm Bowel Dis 2012; 18:685-90. [PMID: 21618353 DOI: 10.1002/ibd.21758] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 04/04/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Adalimumab is an effective treatment for Crohn's disease (CD), but may also be associated with loss of response. Few reports provide insight into the durability of treatment of CD with adalimumab for periods longer than 12 months in clinical practice. AIMS To evaluate the long-term durability of adalimumab maintenance treatment and to identify predictive factors associated with loss of response. METHODS CD patients who initially responded to adalimumab were evaluated in a historical cohort study. Maintenance of long-term response was estimated using Kaplan-Meier analysis. Cox regression analysis was performed to identify potential predictive factors for loss of efficacy. RESULTS In all, 380 CD patients were included (mean age, 38 years; 52% female). Of these, 43% had ileocolic CD, 50% inflammatory CD, and 41% perianal CD. Median follow-up with adalimumab was 8 months (range, 4-75 months). The annual risk of loss of response to adalimumab was 18% per patient-year of follow-up. Twenty-eight percent of patients were anti-TNF-naïve and 72% anti-TNF-experienced. The loss of efficacy was 8% per patient-year of follow-up in the anti-TNF-naïve patients and 22% in the anti-TNF-experienced group (P < 0.01). In the multivariate analysis, the presence of extraintestinal manifestations (hazard ratio [HR] = 1.7; 95% confidence interval [CI] = 1.02-2.9) and previous experience with other anti-TNF agents (HR = 2.5,95% CI = 1.2-5.3) were associated with higher risk of loss of efficacy. CONCLUSIONS A relevant proportion of CD patients on long-term adalimumab lost response. The risk of loss of response was higher (more than 2-fold) in anti-TNF-experienced than in anti-TNF-naïve patients (22% vs. 8% per patient-year of treatment). Having extraintestinal manifestations seems to increase the risk of loss of efficacy.
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Affiliation(s)
- M Chaparro
- Gastroenterology Units of Hospital de La Princesa and Instituto de Investigación Sanitaria Princesa, IP, Madrid, Spain.
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