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Lukin D, Faleck D, Xu R, Zhang Y, Weiss A, Aniwan S, Kadire S, Tran G, Rahal M, Winters A, Chablaney S, Koliani-Pace JL, Meserve J, Campbell JP, Kochhar G, Bohm M, Varma S, Fischer M, Boland B, Singh S, Hirten R, Ungaro R, Lasch K, Shmidt E, Jairath V, Hudesman D, Chang S, Swaminath A, Shen B, Kane S, Loftus EV, Sands BE, Colombel JF, Siegel CA, Sandborn WJ, Dulai PS. Comparative Safety and Effectiveness of Vedolizumab to Tumor Necrosis Factor Antagonist Therapy for Ulcerative Colitis. Clin Gastroenterol Hepatol 2022; 20:126-135. [PMID: 33039584 PMCID: PMC8026779 DOI: 10.1016/j.cgh.2020.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We aimed to compare safety and effectiveness of vedolizumab to tumor necrosis factor (TNF)-antagonist therapy in ulcerative colitis in routine practice. METHODS A multicenter, retrospective, observational cohort study (May 2014 to December 2017) of ulcerative colitis patients treated with vedolizumab or TNF-antagonist therapy. Propensity score weighted comparisons for development of serious adverse events and achievement of clinical remission, steroid-free clinical remission, and steroid-free deep remission. A priori determined subgroup comparisons in TNF-antagonist-naïve and -exposed patients, and for vedolizumab against infliximab and subcutaneous TNF-antagonists separately. RESULTS A total of 722 (454 vedolizumab, 268 TNF antagonist) patients were included. Vedolizumab-treated patients were more likely to achieve clinical remission (hazard ratio [HR], 1.651; 95% confidence interval [CI], 1.229-2.217), steroid-free clinical remission (HR, 1.828; 95% CI, 1.135-2.944), and steroid-free deep remission (HR, 2.819; 95% CI, 1.496-5.310) than those treated with TNF antagonists. Results were consistent across subgroup analyses in TNF-antagonist-naïve and -exposed patients, and for vedolizumab vs infliximab and vs subcutaneous TNF-antagonist agents separately. Overall, there were no statistically significant differences in the risk of serious adverse events (HR, 0.899; 95% CI, 0.502-1.612) or serious infections (HR, 1.235; 95% CI, 0.608-2.511) between vedolizumab-treated and TNF-antagonist-treated patients. However, in TNF-antagonist-naïve patients, vedolizumab was less likely to be associated with serious adverse events than TNF antagonists (HR, 0.192; 95% CI, 0.049-0.754). CONCLUSIONS Treatment of ulcerative colitis with vedolizumab is associated with higher rates of remission than treatment with TNF-antagonist therapy in routine practice, and lower rates of serious adverse events in TNF-antagonist-naïve patients.
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Affiliation(s)
- Dana Lukin
- Montefiore Medical Center, New York, New York
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronghui Xu
- University of California, San Diego, La Jolla, California
| | - Yiran Zhang
- University of California, San Diego, La Jolla, California
| | - Aaron Weiss
- Montefiore Medical Center, New York, New York
| | | | | | | | | | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Joseph Meserve
- University of California, San Diego, La Jolla, California
| | | | | | | | | | | | - Brigid Boland
- University of California, San Diego, La Jolla, California
| | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Ungaro
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Lasch
- Takeda Pharmaceuticals, Lexington, Massachusetts
| | | | - Vipul Jairath
- University of Western Ontario, London, Ontario, Canada
| | | | | | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
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2
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Parker CH, Naliboff BD, Shih W, Presson AP, Kilpatrick L, Gupta A, Liu C, Keefer LA, Sauk JS, Hirten R, Sands BE, Chang L. The Role of Resilience in Irritable Bowel Syndrome, Other Chronic Gastrointestinal Conditions, and the General Population. Clin Gastroenterol Hepatol 2021; 19:2541-2550.e1. [PMID: 32835842 PMCID: PMC7897330 DOI: 10.1016/j.cgh.2020.08.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Resilience is the ability to adapt positively to stress and adversity. It is a potential therapeutic target as it is reduced in irritable bowel syndrome (IBS) compared to healthy controls and associated with worse symptom severity and poorer quality of life. The aim of this study was to examine if these findings are generalizable by comparing resilience between IBS versus the general population and other chronic gastrointestinal (GI) conditions. METHODS Participants in the general population completed an online survey containing questionnaires measuring demographics, diagnosis of IBS and other GI conditions, symptom severity, psychological symptoms, resilience, and early adverse life events (EALs). IBS was defined as having a physician diagnosis of IBS and/or meeting Rome criteria without co-morbid GI disease. All others were included in the general population group. The chronic GI conditions group included those with inflammatory bowel disease, celiac disease and/or microscopic colitis. RESULTS Resilience was lower in IBS (n = 820) than the general population (n = 1026; p < 0.001) and associated with worse IBS symptom severity (p < 0.05). Global mental health affected resilience differently in IBS compared to the general population (all p's < 0.05). EALs were associated with decreased ability to bounce back from adversity in both IBS and the general population (p < 0.001). Resilience scores were similar in IBS and other chronic GI conditions that present with similar symptoms. CONCLUSIONS Resilience is lower compared to the general U.S. population but does not appear to be specific to IBS as it is comparable to other chronic GI conditions. Low resilience negatively affects symptom severity and mental health and thus, may serve as a novel therapeutic target.
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Affiliation(s)
- Colleen H. Parker
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California,Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce D. Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Wendy Shih
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Angela P. Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City Utah
| | - Lisa Kilpatrick
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Cathy Liu
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Laurie A. Keefer
- Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jenny S. Sauk
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Robert Hirten
- Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce E. Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California.
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Ungaro RC, Agrawal M, Park S, Hirten R, Colombel JF, Twyman K, Gulko PS, Klang E. Autoimmune and Chronic Inflammatory Disease Patients with COVID-19. ACR Open Rheumatol 2021; 3:111-115. [PMID: 33527691 PMCID: PMC7882518 DOI: 10.1002/acr2.11221] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
Objective There are limited data on the impact of coronavirus disease 2019 (COVID‐19) on hospitalized patients with autoimmune and chronic inflammatory disease (AICID) compared with patients who do not have AICID. We sought to evaluate whether patients with AICID who have confirmed COVID‐19 presenting to the hospital are at higher risk of adverse outcomes compared with those patients without AICID who are infected with COVID‐19 and whether immunosuppressive medications impact this risk. Methods We performed a multicenter retrospective cohort study with patients presenting to five hospitals in a large academic health system with polymerase chain reaction–confirmed COVID‐19 infection. We evaluated the impact of having an AICID and class of immunosuppressive medication being used to treat patients with AICID (biologics, nonbiologic immunosuppressives, or systemic corticosteroids) on the risk of developing severe COVID‐19 defined as requiring mechanical ventilation (MV) and/or death. Results A total of 6792 patients with confirmed COVID‐19 were included in the study, with 159 (2.3%) having at least one AICID. On multivariable analysis, AICIDs were not significantly associated with severe COVID‐19 (adjusted odds ratio [aOR] 1.3, 95% confidence interval [CI]: 0.9‐1.8). Among patients with AICID, use of biologics or nonbiologic immunosuppressives did not increase the risk of severe COVID‐19. In contrast, systemic corticosteroid use was significantly associated with an increased risk of severe COVID‐19 (aOR 6.8, 95% CI: 2.5‐18.4). Conclusion Patients with AICID are not at increased risk of severe COVID‐19 with the exception of those on corticosteroids. These data suggest that patients with AICID should continue on biologic and nonbiologic immunosuppression but limit steroids during the COVID‐19 pandemic.
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Affiliation(s)
- Ryan C Ungaro
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Manasi Agrawal
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Park
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Kathryn Twyman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Percio S Gulko
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eyal Klang
- Icahn School of Medicine at Mount Sinai, New York, New York
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Dulai PS, Singh S, Casteele NV, Meserve J, Winters A, Chablaney S, Aniwan S, Shashi P, Kochhar G, Weiss A, Koliani-Pace JL, Gao Y, Boland BS, Chang JT, Faleck D, Hirten R, Ungaro R, Lukin D, Sultan K, Hudesman D, Chang S, Bohm M, Varma S, Fischer M, Shmidt E, Swaminath A, Gupta N, Rosario M, Jairath V, Guizzetti L, Feagan BG, Siegel CA, Shen B, Kane S, Loftus EV, Sandborn WJ, Sands BE, Colombel JF, Lasch K, Cao C. Development and Validation of Clinical Scoring Tool to Predict Outcomes of Treatment With Vedolizumab in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol 2020; 18:2952-2961.e8. [PMID: 32062041 PMCID: PMC7899124 DOI: 10.1016/j.cgh.2020.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 07/15/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS We created and validated a clinical decision support tool (CDST) to predict outcomes of vedolizumab therapy for ulcerative colitis (UC). METHODS We performed logistic regression analyses of data from the GEMINI 1 trial, from 620 patients with UC who received vedolizumab induction and maintenance therapy (derivation cohort), to identify factors associated with corticosteroid-free remission (full Mayo score of 2 or less, no subscore above 1). We used these factors to develop a model to predict outcomes of treatment, which we called the vedolizumab CDST. We evaluated the correlation between exposure and efficacy. We validated the CDST in using data from 199 patients treated with vedolizumab in routine practice in the United States from May 2014 through December 2017. RESULTS Absence of exposure to a tumor necrosis factor (TNF) antagonist (+3 points), disease duration of 2 y or more (+3 points), baseline endoscopic activity (moderate vs severe) (+2 points), and baseline albumin concentration (+0.65 points per 1 g/L) were independently associated with corticosteroid-free remission during vedolizumab therapy. Patients in the derivation and validation cohorts were assigned to groups of low (CDST score, 26 points or less), intermediate (CDST score, 27-32 points), or high (CDST score, 33 points or more) probability of vedolizumab response. We observed a statistically significant linear relationship between probability group and efficacy (area under the receiver operating characteristic curve, 0.65), as well as drug exposure (P < .001) in the derivation cohort. In the validation cohort, a cutoff value of 26 points identified patients who did not respond to vedolizumab with high sensitivity (93%); only the low and intermediate probability groups benefited from reducing intervals of vedolizumab administration due to lack of response (P = .02). The vedolizumab CDST did not identify patients with corticosteroid-free remission during TNF antagonist therapy. CONCLUSIONS We used data from a trial of patients with UC to develop a scoring system, called the CDST, which identified patients most likely to enter corticosteroid-free remission during vedolizumab therapy, but not anti-TNF therapy. We validated the vedolizumab CDST in a separate cohort of patients in clinical practice. The CDST identified patients most likely to benefited from reducing intervals of vedolizumab administration due to lack of initial response. ClinicalTrials.gov no: NCT00783718.
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Affiliation(s)
- Parambir S. Dulai
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Siddharth Singh
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Niels Vande Casteele
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Joseph Meserve
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Adam Winters
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shreya Chablaney
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Satimai Aniwan
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Preeti Shashi
- Division of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gursimran Kochhar
- Division of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aaron Weiss
- Division of Gastroenterology, Montefiore Medical Center, Bronx, New York
| | - Jenna L. Koliani-Pace
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Youran Gao
- Division of Gastroenterology, North Shore University Hospital, Manhasset, New York
| | - Brigid S. Boland
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - John T. Chang
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - David Faleck
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Hirten
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dana Lukin
- Division of Gastroenterology, Montefiore Medical Center, Bronx, New York
| | - Keith Sultan
- Division of Gastroenterology, North Shore University Hospital, Manhasset, New York
| | - David Hudesman
- Division of Gastroenterology, New York University, New York, New York
| | - Shannon Chang
- Division of Gastroenterology, New York University, New York, New York
| | - Matthew Bohm
- Division of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Sashidhar Varma
- Division of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Monika Fischer
- Division of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Eugenia Shmidt
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota
| | - Arun Swaminath
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York
| | - Nitin Gupta
- Division of Gastroenterology, University of Mississippi, Jackson, Mississippi
| | | | - Vipul Jairath
- Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada
| | | | - Brian G. Feagan
- Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada
| | - Corey A. Siegel
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Bo Shen
- Division of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sunanda Kane
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | | | - William J. Sandborn
- Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Bruce E. Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Lasch
- Takeda Pharmaceuticals USA, Deerfield, Illinois
| | - Charlie Cao
- Takeda Pharmaceuticals USA, Deerfield, Illinois
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Bohm M, Xu R, Zhang Y, Varma S, Fischer M, Kochhar G, Boland B, Singh S, Hirten R, Ungaro R, Shmidt E, Lasch K, Jairaith V, Hudesman D, Chang S, Lukin D, Swaminath A, Sands BE, Colombel J, Kane S, Loftus EV, Shen B, Siegel CA, Sandborn WJ, Dulai PS. Comparative safety and effectiveness of vedolizumab to tumour necrosis factor antagonist therapy for Crohn's disease. Aliment Pharmacol Ther 2020; 52:669-681. [PMID: 32656800 PMCID: PMC7496810 DOI: 10.1111/apt.15921] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/15/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Direct comparisons are lacking between vedolizumab and tumour necrosis factor (TNF)-antagonist therapy in Crohn's disease (CD). AIM To compare safety and effectiveness of vedolizumab and TNF-antagonist therapy in adult CD patients. METHODS Retrospective observational cohort (May 2014-December 2017) propensity score-weighted comparison of vedolizumab vs TNF-antagonist therapy (infliximab, adalimumab, certolizumab) in CD. Propensity scores were weighted for age, prior treatments, disease complications, extent and severity, steroid dependence, and concomitant immunosuppressive drug use. The primary outcome was comparative risk for infections or non-infectious serious adverse events (requiring antibiotics, antivirals, antifungals, hospitalisation, or treatment discontinuation, or resulting in death). Secondary comparative effectiveness outcomes were clinical remission (resolution of CD-related symptoms), steroid-free clinical remission and endoscopic remission (absence of ulcers/erosions). RESULTS We included 1266 patients (n = 659 vedolizumab). Rates of non-infectious serious adverse events (odds ratio [OR] 0.072, 95% confidence interval [CI] 0.012-0.242), but not serious infections (OR 1.183, 95% CI 0.786-1.795), were significantly lower with vedolizumab vs TNF-antagonist therapy. Safety comparisons for non-infectious serious adverse events remained significant after adjusting for differences in duration of exposure. No significant difference was observed between vedolizumab and TNF-antagonist therapy for clinical remission (hazard ratio [HR] 0.932, 95% CI 0.707-1.228), steroid-free clinical remission (HR 1.250, 95% CI 0.677-2.310) or endoscopic remission (HR 0.827, 95% CI 0.595-1.151). TNF-antagonist therapy was associated with higher treatment persistence compared with vedolizumab. CONCLUSIONS There was a lower risk of non-infectious serious adverse events, but not serious infections, with vedolizumab vs TNF-antagonist therapy, with no significant difference for achieving disease remission.
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Sifers T, Hirten R, Mehandru S, Ko HM, Colombel JF, Cunningham-Rundles C. Vedolizumab therapy in common variable immune deficiency associated enteropathy: A case series. Clin Immunol 2020; 212:108362. [PMID: 32058070 DOI: 10.1016/j.clim.2020.108362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 01/09/2023]
Abstract
A number of gastrointestinal complications occur in common variable immunodeficiency (CVID). Infections are one cause, but various forms of severe non-infectious enteropathy also lead to substantial morbidity. The presence of T cell lymphocytic infiltrates in the mucosa have suggested that vedolizumab, a humanized monoclonal antibody which binds to alpha4 beta7 integrin and inhibits the migration of effector T-lymphocytes into gastrointestinal tissues, would be an effective treatment. A previous report of 3 CVID cases suggested benefit in 2 subjects. In this study 7 CVID patients with severe enteropathy were treated with vedolizumab. Four of the 7 completed vedolizumab induction therapy but 3 subjects had acute decompensation during induction and treatment was stopped. While one subject showed improvement, 6 of the 7 patients were withdrawn from therapy. While vedolizumab may be of use in some CVID subjects, it was not ultimately found helpful in most of these patients.
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Affiliation(s)
- Travis Sifers
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States
| | - Robert Hirten
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States
| | - Saurabh Mehandru
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States; PRISM Immunology Institute, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States
| | - Huaibin Mabel Ko
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States
| | - Charlotte Cunningham-Rundles
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States; PRISM Immunology Institute, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029-6574, United States.
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7
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Fenster M, Ungaro RC, Hirten R, Gallinger Z, Cohen L, Atreja A, Mehandru S, Colombel JF, Cohen BL. Home vs Hospital Infusion of Biologic Agents for Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:257-258. [PMID: 30910602 PMCID: PMC7026825 DOI: 10.1016/j.cgh.2019.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) therapy often requires biologic medications delivered by intravenous infusion.1-4 Historically, intravenous infusions of infliximab and vedolizumab in patients with IBD were delivered under direct supervision of clinicians in infusion centers at hospitals or clinics. Recently, intravenous infusions have transitioned into patient homes. Professional societies have differed on their recommendations for biologic home infusions (HI),5,6 yet limited data exist on the safety and efficacy of HI programs.7,8 Therefore, the primary aim of this study was to compare adverse outcomes (AOs), as defined as a composite of stopping therapy, IBD-related emergency-room (ER) visit, or IBD-related hospitalization, in patients with IBD receiving biologics as HI or at a hospital-based infusion center.
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Affiliation(s)
- Marc Fenster
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan C. Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Hirten
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zane Gallinger
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York,Division of Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Louis Cohen
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ashish Atreja
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Saurabh Mehandru
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin L. Cohen
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Faleck DM, Winters A, Chablaney S, Shashi P, Meserve J, Weiss A, Aniwan S, Koliani-Pace JL, Kochhar G, Boland BS, Singh S, Hirten R, Shmidt E, Kesar V, Lasch K, Luo M, Bohm M, Varma S, Fischer M, Hudesman D, Chang S, Lukin D, Sultan K, Swaminath A, Gupta N, Siegel CA, Shen B, Sandborn WJ, Kane S, Loftus EV, Sands BE, Colombel JF, Dulai PS, Ungaro R. Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn's Disease But Not Ulcerative Colitis. Clin Gastroenterol Hepatol 2019; 17:2497-2505.e1. [PMID: 30625408 PMCID: PMC7026826 DOI: 10.1016/j.cgh.2018.12.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/17/2018] [Accepted: 12/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration. METHODS We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, we compared rates of clinical remission, corticosteroid-free remission (CSFR), and endoscopic remission between patients with early-stage (≤2 years duration) and later-stage (>2 years) CD or UC. We used Cox proportional hazards models to identify factors associated with outcomes. RESULTS Within 6 months initiation of treatment with vedolizumab, significantly higher proportions of patients with early-stage CD, vs later-stage CD, achieved clinical remission (38% vs 23%), CSFR (43% vs 14%), and endoscopic remission (29% vs 13%) (P < .05 for all comparisons). After adjusting for disease-related factors including previous exposure to TNF antagonists, patients with early-stage CD were significantly more likely than patients with later-stage CD to achieve clinical remission (adjusted hazard ratio [aHR], 1.59; 95% CI, 1.02-2.49), CSFR (aHR, 3.39; 95% CI, 1.66-6.92), and endoscopic remission (aHR, 1.90; 95% CI, 1.06-3.39). In contrast, disease duration was not a significant predictor of response among patients with UC. CONCLUSIONS Patients with CD for 2 years or less are significantly more likely to achieve a complete response, CSFR, or endoscopic response to vedolizumab than patients with longer disease duration. Disease duration does not associate with response vedolizumab in patients with UC.
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Affiliation(s)
| | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Joseph Meserve
- University of California - San Diego, La Jolla, California
| | | | | | | | | | | | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Karen Lasch
- Takeda Pharmaceuticals U.S.A., Inc, Deerfield, Illinois
| | - Michelle Luo
- Takeda Pharmaceuticals U.S.A., Inc, Deerfield, Illinois
| | | | | | | | | | | | - Dana Lukin
- Montefiore Medical Center, Bronx, New York
| | - Keith Sultan
- North Shore University Hospital, Manhasset, New York
| | | | - Nitin Gupta
- University of Mississippi, Jackson, Mississippi
| | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Ryan Ungaro
- Icahn School of Medicine at Mount Sinai, New York, New York.
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9
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Koliani-Pace JL, Singh S, Luo M, Hirten R, Aniwan S, Kochhar G, Chang S, Lukin D, Gao Y, Bohm M, Swaminath A, Gupta N, Shmidt E, Meserve J, Winters A, Chablaney S, Faleck DM, Yang J, Huang Z, Boland BS, Shashi P, Weiss A, Hudesman D, Varma S, Fischer M, Sultan K, Shen B, Kane S, Loftus EV, Sands BE, Colombel JF, Sandborn WJ, Lasch K, Siegel CA, Dulai PS. Changes in Vedolizumab Utilization Across US Academic Centers and Community Practice Are Associated With Improved Effectiveness and Disease Outcomes. Inflamm Bowel Dis 2019; 25:1854-1861. [PMID: 31050734 PMCID: PMC6799947 DOI: 10.1093/ibd/izz071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vedolizumab effectiveness estimates immediately after Food and Drug Administration (FDA) approval for ulcerative colitis (UC) and Crohn's disease (CD) are limited by use in refractory populations. We aimed to compare treatment patterns and outcomes of vedolizumab in 2 time frames after FDA approval. METHODS We used 2 data sets for time trend analysis, an academic multicenter vedolizumab consortium (VICTORY) and the Truven MarketScan database, and 2 time periods, May 2014-June 2015 (Era 1) and July 2015-June 2017 (Era 2). VICTORY cumulative 12-month clinical remission, corticosteroid-free remission, and mucosal healing rates, and Truven 12-month hospitalization and surgery rates, were compared between Eras 1 and 2 using time-to-event analyses. RESULTS A total of 3661 vedolizumab-treated patients were included (n = 1087 VICTORY, n = 2574 Truven). In both cohorts, CD and UC patients treated during Era 2 were more likely to be biologic naïve. Compared with Era 1, Era 2 CD patients in the VICTORY consortium had higher rates of clinical remission (31% vs 40%, P = 0.03) and mucosal healing (42% vs 58%, P < 0.01). These trends were not observed for UC. In the Truven database, UC patients treated during Era 2 had lower rates of inflammatory bowel disease-related hospitalization (22.4% vs 9.6%, P < 0.001) and surgery (17.2% vs 9.4%, P = 0.008), which was not observed for CD. CONCLUSION Since FDA approval, remission and mucosal healing rates have increased for vedolizumab-treated CD patients, and vedolizumab-treated UC patients have had fewer hospitalizations and surgeries. This is likely due to differences between patient populations treated immediately after drug approval and those treated later.
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Affiliation(s)
| | - Siddharth Singh
- University of California, San Diego, La Jolla, California, USA
| | - Michelle Luo
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Satimai Aniwan
- Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Dana Lukin
- Montefiore Medical Center, New York, New York, USA
| | - Youran Gao
- North Shore University Hospital, Manhasset, New York, USA
| | | | | | - Nitin Gupta
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Joseph Meserve
- University of California, San Diego, La Jolla, California, USA
| | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shreya Chablaney
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David M Faleck
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jiao Yang
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Zhongwen Huang
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Brigid S Boland
- University of California, San Diego, La Jolla, California, USA
| | | | - Aaron Weiss
- New York University, New York, New York, USA
| | - David Hudesman
- University of California, San Diego, La Jolla, California, USA
| | | | | | - Keith Sultan
- North Shore University Hospital, Manhasset, New York, USA
| | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | | | - Karen Lasch
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Corey A Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Parambir S Dulai
- University of California, San Diego, La Jolla, California, USA
- Address correspondence to: Parambir S. Dulai, MD, Division of Gastroenterology University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093 ()
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10
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Meserve J, Aniwan S, Koliani-Pace JL, Shashi P, Weiss A, Faleck D, Winters A, Chablaney S, Kochhar G, Boland BS, Singh S, Hirten R, Shmidt E, Hartke JG, Chilukuri P, Bohm M, Sagi SV, Fischer M, Lukin D, Hudesman D, Chang S, Gao Y, Sultan K, Swaminath A, Gupta N, Kane S, Loftus EV, Shen B, Sands BE, Colombel JF, Siegel CA, Sandborn WJ, Dulai PS. Retrospective Analysis of Safety of Vedolizumab in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2019; 17:1533-1540.e2. [PMID: 30268561 PMCID: PMC6594363 DOI: 10.1016/j.cgh.2018.09.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There are few real-world data on the safety of vedolizumab for treatment of Crohn's disease (CD) or ulcerative colitis (UC). We quantified rates and identified factors significantly associated with infectious and non-infectious adverse events in clinical practice. METHODS We performed a retrospective review of data from a multicenter consortium database (from May 2014 through June 2017). Infectious and non-infectious adverse events were defined as those requiring antibiotics, hospitalization, vedolizumab discontinuation, or resulting in death. Rates were quantified as proportions and events per 100 patient years of exposure (PYE) or follow up (PYF). We performed multivariable logistic regression analyses to identify factors significantly associated with events and reported as odds ratios (OR) with 95% CIs. RESULTS Our analysis comprised 1087 patients (650 with CD and 437 with UC; 55% female; median age, 37 years) with 861 PYE and 955 PYF. Infections were observed in 68 patients (6.3%; 7.9 per 100 PYE, 7.1 per 100 PYF); gastrointestinal infections (n = 31, 2.4 per 100 PYE, 2.2 per 100 PYF) and respiratory infections (n = 14, 1.6 per 100 PYE, 1.5 per 100 PYF) were the most common. Arthralgias were the most common non-infectious adverse events (n = 31, 2.9%; 3.6 per 100 PYE). Two patients developed malignancies (squamous cell skin cancer and colorectal cancer; 0.23 per 100 PYE, 0.21 per 100 PYF). Active smoker status (OR, 3.39) and number of concomitant immunosuppressive agents (corticosteroids or immunomodulators; OR, 1.72 per agent) used were independently associated with infections. CONCLUSION In a retrospective cohort study of patients with IBD, we found vedolizumab to be well tolerated with an overall favorable safety profile. Active smoking and concomitant use of immunosuppressive agents were independently associated with infections.
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Affiliation(s)
- Joseph Meserve
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Satimai Aniwan
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota; Department of Gastroenterology, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Jenna L Koliani-Pace
- Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Preeti Shashi
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aaron Weiss
- Department of Gastroenterology, Montefiore Medical Center, New York, New York
| | - David Faleck
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Adam Winters
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shreva Chablaney
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gursimran Kochhar
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Brigid S Boland
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Siddharth Singh
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Robert Hirten
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eugenia Shmidt
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota
| | - Justin G Hartke
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Prianka Chilukuri
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Matthew Bohm
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | | | - Monika Fischer
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Dana Lukin
- Department of Gastroenterology, Montefiore Medical Center, New York, New York
| | - David Hudesman
- Department of Gastroenterology, New York University, New York, New York
| | - Shannon Chang
- Department of Gastroenterology, New York University, New York, New York
| | - Youran Gao
- Department of Gastroenterology, North Shore University Hospital, Manhasset, New York
| | - Keith Sultan
- Department of Gastroenterology, North Shore University Hospital, Manhasset, New York
| | - Arun Swaminath
- Department of Gastroenterology, Lenox Hill Hospital, New York, New York
| | - Nitin Gupta
- Department of Gastroenterology, University of Mississippi, Jackson, Mississippi
| | - Sunanda Kane
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Edward V Loftus
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Bo Shen
- Department of Gastroenterology, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Bruce E Sands
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Corey A Siegel
- Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - William J Sandborn
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Parambir S Dulai
- Department of Gastroenterology, University of California, San Diego, La Jolla, California.
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Yzet C, Tse SS, Kayal M, Hirten R, Colombel JF. Novel Targets For Therapeutic Intervention in Inflammatory Bowel Disease. What is the Best Way to Assess the Safety Profile of a Drug? Curr Pharm Des 2019; 25:57-63. [DOI: 10.2174/1381612825666190308102021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/01/2019] [Indexed: 12/23/2022]
Abstract
The emergence of biologic therapies has revolutionized the management of inflammatory bowel disease (IBD) by halting disease progression, increasing remission rates and improving long-term clinical outcomes. Despite these well-described benefits, many patients are reluctant to commence therapy due to drug safety concerns. Adverse events can be detected at each stage of drug development and during the post-marketing period. In this article, we review how to best assess the safety parameters of new IBD medications, from the earliest stage of development to population-based registries, with a focus on the special populations often excluded from the evaluation process.
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Affiliation(s)
- Clara Yzet
- Gastroenterology, Amiens University Hospital, Amiens, France
| | - Stacy S. Tse
- Division of Gastroenterology, Mount Sinai Hospital, New York, NY, United States
| | - Maia Kayal
- Division of Gastroenterology, Icahn School of Medicine, Mount Sinai, New York, NY, United States
| | - Robert Hirten
- Division of Gastroenterology, Icahn School of Medicine, Mount Sinai, New York, NY, United States
| | - Jean-Frédéric Colombel
- Division of Gastroenterology, Icahn School of Medicine, Mount Sinai, New York, NY, United States
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12
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Shmidt E, Kochhar G, Hartke J, Chilukuri P, Meserve J, Chaudrey K, Koliani-Pace JL, Hirten R, Faleck D, Barocas M, Luo M, Lasch K, Boland BS, Singh S, Vande Casteele N, Sagi SV, Fischer M, Chang S, Bohm M, Lukin D, Sultan K, Swaminath A, Hudesman D, Gupta N, Kane S, Loftus EV, Sandborn WJ, Siegel CA, Sands BE, Colombel JF, Shen B, Dulai PS. Predictors and Management of Loss of Response to Vedolizumab in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2461-2467. [PMID: 29788240 PMCID: PMC6693035 DOI: 10.1093/ibd/izy171] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND We quantified loss of response (LOR) to vedolizumab (VDZ) in clinical practice and assessed the effectiveness of VDZ dose intensification for managing LOR. METHODS Retrospective review (May 2014-December 2016) of a prospectively maintained inflammatory bowel disease (IBD) registry. Kaplan-Meier estimates were used to determine rates of LOR to VDZ . Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Success of recapturing response (>50% reduction in symptoms from baseline) and remission (complete resolution of symptoms) after dose intensification was quantified. RESULTS Cumulative rates for VDZ LOR were 20% at 6 months and 35% at 12 months, with slightly lower rates in Crohn's disease than in ulcerative colitis (6 months 15% vs 18% and 12 months 30% vs 39%, P = 0.03). On multivariable analysis, LOR to a tumor necrosis factor (TNF) antagonist before VDZ use was associated with an increased risk for LOR to VDZ [hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.25-2.97] in all patients. For Crohn's disease patients specifically, higher baseline C-reactive protein concentration was associated with increased risk for LOR to VDZ (HR 1.01 per mg/dL increase, 95% CI 1.01-1.02). Shortening of VDZ infusion interval from 8 to every 4 or 6 weeks recaptured response in 49% and remission in 18% of patients. CONCLUSIONS LOR to a TNF antagonist before VDZ use and higher baseline C-reactive protein are important predictors of VDZ LOR. Treatment response can be recaptured in almost half of these patients with VDZ infusion interval shortening.
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Affiliation(s)
- Eugenia Shmidt
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Michelle Luo
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | - Karen Lasch
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | | | | | | | | | | | | | | | - Dana Lukin
- Montefiore Medical Center, New York, NY, USA
| | - Keith Sultan
- North Shore University Hospital, Manhasset, NY, USA
| | | | | | | | | | | | | | | | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Parambir S Dulai
- University of California, San Diego, La Jolla, CA, USA,Address correspondence to: Parambir S. Dulai, MD, University of California, San Diego, Division of Gastroenterology, 9500 Gilman Dr, La Jolla, CA 92093. E-mail:
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13
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Narula N, Peerani F, Meserve J, Kochhar G, Chaudrey K, Hartke J, Chilukuri P, Koliani-Pace J, Winters A, Katta L, Shmidt E, Hirten R, Faleck D, Parikh MP, Whitehead D, Boland BS, Singh S, Sagi SV, Fischer M, Chang S, Barocas M, Luo M, Lasch K, Bohm M, Lukin D, Sultan K, Swaminath A, Hudesman D, Gupta N, Shen B, Kane S, Loftus EV, Siegel CA, Sands BE, Colombel JF, Sandborn WJ, Dulai PS. Vedolizumab for Ulcerative Colitis: Treatment Outcomes from the VICTORY Consortium. Am J Gastroenterol 2018; 113:1345. [PMID: 29946178 PMCID: PMC6445254 DOI: 10.1038/s41395-018-0162-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [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: 08/29/2017] [Accepted: 05/22/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to quantify the safety and effectiveness of vedolizumab (VDZ) when used for UC, and to identify predictors of response to treatment. METHODS Retrospective review (May 2014-December 2016) of VICTORY Consortium data. Adults with follow-up after starting VDZ for clinically active UC were included. Primary effectiveness outcomes were cumulative rates of clinical remission (resolution of all UC-related symptoms) and endoscopic remission (Mayo endoscopic sub-score 0). Key secondary effectiveness outcomes included cumulative rates of corticosteroid-free remission and deep remission (clinical remission and endoscopic remission). Cox proportional hazard analyses were used to identify independent predictors of treatment effectiveness. Non-response imputation (NRI) sensitivity analyses were performed for effectiveness outcomes. Key safety outcomes were rates of serious infection, serious adverse events, and colectomy. RESULTS We included 321 UC patients (71% prior TNFα antagonist exposure, median follow-up 10 months). The 12-month cumulative rates of clinical remission and endoscopic remission were 51% and 41%, respectively. Corresponding rates for corticosteroid-free remission and deep remission were 37% and 30%, respectively. Using NRI, 12-month rates were 20% (n = 64/321) for clinical remission, 17% (n = 35/203) for endoscopic remission, 15% (n = 30/195) for corticosteroid-free remission, and 14% (n = 28/203) for deep remission. A majority of the patients without adequate follow-up at 12 months who were deemed non-responders using NRI had already achieved clinical remission (n = 70) or a significant clinical response (n = 36) prior to 12 months. VDZ discontinuation prior to 12 months was observed in 91 patients, for lack of response (n = 56), need for surgery (n = 29), or adverse event (n = 6). On multivariable analyses, prior exposure to a TNFα antagonist was associated with a reduced probability of achieving clinical remission (HR 0.53, 95% CI 0.38-0.75) and endoscopic remission (HR 0.51, 95% CI 0.29-0.88). Serious adverse events and serious infections were reported in 6% and 4% of patients, respectively. Overall cumulative rates of colectomy over 12 months were 13%, with lower rates observed in patients naive to TNFα antagonist therapy (2%) than those who had been exposed to TNFα antagonists (19%). CONCLUSION In this large real-world cohort we observed that VDZ was well tolerated and effective in achieving key clinical outcomes.
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Affiliation(s)
- Neeraj Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,McMaster University Medical Centre, Hamilton, ON, Canada
| | - Farhad Peerani
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | | | | | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leah Katta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eugenia Shmidt
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,North Shore University Hospital, Manhasset, NY, USA
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Michelle Luo
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | - Karen Lasch
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | | | - Dana Lukin
- Montefiore Medical Center, New York, NY, USA
| | - Keith Sultan
- North Shore University Hospital, Manhasset, NY, USA
| | | | | | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Dulai PS, Boland BS, Singh S, Chaudrey K, Koliani-Pace JL, Kochhar G, Parikh MP, Shmidt E, Hartke J, Chilukuri P, Meserve J, Whitehead D, Hirten R, Winters AC, Katta LG, Peerani F, Narula N, Sultan K, Swaminath A, Bohm M, Lukin D, Hudesman D, Chang JT, Rivera-Nieves J, Jairath V, Zou GY, Feagan BG, Shen B, Siegel CA, Loftus EV, Kane S, Sands BE, Colombel JF, Sandborn WJ, Lasch K, Cao C. Development and Validation of a Scoring System to Predict Outcomes of Vedolizumab Treatment in Patients With Crohn's Disease. Gastroenterology 2018; 155:687-695.e10. [PMID: 29857091 PMCID: PMC6419724 DOI: 10.1053/j.gastro.2018.05.039] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 08/25/2017] [Revised: 04/30/2018] [Accepted: 01/02/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS As more treatment options for inflammatory bowel diseases become available, it is important to identify patients most likely to respond to different therapies. We created and validated a scoring system to identify patients with Crohn's disease (CD) who respond to vedolizumab. METHODS We collected data from the GEMINI 2 phase 3 trial of patients with active CD treated with vedolizumab for 26 weeks (n = 814) and performed logistic regression analysis to identify factors associated with clinical, steroid-free, and durable remission (derivation set). We used these data to develop a clinical decision support tool, which we validated using data from 366 participants in a separate clinical practice observational cohort of patients with active CD treated with vedolizumab for 26 weeks (the VICTORY cohort). We evaluated the ability of this tool to identify patients in clinical remission or corticosteroid-free remission, or those with mucosal healing (MH), clinical remission with MH, or corticosteroid-free remission with MH after vedolizumab therapy using receiver operating characteristic area under the curve (AUC) analyses. The primary outcome was to develop and validate a list of factors associated with achieving remission by vedolizumab in patients with active CD. RESULTS In the derivation analysis, we identified absence of previous treatment with a tumor necrosis factor antagonist (+3 points), absence of prior bowel surgery (+2 points), absence of prior fistulizing disease (+2 points), baseline level of albumin (+0.4 points per g/L), and baseline concentration of C-reactive protein (reduction of 0.5 points for values between 3.0 and 10.0 mg/L and 3.0 points for values >10.0 mg/L) as factors associated with remission. In the validation set, our model identified patients in clinical remission with an AUC of 0.67, patients in corticosteroid-free remission with an AUC of 0.66, patients with MH with an AUC of 0.72, patients in clinical remission with MH with an AUC of 0.73, and patients in corticosteroid-free clinical remission with MH with an AUC of 0.75. A cutoff value of 13 points identified patients in clinical remission after vedolizumab therapy with 92% sensitivity, patients in corticosteroid-free remission with 94% sensitivity, patients with MH with 98% sensitivity, patients with clinical remission and MH with 100% sensitivity, and patients with corticosteroid-free clinical remission with MH with 100% sensitivity. CONCLUSIONS We developed and validated a scoring system to identify patients with CD most likely to respond to 26 weeks of vedolizumab therapy. Further studies are needed to optimize its accuracy in select populations and determine its cost-effectiveness.
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Affiliation(s)
| | | | | | | | | | | | | | - Eugenia Shmidt
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | - Leah G. Katta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Farhad Peerani
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,University of Alberta, Edmonton, AB, Canada
| | - Neeraj Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,McMaster University Medical Centre, Hamilton, ON, Canada
| | - Keith Sultan
- North Shore University Hospital, Manhasset, NY, USA
| | | | | | - Dana Lukin
- Montefiore Medical Center, New York, NY, USA
| | | | - John T. Chang
- University of California - San Diego, La Jolla, CA, USA
| | | | | | - GY Zou
- University of Western Ontario, London, ON, Canada
| | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Karen Lasch
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | - Charlie Cao
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
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15
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Hectors SJ, Gordic S, Semaan S, Bane O, Hirten R, Jia X, Colombel JF, Taouli B. Diffusion and perfusion MRI quantification in ileal Crohn's disease. Eur Radiol 2018; 29:993-1002. [PMID: 30019143 DOI: 10.1007/s00330-018-5627-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments in Crohn's disease (CD) patients and to assess the association of these parameters with clinical and MRI-based measurements of CD activity. METHODS In this prospective study, 27 CD patients (M/F 18/9, mean age 42 years) underwent MR enterography, including IVIM-DWI and DCE-MRI. IVIM-DWI and DCE-MRI parameters were quantified in normal and abnormal small bowel segments, the latter identified by the presence of inflammatory changes. MRI parameter differences between normal and abnormal bowel were tested using Wilcoxon signed-rank tests. IVIM-DWI and DCE-MRI parameters were correlated with clinical data (C-reactive protein, Harvey-Bradshaw Index), conventional MRI parameters (wall thickness, length of involvement) and MRI activity scores (MaRIA, Clermont). Diagnostic performance of (combined) parameters for differentiation between normal and abnormal bowel was determined using ROC analysis. RESULTS The DCE-MRI parameters peak concentration Cpeak, upslope, area-under-the-curve at 60s (AUC60), Ktrans and ve were significantly increased (p<0.023), while IVIM-DWI parameters perfusion fraction (PF) and ADC were significantly decreased (p<0.001) in abnormal bowel segments. None of the DCE-MRI and IVIM-DWI parameters correlated with clinical parameters (p>0.105). DCE-MRI parameters exhibited multiple significant correlations with wall thickness (Cpeak, upslope, AUC60, Ktrans; r range 0.431-0.664, p<0.025) and MaRIA/Clermont scores (Cpeak, AUC60, Ktrans; r range 0.441-0.617, p<0.021). Combined Ktrans+ve+PF+ADC showed highest AUC (0.963) for differentiation between normal and abnormal bowel, while ADC performed best for individual parameters (AUC=0.800). CONCLUSIONS DCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD. KEY POINTS • IVIM-DWI and DCE-MRI parameters were significantly different between normal and abnormal bowel segments in CD patients. • DCE-MRI parameters showed a significant association with wall thickness and MRI activity scores. • Combination of IVIM-DWI and DCE-MRI parameters led to the highest diagnostic performance for differentiation between normal and abnormal bowel segments, while ADC showed the highest diagnostic performance of individual parameters.
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Affiliation(s)
- Stefanie J Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sahar Semaan
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Hirten
- IBD Center, Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xiaoyu Jia
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Frederic Colombel
- IBD Center, Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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16
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Abstract
Perianal fistulizing disease is an aggressive and debilitating phenotype of Crohn's disease (CD), representing a significant therapeutic challenge. New work has led to advancement in epidemiology and long-term outcomes of perianal disease. The range of therapeutic options continues to expand, including new biologic agents, biosimilars, and stem cell therapy. Areas covered: We discuss updates to all aspects of management of perianal disease, with a focus on the last 3 years of published data. Areas considered include new data on epidemiology and prognostication, medical and surgical therapy, and stem cell therapy. Expert commentary: The presence of perianal disease at CD diagnosis portends a significantly worse disease course. Patients with perianal disease require close monitoring to identify those who are at risk for worsening disease, suboptimal biologic drug levels, and signs of developing neoplasm. With the impending availability of local mesenchymal stem cell therapy, this becomes increasingly important as this therapy, although extremely promising, is thus far only effective in patients without proctitis.
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Affiliation(s)
- Ori Rackovsky
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Robert Hirten
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Ryan Ungaro
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Jean-Frederic Colombel
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
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17
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Trindade AJ, Rishi A, Hirten R, Inamdar S, Sejpal DV, Colombel JF. Identification of volumetric laser endomicroscopy features of colon polyps with histologic correlation. Gastrointest Endosc 2018; 87:1558-1564. [PMID: 29477303 DOI: 10.1016/j.gie.2018.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/19/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS There are limited data on the use of volumetric laser endomicroscopy (VLE) for imaging colon polyps. Our aim was to identify VLE features of colon polyps. METHODS A total of 45 patients were included; 43 underwent endoscopic mucosal resection of colorectal polyps 2 cm or greater. These polyps were then scanned with VLE immediately after resection. Two patients who underwent partial colonic resection served as controls. RESULTS Forty-three polyps were included with review of matching histology: 3 intramucosal cancer (IMCA), 5 tubular adenoma (TAs)/tubulovillous adenoma (TVA) with high-grade dysplasia (HGD), 9 TVA with only low-grade dysplasia (LGD), 5 serrated adenoma, and 21 TA with LGD. All TAs and TVAs were hyper-reflective compared with normal tissue. Effacement occurred in 82.4% (14/17) of the colonic polyps with advanced pathology (TVA with HGD/IMCA) compared with 11.6% (3/26) with non-advanced pathology (TA with LGD and serrated adenoma) (P < .0001). Forty-seven percent (8/17) of polyps with advanced pathology had greater than 5 glands on VLE compared with none in the non-advanced pathology group (P = .0001). An irregular surface mainly occurred in polyps with high-grade pathology (HGD/IMCA) versus TAs. Eighty-eight percent of polyps with HGD/IMC had an irregular surface (7/8) versus 6% (2/35) of TAs (P < .0001). CONCLUSIONS In this ex vivo clinicopathologic study, we show that there are distinct VLE features of colon polyps that may help identify polyps or features of a higher-grade lesion. This may have implications for possible in vivo application to aid in dysplasia or polyp detection.
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Affiliation(s)
- Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Arvind Rishi
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Robert Hirten
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Sumant Inamdar
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Divyesh V Sejpal
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
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18
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Palmela C, Chevarin C, Xu Z, Torres J, Sevrin G, Hirten R, Barnich N, Ng SC, Colombel JF. Adherent-invasive Escherichia coli in inflammatory bowel disease. Gut 2018; 67:574-587. [PMID: 29141957 DOI: 10.1136/gutjnl-2017-314903] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/20/2017] [Accepted: 10/28/2017] [Indexed: 02/06/2023]
Abstract
Intestinal microbiome dysbiosis has been consistently described in patients with IBD. In the last decades, Escherichia coli, and the adherent-invasive E coli (AIEC) pathotype in particular, has been implicated in the pathogenesis of IBD. Since the discovery of AIEC, two decades ago, progress has been made in unravelling these bacteria characteristics and its interaction with the gut immune system. The mechanisms of adhesion of AIEC to intestinal epithelial cells (via FimH and cell adhesion molecule 6) and its ability to escape autophagy when inside macrophages are reviewed here. We also explore the existing data on the prevalence of AIEC in patients with Crohn's disease and UC, and the association between the presence of AIEC and disease location, activity and postoperative recurrence. Finally, we highlight potential therapeutic strategies targeting AIEC colonisation of gut mucosa, including the use of phage therapy, bacteriocins and antiadhesive molecules. These strategies may open new avenues for the prevention and treatment of IBD in the future.
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Affiliation(s)
- Carolina Palmela
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Caroline Chevarin
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Zhilu Xu
- Department of Medicine and Therapeutics, Institute of Digestive Diseases, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Joana Torres
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gwladys Sevrin
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Robert Hirten
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Nicolas Barnich
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Diseases, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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19
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Hirten R, Cohen BL, Colombel JF. Colonic Pseudopolyps Resulting in Iron Deficiency Anemia. Clin Gastroenterol Hepatol 2017; 15:A27. [PMID: 28110094 PMCID: PMC6692070 DOI: 10.1016/j.cgh.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Robert Hirten
- Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York
| | - Benjamin L Cohen
- Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York
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20
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Affiliation(s)
- Robert Hirten
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, 1468 Madison Avenue, Box 1069, New York, NY 10029-6574, USA
| | - Bruce E. Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, 1468 Madison Avenue, Box 1069, New York, NY 10029-6574, USA
| | - Benjamin L. Cohen
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, 1468 Madison Avenue, Box 1069, New York, NY 10029-6574, USA
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21
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Trindade AJ, Hirten R, Slattery E, Inamdar S, Sejpal DV. Endoscopic ultrasound-guided fine-needle aspiration of solid lesions on clopidogrel may not be a high-risk procedure for bleeding: A case series. Dig Endosc 2016; 28:216-9. [PMID: 26513424 DOI: 10.1111/den.12565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/15/2015] [Accepted: 10/26/2015] [Indexed: 01/09/2023]
Abstract
The major gastrointestinal endoscopy society guidelines list endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as a high-risk procedure for bleeding. However, there are no studies evaluating the risk of bleeding for EUS-FNA of solid organs while patients continue to take clopidogrel. The aim of the present case series was to evaluate the rate of bleeding in a cohort of patients who underwent EUS-FNA for solid lesions while on clopidogrel. Bleeding was measured at the time of the procedure by bleeding seen on EUS, endoscopic visualization of blood, or drop in hemoglobin after the procedure. From 2013 to 2015, 10 patients were identified for this case series. Lesions that underwent EUS-FNA included gastric and rectal subepithelial lesions, pancreas masses, and liver masses. No immediate or delayed bleeding was observed in any of the patients. EUS-FNA of solid lesions on clopidogrel may not be a high-risk procedure for bleeding. Larger studies are needed to confirm this finding.
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Affiliation(s)
- Arvind J Trindade
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Robert Hirten
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Eoin Slattery
- Department of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, USA
| | - Sumant Inamdar
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Divyesh V Sejpal
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
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22
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Hirten R, Sultan K, Thomas A, Bernstein DE. Hepatic manifestations of non-steroidal inflammatory bowel disease therapy. World J Hepatol 2015; 7:2716-2728. [PMID: 26644815 PMCID: PMC4663391 DOI: 10.4254/wjh.v7.i27.2716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/16/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is composed of Crohn’s disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.
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23
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Sultan K, Inamdar S, Hirten R. The Uncertain Role of Immunomodulator Maintenance After Cessation of Anti-Tumor Necrosis Factor α Therapy. Clin Gastroenterol Hepatol 2015; 13:1551-2. [PMID: 25599656 DOI: 10.1016/j.cgh.2015.01.006] [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] [Received: 01/05/2015] [Accepted: 01/09/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Sultan
- Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | - Sumant Inamdar
- Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | - Robert Hirten
- Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
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24
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Trindade AJ, Hirten R, Greenberg RE, Sejpal DV. EUS-guided botulinum toxin injection of the internal anal sphincter in anorectal outlet obstruction. Am J Gastroenterol 2014; 109:1293-4. [PMID: 25091252 DOI: 10.1038/ajg.2014.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/11/2022]
Affiliation(s)
- Arvind J Trindade
- Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Robert Hirten
- Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Ronald E Greenberg
- Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Divyesh V Sejpal
- Division of Gastroenterology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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