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Meijboom RW, Gardarsdottir H, Becker ML, Movig KLL, Kuijvenhoven J, Egberts TCG, Giezen TJ. Discontinuation of infliximab treatment in patients with inflammatory bowel disease who retransitioned to originator and those who remained on biosimilar. Therap Adv Gastroenterol 2023; 16:17562848231197923. [PMID: 37706094 PMCID: PMC10496466 DOI: 10.1177/17562848231197923] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/12/2023] [Indexed: 09/15/2023] Open
Abstract
Background Many patients with inflammatory bowel disease (IBD) have transitioned from an infliximab originator to a biosimilar. However, some patients retransition to the originator (i.e. stop biosimilar and reinitiate the originator). Whether this sign of potential unsatisfactory treatment response is specifically related to the infliximab biosimilar or the patient and/or the disease including patients' beliefs on the biosimilar is unclear. Objectives We aimed to compare the risk of and reasons for infliximab discontinuation between retransitioned patients and those remaining on biosimilar. Design Non-interventional, multicentre cohort study. Methods IBD patients who transitioned from infliximab originator to biosimilar between January 2015 and September 2019 in two Dutch hospitals were eligible for this study. Retransitioned patients (retransitioning cohort) were matched with patients remaining on biosimilar (biosimilar remainder cohort). Reasons for discontinuation were categorised as the unwanted response (i.e. loss of effect or adverse events) or remission. Risk of unwanted discontinuation was compared using Cox proportional hazards models. Results Patients in the retransitioning cohort (n = 44) were younger (median age 39.9 versus 44.0 years), more often female (65.9% versus 48.9%) and had shorter dosing intervals (median 48.5 versus 56.0 days) than in the biosimilar remainder cohort (n = 127). Infliximab discontinuation due to unwanted response was 22.7% in the retransitioning and 13.4% in the biosimilar remainder cohort, and due to remission was 2.3% and 9.4%, respectively. Retransitioned patients are at increased risk of discontinuing due to unwanted response compared with biosimilar remainder patients (adjusted HR 3.7, 95% CI: 1.0-13.9). Patients who retransitioned due to an increase in objective disease markers had higher discontinuation rates than patients who retransitioned due to symptoms only (66.7% versus 23.7%). Conclusion Retransitioned patients are at increased risk of infliximab discontinuation due to unwanted response. Retransitioning appeared related to the patient and/or disease and not the product. Clinicians might switch patients opting for retransitioning to other treatment regimens.
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Affiliation(s)
- Rosanne W. Meijboom
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, the Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
| | - Matthijs L. Becker
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, the Netherlands
- Department of Clinical Pharmacy, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Kris L. L. Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Johan Kuijvenhoven
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Toine C. G. Egberts
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs J. Giezen
- Pharmacy Foundation of Haarlem Hospitals, Boerhaavelaan 24, Haarlem 2035 RC, the Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy, Spaarne Gasthuis, Haarlem, the Netherlands
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Bosch S, Acharjee A, Quraishi MN, Bijnsdorp IV, Rojas P, Bakkali A, Jansen EEW, Stokkers P, Kuijvenhoven J, Pham TV, Beggs AD, Jimenez CR, Struys EA, Gkoutos GV, de Meij TGJ, de Boer NKH. Integration of stool microbiota, proteome and amino acid profiles to discriminate patients with adenomas and colorectal cancer. Gut Microbes 2022; 14:2139979. [PMID: 36369736 PMCID: PMC9662191 DOI: 10.1080/19490976.2022.2139979] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Screening for colorectal cancer (CRC) reduces its mortality but has limited sensitivity and specificity. Aims We aimed to explore potential biomarker panels for CRC and adenoma detection and to gain insight into the interaction between gut microbiota and human metabolism in the presence of these lesions. METHODS This multicenter case-control cohort was performed between February 2016 and November 2019. Consecutive patients ≥18 years with a scheduled colonoscopy were asked to participate and divided into three age, gender, body-mass index and smoking status-matched subgroups: CRC (n = 12), adenomas (n = 21) and controls (n = 20). Participants collected fecal samples prior to bowel preparation on which proteome (LC-MS/MS), microbiota (16S rRNA profiling) and amino acid (HPLC) composition were assessed. Best predictive markers were combined to create diagnostic biomarker panels. Pearson correlation-based analysis on selected markers was performed to create networks of all platforms. RESULTS Combining omics platforms provided new panels which outperformed hemoglobin in this cohort, currently used for screening (AUC 0.98, 0.95 and 0.87 for CRC vs controls, adenoma vs controls and CRC vs adenoma, respectively). Integration of data sets revealed markers associated with increased blood excretion, stress- and inflammatory responses and pointed toward downregulation of epithelial integrity. CONCLUSIONS Integrating fecal microbiota, proteome and amino acids platforms provides for new biomarker panels that may improve noninvasive screening for adenomas and CRC, and may subsequently lead to lower incidence and mortality of colon cancer.
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Affiliation(s)
- Sofie Bosch
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Endocrinology Metabolism Institute, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, The Netherlands,CONTACT Sofie Bosch Department of Gastroenterology and Hepatology, Amsterdam UMC, VU University Medical Center, De Boelelaan 1118, Amsterdam1081HZ, The Netherlands
| | - Animesh Acharjee
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, Center for Computational Biology, University of Birmingham, Birmingham, UK,Institute of Translational Medicine, University Hospitals Birmingham NHS, Foundation Trust, UK,NIHR Surgical Reconstruction and Microbiology Research Center, University Hospital Birmingham, Birmingham, UK
| | - Mohammed Nabil Quraishi
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK,Microbiome Treatment Center, University of Birmingham Microbiome Treatment Center, University of Birmingham, UK,Center for Liver and Gastroenterology Research, NIHR Birmingham Biomedical Research Center, University of Birmingham, Birmingham, UK
| | - Irene V Bijnsdorp
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands,Department of Urology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Patricia Rojas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Abdellatif Bakkali
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin EW Jansen
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Stokkers
- Department of Gastroenterology and Hepatology, OLVG West, Amsterdam, The Netherlands
| | - Johan Kuijvenhoven
- Spaarne Gasthuis, Department of Gastroenterology and Hepatology, Hoofddorp and Haarlem, The Netherlands
| | - Thang V Pham
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrew D Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Connie R Jimenez
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Eduard A Struys
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Georgios V Gkoutos
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, Center for Computational Biology, University of Birmingham, Birmingham, UK,Institute of Translational Medicine, University Hospitals Birmingham NHS, Foundation Trust, UK,NIHR Surgical Reconstruction and Microbiology Research Center, University Hospital Birmingham, Birmingham, UK,Microbiome Treatment Center, MRC Health Data Research UK (HDR UK), Birmingham, UK,Microbiome Treatment Center, NIHR Experimental Cancer Medicine Center, Birmingham, UK,Microbiome Treatment Center, NIHR Biomedical Research Center, University Hospital Birmingham, Birmingham, UK
| | - Tim GJ de Meij
- Department of Paediatric Gastroenterology, AG&M Research Institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Nanne KH de Boer
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Endocrinology Metabolism Institute, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, The Netherlands
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3
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Bosch S, Acharjee A, Quraishi MN, Rojas P, Bakkali A, Jansen EEW, Brizzio Brentar M, Kuijvenhoven J, Stokkers P, Struys E, Beggs AD, Gkoutos GV, de Meij TGJ, de Boer NKH. The potential of fecal microbiota and amino acids to detect and monitor patients with adenoma. Gut Microbes 2022; 14:2038863. [PMID: 35188868 PMCID: PMC8865277 DOI: 10.1080/19490976.2022.2038863] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The risk of recurrent dysplastic colonic lesions is increased following polypectomy. Yield of endoscopic surveillance after adenoma removal is low, while interval colorectal cancers occur. To longitudinally assess the dynamics of fecal microbiota and amino acids in the presence of adenomatous lesions and after their endoscopic removal. In this longitudinal case-control study, patients collected fecal samples prior to bowel preparation before scheduled colonoscopy and 3 months after this intervention. Based on colonoscopy outcomes, patients with advanced adenomas and nonadvanced adenomas (0.5-1.0 cm) who underwent polypectomy during endoscopy (n = 19) were strictly matched on age, body-mass index, and smoking habits to controls without endoscopic abnormalities (n = 19). Microbial taxa were measured by 16S RNA sequencing, and amino acids (AA) were measured by high-performance liquid chromatography (HPLC). Adenoma patients were discriminated from controls based on AA and microbial composition. Levels of proline (p = .001), ornithine (p = .02) and serine (p = .02) were increased in adenoma patients compared to controls but decreased to resemble those of controls after adenoma removal. These AAs were combined as a potential adenoma-specific panel (AUC 0.79(0.64-0.94)). For bacterial taxa, differences between patients with adenomas and controls were found (Bifidobacterium spp.↓, Anaerostipes spp.↓, Butyricimonas spp.↑, Faecalitalea spp.↑ and Catenibacterium spp.↑), but no alterations in relative abundance were observed after polypectomy. Furthermore, Faecalitalea spp. and Butyricimonas spp. were significantly correlated with adenoma-specific amino acids. We selected an amino acid panel specifically increased in the presence of adenomas and a microbial signature present in adenoma patients, irrespective of polypectomy. Upon validation, these panels may improve the effectiveness of the surveillance program by detection of high-risk individuals and determination of surveillance endoscopy timing, leading to less unnecessary endoscopies and less interval cancer.
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Affiliation(s)
- Sofie Bosch
- Amsterdam Umc, Vu University Medical Center, Department of Gastroenterology and Hepatology, Ag&m Research Institute, Amsterdam, The Netherlands,contact Sofie Bosch Amsterdam UMC, VU University Medical Center, De Boelelaan 11181081HZ, Amsterdam, The Netherlands
| | - Animesh Acharjee
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, Center for Computational Biology, University of Birmingham, UK,Institute of Translational Medicine, University Hospitals Birmingham Nhs, Foundation Trust, UK,Nihr Surgical Reconstruction and Microbiology Research Center, University Hospital Birmingham, Birmingham, UK
| | - Mohammed N Quraishi
- Department of Gastroenterology, University Hospitals Birmingham Nhs Foundation Trust, Birmingham, UK,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK,University of Birmingham Microbiome Treatment Center, University of Birmingham, UK,Center for Liver and Gastroenterology Research, Nihr Birmingham Biomedical Research Center, University of Birmingham, Birmingham, UK
| | - Patricia Rojas
- Institute of Applied Health Research, University of Birmingham, UK
| | - Abdellatif Bakkali
- Department of Clinical Chemistry, Vu University Medical Center, Amsterdam, The Netherlands
| | - Erwin EW Jansen
- Department of Clinical Chemistry, Vu University Medical Center, Amsterdam, The Netherlands
| | - Marina Brizzio Brentar
- Amsterdam Umc, Vu University Medical Center, Department of Gastroenterology and Hepatology, Ag&m Research Institute, Amsterdam, The Netherlands
| | - Johan Kuijvenhoven
- Spaarne Gasthuis, Department of Gastroenterology and Hepatology, Spaarne Gasthuis (primary institute), Hoofddorp and Haarlem, The Netherlands
| | - Pieter Stokkers
- Olvg West, Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
| | - Eduard Struys
- Department of Clinical Chemistry, Vu University Medical Center, Amsterdam, The Netherlands
| | - Andrew D Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, Center for Computational Biology, University of Birmingham, UK,Institute of Translational Medicine, University Hospitals Birmingham Nhs, Foundation Trust, UK,Nihr Surgical Reconstruction and Microbiology Research Center, University Hospital Birmingham, Birmingham, UK,Medical Research Counsil, MRC Health Data Research, UK,NIHR Experimental Cancer Medicine Center, National Institute for Health Research, Birmingham, UK,NIHR Biomedical Research Center, University Hospital Birmingham, Birmingham, UK
| | - Tim GJ de Meij
- Amsterdam Umc, Vu University Amsterdam, Department of Paediatric Gastroenterology, Ag&m Research Institute, Amsterdam, The Netherlands
| | - Nanne KH de Boer
- Amsterdam Umc, Vu University Medical Center, Department of Gastroenterology and Hepatology, Ag&m Research Institute, Amsterdam, The Netherlands
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West R, Russel M, Bodelier A, Kuijvenhoven J, Bruin K, Jansen J, Van der Meulen A, Keulen E, Wolters L, Ouwendijk R, Bezemer G, Koussoulas V, Tang T, Van Dobbenburgh A, Van Nistelrooy M, Minderhoud I, Vandebosch S, Lubbinge H. Lower Risk of Recurrence with a Higher Induction Dose of Mesalazine and Longer Duration of Treatment in Ulcerative Colitis: Results from the Dutch, Non-Interventional, IMPACT Study. J Gastrointestin Liver Dis 2022; 31:18-24. [PMID: 35306553 DOI: 10.15403/jgld-3927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIMS The dose and duration of mesalazine treatment for ulcerative colitis (UC) is a potentially important determinant of effectiveness, with evidence suggesting that continuing the induction dose for 6-12 months may improve outcomes; however, real-world data are lacking. We assessed mesalazine use in Dutch clinical practice, including how differences in dose and duration affected UC outcomes. METHODS Adults with mild-to-moderate UC who received oral prolonged-release mesalazine de novo or had a dose escalation for an active episode were followed for 12 months in this non-interventional study (ClinicalTrials.gov identifier: NCT02261636). The primary endpoint was time from start of treatment to dose reduction (TDR). Secondary endpoints included recurrence rate, adherence, and work productivity. RESULTS In total, 151 patients were enrolled, of whom 108 (71.5%) were newly diagnosed with UC. The majority (120; 79.5%) received a dose of ≥4 g/day. Nearly one-third (48; 31.8%) underwent dose reduction, with mean TDR being 8.3 months. Disease extent and endoscopic appearance did not influence duration of induction therapy, while TDR increased with higher baseline UCDAI scores. TDR was longer in patients without (mean 8.8 months) than with (4.1 months) recurrence, although not significantly (p=0.09). Patients on ≥4 g/day had a significantly lower chance of recurrence versus those on 2-<4 g/day (26.6% vs 62.5%, respectively; p=0.04). Longer treatment duration was associated with significantly reduced recurrence risk [hazard ratio >6 months vs 3-6 months: 0.19 (95%CI: 0.08-0.46); p<0.05], particularly for those on ≥4 g/day [0.15 (0.06-0.40) vs 0.26 (0.01-11.9) for 2-<4 g/day). Patients reported significantly increased work productivity, which was maintained throughout follow-up. CONCLUSIONS Mesalazine was effective induction therapy, with treatment duration not meaningfully influenced by disease extent and endoscopic appearance at initiation. A higher induction dose of oral mesalazine (≥4 g/day) and longer duration of treatment (>6 months) was associated with a lower recurrence risk.
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Affiliation(s)
- Rachel West
- Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands.
| | | | | | | | | | - Jeroen Jansen
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands.
| | | | - Eric Keulen
- Orbis Medisch Centrum, Sittard/Geleen, Netherlands.
| | | | | | | | | | - Thjon Tang
- IJsselland Ziekenhuis, Capelle a/d Ijssel, Netherlands.
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Meijboom RW, Gardarsdottir H, Becker ML, de Groot MCH, Movig KLL, Kuijvenhoven J, Egberts TCG, Leufkens HGM, Giezen TJ. Switching TNFα inhibitors: Patterns and determinants. Pharmacol Res Perspect 2021; 9:e00843. [PMID: 34302442 PMCID: PMC8305431 DOI: 10.1002/prp2.843] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to assess switching patterns and determinants for switching in patients initiating TNFα inhibitor (TNFα-i) treatment. Patients were included who started TNFα-i treatment between July 1, 2012 and December 31, 2017, from three Dutch hospitals, and were diagnosed with rheumatic diseases (RD), inflammatory bowel disease (IBD), or psoriasis. Outcomes were switching, defined as initiating another biological; switching patterns including multiple switches until the end of follow-up; determinants for first switch, assessed using multivariate logistic regression. A total of 2228 patients were included (median age 43.3 years, 57% female), of which 52% (n = 1155) received TNFα-i for RD, 43% (n = 967) for IBD, and 5% (n = 106) for psoriasis. About 16.6% of RD patients, 14.5% of IBD patients, and 16.0% of psoriasis patients switched at least once, mainly to another TNFα-i. TNFα-i dose escalation (OR 13.78, 95% CI 1.40-135.0) and high-dose corticosteroids initiation (OR 3.62, 95% CI 1.10-12.15) were determinants for switching in RD patients. TNFα-i dose escalation (OR 8.22, 95% CI 3.76-17.93), immunomodulator initiation/dose escalation (OR 2.13, 95% CI 1.04-4.34), high-dose corticosteroids initiation (OR 6.91, 95% CI 2.81-17.01) and serum concentration measurement (OR 5.44, 95% CI 2.74-10.79) were determinants for switching in IBD patients. Switching biological treatment occurred in about one in six patients. RD patients with TNFα-i dose escalation and/or high-dose corticosteroids initiation were more likely to switch. IBD patients with TNFα-i or immunomodulator initiation/dose escalation, high-dose corticosteroids initiation or serum concentration measurement were more likely to switch. These findings might help clinicians anticipating switching in TNFα-i treatment.
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Affiliation(s)
- Rosanne W. Meijboom
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
- Department of Clinical PharmacyUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Department of Pharmaceutical SciencesUniversity of IcelandReykjavikIceland
| | - Matthijs L. Becker
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Department of Clinical PharmacySpaarne Gasthuis, Haarlem and HoofddorpHaarlemThe Netherlands
| | - Mark C. H. de Groot
- Central Diagnostic LaboratoryDivision Laboratories, Pharmacy and Biomedical GeneticsUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Kris L. L. Movig
- Department of Clinical PharmacyMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Johan Kuijvenhoven
- Department of Gastroenterology and HepatologySpaarne Gasthuis, Haarlem and HoofddorpThe Netherlands
| | - Toine C. G. Egberts
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
- Department of Clinical PharmacyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
| | - Thijs J. Giezen
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Department of Clinical PharmacySpaarne Gasthuis, Haarlem and HoofddorpHaarlemThe Netherlands
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Bosch S, Bot R, Wicaksono A, Savelkoul E, van der Hulst R, Kuijvenhoven J, Stokkers P, Daulton E, Covington JA, de Meij TGJ, de Boer NKH. Early detection and follow-up of colorectal neoplasia based on faecal volatile organic compounds. Colorectal Dis 2020; 22:1119-1129. [PMID: 32040880 DOI: 10.1111/codi.15009] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/03/2020] [Indexed: 12/22/2022]
Abstract
AIM Early detection and removal of colorectal cancer (CRC) and advanced adenomas (AAs) decreases the incidence of and mortality from the disease. We aimed to evaluate the potential of faecal volatile organic compounds (VOCs) for detection and follow-up of colorectal adenoma using advanced electronic nose technology. METHOD This was a prospective multi-centre case-control cohort including two district hospitals and one tertiary referral hospital. Patients undergoing colonoscopy were instructed to collect a faecal sample prior to bowel cleansing and were included in the study when CRC, AAs, large adenomas (LAs; 0.5-1.0 cm), small adenomas (SAs; 0.1-0.5 cm) or no endoscopic abnormalities (controls) were observed. Patients undergoing polypectomy and controls were asked for a second sample after 3 months. Faecal VOCs were measured with gas chromatography-ion mobility spectrometry. Random forest, support vector machine, Gaussian process and neural net classification were used to evaluate accuracy. RESULTS In total, 14 patients with CRC, 64 with AAs, 69 with LAs, 127 with SAs and 227 controls were included. A second sample was collected from 32 polypectomy patients and 32 controls. Faecal VOCs discriminated CRC and adenomas from control [AUC (95% CI): CRC vs control 0.96 (0.89-1); AA vs control 0.96 (0.93-1); LA vs control 0.96 (0.92-0.99); SA vs control 0.96 (0.94-0.99)]. There were no significant differences between CRC and adenoma groups. Patients with adenomas and controls were discriminated prior to polypectomy, whereas 3 months after polypectomy VOC profiles were similar [T0 adenoma vs control 0.98 (0.95-1); T1 adenoma vs control 0.55 (0.40-0.69)]. CONCLUSIONS Faecal VOC profiles may be useful for early detection of CRC and adenomas and the timing of polyp surveillance as polypectomy led to a normalization of the VOC profile.
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Affiliation(s)
- S Bosch
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - R Bot
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Wicaksono
- School of Engineering, University of Warwick, Coventry, UK
| | - E Savelkoul
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - R van der Hulst
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Hoofddorp and Haarlem, The Netherlands
| | - J Kuijvenhoven
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Hoofddorp and Haarlem, The Netherlands
| | - P Stokkers
- Department of Gastroenterology and Hepatology, OLVG West, Amsterdam, The Netherlands
| | - E Daulton
- School of Engineering, University of Warwick, Coventry, UK
| | - J A Covington
- School of Engineering, University of Warwick, Coventry, UK
| | - T G J de Meij
- Department of Paediatric Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - N K H de Boer
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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7
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Bosch S, Wintjens DSJ, Wicaksono A, Kuijvenhoven J, van der Hulst R, Stokkers P, Daulton E, Pierik MJ, Covington JA, de Meij TGJ, de Boer NKH. The faecal scent of inflammatory bowel disease: Detection and monitoring based on volatile organic compound analysis. Dig Liver Dis 2020; 52:745-752. [PMID: 32402741 DOI: 10.1016/j.dld.2020.03.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is diagnosed and monitored using endoscopic assessment, which is invasive and costly. In this study, potential of faecal volatile organic compounds (VOC) analysis for IBD detection and identification of disease activity was evaluated. METHODS IBD patients visiting outpatient clinics of participating tertiary hospitals were included. Active disease was defined as FCP ≥250 mg/g, remission as FCP <100 mg/g with Harvey Bradshaw Index <4 for Crohn's disease (CD) or Simple Clinical Colitis Activity Index <3 for ulcerative colitis (UC). Healthy controls (HC) were patients without mucosal abnormalities during colonoscopy. Faecal samples were measured using gas chromatography-ion mobility spectrometry. RESULTS A total of 280 IBD patients collected 107 CDa, 84 CDr, 80 UCa and 63 UCr samples. Additionally, 227 HC provided one faecal sample. UC and CD were discriminated from HC with high accuracy (AUC (95%CI): UCa vs HC 0.96(0.94-0.99); UCr vs HC 0.95(0.93-0.98); CDa vs HC 0.96(0.94-0.99); CDr vs HC 0.95(0.93-0.98)). There were small differences between UC and CD (0.55(0.50-0.6)) and no differences between active disease and remission (UCa vs UCr 0.63(0.44-0.82); CDa vs CDr 0.52(0.39-0.65)). CONCLUSION Our study outcomes imply that faecal VOC analysis holds potential for identifying biomarkers for IBD detection but not for monitoring disease activity.
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Affiliation(s)
- Sofie Bosch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, AG&M research institute, Amsterdam, The Netherlands.
| | - Dion S J Wintjens
- MUMC+, Maastricht University, Department of Gastroenterology and Hepatology, Maastricht, The Netherlands
| | - Alfian Wicaksono
- University of Warwick, School of Engineering, Coventry, United Kingdom
| | - Johan Kuijvenhoven
- Spaarne Gasthuis, Department of Gastroenterology and Hepatology, Hoofddorp and Haarlem, The Netherlands
| | - René van der Hulst
- Spaarne Gasthuis, Department of Gastroenterology and Hepatology, Hoofddorp and Haarlem, The Netherlands
| | - Pieter Stokkers
- OLVG West, Department of Gastroenterology and hepatology, Amsterdam, The Netherlands
| | - Emma Daulton
- University of Warwick, School of Engineering, Coventry, United Kingdom
| | - Marieke J Pierik
- MUMC+, Maastricht University, Department of Gastroenterology and Hepatology, Maastricht, The Netherlands
| | - James A Covington
- University of Warwick, School of Engineering, Coventry, United Kingdom
| | - Tim G J de Meij
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pediatric Gastroenterology, AG&M research institute, Amsterdam, The Netherlands
| | - Nanne K H de Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, AG&M research institute, Amsterdam, The Netherlands
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Bosch S, Lemmen JP, Menezes R, van der Hulst R, Kuijvenhoven J, Stokkers PC, de Meij TG, de Boer NK. The influence of lifestyle factors on fecal volatile organic compound composition as measured by an electronic nose. J Breath Res 2019; 13:046001. [PMID: 31170704 DOI: 10.1088/1752-7163/ab2775] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fecal volatile organic compounds (VOCs) are gaseous metabolic products which are increasingly considered potential non-invasive biomarkers for the detection of various (gastrointestinal) diseases. The influence of lifestyle factors on fecal VOC patterns remains unexplored but is of importance prior to implementation of VOC analysis as a diagnostic tool. The aim of this study was to investigate the effects of age, gender, body mass index, smoking status, dietary preferences, medication use and co-morbidity on fecal VOC patterns. METHODS For this study, fecal samples of patients undergoing a colonoscopy were collected prior to endoscopy. All participants completed a questionnaire on lifestyle factors, co-morbidity and medication use. Patients without colonic abnormalities were included in this study. Fecal VOC patterns were analyzed by means of an electronic nose (eNose) device (Cyranose® 320). RESULTS From the 1039 participants willing to participate in the initial study, 211 were eligible as controls. All unique lifestyle variables investigated in this study affected the fecal VOC composition. The strongest influences were caused by low BMI, a vegetarian diet and an active smoking status, whereas the least influence was found for the variables gender, age > 55 years and previous smokers. DISCUSSION Age, gender, BMI, smoking habits, dietary preferences, co-morbidity and medication use all have unique effects on fecal VOC composition. Future studies should carefully consider this influence on VOC outcome when defining VOC signatures as biomarker for diagnostic purposes.
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Affiliation(s)
- Sofie Bosch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, AG&M Research Institute, Amsterdam, The Netherlands
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Gherardi A, Roze S, Kuijvenhoven J, Ghatnekar O, Yip Sonderegger YL. Budesonide with multi-matrix technology as second-line treatment for ulcerative colitis: evaluation of long-term cost-effectiveness in the Netherlands. J Med Econ 2018; 21:869-877. [PMID: 29857775 DOI: 10.1080/13696998.2018.1484371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/11/2022]
Abstract
AIMS Budesonide with multi-matrix technology (MMX) is an oral corticosteroid, shown to have high topical activity against ulcerative colitis (UC) while maintaining low systemic bioavailability with few adverse events. The aim of this study was to evaluate the cost-effectiveness of budesonide MMX versus commonly used corticosteroids, in the second-line treatment of active mild-to-moderate UC in the Netherlands. MATERIALS AND METHODS An eight-state Markov model with an 8 week cycle length captured remission, four distinct therapy stages, hospitalization, possible colectomy and mortality. Remission probability for budesonide MMX was based on the CORE-II study. Population characteristics were derived from the Dutch Inflammatory Bowel Disease South Limburg cohort (n = 598) and included patients with proctitis (39%), left-sided (42%) and extensive disease (19%). Comparators (topical budesonide foam and enema, oral budesonide and prednisolone) were selected based on current Dutch clinical practice. Treatment effects were evaluated by network meta-analysis using a Bayesian framework. Cost-effectiveness analysis was performed over a 5 year time horizon from a societal perspective, with costs, health-state and adverse event utilities derived from published sources. Outcomes were weighted by disease extent distribution and corresponding comparators. RESULTS Budesonide MMX was associated with comparable quality-adjusted life year (QALY) gain versus foam and oral formulations (+0.01 QALYs) in the total UC population, whilst being cost-saving (EUR 366 per patient). Probabilistic sensitivity analysis evaluated an 86.6% probability of budesonide MMX being dominant (cost-saving with QALY gain) versus these comparators. Exploratory analysis showed similar findings versus prednisolone. LIMITATIONS Differing definitions of trial end-points and remission across trials meant indirect comparison was not ideal. However, in the absence of head-to-head clinical data, these comparisons are reasonable alternatives and currently offer the only comparison of second-line UC treatments. CONCLUSIONS In the present analysis, budesonide MMX was shown to be cost-effective versus comparators in the total UC population, for the second-line treatment of active mild-to-moderate UC in the Netherlands.
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Affiliation(s)
| | | | | | - Ola Ghatnekar
- c Ferring International PharmaScience Center , Copenhagen , Denmark
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Kos A, Kuijvenhoven J, Wernars K, Bos CJ, van den Broek HW, Pouwels PH, van den Hondel CA. Isolation and characterization of the Aspergillus niger trpC gene. Gene 1985; 39:231-8. [PMID: 2936650 DOI: 10.1016/0378-1119(85)90317-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Aspergillus niger trpC gene was isolated by complementation experiments with an Escherichia coli trpC mutant. Plasmid DNA containing the A. niger trpC gene transforms an Aspergillus nidulans mutant strain, defective in all three enzymatic activities of the trpC gene, to Trp+, indicating the presence of a complete and functional trpC gene. Southern blot analysis of DNA from these Trp+ transformants showed that plasmid DNA was present but that this DNA was not integrated at the site of the chromosomal trpC locus. The A. niger trpC gene was localized on the cloned fragment by heterologous hybridization experiments and sequence analysis. These experiments suggest that the organization of the A. niger trpC gene is identical to that of the analogous A. nidulans trpC and the Neurospora crassa trp-1 genes.
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