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Tepeš K, Hanžel J, Štubljar D, Strmšek K, Erjavec L, Supovec E, Jagodic Z, Končan M, Grosek J, Košir JA, Tomažič A, Kogovšek U, Norčič G, Šibli R, Žnidaršič M, Pačnik Vižintin T, Sodin B, Breznik J, Hribar VA, Ocepek A, Pernat Drobež C, Bukovnik N, Zafošnik A, Marušič T, Jurečič Brglez N, Denkovski M, Smrekar N, Novak G, Koželj M, Kurent T, Simonič J, Pintar Š, Štabuc B, Drobne D. Biological treatment approach to inflammatory bowel disease is similar in academic and nonacademic centres - prime time for decentralisation of inflammatory bowel disease care? Eur J Gastroenterol Hepatol 2024; 36:728-734. [PMID: 38625825 PMCID: PMC11045401 DOI: 10.1097/meg.0000000000002771] [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: 10/29/2023] [Accepted: 03/08/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND With the increasing number of inflammatory bowel disease (IBD) patients, it is difficult to manage them within specialised IBD teams in academic medical centres: many are therefore treated in nonacademic IBD centres. It is unclear whether the time to introducing biologics is the same in both settings. AIM We aimed to compare treatment approach with biologics in academic vs. nonacademic centres. METHODS We analysed Slovenian national IBD registry data (UR-CARE Registry, supported by the European Crohn's and Colitis Organisation), which included 2 academic (2319 patients) and 4 nonacademic IBD (429 patients) centres. RESULTS The disease phenotype was similar in both settings. In total, 1687 patients received 2782 treatment episodes with biologics. We observed no differences in treatment episodes with TNF-alpha inhibitors (60% vs. 61%), vedolizumab (24% vs. 23%), or ustekinumab (17% vs. 16%) in academic compared to nonacademic centres ( P = 0.949). However, TNF inhibitors were less often the first biologic in academic centres (TNF inhibitors: 67.5% vs. 74.0%, vedolizumab: 20.3% vs. 17.9%, ustekinumab: 12.1% vs. 8.1%; P = 0.0096). Consequently, more patients received ustekinumab (29.8% vs. 18.3%) and vedolizumab (17.4% vs. 13.5%) and fewer TNF inhibitors (52.7% vs. 68.2%) for Crohn's disease in academic compared to nonacademic centres, with no such differences for ulcerative colitis. The time to initiation of the first biologic from diagnosis was short and similar in both settings (11.3 vs. 10.4 months, P = 0.2). CONCLUSION In this nationwide registry analysis, we observed that biological treatment choice was similar in academic and nonacademic settings. These findings support the decentralisation of IBD care.
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Affiliation(s)
- Katja Tepeš
- Department of Gastroenterology, General Hospital Celje, Celje
| | - Jurij Hanžel
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - David Štubljar
- In-Medico, Department of Research and Development, Metlika, Slovenia
| | - Karin Strmšek
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Luka Erjavec
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Eva Supovec
- Faculty of Medicine, University of Ljubljana
| | | | | | - Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Jurij Aleš Košir
- Department of Abdominal Surgery, University Medical Centre Ljubljana
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Urška Kogovšek
- Department of Abdominal Surgery, University Medical Centre Ljubljana
| | - Gregor Norčič
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Renata Šibli
- Department of Gastroenterology, General Hospital Celje, Celje
| | | | | | - Barbara Sodin
- Department of Gastroenterology, General Hospital Celje, Celje
| | - Janez Breznik
- Department of Gastroenterology, General Hospital Jesenice, Jesenice
| | | | - Andreja Ocepek
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | | | - Nejc Bukovnik
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | - Andrej Zafošnik
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | - Tamara Marušič
- Department of Gastroenterology, General Hospital Izola, Izola
| | | | | | - Nataša Smrekar
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Gregor Novak
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Matic Koželj
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Jože Simonič
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Špela Pintar
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Borut Štabuc
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
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Zidar N, Ferkolj I, Tepeš K, Štabuc B, Kojc N, Uršič T, Petrovec M. Diagnosing cytomegalovirus in patients with inflammatory bowel disease--by immunohistochemistry or polymerase chain reaction? Virchows Arch 2015; 466:533-9. [PMID: 25701481 DOI: 10.1007/s00428-015-1741-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/31/2015] [Accepted: 02/08/2015] [Indexed: 12/16/2022]
Abstract
Cytomegalovirus (CMV) reactivation is a common complication in patients with inflammatory bowel diseases (IBD), particularly in those with steroid-resistant ulcerative colitis. It is usually diagnosed by histopathologic and immunohistochemical examination of the colon biopsy. The introduction of quantitative, real-time polymerase chain reaction (qPCR) has been recommended to improve the sensitivity, but there is little consensus on how to use it. We compared the two methods in samples from resected bowel of patients with IBD. Twelve patients with IBD who had undergone bowel resection were analysed for CMV, using qPCR and immunohistochemistry. In all cases, tissue samples from the base and the edge of ulcers and from uninvolved mucosa were obtained. The highest densities of CMV-positive cells were found in samples from the base of ulcers (immunohistochemistry 0-0.47 positive cells/mm(2); qPCR 10-3809 viral copies/mg) or the edge of ulcers (immunohistochemistry 0.06-0.32 positive cells/mm(2); qPCR 35-1049 viral copies/mg). In samples of uninvolved mucosa, immunohistochemistry was negative, whereas qPCR was either negative or showed very low values (0-3 viral copies/mg). We conclude that both immunohistochemistry and qPCR can be successfully used for diagnosing CMV reactivation in patients with IBD. The base and the edge of ulcers are the optimal sites for endoscopic biopsies. The density of CMV-positive cells was low and their distribution within the colon uneven. It therefore seems that the number of sampled biopsies and/or the number of investigated levels is more important that the choice of diagnostic method.
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Affiliation(s)
- Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia,
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