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Gonczi L, Lakatos L, Golovics PA, Angyal D, Balogh F, Ilias A, Pandur T, David G, Erdelyi Z, Szita I, Lakatos PL. Burden of perianal disease in Crohn's disease: Accelerating medical therapy and high rates of perianal surgery over the last four decades - Results from a population-based study over four decades. Aliment Pharmacol Ther 2024; 59:656-665. [PMID: 38115207 DOI: 10.1111/apt.17836] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Few population-based studies have investigated the prevalence and disease course of perianal manifestation in Crohn's disease. AIMS To analyse the prevalence and outcomes of perianal Crohn's disease including medical therapies and need for perianal surgery, over different therapeutic eras based on the time of diagnosis; cohort A (1977-1995), cohort B (1996-2008), and cohort C (2009-2018) METHODS: Patient inclusion lasted between 1977 and 2018. We followed patients prospectively, and regularly reviewed both in-hospital and outpatient records. We defined a perianal surgical procedure as any perianal incision and excision, fistulotomy, or abscess drainage. RESULTS We included 946 incident patients. Perianal disease at diagnosis was present in 17.4% (n = 165) of the total cohort, with a declining prevalence in cohorts A/B/C, respectively (24.7%/18.5%/13.2%; p = 0.001). By the end of follow-up, an additional 9.3% (n = 88) of the total cohort developed perianal disease. Cumulative immunosuppressive and biologic exposure increased over time; biologic use was higher in patients with perianal disease [pLog Rank < 0.001]. The overall rate of perianal surgery was 44.7% (113/253), with a probability of 28.3% (95% CI: 25.4-31.2) after 10 years, 41.0% (95% CI: 37.5-44.5) after 20 years, and 64.1% (95% CI: 59-69.2) after 30 years. There was no statistically significant difference in the probability of first perianal surgery among cohorts A/B/C [Log Rank = 0.594]. CONCLUSIONS The burden of perianal disease and perianal surgery rates were high in this cohort. Therapeutic strategy was accelerated in patients with perianal Crohn's over time with higher exposure to immunosuppressives and biologics. Surgical management of perianal disease remained unchanged amongst the cohorts.
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Affiliation(s)
- Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Dorottya Angyal
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Fruzsina Balogh
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Akos Ilias
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada
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Wetwittayakhlang P, Golovics PA, Gonczi L, Lakatos L, Lakatos PL. Stable Incidence and Risk Factors of Colorectal Cancer in Ulcerative Colitis: A Population-Based Cohort Between 1977-2020. Clin Gastroenterol Hepatol 2024; 22:191-193.e3. [PMID: 37004972 DOI: 10.1016/j.cgh.2023.03.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada; Gastroenterology and Hepatology Unit, Division of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary.
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Gonczi L, Lakatos L, Golovics PA, Ilias A, Pandur T, David G, Erdelyi Z, Szita I, Al Khoury A, Lakatos PL. Declining Trends of Reoperations and Disease Behaviour Progression in Crohn's Disease over Different Therapeutic Eras-A Prospective, Population-Based Study from Western Hungary between 1977-2020, Data from the Veszprem Cohort. J Crohns Colitis 2023; 17:1980-1987. [PMID: 37422727 PMCID: PMC10798863 DOI: 10.1093/ecco-jcc/jjad117] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND AND AIMS Few population-based studies have investigated long-term surgery rates for Crohn's disease [CD]. Our aim was to analyse disease progression and surgery rates in a population-based cohort over different therapeutic eras, based on the time of diagnosis: cohort-A [1977-1995], cohort-B [1996-2008], and cohort-C [2009-2018]. METHODS A total of 946 incident CD patients were analysed (male/female: 496/450; median age at diagnosis: 28 years [y]; interquartile range [IQR]: 22-40]). Patient inclusion lasted between 1977 and 2018. Immunomodulators have become widespread in Hungary since the mid-1990s and biologic therapies since 2008. Patients were followed prospectively, with both in-hospital and outpatient records reviewed regularly. RESULTS The probability of disease behaviour progression from inflammatory [B1] to stenosing or penetrating phenotype [B2/B3] significantly decreased (27.1 ± 5.3%/21.5 ± 2.5%/11.3 ± 2.2% in cohorts A/B/C, respectively, after 5 years; 44.3 ± 5.9%/30.6 ± 2.8%/16.1 ± 2.9% after 10 years, respectively; [pLogRank <0.001]). The probability of first resective surgery between cohorts A/B/C were 33.3 ± 3.8%/26.5 ± 2.1%/28.1 ± 2.4%, respectively, after 5 years; 46.1 ± 4.1%/32.6 ± 2.2%/33.0 ± 2.7% after 10 years, respectively; and 59.1 ± 4.0%/41.4 ± 2.6% [cohorts A/B] after 20 years. There was a significant decrease in first resective surgery risk between cohorts A and B [plog rank = 0.002]; however, no further decrease between cohorts B and C [plog rank = 0.665]. The cumulative probability of re-resection in cohorts A/B/C was decreasing over time (17.3 ± 4.1%/12.6 ± 2.6%/4.7 ± 2.0%, respectively, after 5 years [plog rank = 0.001]). CONCLUSION We report a continuous decline in reoperation rates and disease behaviour progression in CD over time, with the lowest values in the biologic era. In contrast, there was no further decrease in the probability of first major resective surgery after the immunosuppressive era.
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Affiliation(s)
- Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Akos Ilias
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | | | - Peter L Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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Wetwittayakhlang P, Verdon C, Starr M, Drügg Hahn G, Golovics PA, Bessissow T, Afif W, Wild G, Bitton A, Lakatos PL. Mucosal Healing and Clinical Efficacy of Adalimumab in Small Intestinal Crohn's Disease (SIMCHA Study): Final Results From a Prospective, Open-Label, Single-Arm Study. Turk J Gastroenterol 2023; 34:603-610. [PMID: 37162506 PMCID: PMC10441132 DOI: 10.5152/tjg.2023.22527] [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] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/17/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Endoscopic healing is a key treatment target in inflammatory bowel disease; few data are available on the clinical and endoscopic efficacy of biological therapy in upper gastrointestinal Crohn's disease. This study aimed to investigate small bowel mucosal healing and clinical efficacy of adalimumab therapy by video capsule endoscopy in patients with endoscopically active upper gastrointestinal Crohn's disease. METHODS This prospective, open-label, single-arm study included Crohn's disease patients with moderate-severe endoscopic proximal small bowel involvement, defined by a Lewis score >790. Patients were treated with adalimumab monotherapy for 24 weeks. Co-primary outcomes were endoscopic healing, defined as Lewis score <350, and endoscopic response, defined as >50% decrease in Lewis score. Secondary outcomes included clinical (Harvey-Bradshaw index <4) and biomarker remission (fecal calprotectin <250 μg/g, and C-reactive protein <5 mg/L). RESULTS A total of 59 Crohn's disease patients were screened; 17 patients have met eligibility criteria and were enrolled. Endoscopic healing was observed in 8 patients (47.1%) and endoscopic response in additional 5 patients (29.4%) at 24 weeks. Median Lewis score was significantly decreased compared to baseline (1912 vs. 337, P = .0005). Eleven of 13 patients (84.6%) with clinical activity achieved clinical remission (baseline: 13/17 vs. week 24: 2/17, P < .0001). Nine of 10 patients with elevated C-reactive protein achieved normal C-reactive protein after treatment and the median C-reactive protein significantly decreased from 7.4 to 1.6 mg/L, P = .032. In contrast, no change was observed in fecal calprotectin pre- and posttreatment. CONCLUSIONS Adalimumab induced endoscopic healing and clinical remission in patients with active small bowel Crohn's disease, with approximately half of the patients achieving endoscopic healing.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Starr
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gustavo Drügg Hahn
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Porto Alegre, Brazil
| | - Petra A. Golovics
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Gastroenterology, Hungarian Defence Forces, Medical Centre, Budapest, Hungary
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter L. Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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Wetwittayakhlang P, Gonczi L, Golovics PA, Kurti Z, Pandur T, David G, Erdelyi Z, Szita I, Lakatos L, Lakatos PL. Time Trends of Environmental and Socioeconomic Risk Factors in Patients with Inflammatory Bowel Disease over 40 Years: A Population-Based Inception Cohort 1977-2020. J Clin Med 2023; 12:jcm12083026. [PMID: 37109362 PMCID: PMC10147007 DOI: 10.3390/jcm12083026] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Data from population-based studies investigating trends in environmental factors associated with inflammatory bowel disease (IBD) is lacking. We aimed to assess long-term time trends of environmental and socioeconomic factors in IBD patients from a well-defined population-based cohort from Veszprem, Hungary. METHODS Patients were included between 1 January 1977, and 31 December 2020. Trends of environmental and socioeconomic factors were evaluated in three periods based on the decade of diagnosis, representing different therapeutic eras: cohort-A,1977-1995; cohort-B,1996-2008 (immunomodulator era); and cohort-C, 2009-2020 (biological era). RESULTS A total of 2240 incident patients with IBD were included (ulcerative colitis (UC) 61.2%, male 51.2%, median age at diagnosis: 35 years (IQR 29-49)). Rates of active smoking significantly decreased over time in Crohn's disease (CD): 60.2%, 49.9%, and 38.6% in cohorts A/B/C (p < 0.001). In UC, the rates were low and stable: 15.4%, 15.4%, and 14.5% in cohorts A/B/C (p = 0.981). Oral contraceptive use was more common in CD compared to UC (25.0% vs. 11.6%, p < 0.001). In UC, prevalence of appendectomy before diagnosis decreased over time: 6.4%, 5.5%, and 2.3% in cohorts A/B/C (p = 0.013). No significant changes were found in the socio-geographic characteristics of the IBD population (urban living: UC, 59.8%/64.8%/ 62.5% (p = 0.309) and CD, 62.5%/ 62.0%/ 59.0% (p = 0.636), in cohorts A/B/C). A greater percentage of patients had completed secondary school as the highest education level in later cohorts in both UC (42.9%/50.2%/51.6%, p < 0.001) and CD (49.2%/51.7%/59.5%, p = 0.002). A higher percentage of skilled workers (34.4%/36.2%/38.9%, p = 0.027) was found in UC, but not in CD (p = 0.454). CONCLUSION The association between trends of known environmental factors and IBD is complex. Smoking has become less prevalent in CD, but no other major changes occurred in socioeconomic factors over the last four decades that could explain the sharp increase in IBD incidence.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, 1062 Budapest, Hungary
| | - Zsuzsanna Kurti
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, 8500 Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
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Gonczi L, Lakatos L, Kurti Z, Golovics PA, Pandur T, David G, Erdelyi Z, Szita I, Lakatos PL. Incidence, Prevalence, Disease Course, and Treatment Strategy of Crohn's Disease Patients from the Veszprem Cohort, Western Hungary: A Population-based Inception Cohort Study Between 2007 and 2018. J Crohns Colitis 2023; 17:240-248. [PMID: 36087109 DOI: 10.1093/ecco-jcc/jjac132] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The number of prospective population-based studies on Crohn's disease[CD] is still limited from Eastern Europe. The present study is a continuation of the Veszprem IBD cohort. Our aim was to analyse incidence, prevalence, disease phenotype, treatment strategy, disease course, and surgical outcomes in a prospective population-based inception cohort including CD patients diagnosed between 2007 and 2018. METHODS A total of 421 consecutive inception patients were included [male/female:237/184; mean age at diagnosis: 33.3 ± 16.2years]. Both in-hospital and outpatient records were collected and comprehensively reviewed. Demographic data were derived from the Hungarian Central Statistical Office. RESULTS Mean incidence rate was 9.9 [95% CI: 9.0-10.9]/105 person-years in this 12-year period. Prevalence rate was 236.8 [95% CI: 220.8-252.8] in 2015; 17.6% and 20.0% of the patients had stenosing[B2] and penetrating[B3] disease behavior at diagnosis,respectively. The probability of disease behaviour progression from luminal to B2/B3 phenotype was 14.7% (standard error [SE]: 2.2) at 5 years after diagnosis. Distribution of maximal therapeutic steps during the total follow-up (8.5 years [8.5y], standard deviation [SD]: 3.3) was 5-aminosalicylic acid [5-ASA] in 15.7%, corticosteroids in 14.3%, immunosuppressives in 42.5%, and biologic therapy in 26.2%. The probability of receiving biologictherapy after diagnosis was 20.9% [SE: 2.0] at 5 years. The probability of first resective surgery was 20.7% [SE: 2.0] at 1 year, 26.1% [SE: 2.2] at 5 years, and 30.7% [SE: 2.4] at 10 years. The perianal surgery rate was 31.3% among patients with perianal involvement. CONCLUSIONS The incidence of CD in Hungary was high, similar to high-incidence areas in Western Europe. Treatment strategies are reflecting the biologic era. Disease behaviour progression was lower, as well as long-term [10y] surgery rates decreasing compared with data from previous decades.
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Affiliation(s)
- Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Kurti
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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Wetwittayakhlang P, Golovics PA, Khoury AA, Ganni E, Hahn GD, Cohen A, Wyse J, Bradette M, Bessissow T, Afif W, Wild G, Bitton A, Lakatos PL. Adherence to Objective Therapeutic Monitoring and Outcomes in Patients with Inflammatory Bowel Disease with Adalimumab Treatment. A Real-world Prospective Study. J Gastrointestin Liver Dis 2022; 31:403-410. [PMID: 36535055 DOI: 10.15403/jgld-4375] [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] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Objective monitoring and effective early treatment using a treat-to-target approach are key to improving therapeutic outcomes in IBD patients. This study aimed to assess adherence to objective monitoring (clinical, biomarkers, and endoscopy) and its impact on clinical outcomes. METHODS A prospective, multicenter study included consecutive IBD patients starting on adalimumab therapy between January 2019 and December 2020. Disease activity, assessed by the Harvey-Bradshaw index (HBI), partial Mayo, C-reactive protein (CRP), fecal calprotectin (FCAL), and endoscopy were evaluated at adalimumab initiation and 3, 6, 9 and 12 months. Therapeutic drug monitoring, changes in treatment, drug sustainability, and clinical outcomes were assessed. RESULTS 104 IBD patients were enrolled (78.8% CD, median age 34.3 years, disease duration 9 years). During the 12 months follow-up, high adherence to clinical activity assessment was observed in both CD (81.3%- 87.7%) and UC patients (76.5-90.9%). CRP measurement decreased over time in both CD (37.3%-54.9%) and UC (29.4%-50.0%). The adherence to serial FCAL monitoring was low in CD (22.7-31.3%) and UC patients (17.6-56.0%). UC patients had higher adherence to early endoscopic assessment (<6 months) compared to CD patients (40.9% vs. 21.5%). Adherence to early combined clinical and biomarkers resulted in earlier dose optimization in CD and UC (log-rank<0.001), but drug sustainability was not different. The patients with early combined adherence had a significantly higher clinical remission rate at 1 year compared to non-adherence (70.2% vs. 29.8%, p=0.007) but no significant difference in UC patients. CONCLUSIONS The adherence to early objective monitoring with combined clinical and biomarkers assessment in IBD patients starting adalimumab therapy led to dose optimization and improved 1-year clinical remission in CD but did not change drug sustainability and clinical remission in UC.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada; Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. .
| | - Petra A Golovics
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Gastroenterology, Hungarian Defence Forces, Medical Centre, Budapest, Hungary.
| | - Alex Al Khoury
- Division of Gastroenterology, University of Florida- Jacksonville, Florida, USA.
| | - Elie Ganni
- Division of Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Gustavo Drügg Hahn
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Porto Alegre, Brazil.
| | - Albert Cohen
- Division of Gastroenterology, Jewish General Hospital, Montreal, Canada.
| | - Jonathan Wyse
- Division of Gastroenterology, Jewish General Hospital, Montreal, Canada.
| | - Marc Bradette
- Division of Gastroenterology, Centre Hospitalier Universitaire de Québec, Quebec, Canada.
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Waqqas Afif
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Gary Wild
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Peter Laszlo Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada; First Department of Medicine, Semmelweis University, Budapest, Hungary.
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Gonczi L, Szanto K, Farkas K, Molnar T, Szamosi T, Schafer E, Golovics PA, Barkai L, Lontai L, Lovasz B, Juhasz M, Patai A, Sarang K, Vincze A, Sarlos P, Farkas A, Dubravcsik Z, Toth TG, Miheller P, Ilias A, Lakatos PL. Clinical efficacy, drug sustainability and serum drug levels in Crohn's disease patients treated with ustekinumab - A prospective, multicenter cohort from Hungary. Dig Liver Dis 2022; 54:207-213. [PMID: 34344576 DOI: 10.1016/j.dld.2021.07.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although efficacy of ustekinumab (UST) has been demonstrated through randomized trials, data from real-life prospective cohorts are still limited. Our aim was to evaluate clinical efficacy, drug sustainability, dose intensification and results from therapeutic drug monitoring in UST treated patients with Crohn's disease (CD) using a prospective, nationwide, multicenter cohort. METHODS Patients from 10 Inflammatory Bowel Disease centers were enrolled between 2019 January and 2020 May. Patient demographics, disease phenotype, treatment history, clinical disease activity (Crohn's Disease Activity Index(CDAI), Harvey Bradshaw Index(HBI)), biomarkers, and serum drug levels were obtained. Evaluations were performed at week8 (post-induction), w16-20, w32-36, and w52-56 follow-up visits. RESULTS A total of 142 patients were included [57.4% female; complex disease behavior (B2/B3):48%, previous anti-TNF exposition:97%]. Clinical response and remission rates after induction(w8) were 78.1% and 57.7% using CDAI, and 82.5% and 51.8% based on HBI scores. The one-year clinical remission rate was 58%/57.3%(CDAI/HBI). Composite clinical and biomarker remission (CDAI<150 and C-reactive protein<10 mg/L) rates were 35.4%; 33.3%; 38.6% and 36.6% at w8/w16-20/w32-36 and w52-56. Drug sustainability was 81.9%(standard deviation(SD): 3.4) at 1 year(1y). Probability of dose intensification was high and introduced early, 42.2%(SD:4.2) at ~w32 and 51.9%(SD:4.4%) at 1y. CONCLUSION Ustekinumab showed favorable drug sustainability and clinical efficacy in a patient population with severe disease phenotype and previous anti-tumor necrosis factor (anti-TNF) failure, however frequent dose intensification was required.
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Affiliation(s)
- Lorant Gonczi
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kata Szanto
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Molnar
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Szamosi
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Eszter Schafer
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Laszlo Barkai
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Livia Lontai
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Barbara Lovasz
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Mark Juhasz
- Department of Medicine, St. Margit Hospital, Budapest, Hungary
| | - Arpad Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Krisztina Sarang
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Aron Vincze
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Patricia Sarlos
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Alexandra Farkas
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | - Tamas G Toth
- Department of Gastroenterology, St. Janos Hospital, Budapest, Hungary
| | - Pal Miheller
- 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Akos Ilias
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary; McGill University Health Center, Montreal General Hospital, Canada.
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9
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Ilias A, Lovasz BD, Gonczi L, Kurti Z, Vegh Z, Sumegi LD, Golovics PA, Rudas G, Lakatos PL. Optimizing Patient Management in Crohn's Disease in a Tertiary Referral Center: the Impact of Fast-Track MRI on Patient Management and Outcomes. J Gastrointestin Liver Dis 2019; 27:391-397. [PMID: 30574621 DOI: 10.15403/jgld.2014.1121.274.ocm] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Rapid optimization of treatment algorithms and disease outcomes requires an objective measurement of disease activity in patients with Crohn's disease (CD). Our aim was to evaluate the impact of rapid-access to magnetic resonance imaging (MRI) on treatment optimization, clinical decision-making and outcomes for CD patients in a specialized tertiary care for inflammatory bowel disease (IBD) patients. METHODS A cohort of 75 referral CD patients (median age: 34, IQR: 25-43 years) who had underwent 90 fast-track MR enterography (MRE) scans between January 2014 and June 2016 were retrospectively enrolled. The MRI results were compared to clinical activity scores and biomarkers (C-reactive protein). The immediate impact of fast-track MRI on clinical decision-making, including changes in medical therapy, the need of hospitalization and surgery were evaluated. RESULTS The location of CD was ileo-colonic in 61% of the patients with perianal fistulas in 56% and previous surgeries in 55%. The indication for fast-track MRI scans was active disease (clinical or biomarker activity) in 55.6%. The radiological activity (including mild radiological signs to severe lesions) was detected in 94% of cases. Significant/severe MRI activity was depicted in 68% of these patients. Correlation between MRI radiological activity and clinical disease activity or colonoscopy was moderate (kappa: 0.609 and 0.652). A change in therapeutic strategy was made in 94.1% of cases with severe MRI radiological activity vs. 50% of patients without severe MRI radiological activity (p=0.001). Significant/severe MRI activity was followed by higher surgery rates among patients with clinical disease activity (50% vs. 12.5%; p=0.013). MRI performed on patients with clinical and biomarker remission identified disease activity in a significantly smaller proportion. CONCLUSIONS Fast-track MRI had a great impact on patient management in CD patients with clinical or biomarker activity, leading to better patient stratification and faster optimization of the therapy (medical or surgical), while MRI revealed previously undiagnosed disease activity only in a small proportion of patients in clinical remission.
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Affiliation(s)
- Akos Ilias
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Barbara D Lovasz
- Semmelweis University, First Department of Medicine;Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary
| | - Lorant Gonczi
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Zsuzsanna Kurti
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Zsuzsanna Vegh
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - Liza D Sumegi
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | | | - Gabor Rudas
- Semmelweis University, Magnetic Resonance Imaging Research Center, Budapest, Hungary
| | - Peter L Lakatos
- Semmelweis University, First Department of Medicine, Budapest, Hungary;Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada. ;
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10
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Vegh Z, Kurti Z, Golovics PA, Lakatos PL. Can we Predict Disease Course with Clinical Factors? Curr Drug Targets 2018; 19:791-797. [DOI: 10.2174/1389450118666170329095123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Petra A. Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter L. Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
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11
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Kurti Z, Ilias A, Gonczi L, Vegh Z, Fadgyas-Freyler P, Korponay G, Golovics PA, Lovasz BD, Lakatos PL. Therapeutic preferences and outcomes in newly diagnosed patients with Crohn's diseases in the biological era in Hungary: a nationwide study based on the National Health Insurance Fund database. BMC Gastroenterol 2018; 18:23. [PMID: 29378524 PMCID: PMC5789702 DOI: 10.1186/s12876-018-0746-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/18/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Accelerated treatment strategy, including tight disease control and early aggressive therapy with immunosuppressives (IS) and biological agents have become increasingly common in inflammatory bowel disease (IBD). The aim of the present study was to estimate the early treatment strategy and outcomes in newly diagnosed patients with Crohn's disease (CD) between 2004 and 2008 and 2009-2015 in the whole IBD population in Hungary based on the administrative database of the National Health Insurance Fund (OEP). METHODS We used the administrative database of the OEP, the only nationwide state-owned health insurance provider in Hungary. Patients were identified through previously reported algorithms using the ICD-10 codes for CD in the out-, inpatient (medical, surgical) non-primary care records and drug prescription databases between 2004 and 2015. Patients were stratified according to the year of diagnosis and maximum treatment steps during the first 3 years after diagnosis. RESULTS A total of 6173 (male/female: 46.12%/53.87%) newly diagnosed CD patients with physician-diagnosed IBD were found in the period of 2004-2015. The use of 5-ASA and steroids remained common in the biological era, while immunosuppressives and biologicals were started earlier and became more frequent among patients diagnosed after 2009. The probability of biological therapy was 2.9%/6.4% and 8.4%/13.7% after 1 and 3 years in patients diagnosed in 2004-2008/2009-2015. The probability of hospitalization in the first 3 years after diagnosis was different before and after 2009, according to the maximal treatment step (overall 55.7%vs. 47.4% (p = 0.001), anti-TNF: 73%vs. 66.7% (p = 0.103), IS: 64.6% vs. 56.1% (p = 0.001), steroid: 44.2%vs. 36.8% (p < 0.007), 5-ASA: 32.6% vs. 26.7% p = 0.157)). In contrast, surgery rates were not significantly different in patients diagnosed before and after 2009 according to the maximum treatment step (overall 16.0%vs.15.3%(p = 0.672) anti-TNF 26.7%vs.27.2% (p = 0.993), IS: 24.1%vs22.2% (p = 0.565), steroid 8.1%vs.7.9% (p = 0.896), 5-ASA 10%vs. 11% (p = 0.816)). CONCLUSIONS IS and biological exposure became more frequent, while hospitalization decreased and surgery remained low but constant during the observation period. Use of steroids and 5-ASA remained high after 2009. The association between the maximal treatment step and hospitalization/surgery rates suggests that maximal treatment step can be regarded as proxy severity marker in patients with IBD.
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Affiliation(s)
- Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Akos Ilias
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Petra Fadgyas-Freyler
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, H-1139, Hungary
| | - Gyula Korponay
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, H-1139, Hungary
| | - Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary.,Faculty of Health Sciences, Department of Clinical Studies, Semmelweis University, Budapest, H-1088, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary. .,Division of Gastroenterology, McGill University Health Centre, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada. .,Division of Gastroenterology/Hepatology Unit and Endoscopy, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary.
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12
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Gonczi L, Kurti Z, Rutka M, Vegh Z, Farkas K, Lovasz BD, Golovics PA, Gecse KB, Szalay B, Molnar T, Lakatos PL. Drug persistence and need for dose intensification to adalimumab therapy; the importance of therapeutic drug monitoring in inflammatory bowel diseases. BMC Gastroenterol 2017; 17:97. [PMID: 28789636 PMCID: PMC5549364 DOI: 10.1186/s12876-017-0654-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 04/26/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023] Open
Abstract
Background Therapeutic drug monitoring (TDM) aid therapeutic decision making in patients with inflammatory bowel disease (IBD) who lose response to anti-TNF therapy. Our aim was to evaluate the frequency and predictive factors of loss of response (LOR) to adalimumab using TDM in IBD patients. Methods One hundred twelve IBD patients (with 214 TDM measurements, CD/UC 84/28, male/female 50/62, mean age CD/UC: 36/35 years) were enrolled in this consecutive cohort from two referral centres in Hungary. Demographic data were comprehensively collected and harmonized monitoring strategy was applied. Previous and current therapy, laboratory data and clinical activity were recorded at the time of TDM. Patients were evaluated either at the time of suspected LOR or during follow-up. TDM measurements were determined by commercial ELISA (LISA TRACKER, Theradiag, France). Results Among 112 IBD patients, LOR/drug persistence was 25.9%/74.1%. The cumulative ADA positivity (>10 ng/mL) and low TL (<5.0 μg/mL) was 12.1% and 17.8% after 1 year and 17.3% and 29.5% after 2 years of adalimumab therapy. Dose intensification was needed in 29.5% of the patients. Female gender and ADA positivity were associated with LOR (female gender: p < 0.001, OR:7.8 CI 95%: 2.5–24.3, ADA positivity: p = 0.007 OR:3.6 CI 95%: 1.4–9.5). Conclusions ADA development, low TL and need for dose intensification were frequent during adalimumab therapy and support the selective use of TDM in IBD patients treated with adalimumab. ADA positivity and gender were predictors of LOR. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0654-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorant Gonczi
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Vegh
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Barbara D Lovasz
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary.,Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Krisztina B Gecse
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary
| | - Balazs Szalay
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Tamas Molnar
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary. .,Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173. 1, Montreal, QC, H3G 1A4, Canada.
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13
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Farkas K, Rutka M, Golovics PA, Végh Z, Lovász BD, Nyári T, Gecse KB, Kolar M, Bortlik M, Duricova D, Machkova N, Hruba V, Lukas M, Mitrova K, Malickova K, Bálint A, Nagy F, Bor R, Milassin Á, Szepes Z, Palatka K, Lakatos PL, Lukas M, Molnár T. Efficacy of Infliximab Biosimilar CT-P13 Induction Therapy on Mucosal Healing in Ulcerative Colitis. J Crohns Colitis 2016; 10:1273-1278. [PMID: 27106537 DOI: 10.1093/ecco-jcc/jjw085] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 10/21/2015] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION CT-P13 is the first biosimilar to infliximab that has been approved for the same indications as its originator infliximab. No data are available on the effect of infliximab biosimilar on mucosal healing. The aim of this study was to evaluate the efficacy of CT-P13 induction therapy on mucosal healing in patients with ulcerative colitis [UC]. PATIENTS AND METHODS UC patients, who received CT-P13 therapy from its local introduction at three Hungarian and one Czech inflammatory bowel disease centres, were prospectively enrolled. Sigmoidoscopy was performed after the end of the induction therapy at week 14. Mucosal healing was defined as Mayo endoscopic subscore 0 or 1. Complete mucosal healing was defined as Mayo endoscopic subscore 0. Trough level of CT-P13 was measured at week 14. RESULTS Sixty-three UC patients who underwent CT-P13 induction therapy were enrolled in the study. Indication for the therapy was acute, severe flare up and chronic, refractory activity in 24 and 39 patients, respectively. Cumulative clinical response and steroid-free remission at week 14 were achieved in 82.5% and 47.6% of the patients, respectively. Sigmoidoscopy revealed steroid-free mucosal healing in 47.6% of the patients, and complete mucosal healing was present in 27%. Mayo endoscopic subscore decreased significantly at week 14 compared to baseline. Trough levels of infliximab correlated with mucosal healing. CONCLUSION This is, to our knowledge, the first study examining the efficacy of CT-P13 induction therapy on mucosal healing in UC. The results indicate that mucosal healing is achieved in two-thirds of UC patients by the end of the induction treatment with CT-P13.
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Affiliation(s)
- Klaudia Farkas
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Petra A Golovics
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Végh
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara D Lovász
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - Martin Kolar
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,1 Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Department of Internal Medicine, Military Hospital, Charles University, Prague, Czech Republic
| | - Dana Duricova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Institute of Pharmacology, 1 Medical Faculty, Charles University, Prague, Czech Republic
| | - Nadezda Machkova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Veronika Hruba
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Martin Lukas
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Katarina Mitrova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Department of Paediatrics, Faculty Hospital Motol, 2 Medical Faculty, Charles University, Prague, Czech Republic
| | - Karin Malickova
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1 Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Anita Bálint
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Károly Palatka
- 2 Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter L Lakatos
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Milan Lukas
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Institute of Medical Biochemistry and Laboratory Diagnostics, 1 Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Tamás Molnár
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
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14
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Kurti Z, Vegh Z, Golovics PA, Fadgyas-Freyler P, Gecse KB, Gonczi L, Gimesi-Orszagh J, Lovasz BD, Lakatos PL. Nationwide prevalence and drug treatment practices of inflammatory bowel diseases in Hungary: A population-based study based on the National Health Insurance Fund database. Dig Liver Dis 2016; 48:1302-1307. [PMID: 27481587 DOI: 10.1016/j.dld.2016.07.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 04/04/2016] [Revised: 06/27/2016] [Accepted: 07/13/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases associated with a substantial healthcare utilization. AIM Our aim was to estimate the national prevalence of inflammatory bowel disease (IBD), CD and UC and to describe current drug treatment practices in CD and UC. METHODS Patients and drug dispensing events were identified according to international classification codes for UC and CD in in-patient care, non-primary out-patient care and drug prescription databases (2011-2013) of the National Health Insurance Fund. RESULTS A total of 55,039 individuals (men: 44.6%) with physician-diagnosed IBD were alive in Hungary in 2013, corresponding to a prevalence of 0.55% (95% CI, 0.55-0.56). The prevalence of CD 0.20% (95% CI, 0.19-0.20), and UC was 0.34% (95% CI, 0.33-0.34). The prevalence both in men and women was the highest in the 20-39 year-olds in CD. Current use of immunosuppressives and biological therapy was highest in the pediatric CD population (44% and 15%) followed by adult CD (33% and 9%), while their use was lowest in elderly patients. Interestingly, current use of 5-ASA (5-aminosalicylates) was high in both UC and CD irrespective of the age group. CONCLUSIONS The Hungarian IBD prevalence based on nationwide database of the National Health Insurance Fund was high. We identified significant differences in the drug prescription practices according to age-groups.
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Affiliation(s)
- Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Fadgyas-Freyler
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, Hungary
| | - Krisztina B Gecse
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Gimesi-Orszagh
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, Hungary
| | - Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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15
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Golovics PA, Lakatos L, Mandel MD, Lovasz BD, Vegh Z, Kurti Z, Szita I, Kiss LS, Balogh M, Pandur T, Lakatos PL. Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re-Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012). J Gastrointestin Liver Dis 2016; 24:287-92. [PMID: 26405700 DOI: 10.15403/jgld.2014.1121.243.pag] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. METHODS Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. RESULTS Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. CONCLUSION Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.
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Affiliation(s)
- Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest;Hungary
| | - Laszlo Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem; Hungary
| | - Michael D Mandel
- 1st Department of Medicine, Semmelweis University, Budapest;Hungary
| | - Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest;Hungary
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest;Department of Medicine, Csolnoky F. Province Hospital, Veszprem; Hungary
| | - Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest;Hungary
| | - Istvan Szita
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem; Hungary
| | - Lajos S Kiss
- 1st Department of Medicine, Semmelweis University, Budapest;Hungary
| | - Mihaly Balogh
- Department of Medicine, Grof Eszterhazy Hospital, Papa, Hungary
| | - Tunde Pandur
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem; Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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16
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Baji P, Gulácsi L, Golovics PA, Lovász BD, Péntek M, Brodszky V, Rencz F, Lakatos PL. Perceived Risks Contra Benefits of Using Biosimilar Drugs in Ulcerative Colitis: Discrete Choice Experiment among Gastroenterologists. Value Health Reg Issues 2016; 10:85-90. [PMID: 27881284 DOI: 10.1016/j.vhri.2016.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/31/2016] [Revised: 07/12/2016] [Accepted: 07/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND In middle-income countries, access to biological therapy is limited in ulcerative colitis in terms of the number of patients and the length of therapy. Because of their cost advantages, biosimilars have the potential to improve access to therapy, but physicians have concerns toward their use because of the lack of evidence from randomized clinical trials. OBJECTIVES To explore the preferences of gastroenterologists for biosimilar drugs in ulcerative colitis as well as to compare our results with results of previous studies on gastroenterologists' preferences toward biosimilars. METHODS A discrete choice experiment was carried out involving 51 Hungarian gastroenterologists treating patients with inflammatory bowel disease in May 2014 with the following attributes: type of treatment (biosimilar/originator), severity of disease, availability of continuous medicine supply, and the stopping rule (whether the treatment is covered after 12 months). A conditional logit model was used to estimate the probabilities of choosing a given profile. RESULTS According to the results, the stopping rule was the most important attribute. The type of treatment mattered only for patients already on biologicals. The probabilities of choosing the biosimilar option with all the benefits offered in the discrete choice experiment over the originator option under the present reimbursement conditions are 85% for new patients and 63% for patients already treated. CONCLUSIONS Most gastroenterologists have concerns about using biosimilars. They, however, are willing to consider the use of biosimilars if they could reallocate the potential savings to provide their patients better access to biological treatment.
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Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; CERGE-EI, Nové Město, The Czech Republic
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
| | - Petra A Golovics
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara D Lovász
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; Department of Rheumatology, Flór Ferenc County Hospital, Kistarcsa, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; Semmelweis University Doctoral School of Clinical Medicine, Budapest, Hungary
| | - Péter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary
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Baji P, Gulácsi L, Lovász BD, Golovics PA, Brodszky V, Péntek M, Rencz F, Lakatos PL. Treatment preferences of originator versus biosimilar drugs in Crohn's disease; discrete choice experiment among gastroenterologists. Scand J Gastroenterol 2016; 51:22-7. [PMID: 26059967 DOI: 10.3109/00365521.2015.1054422] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore preferences of gastroenterologists for biosimilar drugs in Crohn's disease. MATERIAL AND METHODS Discrete choice experiment was carried out involving 51 Hungarian gastroenterologists in May 2014. The following attributes were used to describe hypothetical choice sets: 1) type of the treatment (biosimilar/originator), 2) severity of disease, 3) availability of continuous medicine supply, 4) frequency of the efficacy check-ups. Multinomial logit model was used to differentiate between three attitude types: 1) always opting for the originator, 2) willing to consider biosimilar for biological-naïve patients only, 3) willing to consider biosimilar treatment for both types of patients. Conditional logit model was used to estimate the probabilities of choosing a given profile. RESULTS Men, senior consultants, working in inflammatory bowel disease center and treating more patients were more likely willing to consider biosimilar for biological-naïve patients only. Treatment type (originator/biosimilar) was the most important determinant of choice for patients already treated with biologicals, and the availability of continuous medicine supply in case of biological-naïve patients. The probabilities of choosing the biosimilar with all the benefits offered over the originator under current reimbursement conditions are 89% versus 11% for new patients, and 44% versus 56% for patients already treated with biological. CONCLUSIONS For gastroenterologist, the continuous medical supply would be one of the major benefits of biosimilars. However, benefits offered in the scenarios do not compensate for the change from the originator to the biosimilar treatment of patients already treated with biologicals.
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Affiliation(s)
- Petra Baji
- a 1 Department of Health Economics, Corvinus University of Budapest , Fővám tér 8, H-1093 Budapest, Hungary, Europe.,b 2 CERGE-EI Fellow, Politických vězňů 936/7 , 110 00 Praha 1-Nové Město, The Czech Republic, Europe
| | - László Gulácsi
- a 1 Department of Health Economics, Corvinus University of Budapest , Fővám tér 8, H-1093 Budapest, Hungary, Europe
| | - Barbara D Lovász
- c 3 1st Department of Medicine, Semmelweis University, Korányi Sándor utca 2a , H-1083 Budapest, Hungary, Europe
| | - Petra A Golovics
- c 3 1st Department of Medicine, Semmelweis University, Korányi Sándor utca 2a , H-1083 Budapest, Hungary, Europe
| | - Valentin Brodszky
- a 1 Department of Health Economics, Corvinus University of Budapest , Fővám tér 8, H-1093 Budapest, Hungary, Europe
| | - Márta Péntek
- a 1 Department of Health Economics, Corvinus University of Budapest , Fővám tér 8, H-1093 Budapest, Hungary, Europe.,d 4 Department of Rheumatology, Flór Ferenc County Hospital , Semmelweis tér 1, H-2143 Kistarcsa, Hungary, Europe
| | - Fanni Rencz
- a 1 Department of Health Economics, Corvinus University of Budapest , Fővám tér 8, H-1093 Budapest, Hungary, Europe.,e 5 Semmelweis University Doctoral School of Clinical Medicine , Üllői út 26, H-1085 Budapest, Hungary, Europe
| | - Péter L Lakatos
- c 3 1st Department of Medicine, Semmelweis University, Korányi Sándor utca 2a , H-1083 Budapest, Hungary, Europe
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Lakatos PL, Sipeki N, Kovacs G, Palyu E, Norman GL, Shums Z, Golovics PA, Lovasz BD, Antal-Szalmas P, Papp M. Risk Matrix for Prediction of Disease Progression in a Referral Cohort of Patients with Crohn's Disease. J Crohns Colitis 2015; 9:891-8. [PMID: 26188353 DOI: 10.1093/ecco-jcc/jjv127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 04/29/2015] [Accepted: 07/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Early identification of patients with Crohn's disease (CD) at risk of subsequent complications is essential for adapting the treatment strategy. We aimed to develop a prediction model including clinical and serological markers for assessing the probability of developing advanced disease in a prospective referral CD cohort. METHODS Two hundred and seventy-one consecutive CD patients (42.4% males, median follow-up 108 months) were included and followed up prospectively. Anti-Saccharomyces cerevisiae antibodies (ASCA IgA/IgG) were determined by enzyme-linked immunosorbent assay. The final analysis was limited to patients with inflammatory disease behaviour at diagnosis. The final definition of advanced disease outcome was having intestinal resection or disease behaviour progression. RESULTS Antibody (ASCA IgA and/or IgG) status, disease location and need for early azathioprine were included in a 3-, 5- and 7-year prediction matrix. The probability of advanced disease after 5 years varied from 6.2 to 55% depending on the combination of predictors. Similar findings were obtained in Kaplan-Meier analysis; the combination of ASCA, location and early use of azathioprine was associated with the probability of developing advanced disease (p < 0.001, log rank test). CONCLUSIONS Our prediction models identified substantial differences in the probability of developing advanced disease in the early disease course of CD. Markers identified in this referral cohort were different from those previously published in a population-based cohort, suggesting that different prediction models should be used in the referral setting.
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Affiliation(s)
- Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Nora Sipeki
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Gyorgy Kovacs
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Eszter Palyu
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | | | | | - Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Antal-Szalmas
- Department of Laboratory Medicine, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Maria Papp
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
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Golovics PA, Lakatos L, Mandel MD, Lovasz BD, Vegh Z, Kurti Z, Szita I, Kiss LS, Pandur T, Lakatos PL. Prevalence and predictors of hospitalization in Crohn’s disease in a prospective population-based inception cohort from 2000-2012. World J Gastroenterol 2015; 21:7272-7280. [PMID: 26109815 PMCID: PMC4476890 DOI: 10.3748/wjg.v21.i23.7272] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/24/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the prevalence, length and predictors of hospitalization in the biological era in the population-based inception cohort from Veszprem province.
METHODS: Data of 331 incident Crohn’s disease (CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (median age at diagnosis: 28; IQR: 21-40 years). Both in- and outpatient records were collected and comprehensively reviewed.
RESULTS: Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%, 53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures (37%), surgery or disease activity (27% and 21%). Non-inflammatory disease behavior at diagnosis (HR = 1.32, P = 0.001) and perianal disease (HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change (HR = 2.38, P = 0.002) and need for steroids (HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate analyses. Early CD-related hospitalization (within the year of diagnosis) was independently associated with need for immunosuppressives (OR = 2.08, P = 0.001) and need for surgeries (OR = 7.25, P < 0.001) during the disease course.
CONCLUSION: Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and re-hospitalization.
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Kurti Z, Lovasz BD, Mandel MD, Csima Z, Golovics PA, Csako BD, Mohas A, Gönczi L, Gecse KB, Kiss LS, Szathmari M, Lakatos PL. Burden of Clostridium difficile infection between 2010 and 2013: Trends and outcomes from an academic center in Eastern Europe. World J Gastroenterol 2015; 21:6728-6735. [PMID: 26074711 PMCID: PMC4458783 DOI: 10.3748/wjg.v21.i21.6728] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/20/2014] [Accepted: 01/30/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the incidence and possible risk factors in hospitalized patients treated with Clostridium difficile infection (CDI).
METHODS: A total of 11751 patients were admitted to our clinic between 1 January 2010 and 1 May 2013. Two hundred and forty-seven inpatients were prospectively diagnosed with CDI. For the risk analysis a 1:3 matching was used. Data of 732 patients matched for age, sex, and inpatient care period and unit were compared to those of the CDI population. Inpatient records were collected from an electronic hospital database and comprehensively reviewed.
RESULTS: Incidence of CDI was 21.0/1000 admissions (2.1% of all-cause hospitalizations and 4.45% of total inpatient days). The incidence of severe CDI was 12.6% (2.63/1000 of all-cause hospitalizations). Distribution of CDI cases was different according to the unit type, with highest incidence rates in hematology, gastroenterology and nephrology units (32.9, 25 and 24.6/1000 admissions, respectively) and lowest rates in 1.4% (33/2312) in endocrinology and general internal medicine (14.2 and 16.9/1000 admissions) units. Recurrence of CDI was 11.3% within 12 wk after discharge. Duration of hospital stay was longer in patients with CDI compared to controls (17.6 ± 10.8 d vs 12.4 ± 7.71 d). CDI accounted for 6.3% of all-inpatient deaths, and 30-d mortality rate was 21.9% (54/247 cases). Risk factors for CDI were antibiotic therapy [including third-generation cephalosporins or fluoroquinolones, odds ratio (OR) = 4.559; P < 0.001], use of proton pump inhibitors (OR = 2.082, P < 0.001), previous hospitalization within 12 mo (OR = 3.167, P < 0.001), previous CDI (OR = 15.32; P < 0.001), while presence of diabetes mellitus was associated with a decreased risk for CDI (OR = 0.484; P < 0.001). Treatment of recurrent cases was significantly different from primary infections with more frequent use of vancomycin alone or in combination (P < 0.001), and antibiotic therapy duration was longer (P < 0.02). Severity, mortality and outcome of primary infections and relapsing cases did not significantly differ.
CONCLUSION: CDI was accounted for significant burden with longer hospitalization and adverse outcomes. Antibiotic, PPI therapy and previous hospitalization or CDI were risk factors for CDI.
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Szabó D, Kökönyei G, Arató A, Dezsőfi A, Molnár K, Müller KE, Lakatos PL, Papp M, Lovász BD, Golovics PA, Cseh A, Veres G. Autoregressive cross-lagged models of IMPACT-III and Pediatric Crohn's Disease Activity Indexes during one year infliximab therapy in pediatric patients with Crohn's disease. J Crohns Colitis 2014; 8:747-55. [PMID: 24434181 DOI: 10.1016/j.crohns.2013.12.020] [Citation(s) in RCA: 10] [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: 11/25/2013] [Accepted: 12/20/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Quality of life (QoL) is an important outcome measure in the evaluation of therapies for inflammatory bowel disease. The primary aim of this study was to determine the effect of one year infliximab treatment on QoL and clinical parameters in pediatric patients with Crohn's diseases (CD). METHODS Our prospective study involved 51 children with conventional therapy resistant, severe CD (mean age: 15.25years, range: 11-18years). Infliximab was given according to the protocol (5mg/kg, at weeks 0, 2, 6 and every 8weeks). During the infliximab courses QoL of patients was evaluated by IMPACT-III questionnaire at weeks 0, 6, 30 and 53. At the same time, the Pediatric Crohn's Disease Activity Index (PCDAI) score was calculated. Moreover, serum C-reactive protein (CRP), serum platelets and serum albumin were followed up. Auto-regressive, cross-lagged models were used to assess relation between QoL and the clinical parameters. RESULTS The initial IMPACT-III scores [median, percentile 25-75 (pc 25-75) at week 0: 115, 102.5-130.25] increased significantly (p<0.001) following infliximab therapy at week 54 (median: 141.5, 124.5-153.75). Clinical and laboratory parameters also improved significantly (p<0.001). Auto-regressive regression coefficients (β value) were significant between each variable over time. The strongest cross-lagged relations were observed between IMPACT-III and serum albumin, IMPACT-III and platelets. Reliability test of IMPACT-III revealed an excellent level of internal consistency (Cronbach's alpha=0.931). CONCLUSION Infliximab treatment has beneficial clinical effect which is confirmed by decrease of PCDAI and increase of IMPACT-III. Autoregressive regression analysis showed regression relation between IMPACT-III and PCDAI and laboratory parameters.
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Affiliation(s)
- Dolóresz Szabó
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - András Arató
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Antal Dezsőfi
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Kriszta Molnár
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | | | | | - Mária Papp
- 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Barbara D Lovász
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Aron Cseh
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gábor Veres
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
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Abstract
Crohn's disease (CD) is a progressive condition, with most patients developing a penetrating or stricturing phenotype over time. The introduction of anti-tumor necrosis factor (TNF) therapies over the past 10-15 years, which was supported by accumulating evidence both from trials and clinical practice, has led to a significant change in patient management, monitoring, and treatment algorithms. Anti-TNF therapy was demonstrated to be effective for both luminal and fistulizing disease. Regular therapy with both infliximab and adalimumab was shown to increase the likelihood of clinical remission and mucosal healing, as well as to reduce the need for surgery and hospitalization in both clinical trials and clinical practice, especially in patients with pediatric-onset CD, shorter disease duration, and when used in combination with immunosuppressives. This has led to new treatment goals and to the use of early aggressive medical therapy in a selected group of patients with a worse prognosis. Exploratory clinical trials are underway to determine if further optimization of therapies and treatment beyond clinical remission leads to superior disease outcomes. However, more long-term clinical data are needed to assess whether an early, aggressive therapeutic strategy employing anti-TNF, alone or in combination with biologicals, can further improve long-term disease outcomes in both pediatric patients and young adults.
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Affiliation(s)
- Michael D Mandel
- First Department of Medicine, Semmelweis University, Budapest, Hungary
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Lovasz BD, Lakatos L, Horvath A, Pandur T, Erdelyi Z, Balogh M, Szipocs I, Vegh Z, Veres G, Müller KE, Golovics PA, Kiss LS, Mandel MD, Lakatos PL. Incidence rates and disease course of paediatric inflammatory bowel diseases in Western Hungary between 1977 and 2011. Dig Liver Dis 2014; 46:405-11. [PMID: 24495511 DOI: 10.1016/j.dld.2013.12.013] [Citation(s) in RCA: 23] [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: 09/10/2013] [Revised: 12/03/2013] [Accepted: 12/14/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Limited data are available on paediatric inflammatory bowel diseases in Eastern Europe. Our aim was to analyse disease characteristics in the population-based Veszprem province database between 1977 and 2011. METHODS 187 (10.5%, ulcerative colitis/Crohn's disease/undetermined colitis: 88/95/4) out of 1565 incident patients were diagnosed with a paediatric onset in this population-based prospective inception cohort. RESULTS The incidence of Crohn's disease and ulcerative colitis increased from 0 and 0.7 in 1977-1981 to 7.2 and 5.2 in 2007-2011 per 100,000 person years. Ileocolonic location (45%) and inflammatory disease behaviour (61%) were most frequent in Crohn's disease, while azathioprine use was frequent (66%) and surgical resection rates were high (33% at 5 years) in cases with paediatric onset. In ulcerative colitis, 34% of patients were diagnosed with extensive disease, with high rates of disease extension (26% and 41% at 5 and 10 years), fulminant episodes (19.3%) and systemic steroid use (52.3%). The cumulative rate of colectomy was low (6.9%). CONCLUSIONS The incidence of paediatric inflammatory bowel diseases has rapidly increased in the last three decades in Western Hungary. Ileocolonic disease and a need for azathioprine were characteristic in paediatric Crohn's disease, while paediatric onset ulcerative colitis was characterised by extensive disease and disease extension, while the need for colectomy was low.
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Affiliation(s)
- Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Agnes Horvath
- Department of Pediatrics, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Tunde Pandur
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Mihaly Balogh
- Department of Medicine, Grof Eszterhazy Hospital, Papa, Hungary
| | - Istvan Szipocs
- Department of Medicine, Municipal Hospital, Tapolca, Hungary
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary; Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - Gabor Veres
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Katalin E Müller
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Lajos S Kiss
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Michael D Mandel
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Mandel MD, Bálint A, Lovász BD, Gulácsi L, Strbák B, Golovics PA, Farkas K, Kürti Z, Szilágyi BK, Mohás A, Molnár T, Lakatos PL. Work disability and productivity loss in patients with inflammatory bowel diseases in Hungary in the era of biologics. Eur J Health Econ 2014; 15 Suppl 1:S121-S128. [PMID: 24832845 DOI: 10.1007/s10198-014-0603-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/31/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS To assess work disability (WD) rates in an inflammatory bowel disease (IBD) cohort involving patients with Crohn's disease (CD) or ulcerative colitis (UC) cohort and to identify possible clinical or demographic factors associated with WD. To our knowledge, this is the first study from Eastern Europe that has estimated indirect costs in IBD. METHODS Data from 443 (M/F: 202/241, CD/UC: 260/183, mean age: 35.5 (CD) and 40.5 (UC) years, biological drug exposure 31.2/11.5%) consecutive patients were included. WD data were collected by questionnaire and the work productivity and activity impairment instrument. Disability pension (DP) rates in the general population were retrieved from public databases. RESULTS The overall DP rate in this IBD population was 32.3%, with partial disability in 24.2%. Of all DP events, 88.8% were directly related to IBD. Overall, full DP was more prevalent in IBD (RR: 1.51, p < 0.001) and CD (RR: 1.74, p < 0.001) but not in UC compared to the general population and also in CD compared to UC (OR 1.57, p = 0.03). RR for full DP was increased only in young CD patients (RR<35 year olds: 9.4; RR36-40 year olds: 9.4 and 5.6, p < 0.01 for both). In CD, age group, previous surgery, disease duration, frequent relapses, and the presence of arthritis/arthralgia were associated with an increased risk for DP. Among employed patients, absenteeism and presenteeism was reported in of 25.9 and 60.3% patients, respectively, leading to a 28% loss of work productivity and a 32% activity loss, and was associated with disease activity and age group. Average cost of productivity loss due to disability and sick leave with a human capital approach was 1,450 and 430 €/patient/year in IBD, respectively (total productivity loss 1,880 €/patient/year), the costs of presenteeism were 2,605 (SD = 2,770) and 2,410 (SD = 2,970) €/patient/year in CD and UC, respectively. CONCLUSION Risk of DP was highly increased in young CD patients (sixfold to ninefold). Previous surgery and presence of arthritis/arthralgia was identified as risk factors for DP. Work productivity is significantly impaired in IBD and is associated with high productivity loss.
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Golovics PA, Mandel MD, Lovasz BD, Lakatos PL. Inflammatory bowel disease course in Crohn’s disease: Is the natural history changing? World J Gastroenterol 2014; 20:3198-3207. [PMID: 24696605 PMCID: PMC3964392 DOI: 10.3748/wjg.v20.i12.3198] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/12/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD) is a multifactorial potentially debilitating disease. It has a variable disease course, but the majority of patients eventually develop penetrating or stricturing complications leading to repeated surgeries and disability. Studies on the natural history of CD provide invaluable data on its course and clinical predictors, and may help to identify patient subsets based on clinical phenotype. Most data are available from referral centers, however these outcomes may be different from those in population-based cohorts. New data suggest the possibility of a change in the natural history in Crohn’s disease, with an increasing percentage of patients diagnosed with inflammatory disease behavior. Hospitalization rates remain high, while surgery rates seem to have decreased in the last decade. In addition, mortality rates still exceed that of the general population. The impact of changes in treatment strategy, including increased, earlier use of immunosuppressives, biological therapy, and patient monitoring on the natural history of the disease are still conflictive. In this review article, the authors summarize the available evidence on the natural history, current trends, and predictive factors for evaluating the disease course of CD.
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Lovasz BD, Lakatos L, Golovics PA, David G, Pandur T, Erdelyi Z, Balogh M, Szita I, Molnar C, Komaromi E, Vegh Z, Mandel MD, Kiss LS, Lakatos PL. Risk of colorectal cancer in Crohn's disease patients with colonic involvement and stenosing disease in a population-based cohort from Hungary. J Gastrointestin Liver Dis 2013; 22:265-268. [PMID: 24078982] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND & AIMS Since data is limited regarding the risk of colorectal cancer (CRC) in Crohn's disease (CD) patients who present with stenosing disease in the colon, this study was undertaken to assess CRC risk in such patients, using a population-based, Veszprem province database, which includes incidental patients diagnosed between January 1, 1977 and December 31, 2011. METHODS Data from 640 incidental CD patients were analyzed (M/F ratio: 321/319, age-at-diagnosis: 28 years (IQR: 22-38)). Both hospital and outpatient records were collected and comprehensively reviewed. RESULTS CRC was diagnosed in six CD patients during a follow-up of 7759 person-years. Sixty-two patients presented with colonic/ileocolonic disease and a stenotic lesion in the colon with a follow-up of 702 person-years (median: 10.5, IQR: 5-16years). Colorectal cancer developed in 6.5% (equalling 0.57/100 person-years), the SIR (6.53, 95% CI: 2.45-17.4) was increased with four patients observed versus 0.61 expected. In a Kaplan-Meier analysis, the probability of developing CRC was 5.5% and 7.5% after 5- and 10 years, respectively, versus 0.4% in patients with other phenotypes (HR: 18.8, p<0.001). A sensitivity analysis included patients with stenosing colonic lesion at diagnosis or during follow-up (n=91, follow-up: 1180 person-years, median: 12, IQR: 6-17years). The probability of developing CRC was 3.6% and 4.9% after 5- and 10 years, respectively. CONCLUSIONS The risk of CRC in CD patients presenting with or developing a stenotic lesion in the colon is high even after a short disease duration, suggesting the need for careful surveillance.
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Affiliation(s)
- Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary;
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Kiss LSS, Lovasz BD, Golovics PA, Vegh Z, Farkas K, Molnar T, Palatka K, Papp M, Mohas A, Szilagyi BK, Fekete SA, Mandel M, Lakatos PL. Levels of anti-double-strained DNA but not antinuclear antibodies are associated with treatment efficacy and adverse outcomes in Crohn's disease patients treated with anti-TNFα. J Gastrointestin Liver Dis 2013; 22:135-140. [PMID: 23799211] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND & AIMS Treatment of Crohn's disease (CD) by infliximab (IFX) has been associated with the induction of antinuclear (ANA) and anti-double strand DNA (dsDNA) autoantibodies and in some studies the formation of dsDNA antibodies was associated with lupus-like syndromes. The aims of this study were to analyse the relationship between the development of ANA and dsDNA antibodies during anti-tumor necrosis factor (TNF)α therapy and the clinical efficacy or adverse outcome in patients with inflammatory bowel disease (IBD). METHODS Data of 96 CD patients (age at presentation: 25.1 years, folow-up: 5 years, males/females 43/53) treated with anti-TNFα for at least one-year were analyzed. Records of a total of 198 one-year treatment cycles were collected and levels of autoantibodies were determined at induction and after one-year treatment periods. RESULTS The majority of CD patients had ileocolonic (67.4%) and complicated disease (B2-B3: 72.6%) with perianal lesions (63.2%). At any time ANA or dsDNA positivity was 28.6% and 18%. Elevated level of ANA at induction or during anti-TNFα therapy was not associated with treatment efficacy or development of adverse outcomes. In contrast, treatment efficacy (dsDNA positivity no/partial response vs. remission: 68.5% vs. 31.5%, P=0.003) was inferior and adverse outcomes were more frequent in patients with dsDNA positivity during the anti-TNFα therapy in both univariate analysis and in logistic regression models (OR efficacy: 4.91, 95%CI: 1.15-20.8; OR adverse outcome: 3.81,95%CI 1.04-13.9). CONCLUSIONS Our data suggest that development of dsDNA during biological therapy may be associated with suboptimal treatment efficacy and adverse outcomes in CD patients.
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Affiliation(s)
- Lajos S S Kiss
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Lakatos PL, Lovasz BD, David G, Pandur T, Erdelyi Z, Mester G, Balogh M, Szipocs I, Molnar C, Komaromi E, Golovics PA, Vegh Z, Mandel M, Horvath A, Szathmari M, Kiss LS, Lakatos L. The risk of lymphoma and immunomodulators in patients with inflammatory bowel diseases: results from a population-based cohort in Eastern Europe. J Crohns Colitis 2013; 7:385-91. [PMID: 22766526 DOI: 10.1016/j.crohns.2012.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 03/18/2012] [Revised: 05/17/2012] [Accepted: 06/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Prior studies suggest a small but significantly increased risk of lymphoma in adults with inflammatory bowel disease (IBD), especially in patients treated with thiopurines. No data was available from Eastern Europe. The aim of this study was to analyze the incidence of lymphomas as related to drug exposure, in a population-based Veszprem province database, which included incident cases diagnosed between January 1, 1977 and December 31, 2008. METHODS Data from 1420 incident patients were analyzed (UC: 914, age at diagnosis: 36.5 years; CD: 506, age at diagnosis: 28.5.5 years). Both in- and outpatient records were collected and comprehensively reviewed. The rate of lymphoma was calculated as patient-years of exposure per medication class, of medications utilized in IBD. RESULTS Of the 1420 patients, we identified three patients who developed lymphoma (one CLL, two low-grade B-cell NHL including one rectal case), during 19,293 patient-years of follow-up (median follow-up: 13 years). All three patients were male. None had received azathioprine or biologicals. The absolute incidence rate of lymphoma was 1.55 per 10,000 patient-years, with 3 cases observed vs. 2.18 expected, with a standardized incidence ratio (SIR) of 1.37 (95% confidence interval [CI]: 0.44-4.26). No cases have been exposed to either azathioprine or biologicals. CONCLUSIONS The overall risk of lymphoma in IBD was not increased; only three cases were seen in this population-based incident cohort over a 30-year period. An association with thiopurine exposure was not found.
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Affiliation(s)
- Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Lovasz BD, Golovics PA, Vegh Z, Lakatos PL. New trends in inflammatory bowel disease epidemiology and disease course in Eastern Europe. Dig Liver Dis 2013; 45:269-76. [PMID: 23010518 DOI: 10.1016/j.dld.2012.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 07/18/2012] [Revised: 08/15/2012] [Accepted: 08/15/2012] [Indexed: 12/11/2022]
Abstract
Trends in current epidemiological data suggest that the incidence of inflammatory bowel diseases is changing. Eastern Europe previously was seen as a low incidence area; however, new data confirm that incidence and prevalence are quickly increasing in some countries, reaching moderate-to-high incidence as reported in Western European countries. The quality of the studies also improved. Recently, data became available on the natural history of the disease from Eastern European countries. Current trends are similar to those reported from Western Europe and North America, including less complicated disease at diagnosis, accelerated use of immunomodulators and decreased need for surgery in Crohn's disease, more cases of proctitis and relatively low colorectal cancer risk in ulcerative colitis. In addition, in-depth analysis of disease course enabled the identification of possible predictive factors leading to some novel findings, such as the association between the decline in surgery risk and early treatment strategy. In contrast, some unexplained differences exist, such as the low overall colectomy risk in ulcerative colitis.
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Affiliation(s)
- Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Kiss LS, Szamosi T, Molnar T, Miheller P, Lakatos L, Vincze A, Palatka K, Barta Z, Gasztonyi B, Salamon A, Horvath G, Tóth GT, Farkas K, Banai J, Tulassay Z, Nagy F, Szenes M, Veres G, Lovasz BD, Vegh Z, Golovics PA, Szathmari M, Papp M, Lakatos PL. Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease. Aliment Pharmacol Ther 2011; 34:911-22. [PMID: 21883326 DOI: 10.1111/j.1365-2036.2011.04827.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adalimumab is a fully human monoclonal antibody targeting tumour necrosis factor with proven efficacy in the treatment of Crohn's disease (CD). AIM To investigate the predictors of medium-term clinical efficacy and mucosal healing during adalimumab therapy, in patients with CD, in specialised centres approved for biological therapy in Hungary. METHODS Data capture of the 201 CD patients was standardised and prospective (male/female: 112/89, median age: 33.0 years, duration: 8 years). Previous infliximab therapy had been administered in 48% of patients, concomitant steroids in 41%, azathioprine in 69% and combined therapy in 27% of patients. RESULTS Overall clinical response and remission rates at 24 weeks were 78% and 52%, respectively; at 52 weeks were 69% and 44%, respectively. Endoscopic improvement and healing were achieved in 43% and 24% of patients. In a logistic regression model, clinical efficacy and CRP at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, whereas CRP at week 12, clinical remission at week 24, inflammatory parameters and nonsmoking were associated to endoscopic improvement/healing. Intensification to weekly dosing was needed in 16% of patients. Parallel azathioprine therapy and clinical remission at week 12 were inversely associated with dose escalation. CONCLUSIONS Clinical efficacy and normalised CRP at week 12 (early deep clinical remission) are associated with medium-term clinical efficacy and mucosal healing during adalimumab therapy, whereas need for combined immunosuppression at induction and smoking status are predictors for non-response. Parallel azathioprine therapy may decrease the probability for dose escalation.
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Affiliation(s)
- L S Kiss
- Semmelweis University, Budapest, Hungary
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