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Leipe J, Schmelz R, Riemekasten G, Thaçi D, Henes J, Schäkel K, Pinter A, Sticherling M, Wegner J, Fusco S, Linke M, Weber V, Manz KC, Bartz H, Roecken M, Schmidt S, Hoyer BF. [Immune-mediated inflammatory diseases in Germany : A cross-sectional analysis of comorbidities and pharmacotherapy]. Z Rheumatol 2024; 83:200-209. [PMID: 36600054 PMCID: PMC10972917 DOI: 10.1007/s00393-022-01306-1] [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] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immune-mediated inflammatory diseases (IMID) can lead to a substantial disease burden for those affected, in particular by the concomitant occurrence of other IMIDs or in the presence of comorbidities. The care of patients with IMIDs is complex and involves various medical disciplines. OBJECTIVE To describe the burden of disease and the current routine drug treatment of patients with IMID. MATERIAL AND METHODS The retrospective cross-sectional analysis was based on statutory health insurance claims data from the InGef database. Prevalent patients with psoriasis (Pso), psoriatic arthritis (PsA), spondylarthritis (SpA), rheumatoid arthritis (RA), Crohn's disease (MC), ulcerative colitis (CU), or connective tissue disease were identified among 3,988,695 insured patients in 2018. The concomitant occurrence of different IMIDs and the extent to which patients with IMID are affected by other comorbidities compared to a reference population were investigated. The current routine drug treatment was described based on the use of predefined forms of treatment. RESULTS In the database 188,440 patients with IMID (4.7%) were identified. Compared to the reference population the prevalence of comorbidities, such as depressive episodes and cardiovascular risk factors was higher in patients with IMID. For MC, CU, RA, and PsA disease-modifying antirheumatic drugs (DMARD) and classical systemic forms of treatment were used most commonly. In Pso, SpA, and connective tissue disease nonsteroidal anti-inflammatory drugs (NSAID) were the most frequently used treatment often in combination with other drugs. CONCLUSION A considerable number of patients with IMIDs (16.9-27.5%) suffer from different diseases of the IMID group. They are frequently affected by accompanying illnesses and require interdisciplinary medical treatment.
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Affiliation(s)
- Jan Leipe
- Sektion Rheumatologie, V. Medizinische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Renate Schmelz
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Gabriela Riemekasten
- Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Diamant Thaçi
- Institut und Exzellenzzentrum für Entzündungsmedizin, Universität zu Lübeck, Schleswig-Holstein, Lübeck, Deutschland
| | - Jörg Henes
- Zentrum für interdisziplinäre und klinische Immunologie, Rheumatologie und autoinflammatorische Erkrankungen (INDIRA) und innere Medizin II, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Knut Schäkel
- Hautklinik, IZEH - Interdisziplinäres Zentrum für chronisch entzündliche Erkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Andreas Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Universtitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Michael Sticherling
- Hautklinik, Psoriasiszentrum, Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Joanna Wegner
- Hautklinik und Poliklinik, Universitätsitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Stefano Fusco
- Medizinische Klinik I, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Miriam Linke
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | | | | | | | | | | | - Bimba F Hoyer
- Klinik für Innere Medizin I, Sektion Rheumatologie und klinische Immunologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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Brinkmann F, Uhlig K, Sambale A, Stommel M, Berning M, Babatz J, Sulk S, Krasz S, Schmelz R, Brückner S, Hampe J, Zeissig S. Anchoring fins of fully covered self-expandable metal stents affect pull-out force and stent migration. Gastrointest Endosc 2024; 99:377-386.e3. [PMID: 37863243 DOI: 10.1016/j.gie.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/29/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND AIMS Stent migration and subsequent adverse events are frequently observed in the use of fully covered self-expandable metal stents (FCSEMSs) for distal biliary stenosis. In this study, we identified predictors for stent migration based on biomechanical stent characteristics and associated these findings with clinical outcomes. METHODS The migration resistance of FCSEMSs was quantified by measuring the pull-out force. We analyzed a single-center retrospective cohort of 178 FCSEMSs for treatment success and adverse events occurring during 180 days of follow-up. RESULTS Biomechanical measurements revealed a 4-fold higher migration resistance of FCSEMSs with anchoring fins (AF-FCSEMSs; Fmax = 14.2 ± .1 N) compared with FCSEMSs with flared ends (FE-FCSEMSs; Fmax = 3.8 ± 1.0 N; P < .0001). Clinically, AF-FCSEMSs showed lower rates of migration compared with FE-FCSEMSs (5% vs 34%, P < .0001). Unscheduled ERCP procedures because of stent dysfunction were less frequent in the AF group compared with the FE group (15% vs 29%, P = .046). Cholangitis because of stent dysfunction was observed in 5% of the AF group compared with 19% in the FE group (P = .02). Stent patency rates at 1, 3, and 6 months were higher in the AF group (96%, 90%, and 80%, respectively) compared with the FE group (90%, 74%, and 66%; log-rank test: P = .03). CONCLUSIONS The pull-out force as a biomechanical stent property predicts the migration resistance of FCSEMSs in distal biliary stenosis and may thus be used to classify stents for this application. AF-FCSEMSs showed a significantly lower rate of migration and adverse events compared with FE-FCSEMSs.
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Affiliation(s)
- Franz Brinkmann
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany; Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Kai Uhlig
- Department Materials Engineering, Leibniz Institute of Polymer Materials, Dresden, Germany
| | - Anna Sambale
- Department Materials Engineering, Leibniz Institute of Polymer Materials, Dresden, Germany
| | - Markus Stommel
- Department Materials Engineering, Leibniz Institute of Polymer Materials, Dresden, Germany; Institute for Materials Science, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Marco Berning
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Jana Babatz
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Stefan Sulk
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Susanne Krasz
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Renate Schmelz
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Stefan Brückner
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Jochen Hampe
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany; Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden (TU Dresden), Dresden, Germany; Center for Regenerative Therapies Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Sebastian Zeissig
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany; Center for Regenerative Therapies Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
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Herzog M, Arsova M, Matthes K, Husman J, Toppe D, Kober J, Trittler T, Swist D, Dorausch EMG, Urbig A, Fettweis GP, Brinkmann F, Martens N, Schmelz R, Kampfrath N, Hampe J. Technical assessment of resolution of handheld ultrasound devices and clinical implications. Ultraschall Med 2024. [PMID: 38428463 DOI: 10.1055/a-2243-9767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE Since handheld ultrasound devices are becoming increasingly ubiquitous, objective criteria to determine image quality are needed. We therefore conducted a comparison of objective quality measures and clinical performance. MATERIAL AND METHODS A comparison of handheld devices (Butterfly IQ+, Clarius HD, Clarius HD3, Philips Lumify, GE VScan Air) and workstations (GE Logiq E10, Toshiba Aplio 500) was performed using a phantom. As a comparison, clinical investigations were performed by two experienced ultrasonographers by measuring the resolution of anatomical structures in the liver, pancreas, and intestine in ten subjects. RESULTS Axial full width at half maximum resolution (FWHM) of 100µm phantom pins at depths between one and twelve cm ranged from 0.6-1.9mm without correlation to pin depth. Lateral FWHM resolution ranged from 1.3-8.7mm and was positively correlated with depth (r=0.6). Axial and lateral resolution differed between devices (p<0.001) with the lowest median lateral resolution observed in the E10 (5.4mm) and the lowest axial resolution (1.6mm) for the IQ+ device. Although devices showed no significant differences in most clinical applications, ultrasonographers were able to differentiate a median of two additional layers in the wall of the sigmoid colon and one additional structure in segmental portal fields (p<0.05) using cartwheel devices. CONCLUSION While handheld devices showed superior or similar performance in the phantom and routine measurements, workstations still provided superior clinical imaging and resolution of anatomical substructures, indicating a lack of objective measurements to evaluate clinical ultrasound devices.
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Affiliation(s)
- Moritz Herzog
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Maia Arsova
- Medical Department 1, University Hospital Dresden, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Katja Matthes
- Medical Department 1, University Hospital Dresden, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Julia Husman
- Medical Department 1, University Hospital Dresden, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - David Toppe
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Julian Kober
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Tönnis Trittler
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Daniel Swist
- Vodafone Chair for Mobile Communications, TU Dresden Faculty of Electrical Engineering and Information Technology, Dresden, Germany
| | - Edgar Manfred Gustav Dorausch
- Vodafone Chair for Mobile Communications, TU Dresden Faculty of Electrical Engineering and Information Technology, Dresden, Germany
| | - Antje Urbig
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Gerhard Paul Fettweis
- Vodafone Chair for Mobile Communications, TU Dresden Faculty of Electrical Engineering and Information Technology, Dresden, Germany
| | - Franz Brinkmann
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Nora Martens
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Renate Schmelz
- Medical Department 1, University Hospital Dresden, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Nicole Kampfrath
- Medical Department 1, University Hospital Dresden, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Jochen Hampe
- Else Kröner Fresenius Center for Digital Health, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
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Raeder V, Batzu L, Untucht R, Fehre A, Rizos A, Leta V, Schmelz R, Hampe J, Bostantjopoulou S, Katsarou Z, Storch A, Reichmann H, Falkenburger B, Ray Chaudhuri K, Klingelhoefer L. The Gut Dysmotility Questionnaire for Parkinson's disease: Insights into development and pretest studies. Front Neurol 2023; 14:1149604. [PMID: 37056364 PMCID: PMC10086186 DOI: 10.3389/fneur.2023.1149604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
ObjectiveA total of 48% of patients with Parkinson's disease (PD) present symptoms of gastrointestinal dysfunction, particularly constipation. Furthermore, gastrointestinal tract (GIT)-related non-motor symptoms (NMSs) appear at all stages of PD, can be prodromal by many years and have a relevant impact on the quality of life. There is a lack of GIT-focused validated tools specific to PD to assess their occurrence, progress, and response to treatment. The aim of this study was to develop and evaluate a novel, disease- and symptom-specific, self-completed questionnaire, titled Gut Dysmotility Questionnaire (GDQ), for screening and monitoring gastrointestinal dysmotility of the lower GIT in patients with PD.MethodsIn phase 1, a systematic literature review and multidisciplinary expert discussions were conducted. In phase 2, cognitive pretest studies comprising standard pretests, interviews, and evaluation questionnaires were performed in patients with PD (n = 21), age- and sex-matched healthy controls (HC) (n = 30), and neurologists (n = 11). Incorporating these results, a second round of cognitive pretests was performed investigating further patients with PD (n = 10), age- and sex-matched HC (n = 10), and neurologists (n = 5). The questionnaire was adapted resulting in the final GDQ, which underwent cross-cultural adaptation to the English language.ResultsWe report significantly higher GDQ total scores and higher scores in five out of eight domains indicating a higher prevalence of gastrointestinal dysmotility in patients with PD than in HC (p < 0.05). Cognitive pretesting improved the preliminary GDQ so that the final GDQ was rated as relevant (100/100%), comprehensive (100/90%), easy to understand concerning questions and answer options (100/90%), and of appropriate length (80/100%) by neurologists and patients with PD, respectively. The GDQ demonstrated excellent internal consistency (Cronbach‘s alpha value of 0.94). Evidence for good construct validity is given by moderate to high correlations of the GDQ total score and its domains by intercorrelations (rs = 0.67–0.91; p < 0.001) and with validated general NMS measures as well as with specific items that assess gastrointestinal symptoms.InterpretationThe GDQ is a novel, easy, and quick 18-item self-assessment questionnaire to screen for and monitor gastrointestinal dysmotility with a focus on constipation in patients with PD. It has shown high acceptance and efficacy as well as good construct validity in cognitive pretests.
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Affiliation(s)
- Vanessa Raeder
- Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu, Berlin, Germany
| | - Lucia Batzu
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Robert Untucht
- Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | | | - Alexandra Rizos
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Valentina Leta
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Renate Schmelz
- Department of Internal Medicine I, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - Jochen Hampe
- Department of Internal Medicine I, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | | | - Zoe Katsarou
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - Björn Falkenburger
- Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - K. Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Lisa Klingelhoefer
- Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
- *Correspondence: Lisa Klingelhoefer
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Hennig A, Baenke F, Klimova A, Drukewitz S, Jahnke B, Brückmann S, Secci R, Winter C, Schmäche T, Seidlitz T, Bereuter JP, Polster H, Eckhardt L, Schneider SA, Brückner S, Schmelz R, Babatz J, Kahlert C, Distler M, Hampe J, Reichert M, Zeißig S, Folprecht G, Weitz J, Aust D, Welsch T, Stange DE. Detecting drug resistance in pancreatic cancer organoids guides optimized chemotherapy treatment. J Pathol 2022; 257:607-619. [PMID: 35373359 DOI: 10.1002/path.5906] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 12/17/2023]
Abstract
Drug combination therapies for cancer treatment show high efficacy but often induce severe side effects, resulting in dose or cycle number reduction. We investigated the impact of neoadjuvant chemotherapy (neoCTx) adaptions on treatment outcome in 59 patients with pancreatic ductal adenocarcinoma (PDAC). Resections with tumor-free margins were significantly more frequent when full-dose neoCTx was applied. We determined if patient-derived organoids (PDOs) can be used to personalize poly-chemotherapy regimens by pharmacotyping of treatment-naïve and post-neoCTx PDAC PDOs. Five out of ten CTx-naïve PDO lines exhibited a differential response to either the FOLFIRINOX or the Gem/Pac regimen. NeoCTx PDOs showed a poor response to the neoadjuvant regimen that had been administered to the respective patient in 30% of cases. No significant difference in PDO response was noted when comparing modified treatments in which the least effective single drug was removed from the complete regimen. Drug testing of CTx-naïve PDAC PDOs and neoCTx PDOs may be useful to guide neoadjuvant and adjuvant regimen selection, respectively. Personalizing poly-chemotherapy regimens by omitting substances with low efficacy could potentially result in less severe side effects, thereby increasing the fraction of patients receiving a full course of neoadjuvant treatment. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Alexander Hennig
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Franziska Baenke
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- Institute for Medical Informatics and Biometry, Technical University Dresden, Dresden, Germany
| | - Stephan Drukewitz
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- Core Unit for Molecular Tumor Diagnostics (CMTD), Technical University Dresden, Dresden, Germany
| | - Beatrix Jahnke
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sascha Brückmann
- Institute of Pathology and Tumor- and Normal Tissue Bank of the University Cancer Center (UCC), University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Ramona Secci
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
| | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Schmäche
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Therese Seidlitz
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jean-Paul Bereuter
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heike Polster
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lisa Eckhardt
- Core Unit for Molecular Tumor Diagnostics (CMTD), Technical University Dresden, Dresden, Germany
| | - Sidney A Schneider
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Brückner
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Renate Schmelz
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jana Babatz
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Kahlert
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Jochen Hampe
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Regenerative Therapies (CRTD), Technische Universität (TU) Dresden, Dresden, Germany
| | - Maximilian Reichert
- German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Pancreatic Cancer Research Center, Medical Clinic and Polyclinic II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Protein Assemblies (CPA), Technische Universität München, Munich, Germany
| | - Sebastian Zeißig
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Regenerative Therapies (CRTD), Technische Universität (TU) Dresden, Dresden, Germany
| | - Gunnar Folprecht
- Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Daniela Aust
- Institute of Pathology and Tumor- and Normal Tissue Bank of the University Cancer Center (UCC), University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniel E Stange
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
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Weber K, Zeißig Y, Haag C, Schmelz R, Pazmandi J, Kalinichenko A, Boztug K, Zeißig S, Aust D, Laass MW, Schuetz C. [Chronic or severe enteropathy and immunodeficiency: be prepared for a rara avis]. Z Gastroenterol 2022; 60:1668-1677. [PMID: 35297030 DOI: 10.1055/a-1709-5024] [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] [Indexed: 10/18/2022]
Abstract
In the work-up of chronic enteropathies an underlying inborn error of immunity (IEI) should be considered in certain cases. IEI are rare, but approximately 10% of patients may present with symptoms of inflammatory bowel disease (IBD), which is a much more common entity. Patients with IEI associated IBD may show extraintestinal symptoms or signs, and are often refractory to conventional anti-inflammatory treatment. In case of early-onset bowel inflammation and other intestinal or extraintestinal manifestations, an IEI should be excluded. A small fraction of monogenic IEI can be amenable to targeted therapies, or even corrected by allogeneic stem cell transplantation. Therefore, early diagnosis is crucial. This paper shows examples of clinical - gastrointestinal as well as extraintestinal - signs and findings which require immunological and possibly genetic workup.
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Affiliation(s)
- Katrin Weber
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Yvonne Zeißig
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Cornelie Haag
- Universitätsklinikum Carl Gustav Carus Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Renate Schmelz
- Universitätsklinikum Carl Gustav Carus Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Julia Pazmandi
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Artem Kalinichenko
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,St. Anna Kinderspital und Universitätsklinik für Kinder und Jugendliche, Medizinische Universitat Wien, Wien, Austria.,St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Sebastian Zeißig
- Center for Regenerative Therapies Dresden, Dresden, Germany.,Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Daniela Aust
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Martin W Laass
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Catharina Schuetz
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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7
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Elkharsawi A, Arnim UV, Schmelz R, Sander C, Stallmach A, Teich N, Walldorf J, Reuken PA. SARS-CoV-2 vaccination does not induce relapses of patients with inflammatory bowel disease. Z Gastroenterol 2022; 60:77-80. [PMID: 35042256 DOI: 10.1055/a-1710-3861] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vaccination against SARS-CoV-2 is a promising strategy to protect immunocompromised IBD patients from a severe course of COVID-19. As these patients were excluded from initial clinical vaccination trials, patients frequently express concerns regarding the safety of these vaccines, especially whether vaccination might trigger IBD flares ("hit-and-run-hypothesis"). METHODS In order to assess the risk of an IBD flare after vaccination against SARS-CoV-2, an anonymous survey was performed at five German IBD centers and one patient organization (Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung (DCCV) e.V.) in August and October 2021. RESULTS The questionnaire was answered by 914 patients, 781 of whom reported a previous vaccination against SARS-CoV-2 (85.4%). Vaccination against SARS-CoV-2 was not associated with an increased risk of IBD flares (p=0.319) or unscheduled visits to the IBD physician (p=0.848). Furthermore, typical symptoms of an IBD flare including abdominal pain, increases in stool frequency, or rectal bleeding were not influenced by the vaccination. CONCLUSION Vaccination against SARS-CoV-2 is safe in IBD patients. These results may help to reduce fears regarding the vaccination in IBD patients. Our results can help to reduce fears in IBD patients regarding the SARS-CoV-2 vaccine. A close communication between patients and physicians before and after the vaccination may be beneficial.
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Affiliation(s)
- Ahmed Elkharsawi
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious diseases, Universitätsklinikum Magdeburg AöR, Magdeburg, Germany
| | - Renate Schmelz
- Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Cornelia Sander
- Deutsche Morbus Crohn/Colitis Ulcerosa Vereinigung e.V., Berlin, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany
| | - Jens Walldorf
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Philipp A Reuken
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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8
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Sarraf AA, Schetelig J, Baldauf H, Stölzel F, Middeke JM, Sockel K, Teipel R, Brückner S, Berning M, Zeissig S, Babatz J, Baretton GB, Hampe J, Bornhäuser M, Aust D, Schmelz R. Macroscopic, Histologic and Clinical Assessment of Acute GVHD of the Upper Gastrointestinal Tract within 6 Weeks after Allogeneic Hematopoietic Cell Transplantation. Exp Hematol 2022; 108:36-45. [PMID: 35033627 DOI: 10.1016/j.exphem.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/02/2022] [Accepted: 01/08/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Abed A Sarraf
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany.
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany; Clinical Trials Unit, German Bone Marrow Donor Center (DKMS), Dresden, Germany
| | - Henning Baldauf
- Clinical Trials Unit, German Bone Marrow Donor Center (DKMS), Dresden, Germany
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany; Clinical Trials Unit, German Bone Marrow Donor Center (DKMS), Dresden, Germany
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Katja Sockel
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Raphael Teipel
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Stefan Brückner
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Marco Berning
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Sebastian Zeissig
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Jana Babatz
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Gustavo B Baretton
- Institute of Pathology, Faculty of Medicine and University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Hampe
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Aust
- Institute of Pathology, Faculty of Medicine and University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
| | - Renate Schmelz
- Department of Internal Medicine I, University Hospital "Carl Gustav Carus," TU Dresden, Dresden, Germany
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9
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Teich N, Ludewig C, Schmelz R, Bästlein EC, Geißler S, Nagl S, Walldorf J, Krause T, Maaser C, Mohl W, Wedemeyer HH, Bauer T, Büning C, Grunert P, Hasselblatt P, Hänschen M, Kahl M, Engelke O, Schubert S, Holler B, Streetz K, Arnim UV, Schmidt K, Stallmach A. [Effects of SARS-CoV-2 Infection on Symptoms and Therapy of Inflammatory Bowel Disease]. Z Gastroenterol 2021; 59:1189-1196. [PMID: 34748206 DOI: 10.1055/a-1508-6734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The influence of a SARS-CoV-2 infection on inflammatory bowel disease (IBD) has not yet been well characterized and it is unclear whether this requires an adaptation of the immunosuppressive therapy. METHODS A national register was established for the retrospective documentation of clinical parameters and changes in immunosuppressive therapy in SARS-CoV-2 infected IBD patients. RESULTS In total, only 3 of 185 IBD patients (1.6 %) were tested for SARS-CoV-2 infection because of abdominal symptoms. In the course of COVID-19 disease, 43.5 % developed diarrhea, abdominal pain or hematochezia (risk of hospitalization with vs. without abdominal symptoms: 20.0 % vs. 10.6 %, p < 0.01). With active IBD at the time of SARS-CoV-2 detection, there was an increased risk of hospitalization (remission 11.2 %, active IBD 23.3 % p < 0.05). IBD-specific therapy remained unchanged in 115 patients (71.4 %); the most common change was an interruption of systemic therapy (16.2 %). DISCUSSION New abdominal symptoms often appeared in SARS-CoV-2 infected IBD patients. However, these only rarely led to SARS-CoV-2 testing. A high IBD activity at the time of SARS-CoV-2 detection was associated with an increased risk of hospitalization.
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Affiliation(s)
- Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany
| | - Clara Ludewig
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany
| | - Renate Schmelz
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Sven Geißler
- Praxisgemeinschaft für Rheumatologie und Gastroenterologie, Cottbus, Germany
| | - Sandra Nagl
- III. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Jens Walldorf
- Universitätsklinik für Innere Medizin I, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | | | - Christian Maaser
- Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany
| | - Wolfgang Mohl
- Zentrum für Gastroenterologie Saar MVZ GmbH Saarbrücken, Saarbrücken, Germany
| | - Heiner H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Tilman Bauer
- Gemeinschaftspraxis für Gastroenterologie und Kindergastroenterologie, Freinurg, Germany
| | | | - Philip Grunert
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitatsklinikum Jena, Jena, Germany
| | - Peter Hasselblatt
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | | | - Matthias Kahl
- Fachinternistische Schwerpunktpraxis, Hamburg, Germany
| | - Olaf Engelke
- Internistische Gemeinschaftspraxis Wanne-Eickel, Herne, Germany
| | - Stefan Schubert
- MVZ für Gastroenterologie am Bayerischen Platz, Berlin, Germany
| | - Babett Holler
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Germany
| | | | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious diseases, Universitätsklinikum Magdeburg AöR, Magdeburg, Germany
| | | | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitatsklinikum Jena, Jena, Germany
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10
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Walldorf J, von Arnim U, Schmelz R, Riesner-Wehner A, Michl P, Grunert PC, Stallmach A, Teich N, Reuken PA. SARS-CoV-2 Vaccination in Patients With Inflammatory Bowel Disease-Fear and Desire. Inflamm Bowel Dis 2021; 27:1858-1861. [PMID: 34181021 PMCID: PMC8344527 DOI: 10.1093/ibd/izab150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Jens Walldorf
- Martin Luther University of Halle-Wittenberg, Department of Internal Medicine I, Halle, Germany,Address correspondence to: Jens Walldorf, MD, Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle, Germany ()
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Magdeburg, Germany
| | - Renate Schmelz
- University Hospital Dresden, Department of Internal Medicine I, TU Dresden, Germany
| | - Anica Riesner-Wehner
- Martin Luther University of Halle-Wittenberg, Department of Internal Medicine I, Halle, Germany
| | - Patrick Michl
- Martin Luther University of Halle-Wittenberg, Department of Internal Medicine I, Halle, Germany
| | - Philip C Grunert
- Jena University Hospital, Department of Internal Medicine IV, Jena, Germany
| | - Andreas Stallmach
- Jena University Hospital, Department of Internal Medicine IV, Jena, Germany
| | - Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs-und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany
| | - Philipp A Reuken
- Jena University Hospital, Department of Internal Medicine IV, Jena, Germany
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11
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Mahlich J, May M, Feig C, Straub V, Schmelz R. Persistence With Biologic Therapy and Associated Costs of Patients With Inflammatory Bowel Disease: A German Retrospective Claims Data Analysis. Crohns Colitis 360 2021; 3:otab011. [PMID: 36778945 PMCID: PMC9802337 DOI: 10.1093/crocol/otab011] [Citation(s) in RCA: 7] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background In recent years, biologic agents became a relevant and promising treatment option for inflammatory bowel diseases (IBDs). However, high treatment costs and moderate remission rates lead to a high interest in treatment persistence and corresponding economic consequences. Methods A retrospective health claims data analysis was conducted including biologic naive patients diagnosed with IBD between 2013 and 2018. Observation points were at 12 and 18 months of follow-up, starting from the first biologic prescription. Nonpersistence was defined as either no further prescription or prescription of another biologic agent within the days of supply per original prescription. Biologic agents included were Adalimumab, Golimumab, Infliximab, Ustekinumab, and Vedolizumab. Results In total, 1444 patients with IBD were included in this analysis, mostly treated with Adalimumab (46.9%) and Infliximab (39.9%) as their first biologic treatment. After 12 months, 72.2% of patients were still persistent with their initial biologic treatment with the highest shares for Infliximab (74%) and Vedolizumab (72.4%). 27.8% of patients were nonpersistent, mostly due to a switch of biologic agent (75.8%). Cox regression identified female, hospitalizations, and simultaneous prescriptions of corticosteroids and immunomodulators as risk factors for nonpersistence. Treatment costs per year were approximately 3000€ higher for nonpersistent patients (27,146€) than for persistent patients (23,839€), mostly due to inpatient treatment costs. Conclusions The persistence of biologic therapy in this study was rather high at 72% after 12 months, while nonpersistence was mostly due to switches to other biologic agents. Lack of persistence is associated with increased cost, mostly due to nonbiologic medication and inpatient treatment.
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Affiliation(s)
- Joerg Mahlich
- Health Economics and Outcomes Research, Janssen-Cilag GmbH, Neuss, Germany,Düsseldorf Institute for Competition Economics (DICE), DICE, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany,Address correspondence to: Joerg Mahlich, PhD, Janssen-Cilag, Johnson & Johnson Platz 1, 41470 Neuss, Germany ()
| | - Melanie May
- Health Economics, HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - Chiara Feig
- Health Economics, HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - Vincent Straub
- Health Economics, HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - Renate Schmelz
- Medical Department, Universitätsklinikum Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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12
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Terjung B, Schmelz R, Ehehalt R, Klaus J, Knop J, Schwind S, Wilke T, Stallmach A. Safety of vedolizumab in the treatment of pregnant women with inflammatory bowel disease: a targeted literature review. Therap Adv Gastroenterol 2020; 13:1756284820952592. [PMID: 33149762 PMCID: PMC7580131 DOI: 10.1177/1756284820952592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/21/2020] [Accepted: 07/31/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC) commonly affect women in their childbearing years. Vedolizumab (VDZ) is approved for treatment of moderate-to-severe CD and UC, but there is a knowledge gap regarding its use during pregnancy. This targeted literature review describes available evidence on safety of VDZ in pregnant patients in order to offer physicians a detailed and balanced view on persistent data during their decision-making process for an individualized treatment concept. METHODS The search included literature from the MEDLINE database and abstracts of five gastroenterological conferences published until November 2019. Publications were included if pregnancy outcomes in women receiving VDZ or neonatal outcomes in newborns of women previously exposed to VDZ were reported. RESULTS Out of 196 initially identified records, 18 publications reporting results of five different studies were identified. In total, for 213 of 284 VDZ-exposed documented pregnancies the following pregnancy outcomes were reported: 167 live births (172 infants due to twin births), 1 stillbirth, 35 miscarriages, 10 elective terminations (1 due to detected Down syndrome). Furthermore, during pregnancy, the following complications were observed: seven cases of (pre) eclampsia, three cases of premature rupture of membranes and one case each of placenta previa, chorioamnionitis, pneumonia, first-trimester bleeding, cholestasis, sepsis, or neonatal intraventricular hemorrhage. Based on 172 infants, 30 preterm deliveries (17.4%), 9 cases of low birth weight (5.2%), 5 infections (2.9%), and 6 cases (3.8%) with congenital anomalies were reported. CONCLUSION There was no evidence for safety concerns regarding pregnancy outcomes associated with VDZ therapy. Due to the limited scope of included records, further research is needed to understand the safety profile regarding the use of VDZ during pregnancy.
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Affiliation(s)
- Birgit Terjung
- Department of Internal Medicine - Gastroenterology, GFO Kliniken Bonn, Nordrhein-Westfalen, Germany
| | - Renate Schmelz
- Medical Department 1, University Hospital Dresden, TU Dresden, Germany
| | - Robert Ehehalt
- Gastroenterology Outpatient Clinic Heidelberg, Heidelberg, Germany
| | - Jochen Klaus
- Innere Medizin I, Universitätsklinikum Ulm, Ulm, Germany
| | - Jana Knop
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | | | - Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM) an der Hochschule Wismar, Wismar, Germany
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13
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Lucendo AJ, Miehlke S, Schlag C, Vieth M, von Arnim U, Molina-Infante J, Hartmann D, Bredenoord AJ, Ciriza de Los Rios C, Schubert S, Brückner S, Madisch A, Hayat J, Tack J, Attwood S, Mueller R, Greinwald R, Schoepfer A, Straumann A, Vanuytsel T, Louis H, Musala C, Miehlke S, Frederking D, Bajbouj M, Schlag C, Nennstiel S, Brückner S, Schmelz R, Heimerl S, Stephan AM, Fibbe C, Liedtke (née Laschinsky) N, Keller J, Rosien U, Haag S, Schneider A, Hartmann D, Schmöcker C, Buchholz H, Lammert F, Casper M, Reichert M, Madisch A, Sommer D, Mönnikes H, Stengel M, Schmidtmann M, Müller M, Eckardt A, Wehrmann T, Schubert S, Armerding P, Hofmann WP, Liceni T, von Arnim U, Kandulski A, Weigt J, Börner N, Lutz-Vorderbrügge A, Albert J, Zeuzem S, Blumenstein I, Sprinzl K, Hausmann J, Bredenoord A, Bredenoord A, Warners M, Villarin AL, Arias ÁA, Tejero Bustos MÁ, Carrillo Ramos MJ, Olalla Gallardo JM, Tosina RJ, Molina-Infante J, Zamorano J, Vaquero CS, Francés SC, Pérez T, Rodriguez T, Ciriza de los Ríos C, Rodríguez-Valcárcel FC, Castel de Lucas I, Juan AP, Barenys M, Pons C, Martinez IP, Lauret ME, García AC, Rubio E, Straumann A, Hruz P, Brunner S, Hayat J, Poullis A. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology 2019; 157:74-86.e15. [PMID: 30922997 DOI: 10.1053/j.gastro.2019.03.025] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Swallowed topical-acting corticosteroids are recommended as first-line therapy for eosinophilic esophagitis (EoE). Asthma medications not optimized for esophageal delivery are sometimes effective, although given off-label. We performed a randomized, placebo-controlled trial to assess the effectiveness and tolerability of a budesonide orodispersible tablet (BOT), which allows the drug to be delivered to the esophagus in adults with active EoE. METHODS We performed a double-blind, parallel study of 88 adults with active EoE in Europe. Patients were randomly assigned to groups that received BOT (1 mg twice daily; n = 59) or placebo (n = 29) for 6 weeks. The primary end point was complete remission, based on clinical and histologic factors, including dysphagia and odynophagia severity ≤2 on a scale of 0-10 on each of the 7 days before the end of the double-blind phase and a peak eosinophil count <5 eosinophils/high power field. Patients who did not achieve complete remission at the end of the 6-week double-blind phase were offered 6 weeks of open-label treatment with BOT (1 mg twice daily). RESULTS At 6 weeks, 58% of patients given BOT were in complete remission compared with no patients given placebo (P < .0001). The secondary end point of histologic remission was achieved by 93% of patients given BOT vs no patients given placebo (P < .0001). After 12 weeks, 85% of patients had achieved remission. Six-week and 12-week BOT administration were safe and well tolerated; 5% of patients who received BOT developed symptomatic, mild candida, which was easily treated with an oral antifungal agent. CONCLUSIONS In a randomized trial of adults with active EoE, we found that budesonide oral tablets were significantly more effective than placebo in inducing clinical and histologic remission. Eudra-CT number 2014-001485-99; ClinicalTrials.gov ID NCT02434029.
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Affiliation(s)
- Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Spain.
| | - Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany; Center for Esophageal Diseases, University Hospital Hamburg-Eppendorf, Germany
| | - Christoph Schlag
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Michael Vieth
- Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
| | - Javier Molina-Infante
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Spain; Department of Gastroenterology, Hospital Universitario San Pedro de Alcantara, Caceres, Spain
| | - Dirk Hartmann
- Klinik für Innere Medizin I, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Albert Jan Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Stefan Brückner
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Technische Universität Dresden, Dresden, Germany
| | - Ahmed Madisch
- Department of Gastroenterology, CRH Clinic Siloah, Hannover, Germany
| | - Jamal Hayat
- Department of Gastroenterology, Saint George's University Hospitals National Health Service Trust, London, United Kingdom
| | - Jan Tack
- Department of Gastroenterology, University Hospital, Leuven, Belgium
| | - Stephen Attwood
- Department of Health Services Research, Durham University, Durham, United Kingdom
| | - Ralph Mueller
- Department of Clinical Research and Development, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Roland Greinwald
- Department of Clinical Research and Development, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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14
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Strnad P, Buch S, Hamesch K, Fischer J, Rosendahl J, Schmelz R, Brueckner S, Brosch M, Heimes CV, Woditsch V, Scholten D, Nischalke HD, Janciauskiene S, Mandorfer M, Trauner M, Way MJ, McQuillin A, Reichert MC, Krawczyk M, Casper M, Lammert F, Braun F, von Schönfels W, Hinz S, Burmeister G, Hellerbrand C, Teufel A, Feldman A, Schattenberg JM, Bantel H, Pathil A, Demir M, Kluwe J, Boettler T, Ridinger M, Wodarz N, Soyka M, Rietschel M, Kiefer F, Weber T, Marhenke S, Vogel A, Hinrichsen H, Canbay A, Schlattjan M, Sosnowsky K, Sarrazin C, von Felden J, Geier A, Deltenre P, Sipos B, Schafmayer C, Nothnagel M, Aigner E, Datz C, Stickel F, Morgan MY, Hampe J, Berg T, Trautwein C. Heterozygous carriage of the alpha1-antitrypsin Pi*Z variant increases the risk to develop liver cirrhosis. Gut 2019; 68:1099-1107. [PMID: 30068662 DOI: 10.1136/gutjnl-2018-316228] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Homozygous alpha1-antitrypsin (AAT) deficiency increases the risk for developing cirrhosis, whereas the relevance of heterozygous carriage remains unclear. Hence, we evaluated the impact of the two most relevant AAT variants ('Pi*Z' and 'Pi*S'), present in up to 10% of Caucasians, on subjects with non-alcoholic fatty liver disease (NAFLD) or alcohol misuse. DESIGN We analysed multicentric case-control cohorts consisting of 1184 people with biopsy-proven NAFLD and of 2462 people with chronic alcohol misuse, both cohorts comprising cases with cirrhosis and controls without cirrhosis. Genotyping for the Pi*Z and Pi*S variants was performed. RESULTS The Pi*Z variant presented in 13.8% of patients with cirrhotic NAFLD but only in 2.4% of counterparts without liver fibrosis (p<0.0001). Accordingly, the Pi*Z variant increased the risk of NAFLD subjects to develop cirrhosis (adjusted OR=7.3 (95% CI 2.2 to 24.8)). Likewise, the Pi*Z variant presented in 6.2% of alcohol misusers with cirrhosis but only in 2.2% of alcohol misusers without significant liver injury (p<0.0001). Correspondingly, alcohol misusers carrying the Pi*Z variant were prone to develop cirrhosis (adjusted OR=5.8 (95% CI 2.9 to 11.7)). In contrast, the Pi*S variant was not associated with NAFLD-related cirrhosis and only borderline with alcohol-related cirrhosis (adjusted OR=1.47 (95% CI 0.99 to 2.19)). CONCLUSION The Pi*Z variant is the hitherto strongest single nucleotide polymorphism-based risk factor for cirrhosis in NAFLD and alcohol misuse, whereas the Pi*S variant confers only a weak risk in alcohol misusers. As 2%-4% of Caucasians are Pi*Z carriers, this finding should be considered in genetic counselling of affected individuals.
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Affiliation(s)
- Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.,Coordinating Center for Alpha1-antitrypsin Deficiency-related Liver Disease of the European Reference Network (ERN) 'Rare Liver', European Association for the Study of the Liver (EASL) Registry Group 'Alpha1-Liver', Aachen, Germany
| | - Stephan Buch
- Medical Department 1, University Hospital Dresden, Dresden, Germany
| | - Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.,Coordinating Center for Alpha1-antitrypsin Deficiency-related Liver Disease of the European Reference Network (ERN) 'Rare Liver', European Association for the Study of the Liver (EASL) Registry Group 'Alpha1-Liver', Aachen, Germany
| | - Janett Fischer
- Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Jonas Rosendahl
- Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.,Department of Internal Medicine I, University Hospital Halle, Martin Luther University, Halle, Germany
| | - Renate Schmelz
- Medical Department 1, University Hospital Dresden, Dresden, Germany
| | - Stefan Brueckner
- Medical Department 1, University Hospital Dresden, Dresden, Germany
| | - Mario Brosch
- Medical Department 1, University Hospital Dresden, Dresden, Germany
| | - Carolin V Heimes
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Vivien Woditsch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - David Scholten
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Sabina Janciauskiene
- Clinic for Pneumology, German Center for Lung Research (DZL), Medical University Hannover, Hannover, Germany
| | - Mattias Mandorfer
- Clinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria
| | - Michael Trauner
- Clinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria
| | - Michael J Way
- Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.,Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| | - Andrew McQuillin
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Department of General, Transplantation and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Markus Casper
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Felix Braun
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Witigo von Schönfels
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian Hinz
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Greta Burmeister
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Claus Hellerbrand
- Institute of Biochemistry, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Teufel
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Alexandra Feldman
- Department of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria
| | - Joern M Schattenberg
- Department of Medicine I, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Heike Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Anita Pathil
- Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Heidelberg, Heidelberg, Germany
| | - Muenevver Demir
- Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Johannes Kluwe
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Monika Ridinger
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Norbert Wodarz
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Soyka
- Psychiatric Hospital, Ludwig Maximilians University, Munich, Germany
| | - Marcella Rietschel
- Faculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Falk Kiefer
- Faculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Thomas Weber
- Department for Clinical Research, University Hospital Bern, Bern, Switzerland
| | - Silke Marhenke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Holger Hinrichsen
- Department of Gastroenterology, University Hospital Kiel, Kiel, Germany
| | - Ali Canbay
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.,Department of Gastroenterology and Hepatology, University Duisburg-Essen, Essen, Germany
| | - Martin Schlattjan
- Department of Gastroenterology and Hepatology, University Duisburg-Essen, Essen, Germany
| | - Katharina Sosnowsky
- Department of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Johann von Felden
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Geier
- Division of Hepatology, Department of Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Pierre Deltenre
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.,Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Bence Sipos
- Institute of Pathology, University of Tuebingen, Tuebingen, Germany
| | - Clemens Schafmayer
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Nothnagel
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Elmar Aigner
- Department of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private University of Salzburg, Oberndorf, Austria
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - Marsha Yvonne Morgan
- Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Dresden, Germany
| | - Thomas Berg
- Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Christian Trautwein
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.,Coordinating Center for Alpha1-antitrypsin Deficiency-related Liver Disease of the European Reference Network (ERN) 'Rare Liver', European Association for the Study of the Liver (EASL) Registry Group 'Alpha1-Liver', Aachen, Germany
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15
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Schmelz R, Miehlke S, Thiede C, Brueckner S, Dawel M, Kuhn M, Ruskoné-Formestraux A, Stolte M, Jentsch C, Hampe J, Morgner A. Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE & II1E: a prospective randomized trial. J Gastroenterol 2019; 54:388-395. [PMID: 30327875 DOI: 10.1007/s00535-018-1517-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/25/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Helicobacter pylori (H. pylori) positive stage I gastric low-grade MALT lymphoma, eradication is the accepted first-line therapy. The role of eradication therapy in lymphoma > stage IE is still unclear. However, about 20% of patients show persistent lymphoma following successful eradication or primary H. pylori-negative lymphoma. A prospective study for salvage radiation therapy with standard 36 Gy in comparison to a reduced dose of 25.2 Gy is still missing. METHODS A prospective, multicentre study investigated the efficacy of eradication in H. pylori-positive gastric low-grade MALT lymphoma stages IE and II1E (HELYX I). Refractory lymphoma or H. pylori-negative patients were treated in a prospective, randomised, multicentre, phase II study to receive either 25.2 Gy or 36 Gy radiotherapy (HELYX II). RESULTS 102 patients (3 drop outs) were included in HELYX I: 75/99 (75.8%) showed complete remission after a median of 2.8 months. 18 (18.2%) had partial remission (PR) and 6 (6.0%) no change (NC). 29 patients (7 drop outs) were randomized in HELYX II (7 primarily H. pylori-negative, 15 patients from HELYX I with refractory disease after eradication). All patients achieved stable CR irrespective of radiation dose. Both presence of the t(11,18) translocation (OR 9.0, p = 0.01) and monoclonality of the tumour cells (OR 6.3, p = 0.006) were predictors for persistant lymphoma after eradication therapy. CONCLUSIONS Most H. pylori-positive low grade gastric MALT lymphoma stage IE and II1E respond with stable CR after eradication therapy. In patients with refractory disease or H. pylori negative low grade gastric MALT lymphoma a dosage-reduced radiation therapy with 25.2 Gy is an effective standard dose in stage IE and II1E. TRIAL REGISTRATION ClinicalTrials.gov: NCT00154440.
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Affiliation(s)
- Renate Schmelz
- Medical Departement 1, University Hospital Carl Gustav Carus, Technical University, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Stephan Miehlke
- Center for Digestive Diseases, Cooperation of Internal Medicine, Hamburg, Germany
| | - Christian Thiede
- Medical Departement 1, University Hospital Carl Gustav Carus, Technical University, Fetscherstr. 74, 01307, Dresden, Germany
| | - Stefan Brueckner
- Medical Departement 1, University Hospital Carl Gustav Carus, Technical University, Fetscherstr. 74, 01307, Dresden, Germany
| | - Monic Dawel
- Department of Radiation Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Matthias Kuhn
- Institute for Medical Informatics and Biometry, Technical University, Dresden, Germany
| | | | - Manfred Stolte
- Institute for Pathology, Hospital Kulmbach, Kulmbach, Germany
| | - Christina Jentsch
- Department of Radiation Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Jochen Hampe
- Medical Departement 1, University Hospital Carl Gustav Carus, Technical University, Fetscherstr. 74, 01307, Dresden, Germany
| | - Andrea Morgner
- University Hospital Hamburg-Eppendorf, Center for Oncology and University Cancer Center Hamburg (UCCH), Hamburg, Germany
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16
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Hohmann M, Schmelz R, Hampe J, Zeißig S. [Practical Genetic Testing in Gastroenterology]. Dtsch Med Wochenschr 2018; 143:1477-1480. [PMID: 30286498 DOI: 10.1055/a-0588-1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Genetic testing has become increasingly relevant in daily clinical practice due to the identification of susceptibility genes for several diseases. This article focuses on genetic testing for hereditary pancreatitis, inflammatory bowel disease and fatty liver disease. Several genetic variants that contribute to chronic pancreatitis development have been identified. If the individual aetiology of chronic pancreatitis is unclear, genetic testing for common predisposing variants should be offered. Inflammatory bowel diseases are complex and multifactorial disorders. However, rare mono- or oligogenic forms of disease exist and should be screened for, as personalized therapies can be offered to subsets of these patients. Genetic risk factors also promote the manifestation and progression of fatty liver disease, liver cirrhosis and hepatocellular carcinoma. In conclusion, genetic testing plays an increasing role in delineating the pathogenesis of gastroenterological and hepatic diseases, in the stratification of patients at risk for severe disease complications, and in the optimization of patient care.
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Affiliation(s)
- Margarete Hohmann
- Medizinische Klinik und Poliklinik I, Bereich Gastroenterologie, Universitätsklinikum Dresden
| | - Renate Schmelz
- Medizinische Klinik und Poliklinik I, Bereich Gastroenterologie, Universitätsklinikum Dresden
| | - Jochen Hampe
- Medizinische Klinik und Poliklinik I, Bereich Gastroenterologie, Universitätsklinikum Dresden
| | - Sebastian Zeißig
- Medizinische Klinik und Poliklinik I, Bereich Gastroenterologie, Universitätsklinikum Dresden
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17
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Reuken PA, Kruis W, Maaser C, Teich N, Büning J, Preiß JC, Schmelz R, Bruns T, Fichtner-Feigl S, Stallmach A. Microbial Spectrum of Intra-Abdominal Abscesses in Perforating Crohn's Disease: Results from a Prospective German Registry. J Crohns Colitis 2018; 12:695-701. [PMID: 29415186 DOI: 10.1093/ecco-jcc/jjy017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/02/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intra-abdominal abscesses [IAAs] are common life-threatening complications in patients with Crohn's disease [CD]. In addition to interventional drainage and surgical therapy, empirical antibiotic therapy represents a cornerstone of treatment, but contemporary data on microbial spectra and antimicrobial resistance are scarce. METHODS We recruited 105 patients with CD and IAAs from nine German centres for a prospective registry in order to characterize the microbiological spectrum, resistance profiles, antibiotic therapy and outcome. RESULTS In 92 of 105 patients, microbial investigations of abscess material revealed pathogenic microorganisms. A total of 174 pathogens were isolated, with a median of 2 pathogens per culture [range: 1-6]. Most frequently isolated pathogens were E. coli [45 patients], Streptococcus spp. [28 patients], Enterococci [27 patients], Candida [13 patients] and anaerobes [12 patients]. Resistance to third-generation cephalosporins, penicillins with beta-lactamase inhibitors and quinolones were observed in 51, 36 and 35 patients, respectively. Seven patients had multiple-drug-resistant bacteria. Thirty patients received inadequate empirical treatment, and this was more frequent in patients receiving steroids or immunosuppression [37%] than in patients without immunosuppression [10%: p = 0.001] and was associated with a longer hospital stay [21 days vs 13 days, p = 0.003]. CONCLUSION Based on antimicrobial resistance profiles, we herein report a high rate of inadequate empirical first-line therapy for IAAs in CD, especially in patients receiving immunosuppression, and this is associated with prolonged hospitalization.
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Affiliation(s)
- P A Reuken
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
| | - W Kruis
- Klinik für Gastroenterologie, Pulmonologie und Allgemeine Innere Medizin, Evangelisches Krankenhaus Köln Kalk, University of Cologne, Cologne, Germany
| | - C Maaser
- Ambulanzzentrum Gastroenterologie, University Teaching Hospital Lüneburg, Lüneburg, Germany
| | - N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany.,Medical Faculty, Friedrich-Schiller University, Jena, Germany
| | - J Büning
- Department of Internal Medicine I [Gastroenterology], University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - J C Preiß
- Department of Medicine I [Gastroenterology, Infectious Diseases, Rheumatology], Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - R Schmelz
- Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Bruns
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
| | - S Fichtner-Feigl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - A Stallmach
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
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18
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Bär F, Kühbacher T, Dietrich NA, Krause T, Stallmach A, Teich N, Schreiber S, Walldorf J, Schmelz R, Büning C, Fellermann K, Büning J, Helwig U. Vedolizumab in the treatment of chronic, antibiotic-dependent or refractory pouchitis. Aliment Pharmacol Ther 2018; 47:581-587. [PMID: 29266360 DOI: 10.1111/apt.14479] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/27/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The most common complication after ileal pouch anal anastomosis in up to 50% of patients is an acute pouchitis. The majority of patients respond to antibiotic treatment. However, 10%-15% develops chronic antibiotic-dependent or refractory pouchitis which is usually hard to treat. AIM To evaluate the effectiveness of vedolizumab in patients with chronic pouchitis. METHODS Patients with chronic antibiotic-dependent or refractory pouchitis were treated with vedolizumab (300 mg at week 0, 2, 6 and 10) in 10 IBD centres and retrospectively registered. Data were recorded until week 14 of vedolizumab treatment. In total 20 patients (12 male, median age 43 years) were included for analysis. The effectiveness was measured using the Oresland Score (OS) at week 2, 6, 10 and 14 and the pouch disease activity index (PDAI) at week 0 and 14. RESULTS The mean OS declined from 6.8 (range 2-12) to 3.4 (range 0-11). Concordantly, the mean PDAI after 14 weeks of treatment dropped from 10 (range 5-18) to 3 (range 0-10). Only three patients reported moderate side effects. No serious side effects were recorded. In addition, symptomatic co-medication such as loperamide and tincture of opium could be terminated in 8 out of 12 patients as well as antibiotic treatment could be stopped in 17 out of 19 patients. CONCLUSION Our data indicate that vedolizumab could be an option in the treatment of patients with chronic, antibiotic-dependent or refractory pouchitis.
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Affiliation(s)
- F Bär
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - T Kühbacher
- Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - N A Dietrich
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - T Krause
- Gastroenterology Opernstraße, Kassel, Germany
| | - A Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Jena, Jena, Germany
| | - N Teich
- Practice for Digestive and Metabolic Diseases, Leipzig, Germany
| | - S Schreiber
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Walldorf
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - R Schmelz
- Department of Gastroenterology, University Hospital of Dresden, Dresden, Germany
| | - C Büning
- Department of Internal Medicine, Hospital Waldfriede, Berlin, Germany
| | - K Fellermann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - J Büning
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - U Helwig
- Practice of Internal Medicine, Oldenburg, Germany
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19
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Zeissig S, Schmelz R, Brückner S, Aust DE, Baretton GB, Hampe J. Direct endoscopy and diagnosis of adenocarcinoma following metal stent-based drainage of a pancreatic cyst. Endoscopy 2018; 50:E72-E73. [PMID: 29329480 DOI: 10.1055/s-0043-124182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Sebastian Zeissig
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Renate Schmelz
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Brückner
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniela E Aust
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gustavo B Baretton
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jochen Hampe
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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20
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Hausmann J, Schmelz R, Walldorf J, Filmann N, Zeuzem S, Albert JG. Pan-intestinal capsule endoscopy in patients with postoperative Crohn's disease: a pilot study. Scand J Gastroenterol 2017; 52:840-845. [PMID: 28431493 DOI: 10.1080/00365521.2017.1310289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients are at increased risk of disease recurrence after surgical treatment of Crohn's disease. Endoscopic detection of postoperative, ileo-colonic inflammation is well established, but the potential of pan-intestinal endoscopy is yet unknown. METHODS This prospective multicenter pilot study assessed the value of pan-intestinal capsule endoscopy using a colon capsule endoscope for the detection of inflammatory recurrence of Crohn´s disease. Patients who had been operatively treated for Crohn´s disease were included. Colon capsule endoscopy was performed 4-8 weeks (d1) and 4-8 months (d2) postoperatively together with ileo-colonoscopy at d2 using a modified Ruttgeerts index for evaluating disease activity. RESULTS Twenty-two patients were included into this study. At d1, significant disease activity (Ruttgeerts index ≥2) was detected in 3/16 (19%) of the patients. At d2, half of the patients (6/12) showed active disease, whereas ileo-colonoscopy revealed significant inflammation in 5/15 (33%). All patients rated as having active disease by ileo-colonoscopy had been revealed by PICE as well. These findings influenced the medical treatment in every case. CONCLUSION Pan-intestinal capsule endoscopy seems to be feasible in the postoperative surveillance of Crohn's disease. Disease activity is reliably detected. Especially, the findings in the small bowl might be a significant advantage in comparison to ileo-colonoscopy, as they can have significant impact on clinical management. Further studies with a larger number of patients are needed to confirm these findings and might lead to a replacement of the flexible ileo-colonoscopy with pan-intestinal capsule endoscopy in this indication in the future.
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Affiliation(s)
- Johannes Hausmann
- a Department of Internal Medicine 1 , J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Renate Schmelz
- b Department of Internal Medicine 1 , University Hospital Carl Gustav Carus , Dresden , Germany
| | - Jens Walldorf
- c Department of Internal Medicine 1 , University Hospital Halle (Saale) , Halle , Germany
| | - Natalie Filmann
- d Institute of Biostatistics and Math Modeling, J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Stefan Zeuzem
- a Department of Internal Medicine 1 , J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
| | - Jörg G Albert
- a Department of Internal Medicine 1 , J.W. Goethe University Hospital Frankfurt , Frankfurt , Germany
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Stallmach A, Langbein C, Atreya R, Bruns T, Dignass A, Ende K, Hampe J, Hartmann F, Neurath MF, Maul J, Preiss JC, Schmelz R, Siegmund B, Schulze H, Teich N, von Arnim U, Baumgart DC, Schmidt C. Vedolizumab provides clinical benefit over 1 year in patients with active inflammatory bowel disease - a prospective multicenter observational study. Aliment Pharmacol Ther 2016; 44:1199-1212. [PMID: 27714831 DOI: 10.1111/apt.13813] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [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: 07/20/2016] [Revised: 08/03/2016] [Accepted: 09/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab, a monoclonal antibody targeting the α4β7-integrin, is effective in inducing and maintaining clinical remission in Crohn's disease and ulcerative colitis according to randomised clinical trials. AIM To determine the long-term effectiveness of vedolizumab in a real-world clinical setting. METHODS This observational registry assessed the clinical outcome in patients treated with vedolizumab for clinically active Crohn's disease (n = 67) or ulcerative colitis (n = 60). Primary endpoint was clinical remission (HBI ≤ 4/pMayo ≤ 1) at week 54. Secondary endpoints included clinical response rates (HBI/pMayo score drop ≥3) and steroid-free clinical remission at weeks 30 and 54. RESULTS Vedolizumab was stopped in 69/127 (56%) patients after a median time of 18 weeks (range 2-49) predominantly owing to lack or loss of response. Using nonresponder imputation analysis, clinical remission and steroid-free remission rates were 21% and 15% in Crohn's disease and 25% and 22% in ulcerative colitis, respectively. Lack of clinical remission was associated with prior treatment with anti-TNF or with steroids for more than 3 months in the last 6 months in ulcerative colitis. At week 14, the absence of remission in Crohn's disease or nonresponse in ulcerative colitis indicated a low likelihood of clinical remission at week 54 [2/31 (7%) in Crohn's disease, 4/41 (10%) in ulcerative colitis]. Accordingly, declining C-reactive protein in inflammatory bowel disease and/or lower faecal calprotectin in ulcerative colitis at week 14 predicted remission at week 54. CONCLUSION Among patients who started vedolizumab for active inflammatory bowel disease, clinical remission rates are 21-25% after 54 weeks.
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Zeissig S, Schmelz R. [Infections in inflammatory bowel disease]. Dtsch Med Wochenschr 2016; 141:196-200. [PMID: 26841183 DOI: 10.1055/s-0041-107951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Infections significantly contribute to morbidity and mortality in inflammatory bowel diseases (IBD). Major risk factors for opportunistic infections in IBD include malnutrition, comorbidities, age and immunosuppression. While the risk of infection associated with corticosteroids, thiopurines, and TNFα antibodies has been determined in large, population-based studies, less is known about the risk associated with antibodies targeting gut-selective integrins. Furthermore, controversial data exist regarding the risk of infection under combined immunosuppression. In clinical practice, screening for infectious diseases before medical immunosuppression and delineation of disease flares from infectious complications remains of critical importance.
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Hausmann J, Schmelz R, Walldorf J, Albert J. Pan-intestinale Kapselendoskopie zur postoperativen Überwachung von Patienten mit M. Crohn. Z Gastroenterol 2015. [DOI: 10.1055/s-0035-1559070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schmelz R, Bornhäuser M, Schetelig J, Kiani A, Platzbecker U, Schwanebeck U, Grählert X, Uharek L, Aust D, Baretton G, Schwerdtfeger R, Hampe J, Greinwald R, Mueller R, Ehninger G, Miehlke S. Randomised, double-blind, placebo-controlled trial of oral budesonide for prophylaxis of acute intestinal graft-versus-host disease after allogeneic stem cell transplantation (PROGAST). BMC Gastroenterol 2014; 14:197. [PMID: 25425214 PMCID: PMC4258813 DOI: 10.1186/s12876-014-0197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/31/2014] [Indexed: 11/11/2022] Open
Abstract
Background Gastrointestinal graft–versus-host disease (GvHD) is a potentially life-threatening complication after allogeneic stem cell transplantation (SCT). Since therapeutic options are still limited, a prophylactic approach seems to be warranted. Methods In this randomised, double-blind-phase III trial, we evaluated the efficacy of budesonide in the prophylaxis of acute intestinal GvHD after SCT. The trial was registered at https://clinicaltrials.gov, number NCT00180089. Patients were randomly assigned to receive either 3 mg capsule three times daily oral budesonide or placebo. Budesonide was applied as a capsule with pH-modified release in the terminal ileum. Study medication was administered through day 56, follow-up continued until 12 months after transplantation. If any clinical signs of acute intestinal GvHD appeared, an ileocolonoscopy with biopsy specimens was performed. Results The crude incidence of histological or clinical stage 3–4 acute intestinal GvHD until day 100 observed in 91 (n =48 budesonide, n =43 placebo) evaluable patients was 12.5% (95% CI 3-22%) under treatment with budesonide and 14% (95% CI 4-25%) under placebo (p = 0.888). Histologic and clinical stage 3–4 intestinal GvHD after 12 months occurred in 17% (95% CI 6-28%) of patients in the budesonide group and 19% (CI 7-32%) in the placebo group (p = 0.853). Although budesonide was tolerated well, we observed a trend towards a higher rate of infectious complications in the study group (47.9% versus 30.2%, p = 0.085). The cumulative incidences at 12 months of intestinal GvHD stage >2 with death as a competing event (budesonide 20.8% vs. placebo 32.6%, p = 0.250) and the cumulative incidence of relapse (budesonide 20.8% vs. placebo 16.3%, p = 0.547) and non-relapse mortality (budesonide 28% (95% CI 15-41%) vs. placebo 30% (95% CI 15-44%), showed no significant difference within the two groups (p = 0.911). The trial closed after 94 patients were enrolled because of slow accrual. Within the limits of the final sample size, we were unable to show any benefit for the addition of budesonide to standard GvHD prophylaxis. Conclusions Budesonide did not decrease the occurrence of intestinal GvHD in this trial. These results imply most likely that prophylactic administration of budenoside with pH-modified release in the terminal ileum is not effective.
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Schmelz R, Hampe J. [Fecal microbiota transplantation: when and for whom?]. Dtsch Med Wochenschr 2014; 139:1237-9. [PMID: 24866958 DOI: 10.1055/s-0034-1370032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R Schmelz
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus der TU Dresden
| | - J Hampe
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus der TU Dresden
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Sommer U, Larsson B, Tuve S, Wehner R, Zimmermann N, Kramer M, Kloβ A, Günther C, Babatz J, Schmelz R, Brückner S, Schetelig J, Bornhäuser M, Schäkel K, Bachmann MP, Aust D, Baretton G, Schmitz M. Proinflammatory human 6-sulfo LacNAc-positive dendritic cells accumulate in intestinal acute graft-versus-host disease. Haematologica 2014; 99:e86-9. [PMID: 24682513 DOI: 10.3324/haematol.2013.101071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ulrich Sommer
- Institute of Pathology, University Hospital of Dresden, Dresden, Germany
| | - Brit Larsson
- Department of Medicine I, University Hospital of Dresden, Dresden, Germany
| | - Sebastian Tuve
- Department of Medicine I, University Hospital of Dresden, Dresden, Germany
| | - Rebekka Wehner
- Institute of Immunology, Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Nick Zimmermann
- Department of Dermatology, University Hospital of Dresden, Dresden, Germany
| | - Michael Kramer
- Department of Medicine I, University Hospital of Dresden, Dresden, Germany
| | - Anja Kloβ
- Institute of Immunology, Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital of Dresden, Dresden, Germany
| | - Jana Babatz
- Institute of Immunology, Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Renate Schmelz
- Institute of Immunology, Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Stefan Brückner
- Institute of Immunology, Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Johannes Schetelig
- Department of Medicine I, University Hospital of Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital of Dresden, Dresden, Germany Center for Regenerative Therapies Dresden, Dresden, Germany
| | - Knut Schäkel
- Department of Dermatology, University Hospital of Heidelberg, Dresden, Germany
| | - Michael Philipp Bachmann
- Institute of Immunology, Medical Faculty, Dresden University of Technology, Dresden, Germany Center for Regenerative Therapies Dresden, Dresden, Germany Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Deparment of Radioimmunology, Dresden, Germany
| | - Daniela Aust
- Institute of Pathology, University Hospital of Dresden, Dresden, Germany
| | - Gustavo Baretton
- Institute of Pathology, University Hospital of Dresden, Dresden, Germany
| | - Marc Schmitz
- Institute of Immunology, Medical Faculty, Dresden University of Technology, Dresden, Germany Center for Regenerative Therapies Dresden, Dresden, Germany
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Werber KD, Schmelz R, Peimer CA, Wagenpfeil S, Machens HG, Lohmeyer JA. Biomechanical effect of isolated capitate shortening in Kienbock's disease: an anatomical study. J Hand Surg Eur Vol 2013; 38:500-7. [PMID: 22918882 DOI: 10.1177/1753193412458996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 02/03/2023]
Abstract
Multiple operations have been proposed to slow the progression of osteonecrosis and secondary carpal damage in Kienböck's disease. To assess the biomechanical changes after capitate shorting, we inserted pressure-testing devices into the carpal and radiocarpal joints in an anatomical study. Pressure sensors were placed into eight thawed non-fixated human cadaver arms to measure the forces transmitted in physiological loading. Longitudinal 9.8 N and 19.6 N forces were applied before and after capitate shortening. After capitate shortening, significant load reduction on the lunate was evident in all specimens. An average decrease of 49% was seen under a 9.8 N load and 56% under a 19.6 N load. The load was transferred to the radial and ulnar intercarpal joints. More relief of pressure on the lunate after isolated capitate shortening is achieved with a shallow angle between the scaphoid and capitate in the posteroanterior radiograph.
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Affiliation(s)
- K-D Werber
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Wermke M, Maiwald S, Schmelz R, Thiede C, Schetelig J, Ehninger G, Bornhäuser M, Wassmuth R. Genetic variations of interleukin-23R (1143A>G) and BPI (A645G), but not of NOD2, are associated with acute graft-versus-host disease after allogeneic transplantation. Biol Blood Marrow Transplant 2010; 16:1718-27. [PMID: 20541026 DOI: 10.1016/j.bbmt.2010.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 06/01/2010] [Indexed: 10/19/2022]
Abstract
Single nucleotide polymorphisms (SNPs) in genes of the immune system predict for aGVHD and mortality after allo-SCT. We investigated the effect of SNPs in the NOD2, BPI, and IL-23R genes on posttransplantation outcome in a cohort of 304 patients. NOD2 patient and donor genotype and BPI recipient genotype were not associated with the occurrence of aGVHD. However, IL-23R-SNP in the donor was correlated with less aGVHD. This association could be confirmed in multivariate analysis (odds ratio [OR], 0.39; P = .039), which identified in vivo T cell depletion (OR, 0.32; P < .001) and multiagent GVHD prophylaxis (OR, 0.51; P = .031) as other independent factors predicting for less-severe aGVHD. This multivariate model also revealed a trend toward less aGVHD in patients receiving a BPI G allele transplant (OR, 0.60; P = .067) and in those receiving a transplant from an HLA-matched donor (OR, 0.57; P = .058). In contrast, relapse was more frequent in patients with NOD2-SNPs (46.2% for SNP vs 33.2% for wild-type; P = .020). This association was found to be of borderline significance in multivariate analysis. Neither BPI nor IL-23R genotype predicted for relapse, and none of the investigated SNPs was correlated with 5-year overall survival. In our analysis, NOD2 SNPs did not predict aGVHD, but IL-23R(1142A>G) and BPI(A645G) SNPs appeared to be promising markers in this regard. The importance of these markers in prediction models for GVHD and relapse remain to be defined in large prospective clinical trials.
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Affiliation(s)
- Martin Wermke
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Fetscherstraße 74, Dresden, Germany.
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Abstract
Gastric mucosa associated lymphoid tissue (MALT) lymphoma has recently been incorporated into the World Health Organization (WHO) lymphoma classification, termed as extranodal marginal zone B-cell lymphoma of MALT-type. In about 90% of cases this lymphoma is associated with H pylori infection which has been clearly shown to play a causative role in lymphomagenesis. Although much knowledge has been gained in defining the clinical features, natural history, pathology, and molecular genetics of the disease in the last decade, the optimal treatment approach for gastric MALT lymphomas, especially locally advanced cases, is still evolving. In this review we focus on data for the therapeutic, stage dependent management of gastric MALT lymphoma. Hence, the role of eradication therapy, surgery, chemotherapy and radiotherapy is critically analyzed. Based on these data, we suggest a therapeutic algorithm that might help to better stratify patients for optimal treatment success.
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Affiliation(s)
- Andrea Morgner
- Medical Department I, University Hospital, Technical University Dresden, Germany.
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von Delius S, Eckel F, Wagenpfeil S, Mayr M, Stock K, Kullmann F, Obermeier F, Erdmann J, Schmelz R, Quasthoff S, Adelsberger H, Bredenkamp R, Schmid RM, Lersch C. Carbamazepine for prevention of oxaliplatin-related neurotoxicity in patients with advanced colorectal cancer: Final results of a randomised, controlled, multicenter phase II study. Invest New Drugs 2006; 25:173-80. [PMID: 16983507 DOI: 10.1007/s10637-006-9010-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 08/28/2006] [Indexed: 12/22/2022]
Abstract
BACKGROUND Oxaliplatin-induced neurotoxicity is a growing, relevant clinical problem. In this study we evaluated the efficacy and safety of carbamazepine for prevention of oxaliplatin-associated neuropathy in patients with advanced colorectal cancer. METHODS Chemotherapeutic treatment consisted of oxaliplatin 85 mg/m(2) given biweekly and weekly folinic acid 500 mg/m(2) followed by a 24-h infusion of 5-FU 2000 mg/m(2) (FUFOX). One cycle consisted of six consecutive weeks of treatment followed by two weeks of rest (=Treatment B). For Treatment A carbamazepine was added in a dosage for targeted plasma levels of 4-6 mg/L. Neurotoxicity was regularly assessed using a specific scale. Moreover, an evaluation of chronic sensory symptoms and a neurologic examination including tests for vibrational sense, strength and deep tendon reflexes were added creating a peripheral neuropathy (PNP) score. RESULTS The prospectively defined adequate number of patients needed to provide power for the primary outcome could not be achieved. 19 patients were assigned to Treatment A and 17 to Treatment B. At baseline, the distribution of all clinicopathologic variables was comparable between the two groups. Overall response rates were 16% and 24% and overall survival 15.1 months and 17.4 months for Treatment A and Treatment B, respectively. Between Treatment A and Treatment B there were no major differences when considering worst neurotoxicity during the study period (p=0.46). Grade 3/4 neurotoxicity occured in 4 patients with Treatment A vs. 6 patients with Treatment B. There were no major differences between both groups in each category of the PNP score. CONCLUSIONS Based on the small number of patients and low statistical power of our study definite conclusions regarding efficacy and safety of carbamazepine for prevention of oxaliplatin-associated neuropathy in patients with advanced colorectal cancer cannot be drawn.
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Affiliation(s)
- Stefan von Delius
- Department of Internal Medicine II, Technical University of Munich, Munich, Germany.
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Huber W, Eckel F, Hennig M, Rosenbrock H, Wacker A, Saur D, Sennefelder A, Hennico R, Schenk C, Meining A, Schmelz R, Fritsch R, Weiss W, Hamar P, Heemann U, Schmid RM. Prophylaxis of contrast material-induced nephropathy in patients in intensive care: acetylcysteine, theophylline, or both? A randomized study. Radiology 2006; 239:793-804. [PMID: 16714461 DOI: 10.1148/radiol.2393041456] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To prospectively compare the protective effect of acetylcysteine, theophylline, and both agents combined in patients who are admitted to the intensive care unit with at least one risk factor for contrast material-induced nephropathy and who receive at least 100 mL of iodinated contrast medium. MATERIALS AND METHODS Institutional ethics review board approval and informed consent were obtained. A total of 91 patients (mean age, 58.5 years+/-14.8 [standard deviation]; 31 women, 60 men; 150 examinations) were admitted to the intensive care unit with at least one risk factor for contrast-induced nephropathy and received either (a) 200 mg theophylline 30 minutes before contrast medium administration (group T), (b) 600 mg acetylcysteine twice daily on the day of and (if possible) the day before the examination (group A), or (c) both agents combined (group AT). The primary endpoint for this study was the incidence of contrast-induced nephropathy (chi2 test). RESULTS Groups T, A, and AT were comparable with regard to baseline creatinine levels and the amount of contrast medium administered. The incidence of contrast-induced nephropathy in groups T, A, and AT was 2%, 12%, and 4%, respectively, and was significantly lower in group T than in group A (P=.047). There was no significant difference in the incidence of contrast-induced nephropathy between groups A and AT (P=.148) or between groups T and AT (P=.53). For group A, serum creatinine did not change after 12, 24, or 48 hours compared with baseline. Creatinine levels in group T decreased 12 hours (1.19 mg/dL+/-0.58; P=.008) and 48 hours (1.16 mg/dL+/-0.55; P=.034) after contrast material injection compared with baseline (1.25 mg/dL+/-0.61). In group AT, creatinine significantly decreased 24 hours (1.21 mg/dL+/-0.74; P=.003) and 48 hours (1.17 mg/dL+/-0.69; P<.001) after contrast material injection compared with baseline (1.28 mg/dL+/-0.74). Group A had significantly higher maximal increases in creatinine than groups T and AT (P=.014). CONCLUSION For prophylaxis of contrast-induced nephropathy in patients who are admitted to the intensive care unit and who receive 100 mL or more of contrast medium, theophylline is superior to acetylcysteine.
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Affiliation(s)
- Wolfgang Huber
- II. Medizinische Klinik, Institut für Medizinische Statistik und Epidemiologie, Universitaetsklinik Tuebingen, Kinderkardiologie, Munich, Germany.
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Madisch A, Aust D, Morgner A, Grossmann D, Schmelz R, Kropp J, Ehninger G, Baretton G, Miehlke S. Resolution of gastrointestinal protein loss after Helicobacter pylori eradication in a patient with hypertrophic lymphocytic gastritis. Helicobacter 2004; 9:629-31. [PMID: 15610076 DOI: 10.1111/j.1083-4389.2004.00275.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Lymphocytic gastritis is a rare condition found in approximately 1% of dyspeptic patients. An association with Helicobacter pylori infection has been described. Hypertrophic lymphocytic gastritis is a rare cause of gastrointestinal protein loss. Here, we describe a patient with hypertrophic lymphocytic gastritis, in whom gastrointestinal protein loss resolved completely following H. pylori eradication. CASE REPORT A 38-year old obese man without gastrointestinal symptoms showed a markedly decreased serum protein (53 g/l, normal 66-85 g/l), a decreased serum albumin (33 g/l, normal 35-52 g/l) and decreased serum immunoglobulin G and immunoglobulin M levels. A renal cause for protein loss was excluded, liver function was normal. Endoscopy of the upper gastrointestinal tract revealed enlarged rigid gastric folds, and an H. pylori-associated lymphocytic gastritis. 99mTc-labelled albumin scintigraphy showed an increased activity in the upper left abdomen compatible with protein secretion in the stomach, and tracer pooling in the upper small bowel. Push enteroscopy with histology demonstrated a normal upper small bowel. Two months after eradication therapy, cure of H. pylori infection was documented and serum protein (71 g/l) and albumin (41 g/l) had returned to normal, while lymphocytic gastritis was still present. One year after eradication therapy endoscopy of the upper gastrointestinal tract and histology and laboratory values were normal. CONCLUSION Protein-losing gastropathy caused by H. pylori-associated hypertrophic lymphocytic gastritis can be cured solely by H. pylori eradication therapy.
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Affiliation(s)
- Ahmed Madisch
- Medical Department I, Technical University Hospital, Dresden, Germany.
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Lersch C, Schmelz R, Erdmann J, Hollweck R, Schulte-Frohlinde E, Eckel F, Nader M, Schusdziarra V. Treatment of HCC with pravastatin, octreotide, or gemcitabine--a critical evaluation. Hepatogastroenterology 2004; 51:1099-103. [PMID: 15239254] [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: 04/30/2023]
Abstract
BACKGROUND/AIMS New perspectives in the treatment of advanced hepatocellular carcinomas have recently been inaugurated with the application of hydroxymethylglutaryl coenzyme A reductase inhibitors i.e. pravastatin, the somatostatin analogue octreotide, or the cytidine analogue gemcitabine. The present study aimed to evaluate these substances in patients with progressive tumor growth. METHODOLOGY A total of 58 patients either received 3 x 200 microg/day octreotide for 2 months followed by 20mg octreotide LAR every 4 weeks (n=30) or 40-80 mg pravastatin (n=20) or 80-90 mg/m2 gemcitabine over 24 hours weekly in cycles of 4 weeks (n=8). Kaplan-Meier survival curves and the log-rank test were used for univariate comparison of sur vival. RESULTS The median overall survival of patients receiving octreotide was 5 months, of patients receiving pravastatin 7.2 months and of patients receiving gemcitabine 3.5 months. The difference between the pravastatin and the gemcitabine groups was significant. No WHO grade 3 or 4 side effects were seen in either group of patients. CONCLUSIONS These results do not confirm those of former studies. Neither pravastatin, nor octreotide, nor gemcitabine did prolong the patients' median overall survival as compared to control groups reported by other authors. New therapeutic strategies have to be found for patients with advanced hepatocellular carcinomas.
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Affiliation(s)
- C Lersch
- II. Department of Internal Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany.
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Eckel F, Schmelz R, Erdmann J, Mayr M, Lersch C. Phase II trial of a 24-hour infusion of gemcitabine in previously untreated patients with advanced pancreatic adenocarcinoma. Cancer Invest 2003; 21:690-4. [PMID: 14628426 DOI: 10.1081/cnv-120023767] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The antitumor effect of gemcitabine is not dose-response related but schedule dependent. Here we report a phase II trial of a weekly 24-hour infusion of gemcitabine in previously untreated patients with advanced pancreatic cancer. Patients with histologically proven, measurable, and irresectable pancreatic adenocarcinoma were treated with gemcitabine at a dose of 100 mg/m2 infused over 24 hr on days 1, 8, and 15. Treatment was repeated every 28 days until progression of disease or limiting toxicity. All 18 patients enrolled were evaluable for response. Neutropenia and thrombocytopenia grade 3 occurred in 1 patient each. One partial response and two minor responses were observed. Median time to progression of disease was 4.4 months. Improvement of the European Organization for Research and Treatment of Cancer C30 scores was observed in 6 patients (pain and overall symptom score, respectively) and in 3 patients (overall functioning score and global quality of life, respectively). Weekly 24-hr gemcitabine was well tolerated in previously untreated patients with advanced pancreatic cancer. It shows marginal antitumor activity in terms of response rate. However, the 24-hr infusion at a dose of 100 mg/m2 seems to be as active as the standard 30-min gemcitabine at a dose of 1000 mg/m2. Relatively long median time to progression of disease and improvement of symptom and quality-of-life scores suggest, that patients may benefit from 24-hr gemcitabine.
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Affiliation(s)
- Florian Eckel
- Department of Internal Medicine II, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
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Lersch C, Schmelz R, Eckel F, Erdmann J, Mayr M, Schulte-Frohlinde E, Quasthoff S, Grosskreutz J, Adelsberger H. Prevention of oxaliplatin-induced peripheral sensory neuropathy by carbamazepine in patients with advanced colorectal cancer. Clin Colorectal Cancer 2002; 2:54-8. [PMID: 12453338 DOI: 10.3816/ccc.2002.n.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Oxaliplatin plays a key role in the treatment of advanced colorectal cancer. The dose-limiting side effect of this platinum analogue is neurotoxicity. Significant efforts have been undertaken in an attempt to prevent and/or circumvent the development of neurotoxicity. Sodium channel inactivation kinetics on rat sensory sural nerve preparations are altered after exposure to oxaliplatin. Carbamazepine antagonizes this effect in vitro. Results from preliminary clinical studies indicate that the sodium channel blockers carbamazepine and gabapentin may be effective in preventing neurotoxicity. The role of amifostine is not yet clear. Randomized clinical studies are necessary to confirm the potential benefit of carbamazepine and other sodium channel blockers in preventing and/or overcoming the development of oxaliplatin-induced neurotoxicity.
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Affiliation(s)
- Christian Lersch
- II. Medical Hospital and Health Center, Technischen Universität München, Klinikum rechts der Isar, Ismaninger St 22, 81675 Munich, Germany.
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Eckel F, Schmelz R, Adelsberger H, Erdmann J, Quasthoff S, Lersch C. [Prevention of oxaliplatin-induced neuropathy by carbamazepine. A pilot study]. Dtsch Med Wochenschr 2002; 127:78-82. [PMID: 11797144 DOI: 10.1055/s-2002-19594] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Oxaliplatin has been proven antitumoral activity in numerous clinical trials. Peripheral sensory neuropathy with predominantly hyperpathic symptoms induced by cold is the most severe and dose-limiting toxicity resulting from oxaliplatin therapy. We demonstrated that oxaliplatin alters sodium channel kinetics on sensory neurons. This effect could be antagonized in vitro by the sodium channel blocker carbamazepine. Therefore a pilot study was initiated to investigate if carbamazepine prevents oxaliplatin-induced neuropathy in patients with colorectal cancer. PATIENTS AND METHODS Ten patients (six males, four females, mean age 56 +/- 12 years) refractory to 5-fluorouracil were treated with oxaliplatin, 5-fluorouracil, and folinic acid. The patients additionally received carbamazepine. Doses were adapted to a serum level of 3 - 6 mg/l. Patients were questioned about side-effects weekly and treatment-related toxicities were documented using the modified WHO scale. Results were compared with 30 historic controls treated with the same chemotherapy without carbamazepine. RESULTS The cumulative oxaliplatin dose was higher in the carbamazepine group (median 722 mg/m(2) and 510 mg/m(2), respectively, p = 0.020). Carbamazepine levels were 4.5 +/- 1.5 mg/l. In contrast to the control group no neuropathy higher than grade 1 occurred in the carbamazepine group. Rate of carbamazepine-induced side effects was low. CONCLUSIONS These observations demonstrate that oxaliplatin-induced sensory neuropathy more than grade 1 may be prevented by carbamazepine. Prevention of oxaliplatin-induced neurotoxicity by carbamazepine would possibly enable chemotherapy with considerable higher doses of oxapliplatin and thus enhance activity. A multicenter trial will elucidate if more serious distal neurotoxicities, which occur after application of higher cumulative doses of oxaliplatin, can also be prevented by carbamazepine.
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Affiliation(s)
- F Eckel
- Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany.
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