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Vernero M, Bezzio C, Ribaldone DG, Caprioli FA, Fantini MC, Festa S, Macaluso FS, Orlando A, Pugliese D, Renna S, Rispo A, Savarino EV, Variola A, Saibeni S. Immune-Mediated Inflammatory Diseases Awareness and Management among Physicians Treating Patients with Inflammatory Bowel Disease: An IG-IBD Survey. J Clin Med 2024; 13:1857. [PMID: 38610623 PMCID: PMC11012957 DOI: 10.3390/jcm13071857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Inflammatory bowel disease (IBD) is frequently associated to other immune-mediated inflammatory diseases (IMIDs). This study aims at assessing physicians' awareness of the issue and the current status of IMID management. (2) Methods: A web-based survey was distributed to all 567 physicians affiliated to IG-IBD. (3) Results: A total of 249 (43.9%) physicians completed the survey. Over 90% of the responding physicians were gastroenterology specialists, primarily working in public hospitals. About 51.0% of the physicians had access to an integrated outpatient clinic, where gastroenterologists collaborated with rheumatologists and 28.5% with dermatologists. However, for 36.5% of physicians, integrated ambulatory care was not feasible. Designated appointment slots for rheumatologists and dermatologists were accessible to 72.2% and 58.2% of physicians, respectively, while 20.1% had no access to designated slots. About 5.2% of physicians report investigating signs or symptoms of IMIDs only during the initial patient assessment. However, 87.9% inquired about the presence of concomitant IMIDs at the initial assessment and actively investigated any signs or symptoms during subsequent clinical examination. (4) Conclusions: While Italian physicians recognize the importance of IMIDs associated with IBD, organizational challenges impede the attainment of optimal multidisciplinary collaboration. Efforts should be directed toward enhancing practical frameworks to improve the overall management of these complex conditions.
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Affiliation(s)
- Marta Vernero
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (M.V.); (D.G.R.)
| | - Cristina Bezzio
- IBD Centre, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Davide G. Ribaldone
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (M.V.); (D.G.R.)
| | - Flavio A. Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Massimo C. Fantini
- Department of Medical Science and Public Health, University of Cagliari, 09042 Cagliari, Italy;
- Gastroenterology Unit, Cittadella Universitaria di Monserrato, 09042 Cagliari, Italy
| | - Stefano Festa
- IBD Unit, San Filippo Neri Hospital, 00135 Rome, Italy; (S.F.); (S.R.)
| | - Fabio S. Macaluso
- IBD Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.)
| | - Ambrogio Orlando
- IBD Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.)
| | - Daniela Pugliese
- CEMAD—IBD Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Sara Renna
- IBD Unit, San Filippo Neri Hospital, 00135 Rome, Italy; (S.F.); (S.R.)
| | - Antonio Rispo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy;
| | - Edoardo V. Savarino
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, 35128 Padua, Italy;
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy;
| | - Simone Saibeni
- IBD Centre, Gastroenterology Unit, Rho Hospital, ASST Rhodense, 20017 Rho, Italy
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Macaluso FS, D'Antonio E, Fries W, Viola A, Ksissa O, Cappello M, Muscarella S, Belluardo N, Giangreco E, Mocciaro F, Di Mitri R, Ferracane C, Vitello A, Grova M, Renna S, Casà A, De Vivo S, Ventimiglia M, Orlando A. Safety and effectiveness of tofacitinib in ulcerative colitis: Data from TOFA-UC, a SN-IBD study. Dig Liver Dis 2024; 56:15-20. [PMID: 37741749 DOI: 10.1016/j.dld.2023.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Real-world evidence is needed to determine the value of tofacitinib (TOFA) for the treatment of ulcerative colitis (UC). AIM To assess the safety and effectiveness of TOFA in clinical practice. METHODS TOFA-UC is a multicenter, observational study performed among the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). All consecutive patients with UC starting TOFA from its introduction in Sicily (July 2021) to July 2022 were included. RESULTS 111 patients were included (mean follow-up: 31.7 ± 14.9 weeks; biologic-experienced: 92.8%). Nineteen adverse events were reported (17.1%; incidence rate: 28.2 per 100 patient years), including 11 cases of hypercholesterolemia and 3 infections (no cases of herpes zoster reactivation. At week 8, the rates of clinical response, steroid free clinical remission, and CRP normalization were 74.8%, 45.0%, and 56.9%, respectively, and 68.5%, 51.4%, and 65.2%, respectively, at the end of follow-up. Eighteen patients experienced a loss of response after successful induction (21.7%; incidence rate: 33.2 per 100 patient years). Twenty-six patients (23.4%) discontinued TOFA over time, of whom 3 due to AEs, and 23 to non response or loss of response. CONCLUSIONS TOFA is safe and effective in patients with UC, including those with history of multiple failures to biological therapies.
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Affiliation(s)
| | - Elvira D'Antonio
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Walter Fries
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Anna Viola
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Omar Ksissa
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Maria Cappello
- Gastroenterology & Hepatology Section, PROMISE, University of Palermo, Italy
| | - Stefano Muscarella
- Gastroenterology & Hepatology Section, PROMISE, University of Palermo, Italy
| | | | | | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | | | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Mauro Grova
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Simona De Vivo
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Grova M, Vitello A, Mannino M, Casà A, Renna S, Macaluso FS, Orlando A. Role of ustekinumab in treatment of ulcerative colitis: a narrative review. Immunotherapy 2023; 15:1539-1552. [PMID: 38018475 DOI: 10.2217/imt-2023-0106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
The therapeutic armamentarium for gastroenterologists in treating ulcerative colitis (UC) has been rapidly growing since the introduction of monoclonal antibodies directed against anti-TNFs. Ustekinumab is a monoclonal antibody binding the shared p40 subunit of IL-12 and IL-23, and the inhibition of these two cytokines, implicated in host response to microbial pathogens, has demonstrated clinical efficacy in different immune-mediated diseases, including moderate-to-severe UC. This narrative review summarizes the newest clinical evidence regarding the efficacy, effectiveness and safety of ustekinumab in moderate-to-severe UC, including specific situations (pregnancy, breastfeeding, elderly/pediatric populations, extraintestinal manifestations, acute severe UC, pouchitis and dual biological therapy). Finally, positioning is discussed in light of the existing evidence.
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Affiliation(s)
- Mauro Grova
- Digestive Endoscopy Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Alessandro Vitello
- Gastroenterology & Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, 93100, Italy
| | - Mariella Mannino
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
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Macaluso FS, Grova M, Mocciaro F, Di Mitri R, Privitera AC, Distefano ME, Vitello A, Camilleri S, Ferracane C, Pluchino D, Belluardo N, Giangreco E, Fries W, Viola A, Cappello M, D'Amato L, Bertolami C, Ventimiglia M, Renna S, Casà A, D'Antonio E, De Vivo S, Orlando A. Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn's disease. J Gastroenterol Hepatol 2023; 38:1503-1509. [PMID: 37148148 DOI: 10.1111/jgh.16208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND AIM Postoperative recurrence (POR) following ileocolonic resection is a major concern in patients with Crohn's disease (CD). The role of ustekinumab (UST) in this setting is poorly known. METHODS All consecutive CD patients with a baseline colonoscopy at 6-12 months from ileocolonic resection showing POR (Rutgeerts score ≥ i2) who were treated with UST after the baseline colonoscopy and with an available post-treatment endoscopy, were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was endoscopic success, defined as reduction of at least one point of Rutgeerts score. The secondary outcome was clinical success, assessed at the end of follow-up. Reasons for clinical failure included mild clinical relapse (Harvey-Bradshaw index 5-7), clinically relevant relapse (Harvey-Bradshaw index > 7), and need for new resection. RESULTS Forty-four patients were included (mean follow-up: 17.8 ± 8.4 months). The baseline postoperative colonoscopy showed severe POR (Rutgeerts score i3 or i4) in 75.0% of patients. The post-treatment colonoscopy was performed after a mean of 14.5 ± 5.5 months following initiation of UST. Endoscopic success was reported in 22 out of 44 (50.0%) patients, of whom 12 (27.3%) achieved a Rutgeerts score i0 or i1. Clinical success at the end of follow-up was reported in 32 out of 44 patients (72.7%); none of the 12 patients with clinical failure had achieved endoscopic success at post-treatment colonoscopy. CONCLUSIONS Ustekinumab could be a promising option for the treatment of POR of CD.
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Affiliation(s)
| | - Mauro Grova
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | | | | | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Salvatore Camilleri
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | | | - Dario Pluchino
- Gastroenterology Unit, "Vittorio Emanuele" Hospital, Catania, Italy
| | | | | | - Walter Fries
- Inflammatory Bowel Disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, University of Palermo, Palermo, Italy
| | - Livia D'Amato
- Gastroenterology and Hepatology Section, University of Palermo, Palermo, Italy
| | | | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service; Italian Ministry of Health, Rome, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Elvira D'Antonio
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Simona De Vivo
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Grova M, Crispino F, Maida M, Vitello A, Renna S, Casà A, Tesè L, Macaluso FS, Orlando A. Sarcopenia is a negative predictive factor for endoscopic remission in patients with Crohn's disease treated with biologics. Dig Liver Dis 2023:S1590-8658(23)00482-6. [PMID: 36925319 DOI: 10.1016/j.dld.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Sarcopenia has been associated with poor prognosis in chronic diseases. AIMS To investigate the role of sarcopenia in predicting clinical and endoscopic outcomes in patients with Crohn's disease (CD). METHODS Consecutive CD patients who started biologics between 2014 and 2020 and underwent abdominal magnetic resonance or computed tomography within 6 months from the beginning of the biological therapy were enroled. Sarcopenia was defined as Psoas Muscle Index (PMI) lower than 5.4 cm²/m² (men) and 3.56 cm²/m² (women). Univariate and multivariate analyses were used to evaluate whether sarcopenia could predict steroid-free clinical remission (SFCR), endoscopic remission (ER), hospitalisation and surgery after 12 months of therapy. RESULTS 358 patients were included. Sarcopenia was found in 18.2% of patients, and it was associated with a lower rate of ER (14.8% vs 47.7%; p = 0.002) after 12 months of therapy, while it was not associated with SFCR (65.1% vs 70.1%; p = 0.435), hospitalisation (9.2% vs 7.8%; p = 0.801) and surgery (3.1% vs 6.1%; p = 0.549). Sarcopenia was identified as a predictor of lack of ER (odds ratio [OR]=5.2; p = 0.006), as well as smoking (OR=2.5; p = 0.028) and perianal disease (OR=2.6; p = 0.020). CONCLUSION Sarcopenia is a negative prognostic factor for ER in CD patients treated with biologics.
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Affiliation(s)
- Mauro Grova
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
| | - Federica Crispino
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Marcello Maida
- Section of Gastroenterology, "S. Elia-Raimondi" Hospital", Caltanissetta, Italy
| | - Alessandro Vitello
- Section of Gastroenterology, "S. Elia-Raimondi" Hospital", Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Lorenzo Tesè
- Radiology Unit, A.O.O.R. "Villa Sofia-Cervello Hospital", Palermo, Italy
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Casà A, Renna S, Grova M, Mannino M, Orlando A. Switching from SB2 to PF-06438179/GP1111 and back in inflammatory bowel disease: "The Superswitchers". Dig Liver Dis 2023; 55:424-425. [PMID: 36609013 DOI: 10.1016/j.dld.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Affiliation(s)
| | - Angelo Casà
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Mauro Grova
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Grova M, Saladino M, Cappello M, Demarzo MG, Privitera AC, Giangreco E, Garufi S, Renna S, Casà A, Ventimiglia M, Fries W, Orlando A. The effectiveness of ustekinumab and vedolizumab as third-line biologic therapy in patients with Crohn's disease. Dig Liver Dis 2022; 55:471-477. [PMID: 36127230 DOI: 10.1016/j.dld.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effectiveness of Ustekinumab (UST) and Vedolizumab (VDZ) in patients with Crohn's disease (CD) as third-line biologic therapies is unclear. AIMS We performed a multicentre, real-world assessment of the effectiveness of UST and VDZ among highly-refractory patients with CD. METHODS Data of consecutive patients with CD treated with UST and VDZ as third-line biologic therapy until December 2021 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). RESULTS 143 patients (UST: n = 113; VDZ: n = 30) were included. At the end of induction, the rates of clinical response (CR) were 61.9% for UST and 60.0% for VDZ (p = 1.00), with steroid-free clinical remission (SFCR) achieved in 38.1% of patients in the UST group and 43.3% of patients in the VDZ group (p = 0.75). After 52 weeks of observation, the rates of CR were 65.9% for UST and 71.4% for VDZ (p = 0.77), while the rates of SFCR were 51.8% for UST and 57.1% for VDZ (p = 0.78). At multiple Cox proportional hazard regression model, age (HR 0.98; p = 0.04) and need for systemic steroids at baseline (HR 3.29; p = 0.003) were found to be independent predictors of treatment discontinuation. CONCLUSIONS Both VDZ and UST showed high effectiveness as third-line biologic therapy in CD, without significant differences between them.
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Affiliation(s)
| | - Mauro Grova
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
| | - Marica Saladino
- Gastroenterology and Hepatology Section, PROMISE, University of Palermo, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, PROMISE, University of Palermo, Italy
| | | | | | | | - Serena Garufi
- Gastroenterology Unit, A.R.N.A.S. "Garibaldi", Catania, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
| | - Angelo Casà
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
| | - Walter Fries
- IBD Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Ambrogio Orlando
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
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Grova M, Crispino F, Maida M, Renna S, Mannino M, Casà A, Rizzuto G, Macaluso FS, Orlando A. Effectiveness and safety of an on-demand ferric carboxymaltose infusion strategy in patients with inflammatory bowel disease: a real world experience. Eur J Gastroenterol Hepatol 2022; 34:607-612. [PMID: 35102111 DOI: 10.1097/meg.0000000000002348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND We evaluated an on-demand ferric carboxymaltose (FCM) infusion strategy in inflammatory bowel disease (IBD) patients with iron deficiency anemia (IDA). AIMS The primary outcome was the response rate to single or multiple FCM infusions after 12 months. Secondary outcomes were the response rate to a single FCM infusion after 3 months and the FCM safety profile. METHODS We retrospectively included 185 IBD patients who received at least one FCM infusion of 500 mg, between 2015 and 2018. FCM was administered to patients with Hb ≤10 g/dL and hypoferritinemia and repeated according to the physician's assessment. Complete response (CR) was defined as Hb ≥12 g/dL (≥13 g/dL for men) or Hb increase ≥2 g/dL. Partial response (PR) was defined as an Hb increase between 1 and 2 g/dL. A univariate analysis was performed at 3 and 12 months. RESULTS After 12 months, the response rate was 75.1% (CR, 48.6%; PR, 26.4%; mean number of FCM infusions, 1.7 ± 1.1). In total 169/185 patients received a single FCM infusion during the first 3 months and 79.2% achieved response (CR, 56.8%; PR, 22.4%). At univariate analysis, no variable was associated with response. No adverse events were reported. CONCLUSIONS An on-demand strategy was effective and well-tolerated in treating IDA in IBD patients.
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Affiliation(s)
- Mauro Grova
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Federica Crispino
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Marcello Maida
- Department of Gastroenterology and Digestive Endoscopy, Section of Gastroenterology, "S. Elia-Raimondi" Hospital, Caltanissetta, Italy
| | - Sara Renna
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Mariella Mannino
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Angelo Casà
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Giulia Rizzuto
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Fabio Salvatore Macaluso
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Ambrogio Orlando
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
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Macaluso FS, Cappello M, Crispino F, Grova M, Privitera AC, Piccillo G, Magnano A, Ferracane C, Belluardo N, Giangreco E, Fries W, Viola A, Di Mitri R, Mocciaro F, Camilleri S, Garufi S, Renna S, Casà A, Maida M, Orlando A. Vedolizumab may be an effective option for the treatment of postoperative recurrence of Crohn's disease. Dig Liver Dis 2022; 54:629-634. [PMID: 34924320 DOI: 10.1016/j.dld.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/04/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of Vedolizumab (VDZ) as therapeutic option for the postoperative recurrence of Crohn's disease (CD) following ileocolonic resection is unknown. AIMS To assess the effectiveness of VDZ in this setting. METHODS All consecutive CD patients with a baseline colonoscopy at 6-12 months from the ileocolonic resection showing postoperative recurrence (Rutgeerts score ≥i2) and treated with VDZ after the baseline colonoscopy were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was endoscopic success, assessed at the first colonoscopy following initiation of VDZ and defined as reduction of at least one point of Rutgeerts score. The secondary outcome was clinical failure, assessed at one year and at the end of follow-up. RESULTS Fifty-eight patients were included (mean follow-up: 24.8 ± 13.1 months). Endoscopic success was reported in 47.6% of patients. Clinical failure was reported in 19.0% of patients at one year, and in 32.8% of patients at the end of follow-up. A new resection was required in 7 patients (12.1%). CONCLUSIONS VDZ may be an effective option for the treatment of postoperative recurrence of CD.
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Affiliation(s)
| | - Maria Cappello
- Gastroenterology & Hepatology Section, Promise, University of Palermo, Italy
| | - Federica Crispino
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Gastroenterology & Hepatology Section, Promise, University of Palermo, Italy
| | - Mauro Grova
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Gastroenterology & Hepatology Section, Promise, University of Palermo, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, "Cannizzaro" Hospital, Catania, Italy
| | - Antonio Magnano
- Gastroenterology Unit, "Vittorio Emanuele" Hospital, Catania, Italy
| | | | | | | | - Walter Fries
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Anna Viola
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Salvatore Camilleri
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Sara Renna
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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10
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Macaluso FS, Giuliano A, Fries, W, Viola A, Abbruzzese A, Cappello M, Giuffrida E, Carrozza L, Privitera AC, Magnano A, Ferracane C, Scalisi G, Minissale MG, Giangreco E, Garufi S, Bertolami C, Cucinotta U, Graziano F, Casà A, Renna S, Teresi G, Rizzuto G, Mannino M, Maida M, Orlando A. Severe Activity of Inflammatory Bowel Disease is a Risk Factor for Severe COVID-19. Inflamm Bowel Dis 2022; 29:217-221. [PMID: 35385102 PMCID: PMC9383704 DOI: 10.1093/ibd/izac064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Data from the first wave of the coronavirus disease 2019 (COVID-19) pandemic suggested that patients with inflammatory bowel disease (IBD) are not at higher risk of being infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than the general population and that a worse prognosis is not associated with immunomodulatory drugs, with the possible exception of systemic steroids. METHODS This retrospective, observational study included consecutive IBD patients from the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) cohort who had a SARS-CoV-2 infection diagnosis (polymerase chain reaction-confirmed presence of the viral genome in a nasopharyngeal swab) during the second COVID-19 pandemic wave (September 2020 to December 2020). Data regarding demographics, IBD features and treatments, and comorbidities were analyzed in correlation with COVID-19 clinical outcomes. RESULTS Data on 122 patients (mean age, 43.9 ± 16.7 years; males, 50.0%; Crohn's disease, 62.3%; ulcerative colitis, 37.7%) were reported. Twelve patients developed COVID-19-related pneumonia (9.8%), 4 (3.3%) required respiratory assistance (nonmechanical ventilation or orotracheal intubation), and 4 died (case fatality rate, 3.3%). In a multivariable analysis, age (odds ratio [OR], 1.034; 95% CI, 1.006-1.147; P = .032) and severe IBD activity (OR, 13.465; 95% CI, 1.104-164.182; P = .042) were independent predictors of COVID-19-related pneumonia, while severe IBD activity (OR, 15.359; 95% CI, 1.320-178.677; P = .030) was the only independent predictor of severe COVID-19, a composite endpoint defined as the need for respiratory assistance or death. A trend towards a protective role of tumor necrosis factor α inhibitors on pneumonia development was reported (P = .076). CONCLUSIONS In this cohort of patients with IBD and SARS-CoV-2 infection, severe IBD activity was the only independent risk factor for severe COVID-19.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy,Address correspondence to: Fabio Salvatore Macaluso, MD, IBD Unit, “Villa Sofia-Cervello” Hospital, Viale Strasburgo 233, 90146 Palermo, Italy ()
| | - Alessandra Giuliano
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Walter Fries,
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Alfredo Abbruzzese
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | - Lucio Carrozza
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | | | - Antonio Magnano
- Gastroenterology Unit, Policlinico “Vittorio Emanuele,”Catania, Italy
| | | | | | - Maria Giovanna Minissale
- **Gastroenterology and Endoscopy Unit, “Buccheri La Ferla Fatebenefratelli” Hospital, Palermo, Italy
| | | | - Serena Garufi
- Gastroenterology Unit, “S. Elia- M. Raimondi” Hospital, Caltanissetta, Italy
| | | | - Ugo Cucinotta
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Francesco Graziano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy,Pediatric Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Giulia Teresi
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Mariella Mannino
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Marcello Maida
- Gastroenterology Unit, “Papardo Piemonte” Hospital, Messina, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
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11
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Armuzzi A, Bortoli A, Castiglione F, Contaldo A, Daperno M, D'Incà R, Labarile N, Mazzuoli S, Onali S, Milla M, Orlando A, Principi M, Pugliese D, Renna S, Rizzello F, Scribano ML, Todeschini A. Female reproductive health and inflammatory bowel disease: A practice-based review. Dig Liver Dis 2022; 54:19-29. [PMID: 34120858 DOI: 10.1016/j.dld.2021.05.020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel diseases, namely ulcerative colitis and Crohn's disease, occur worldwide and affect people of all ages, with a high impact on their quality of life. Sex differences in incidence and prevalence have been reported, and there are also gender-specific issues that physicians should recognize. For women, there are multiple, important concerns regarding issues of body image and sexuality, menstruation, contraception, fertility, pregnancy, breastfeeding and menopause. This practice-based review focuses on the main themes that run through the life of women with inflammatory bowel diseases from puberty to menopause. Gastroenterologists who specialize in inflammatory bowel diseases and other physicians who see female patients with inflammatory bowel diseases should provide support for these problems and offer adequate therapy to ensure that their patients achieve the same overall well-being and health as do women without inflammatory bowel diseases.
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Affiliation(s)
| | - Alessandro Armuzzi
- CEMAD - IBD Unit, Department of Medical and Surgical Sciences, A Gemelli University Hospital, Rome, Italy
| | | | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Antonella Contaldo
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
| | - Marco Daperno
- Gastroenterology and Endoscopic Unit, Umberto I Mauriziano Hospital, Turin, Italy
| | - Renata D'Incà
- Gastroenterology Unit, Padua University Hospital, Padua, Italy
| | - Nunzia Labarile
- Gastroenterology Unit, Ospedale Santissima Annunziata, Taranto, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Department, "Mons. Dimiccoli " Barletta, Italy
| | - Sara Onali
- Gastroenterology Unit, Department of Science and Public Health, University Hospital of Cagliari, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Clinic, Careggi University Hospital, Florence, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Mariabeatrice Principi
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy.
| | - Daniela Pugliese
- CEMAD - IBD Unit, Department of Medical and Surgical Sciences, A Gemelli University Hospital, Rome, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Alessia Todeschini
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
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12
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Macaluso FS, Cappello M, Busacca A, Fries W, Viola A, Costantino G, Magnano A, Vinci E, Ferracane C, Privitera AC, Piccillo G, Belluardo N, Giangreco E, Romano C, Citrano M, Graziano F, Garufi S, Bertolami C, Ventimiglia M, Scrivo B, Teresi G, Renna S, Rizzuto G, Casà A, Orlando A. SPOSAB ABP 501: A Sicilian Prospective Observational Study of Patients with Inflammatory Bowel Disease Treated with Adalimumab Biosimilar ABP 501. J Gastroenterol Hepatol 2021; 36:3041-3049. [PMID: 34152636 DOI: 10.1111/jgh.15590] [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: 02/05/2021] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM There are few clinical data on Adalimumab (ADA) biosimilars in inflammatory bowel disease. We aimed to perform a multicenter, observational, prospective study on safety and effectiveness of ADA biosimilar ABP 501 in patients with inflammatory bowel disease. METHODS All consecutive patients from the cohort of the Sicilian Network for Inflammatory Bowel Disease treated with ADA biosimilar ABP 501 from February 2019 to February 2020 were enrolled. Patients were divided into three groups: group A, naïve to ADA and naïve to anti-tumor necrosis factors; group B, naïve to ADA and previously exposed to anti-tumor necrosis factors; and group C: switched from ADA originator to ABP 501. RESULTS A total of 559 patients (median age 39 years; Crohn's disease 88.0%, ulcerative colitis 12.0%) were included, with a follow-up time of 403.4 patient-years. Thirty-six serious adverse events occurred in 36 patients (6.4%; incidence rate [IR]: 8.9 per 100 person-years [PY]). The IR of serious adverse events was higher among patients in group A compared with group C (17.4 vs 4.8 per 100 PY; IR ratio = 3.61; P < 0.001) and among patients in group B compared with group C (16.4 vs 4.8 per 100 PY; IR ratio = 3.42; P = 0.041). Among ADA-naïve patients (group A + B), 188 (85.8%) had a clinical response after 12 weeks, including 165 (75.3%) who achieved steroid-free remission. Higher treatment persistence estimates were reported for patients in group C compared with groups A and B (log-rank P < 0.001). CONCLUSIONS Safety and effectiveness of ABP 501 seem to be overall similar to those reported for ADA originator. Switching from originator to ABP 501 was safe and effective.
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Affiliation(s)
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Anita Busacca
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Giuseppe Costantino
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Elisa Vinci
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Concetta Ferracane
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, A.O. "Cannizzaro", Catania, Italy
| | | | | | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Michele Citrano
- Pediatric Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | | | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Barbara Scrivo
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Teresi
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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13
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Chiappetta MF, Viola A, Mastronardi M, Turchini L, Carparelli S, Orlando A, Biscaglia G, Miranda A, Guida L, Costantino G, Scaldaferri F, Bossa F, Renna S, Cappello M, Alibrandi A, Orlando A, Armuzzi A, Fries W. One-year effectiveness and safety of ustekinumab in ulcerative colitis: a multicenter real-world study from Italy. Expert Opin Biol Ther 2021; 21:1483-1489. [PMID: 34521307 DOI: 10.1080/14712598.2021.1981855] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Efficacy and safety of ustekinumab for the treatment of ulcerative colitis (UC) has been demonstrated in clinical trials, but few real-world data are available so far. The aim of this study was to assess effectiveness and safety of ustekinumab in a cohort of refractory UC patients. METHODS Data of patients with moderate to severe UC treated with ustekinumab were retrospectively collected. Primary endpoint was steroid-free clinical remission at weeks 24 and 52 of therapy. Secondary endpoints were treatment response, endoscopic remission, treatment persistence at 12 months and safety. RESULTS A total of 68 patients [males 63%; median (range) age 42 (16-72) years] were included. Almost all patients (97%) were biologics experienced. At weeks 24 and 52, 31% and 50% of patients achieved steroid-free clinical remission, 84% and 82% had clinical response, respectively. At the end of follow-up, there was a significant reduction of pMS from baseline (p < 0.001) and of steroid use (p < 0.001). At week 52, 22% of the available endoscopies (18/38) showed mucosal healing. The probability to persist in therapy at week 52 was 87%. Only one adverse event occurred. CONCLUSIONS Data from our real-life cohort of refractory UC patients suggest satisfactory effectiveness and a good safety of ustekinumab.
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Affiliation(s)
- Michele Francesco Chiappetta
- IBD-unit, Dept. Of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Section of Gastroenterology and Hepatology, Promise, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Anna Viola
- IBD-unit, Dept. Of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mauro Mastronardi
- Inflammatory Bowel Disease Unit, National Institute of Gastroenterology, "Saverio De Bellis" Research Hospital, Castellana Grotte, Italy
| | - Laura Turchini
- CEMAD IBD Center, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" Irccs, Rome, Italy
| | - Sonia Carparelli
- U.O.C Di Gastroenterologia Ed Endoscopia Digestiva, Fondazione Casa Sollievo Della Sofferenza Irccs, San Giovanni Rotondo, Italy
| | - Adele Orlando
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello Hospital", Palermo, Italy
| | - Giuseppe Biscaglia
- U.O.C Di Gastroenterologia Ed Endoscopia Digestiva, Fondazione Casa Sollievo Della Sofferenza Irccs, San Giovanni Rotondo, Italy
| | - Agnese Miranda
- Gastroenterologia Ed Endoscopia Digestiva, A.u.o Policlinico Di Napoli "L. Vanvitelli", Naples, Italy
| | - Laura Guida
- Section of Gastroenterology and Hepatology, Promise, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Giuseppe Costantino
- IBD-unit, Dept. Of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Franco Scaldaferri
- CEMAD IBD Center, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" Irccs, Rome, Italy.,Dipartimento Di Medicina E Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Fabrizio Bossa
- U.O.C Di Gastroenterologia Ed Endoscopia Digestiva, Fondazione Casa Sollievo Della Sofferenza Irccs, San Giovanni Rotondo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello Hospital", Palermo, Italy
| | - Maria Cappello
- Section of Gastroenterology and Hepatology, Promise, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello Hospital", Palermo, Italy
| | - Alessandro Armuzzi
- CEMAD IBD Center, Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" Irccs, Rome, Italy.,Dipartimento Di Medicina E Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Walter Fries
- IBD-unit, Dept. Of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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14
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Orlando A, Mocciaro F, Ventimiglia M, Renna S, Rispo A, Scribano ML, Testa A, Aratari A, Bossa F, Angelucci E, Onali S, Cappello M, Giunta M, Scimeca D, Macaluso FS, Castiglione F, Papi C, Annese V, Biancone L, Kohn A, Di Mitri R, Cottone M. Azathioprine for prevention of clinical recurrence in Crohn's disease patients with severe endoscopic recurrence: an IG-IBD randomized double-blind trial. Eur Rev Med Pharmacol Sci 2021; 24:11356-11364. [PMID: 33215456 DOI: 10.26355/eurrev_202011_23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The recurrence of Crohn's Disease after ileo-colonic resection is a crucial issue. Severe endoscopic lesions increase the risk of developing early symptoms. Prevention and treatment of post-operative Endoscopic Recurrence (ER) have been studied with conflicting results. We compare effi cacy of azathioprine (AZA) vs. high-dose 5-aminosalicylic acid (5-ASA) in preventing clinical recurrence and treating severe post-operative ER. PATIENTS AND METHODS We performed a 1-year multicenter randomized double-blind double-dummy trial. Primary end-points were endoscopic improvement and therapeutic failure (clinical recurrence or drug discontinuation due to lack of efficacy or adverse events) 12 months after randomization. We also performed a post-trial analysis on symptomatic and endoscopic outcomes 10 years after the beginning of the trial, with a median follow-up of 60 months. RESULTS Therapeutic failure occurred in 8 patients (17.4%) within 12 months from randomization, with no significant difference between patients treated with 5-ASA (20.8%, 5 patients) and those with AZA (13.6%, 3 patients). Therapeutic failure was due to clinical recurrence in the 5-ASA group and to adverse events in the AZA group. Endoscopic improvement at 12 months was observed in 8 patients, 2 (11.8%) in the 5-ASA group and 6 (30%) in the AZA group. No serious adverse event was recorded. At the post-trial analysis (median follow-up 60 months), 47.8% (22/46) of patients experienced clinical recurrence: 54.2% (13/24) in the 5-ASA group and 40.9% (9/22) in the AZA group, p=0.546. Patients treated with AZA had lower risk of drug escalation. Clinical recurrence was associated with smoking (p=0.031) and previous surgery (p=0.003). CONCLUSIONS Our trial indicates that there was no difference in terms of treatment failure between 5-ASA and AZA in patients with severe ER. The main limit of AZA is its less favorable safety profile.
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Affiliation(s)
- A Orlando
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy.
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15
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Crispino F, Grova M, Maida M, Renna S, Mocciaro F, Casà A, Rizzuto G, Tesè L, Scimeca D, Di Mitri R, Macaluso FS, Orlando A. Blood-based prognostic biomarkers in Crohn's Disease patients on biologics: a promising tool to predict endoscopic outcomes. Expert Opin Biol Ther 2021; 21:1133-1141. [PMID: 34042009 DOI: 10.1080/14712598.2021.1935857] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is a growing need for biomarkers to predict therapeutic outcome in Crohn's disease (CD). MAIN OUTCOME MEASURES The aim was to evaluate whether NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), ELR (eosinophil-to-lymphocyte ratio), and ENLR (eosinophil*neutrophil-to-lymphocyte ratio), could be prognostic biomarkers of endoscopic response (ER) when starting biologics. RESEARCH DESIGN AND METHODS Patients with CD who started biologics were enrolled. Multivariate analysis was used to evaluate whether NLR, PLR, ELR and ENLR at baseline and at w12 could predict ER (Simple Endoscopic Score for Crohn's disease [SES-CD] ≤2 or SES-CD≤2 and Rutgeerts i0-i1) after 52 weeks of treatment. Area under the curve (AUC) was calculated to find the cutoffs. RESULTS 107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013), and ENLR (p = 0.020) compared with those without ER; results after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.003). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p = 0.014) for NLR, ELR and ENLR. CONCLUSIONS Low NLR, ELR and ENLR can predict ER and could be used in clinical practice for a better management of CD patients.
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Affiliation(s)
- Federica Crispino
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology & Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy.,Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Mauro Grova
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology & Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy.,Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Marcello Maida
- Section of Gastroenterology, "S.Elia-Raimondi" Hospital, Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Lorenzo Tesè
- Radiology Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | | | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
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Macaluso FS, Mazzola G, Ventimiglia M, Alvisi P, Renna S, Adamoli L, Galli M, Armuzzi A, Ardizzone S, Cascio A, Cottone M, Orlando A. Physicians' Knowledge and Application of Immunization Strategies in Patients with Inflammatory Bowel Disease: A Survey of the Italian Group for the Study of Inflammatory Bowel Disease. Digestion 2021; 101:433-440. [PMID: 31167191 DOI: 10.1159/000500798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND No data on European countries about knowledge and application of immunization strategies in patients with inflammatory bowel disease (IBD) are available. OBJECTIVES We designed a questionnaire aimed at exploring these issues among Italian gastroenterologists dealing with adult and paediatric IBD. METHODS An anonymous, 24-item, questionnaire was sent via e-mail to all members of the Italian Group for the study of Inflammatory Bowel Disease. Three sets of questions were formulated: (1) Characteristics of respondents; (2) General opinions on the role of vaccines in IBD patients; (3) Immunizations of IBD patients in clinical practice. RESULTS Of the 455 total surveys sent, there were 198 respondents (response rate: 43.5%). The great majority of respondents (82.9%) reputed as "very important" to perform the vaccinations recommended by the guidelines in patients with IBD. The indication to immunization is given at the diagnosis of the disease by 55.6% of the respondents. The most frequently recommended vaccine in IBD patients is the annual flu vaccine, while the recommendation rate for the other vaccines is variable depending on the different pathogens. CONCLUSIONS Efforts carried out by the scientific societies are required to increase the awareness of this relevant topic among physicians.
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Affiliation(s)
| | - Giovanni Mazzola
- Department of Sciences for Health Promotion " G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Patrizia Alvisi
- Gastroenterology of Pediatric Unit, Maggiore Hospital, Bologna, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Lucia Adamoli
- Department of Sciences for Health Promotion " G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Massimo Galli
- Infectious Disease Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sandro Ardizzone
- Department of Biochemical and Clinical Science "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Cascio
- Department of Sciences for Health Promotion " G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Mario Cottone
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Mocciaro F, Di Mitri R, Macaluso FS, Renna S, Scimeca D, Orlando A. The key role of colonoscopy at 6 months from ileocolonic resection in Crohn's disease patients. Dig Liver Dis 2021; 53:517-518. [PMID: 33500236 DOI: 10.1016/j.dld.2020.12.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy.
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | | | - Sara Renna
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
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18
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Macaluso FS, Fries W, Viola A, Centritto A, Cappello M, Giuffrida E, Privitera AC, Piccillo G, Magnano A, Vinci E, Vassallo R, Trovatello A, Belluardo N, Giangreco E, Camilleri S, Garufi S, Bertolami C, Ventimiglia M, Renna S, Orlando R, Rizzuto G, Orlando A. The SPOSIB SB2 Sicilian Cohort: Safety and Effectiveness of Infliximab Biosimilar SB2 in Inflammatory Bowel Diseases, Including Multiple Switches. Inflamm Bowel Dis 2021; 27:182-189. [PMID: 32083291 DOI: 10.1093/ibd/izaa036] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/31/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND No data on the recently introduced infliximab (IFX) biosimilar SB2 in inflammatory bowel disease (IBD) are available. METHODS The Sicilian Prospective Observational Study of Patients With IBD Treated With Infliximab Biosimilar SB2 is a multicenter, observational, prospective study performed among the cohort of the Sicilian Network for Inflammatory Bowel Disease. All consecutive IBD patients starting the IFX biosimilar SB2 from its introduction in Sicily (March 2018) to September 2019 (18 months) were enrolled. RESULTS Two hundred seventy-six patients (Crohn disease: 49.3%, ulcerative colitis: 50.7%) were included: 127 (46.0%) were naïve to IFX and naïve to anti-tumor necrosis factor medications (anti-TNFs), 65 (23.5%) were naïve to IFX and previously exposed to anti-TNFs, 17 (6.2%) were switched from an IFX originator to SB2, 43 (15.6%) were switched from the biosimilar CT-P13 to SB2, and 24 (8.7%) were multiply switched (from IFX originator to CT-P13 to SB2). The cumulative number of infusions of SB2 was 1798, and the total follow-up time was 182.7 patient-years. Sixty-seven serious adverse events occurred in 57 patients (20.7%; incidence rate: 36.7 per 100 patient-year), and 31 of these events caused the withdrawal of the drug. The effectiveness after 8 weeks of treatment was evaluated in patients naïve to IFX (n = 192): 110 patients (57.3%) had steroid-free remission, while 56 patients had no response (29.2%). At the end of follow-up, 72 patients (26.1%) interrupted the treatment, without significant differences in treatment persistency estimations between the five groups (log-rank P = 0.15). CONCLUSIONS The safety and effectiveness of SB2 seem to be overall similar to those reported for the IFX originator and CT-P13.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Andrea Centritto
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico G. Giaccone, Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico G. Giaccone, Palermo, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, A.O. Cannizzaro, Catania, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Elisa Vinci
- Gastroenterology Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, A.O. Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | | | | | | | | | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. S. Elia- M. Raimondi, Caltanissetta, Italy
| | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
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Macaluso FS, Ventimiglia M, Fries W, Viola A, Sitibondo A, Cappello M, Scrivo B, Busacca A, Privitera AC, Camilleri S, Garufi S, Di Mitri R, Mocciaro F, Belluardo N, Giangreco E, Bertolami C, Renna S, Orlando R, Rizzuto G, Cottone M, Orlando A. A propensity score weighted comparison of vedolizumab and adalimumab in Crohn's disease. J Gastroenterol Hepatol 2021; 36:105-111. [PMID: 32428981 DOI: 10.1111/jgh.15107] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM There are no head-to-head randomized controlled trials between biologics in Crohn's disease (CD). We aimed to perform a multicenter, real-life comparison of the effectiveness of vedolizumab (VDZ) and adalimumab (ADA) in CD. METHODS Data of consecutive patients with CD treated with VDZ and ADA from January 2016 to April 2019 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease. The effectiveness was evaluated at 12, 52 weeks, and as failure-free survival at the end of follow up. Propensity score analysis was performed using the inverse probability of treatment weighting method. RESULTS Five hundred eighty-five treatments (VDZ: n = 277; ADA: n = 308) were included (median follow-up: 56.0 weeks). After 12 weeks, a clinical response was achieved in 64.3% patients treated with VDZ and in 83.1% patients treated with ADA (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.38-1.10, P = 0.107), while at 52 weeks, a clinical response was observed in 54.0% patients treated with VDZ and in 69.1% patients treated with ADA (OR 0.77, 95% CI 0.45-1.31, P = 0.336). Cox survival analysis weighted for propensity score showed no significant difference in the probability of failure-free survival between the two drugs (hazard ratio = 1.20, 95% CI 0.83-1.74, P = 0.340). Post-treatment endoscopic response and mucosal healing rates were similar between the two groups (endoscopic response: 35.3% for VDZ and 25.5% for ADA, P = 0.15; mucosal healing: 31.8% for VDZ and 33.8% for ADA, P = 0.85). CONCLUSIONS In the first study comparing VDZ and ADA in CD via propensity score analysis, the drugs showed comparable effectiveness and a similar safety profile.
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Affiliation(s)
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Aldo Sitibondo
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Barbara Scrivo
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Anita Busacca
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | | | - Salvatore Camilleri
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | | | | | | | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Mario Cottone
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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20
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Macaluso FS, Ventimiglia M, Fries W, Viola A, Cappello M, Scrivo B, Magnano A, Pluchino D, Camilleri S, Garufi S, Mitri RD, Mocciaro F, Magrì G, Ferracane C, Citrano M, Graziano F, Bertolami C, Renna S, Orlando R, Rizzuto G, Cottone M, Orlando A. A propensity score weighted comparison of Vedolizumab, Adalimumab, and Golimumab in patients with ulcerative colitis. Dig Liver Dis 2020; 52:1461-1466. [PMID: 32601033 DOI: 10.1016/j.dld.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/27/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND No real-life study on the comparative effectiveness of Vedolizumab (VDZ), Adalimumab (ADA), and Golimumab (GOL) in ulcerative colitis (UC) is currently available. AIMS To compare the effectiveness of the three biologics in consecutive patients with UC. METHODS A three-arms propensity score-adjusted analysis was performed using the Inverse Probability of Treatment Weighting method. RESULTS 463 treatments (VDZ: n = 187; ADA: n = 168; GOL: n = 108) were included (median follow-up: 47.6 weeks). At 12 weeks (n = 463), a steroid-free remission was reported in 24.1% patients in the VDZ group, in 33.3% patients in the ADA group, and in 30.6% patients in the GOL group (p = n.s. for all comparisons). At 52 weeks (n = 377), a steroid-free remission was reported in 51.5% patients in the VDZ group, in 31.2% patients in the ADA group, and in 29.4% patients in the GOL group (p = 0.002 for VDZ vs. ADA, p = 0.001 for VDZ vs. GOL, p = n.s. for ADA vs. GOL). Cox survival analysis demonstrated that patients treated with VDZ had reduced probability of treatment discontinuation compared to those treated with ADA (HR: 0.42, 95% CI 0.28-0.64, p < 0.001) and GOL (HR: 0.30, 95% CI 0.19-0.46, p < 0.001), while patients treated with ADA had reduced risk of treatment discontinuation compared to those treated with GOL (HR: 0.71, 95% CI 0.50-1.00, p = 0.048). CONCLUSIONS VDZ was superior to ADA and GOL at 52 weeks and as treatment persistence, while ADA showed a superior treatment persistence compared to GOL.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy.
| | - Marco Ventimiglia
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Walter Fries
- Inflammatory bowel disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Anna Viola
- Inflammatory bowel disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Barbara Scrivo
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Dario Pluchino
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Salvatore Camilleri
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Roberto Di Mitri
- Gastroenterology and endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | - Giovanni Magrì
- Gastroenterology Unit, A.O. "Santa Marta e S. Venera", Acireale, Italy
| | | | - Michele Citrano
- Pediatrics Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | | | | | - Sara Renna
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Rosalba Orlando
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Mario Cottone
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
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21
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Macaluso FS, Fries W, Viola A, Costantino G, Muscianisi M, Cappello M, Guida L, Giuffrida E, Magnano A, Pluchino D, Ferracane C, Magrì G, Di Mitri R, Mocciaro F, Privitera AC, Camilleri S, Garufi S, Renna S, Casà A, Scrivo B, Ventimiglia M, Orlando A. Effectiveness of Ustekinumab on Crohn's Disease Associated Spondyloarthropathy: Real-World Data from the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). Expert Opin Biol Ther 2020; 20:1381-1384. [PMID: 32981373 DOI: 10.1080/14712598.2020.1830057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The effectiveness of Ustekinumab (UST) on Crohn's disease (CD)-associated spondyloarthropathy (SpA) is currently unknown. RESEARCH DESIGN AND METHODS All consecutive CD patients with active SpA at the initiation of the treatment with UST were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was the articular response at 8 and 24 weeks, defined as the disappearance of objective signs of arthritis (swelling and/or articular stiffness) and resolution of pain. RESULTS Thirty CD patients with active SpA at the initiation of the treatment with UST were assessed. At 24 weeks, 13 patients (43.3%) had an articular response, including 10/18 patients (55.5%) with peripheral SpA and 3/9 patients (33.3%) with axial and peripheral SpA. No patient with axial SpA experienced an articular response. The drop of mean as Harvey-Bradshaw Index values from baseline to week 24 was higher in patients with articular response compared with non-responders (3.8 ± 2.4 vs. 1.3 ± 2.8, p = 0.02). CONCLUSIONS Our real-world, multicentre experience showed that UST was able to obtain a response on articular symptoms in nearly half of the patients with CD and active SpA after 24 weeks of treatment.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Giuseppe Costantino
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Marco Muscianisi
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone" , Palermo, Italy
| | - Laura Guida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone" , Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone" , Palermo, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele" , Catania, Italy
| | - Dario Pluchino
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele" , Catania, Italy
| | - Concetta Ferracane
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele" , Catania, Italy
| | - Giovanni Magrì
- Gastroenterology Unit, A.O. "Santa Marta E S. Venera" , Acireale, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli" , Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli" , Palermo, Italy
| | | | - Salvatore Camilleri
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi" , Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi" , Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Barbara Scrivo
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
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Macaluso FS, Fries W, Renna S, Viola A, Muscianisi M, Cappello M, Guida L, Siringo S, Camilleri S, Garufi S, Privitera AC, Belluardo N, Giangreco E, Bertolami C, Vassallo R, Rizzuto G, Orlando R, Ventimiglia M, Orlando A. Effectiveness and safety of vedolizumab in biologically naïve patients: A real-world multi-centre study. United European Gastroenterol J 2020; 8:1045-1055. [PMID: 32772830 DOI: 10.1177/2050640620948802] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Biologically naïve patients with inflammatory bowel disease treated with vedolizumab (VDZ) are largely underrepresented in real-world cohorts. A multi-centre, observational cohort study was performed on the effectiveness and safety of VDZ in biologically naïve subjects with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Data of consecutive biologically naïve patients with CD and UC treated with VDZ from July 2016 to December 2019 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease. RESULTS A total of 172 consecutive patients (CD: N = 88; UC: N = 84; median age 66.0 years) were included, with a median follow-up of 58.8 weeks. After 14 weeks, a clinical response was reported in 68.2% of patients with CD and 67.9% of patients with UC treated with VDZ, including 45.5% patients in the CD group and 46.4% patients in the UC group who achieved steroid-free remission. After 52 weeks, a clinical response was reported in 77.4% of CD and in 73.8% of UC patients treated with VDZ, including 59.7% patients in the CD group and 60.7% patients in the UC group who achieved steroid-free remission. CONCLUSIONS This study demonstrates the effectiveness and safety of VDZ as a first-line biological, particularly among elderly patients.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Marco Muscianisi
- Inflammatory Bowel Disease Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, AOU Policlinico 'G. Giaccone', Palermo, Italy
| | - Laura Guida
- Gastroenterology and Hepatology Unit, AOU Policlinico 'G. Giaccone', Palermo, Italy
| | | | | | - Serena Garufi
- Gastroenterology Unit, AOOR 'S. Elia-M. Raimondi', Caltanissetta, Italy
| | | | | | | | | | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, AO 'Buccheri La Ferla Fatebenefratelli', Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
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Privitera G, Onali S, Pugliese D, Renna S, Savarino E, Viola A, Ribaldone DG, Buda A, Bezzio C, Fiorino G, Fantini MC, Scaldaferri F, Guidi L, Danese S, Gasbarrini A, Orlando A, Armuzzi A. Dual Targeted Therapy: a possible option for the management of refractory Inflammatory Bowel Disease. J Crohns Colitis 2020; 15:jjaa149. [PMID: 32674156 DOI: 10.1093/ecco-jcc/jjaa149] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Dual Targeted Therapy (DTT) has been proposed as a novel therapeutic strategy for the management of complicated patients with Inflammatory Bowel Diseases (IBD). Our aim was to investigate the safety and effectiveness of this approach in a real-life setting. METHODS We retrospectively extracted data from IBD patients receiving DTT in Italian IBD referral centres. Baseline characteristics, clinical activity of intestinal and extraintestinal disease and C-reactive proteins levels were recorded. All adverse events were reported. Clinical effectiveness, biochemical remission and safety of DTT were investigated. RESULTS Sixteen patients were identified; indications for DTT were: "active IBD" or "active EIM" despite ongoing biological therapy. The most commonly used DTT were: vedolizumab + ustekinumab (3 patients) and vedolizumab + adalimumab (3 patients). Clinical response of intestinal or extraintestinal symptoms, according to the indication for DTT, was reported by all patients by the end of the induction. Four patients discontinued DTT during follow-up. Three patients experienced an adverse event; no serious adverse event was reported. CONCLUSIONS DTT seems to be an effective and safe treatment and may represent an appealing therapeutic strategy for the management of complicated IBD patients.
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Affiliation(s)
- Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Onali
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniela Pugliese
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, Padua, Italy
| | - Anna Viola
- Clinical Unit for Chronic Bowel Disorders, Dept. of Clinical and Experimental Medicine, University of Messina
| | | | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology, Ospedale S. Maria del Prato, Feltre, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan 20089, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Massimo Claudio Fantini
- Gastroenterology Unit, University Hospital of Cagliari, Department of Science and Public Health, University of Cagliari
| | - Franco Scaldaferri
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luisa Guidi
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan 20089, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Gasbarrini
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Alessandro Armuzzi
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Scrivo B, Renna S, Casà A, Monachino N, Macaluso FS, Orlando A. Letter: mesalazine-a safe drug with rare serious adverse events. Aliment Pharmacol Ther 2020; 51:1210-1211. [PMID: 32424923 DOI: 10.1111/apt.15691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/09/2022]
Affiliation(s)
| | - Sara Renna
- IBD Unit, Villa Sofia Cervello Hospital, Palermo, Italy
| | - Angelo Casà
- IBD Unit, Villa Sofia Cervello Hospital, Palermo, Italy
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Miceli MC, Arcuri C, Renna S, Orlando A, Provenzano G. Letter: golimumab efficacy in patients with Crohn's disease and concomitant severe arthritis. Aliment Pharmacol Ther 2020; 51:1449-1451. [PMID: 32445531 DOI: 10.1111/apt.15768] [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: 12/09/2022]
Affiliation(s)
| | - Chiara Arcuri
- Rheumatology Unit, Villa Sofia -Cervello Hospital, Palermo, Italy
| | - Sara Renna
- IBD Unit, Villa Sofia -Cervello Hospital, Palermo, Italy
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Affiliation(s)
| | | | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Emanuele Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
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Biancone L, Armuzzi A, Scribano ML, Castiglione F, D'Incà R, Orlando A, Papi C, Daperno M, Vecchi M, Riegler G, Fries W, Alvisi P, Meucci G, Mocciaro F, Rogai F, Festa S, Guidi L, Testa A, Spina L, Renna S, Viola A, Patturelli M, Di Mitri R, Frankovic I, Calabrese E, Petruzziello C, De Cristofaro E, Sena G, Ruffa A, Neri B, Rossi A. Cancer Risk in Inflammatory Bowel Disease: A 6-Year Prospective Multicenter Nested Case-Control IG-IBD Study. Inflamm Bowel Dis 2020; 26:450-459. [PMID: 31498388 DOI: 10.1093/ibd/izz155] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND In a 6-year, multicenter, prospective nested case-control study, we aimed to evaluate risk factors for incident cancer in inflammatory bowel disease (IBD), when considering clinical characteristics of IBD and immunomodulator use. The secondary end point was to provide characterization of incident cancer types. METHODS All incident cases of cancer occurring in IBD patients from December 2011-2017 were prospectively recorded in 16 Italian Group for the Study of Inflammatory Bowel Disease units. Each of the IBD patients with a new diagnosis of cancer was matched with 2 IBD patients without cancer, according to IBD phenotype (ulcerative colitis [UC] vs Crohn's disease [CD]), age (±5 years), sex. Risk factors were assessed by multivariate logistic regression analysis. RESULTS Cancer occurred in 403 IBD patients: 204 CD (CD cases), 199 UC (UC cases). The study population included 1209 patients (403 IBD cases, 806 IBD controls). Cancer (n = 403) more frequently involved the digestive system (DS; 32%), followed by skin (14.9%), urinary tract (9.7%), lung (6.9%), genital tract (6.5%), breast (5.5%), thyroid (1.9%), lymphoma (2.7%, only in CD), adenocarcinoma of the small bowel (SBA; 3.9%, 15 CD, 1 pouch in UC), other cancers (15.9%). Among cancers of the DS, colorectal cancer (CRC) more frequently occurred in UC (29% vs 17%; P < 0.005), whereas SBA more frequently occurred in CD (13% vs 6.3% P = 0.039). In CD, perforating (B3) vs non-stricturing non-perforating (B1) behavior represented the only risk factor for any cancer (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.33-4.11). In CD, risk factors for extracolonic cancer (ECC) were a B3 vs B1 and a stricturing (B2) vs B1 behavior (OR, 2.95; 95% CI, 1.62-5.43; OR, 1.79; 95% CI, 1.09-2.98). In UC, risk factors for ECC and for overall cancer were abdominal surgery for UC (OR, 4.63; 95% CI, 2.62-8.42; OR, 3.34; 95% CI, 1.88-5.92) and extensive vs distal UC (OR, 1.73; 95% CI, 1.10-2.75; OR, 1.99; 95% CI, 1.16-3.47). Another risk factor for ECC was left-sided vs distal UC (OR, 1.68; 95% CI, 1.00-2.86). Inflammatory bowel disease duration was a risk factor for skin and urinary tract cancers. CONCLUSIONS Perforating CD, extensive UC, and abdominal surgery for UC were identified as risk factors for overall incident cancer and for ECC. The clinical characteristics associated with severe IBD may increase cancer risk.
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Affiliation(s)
- Livia Biancone
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Renata D'Incà
- IBD Unit, Gastroenterology, Azienda-Università of Padova, Padua, Italy
| | | | | | - Marco Daperno
- AO Ordine Mauriziano, SC Gastroenterologia, Turin, Italy
| | - Maurizio Vecchi
- University of Milan, IRCCS Ca' Granda, Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Gabriele Riegler
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Walter Fries
- IBD Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Filippo Mocciaro
- GI and Endoscopy Unit, ARNAS Civico Di Cristina-Benfratelli, Palermo, Italy
| | | | | | - Luisa Guidi
- IBD Unit, Presidio Columbus Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Anna Viola
- IBD Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marta Patturelli
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Roberto Di Mitri
- GI and Endoscopy Unit, ARNAS Civico Di Cristina-Benfratelli, Palermo, Italy
| | - Iris Frankovic
- IBD Unit, Gastroenterology, Azienda-Università of Padova, Padua, Italy
| | - Emma Calabrese
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Carmelina Petruzziello
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Elena De Cristofaro
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Giorgia Sena
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Alessandra Ruffa
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Benedetto Neri
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Alessandra Rossi
- Department of Systems Medicine, GI Unit, Università degli Studi di Roma "Tor Vergata", Rome, Italy
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Macaluso FS, Sapienza C, Ventimiglia M, Renna S, Cottone M, Orlando A. Lupus-like reactions in patients with inflammatory bowel disease treated with anti-TNFs are insidious adverse events: data from a large single-center cohort. Scand J Gastroenterol 2019; 54:1102-1106. [PMID: 31491360 DOI: 10.1080/00365521.2019.1663260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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
Objectives: Very few data on the incidence, predictors, and clinical outcomes of lupus-like reactions (LLRs) in patients with inflammatory bowel disease (IBD) treated with anti-TNFs have been reported. Materials and methods: All records of consecutive IBD patients who started a treatment with an anti-TNF from January 2006 to June 2018 were retrospectively reviewed. Patients were defined as having LLR by the presence of immunologic abnormalities (positivity for ANA and/or anti-ds-DNA), along with clinical features that included at least two of the following: arthralgia, fatigue, fever, cutaneous manifestations, or serositis, which had a clear temporal association with exposure to the anti-TNFs, and resolved without recurrence once the drug was discontinued. Results: 760 patients (1059 total treatments with anti-TNFs) were included. Participants contributed a total of 2863.5 person-years of follow-up, during which 16 cases of LLRs (2.1% of patients) were reported, accounting for an incidence rate of 5.6 per 1000 person-years. Female gender and being former smokers were more prevalent in the LLR group (75.0% versus 44.1%, p = .02; and 18.8% versus 5.4%, p = .037, respectively), with a hazard ratio of 4.40 (95% CI: 1.40-13.81; p = .011) and 4.87 (95% CI: 1.37-17.38; p = .015), respectively, at Cox regression analysis. All LLRs resolved following discontinuation of the drug after a mean of 8.1 ± 4.2 weeks. Ten patients required corticosteroids to control severe symptoms. Conclusions: In this large cohort of patients treated with anti-TNFs with long follow-up, LLRs were rare adverse events, more common in women and former smokers, occurring with nonspecific and insidious clinical features.
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Affiliation(s)
| | - Chiara Sapienza
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo , Italy
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo , Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo , Italy
| | - Mario Cottone
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo , Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo , Italy
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Garbo GM, Renna S, Caputo V, Orlando E, Macaluso FS, Orlando R, Bongiorno MR, Orlando A. Letter: psoriasiform eruption during vedolizumab therapy. Aliment Pharmacol Ther 2019; 50:342-343. [PMID: 31313356 DOI: 10.1111/apt.15389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/28/2022]
Affiliation(s)
| | - Sara Renna
- IBD Unit, Villa Sofia Cervello Hospital, Palermo, Italy
| | - Valentina Caputo
- Department of Pro.M.I.S.E. "Giuseppe D'Alessandro," Section of Dermatology, University of Palermo, AOUP Paolo Giaccone, Palermo, PA, Italy
| | - Elisabetta Orlando
- Department of Pro.M.I.S.E. "Giuseppe D'Alessandro," Section of Pathology, University of Palermo, AOUP Paolo Giaccone, Palermo, PA, Italy
| | | | | | - Maria Rita Bongiorno
- Department of Pro.M.I.S.E. "Giuseppe D'Alessandro," Section of Dermatology, University of Palermo, AOUP Paolo Giaccone, Palermo, PA, Italy
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Macaluso FS, Maida M, Ventimiglia M, Renna S, Cottone M, Orlando A. Factors Affecting Clinical and Endoscopic Outcomes of Placebo Arm in Trials of Biologics and Small Molecule Drugs in Ulcerative Colitis: A Meta-Analysis. Inflamm Bowel Dis 2019; 25:987-997. [PMID: 30590590 DOI: 10.1093/ibd/izy365] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/28/2018] [Accepted: 11/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous systematic cumulative analyses of the placebo arm in ulcerative colitis (UC) were limited by the wide heterogeneity in the scores and definitions of response. We aimed at estimating the placebo rates of remission, response, and mucosal healing (MH) in phase 2 and 3 randomized placebo-controlled trials of biologics and small molecule drugs that used homogeneous criteria for the assessment of outcomes. METHODS PubMed Central, Embase, and reference lists of articles were systematically searched through July 2017. Only studies that employed the Mayo score were included. RESULTS Thirty-one randomized placebo-controlled trials consisting of 2702 patients met the inclusion criteria. At induction, the pooled estimates of the placebo rates of remission, response, and MH were 9% (95% confidence interval [CI], 7%-12%; range: 0%-29%; I2 = 75.0%), 34% (95% CI, 31%-38%; range: 12%-75%; I2 = 61.3%), and 26% (95% CI, 22%-30%; range: 2%-65%; I2 = 77.7%), respectively. At maintenance, the pooled estimates of the placebo rates of remission, response, and MH were 14% (95% CI, 10%-18%; range: 6%-30%; I2 = 73.0%), 23% (95% CI, 20%-27%; range: 18%-36%; I2 = 53.0%), and 19% (95% CI, 15%-23%; range: 12%-30%; I2 = 65.0%), respectively. Among the variables assessed by logistic regression analysis, multiple factors influenced the outcomes of placebo arms, including concomitant systemic steroids at baseline, endoscopic central reading, being naïve or non-naïve to anti-TNFs, and disease duration. CONCLUSIONS Despite the wide use of homogeneous criteria for the assessment of clinical and endoscopic outcomes, a high heterogeneity among placebo arms of modern trials in UC still exists.
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Affiliation(s)
| | - Marcello Maida
- Section of Gastroenterology, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | | | - Sara Renna
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Mario Cottone
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
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31
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Fiorino G, Caprioli F, Daperno M, Mocciaro F, Principi M, Viscido A, Fantini MC, Orlando A, Papi C, Annese V, Danese S, Vecchi M, Rizzello F, Armuzzi A, Previtali E, Aloi M, Alvisi P, Antonelli E, Ardizzone S, Astegiano M, Baldoni M, Beltrami M, Biancone L, Bodini G, Buda A, Bossa F, Bracci F, Calabrese E, Cappello M, Castiglione F, Ciacci C, Cicala M, Ciccocioppo R, Comberlato M, Cortelezzi CC, Cosintino R, Costa F, Costantino G, Cucchiara S, Cuomo A, D’Incà R, Di Paolo MC, Di Sabatino A, Di Sario A, Frieri G, Fries W, Gasbarrini A, Geccherle A, Gionchetti P, Graziani MG, Grossi L, Guidi L, Imperiali G, Latella G, Lionetti P, Inserra G, Maconi G, Manguso F, Marino M, Mastronardi M, Mazzuoli S, Meucci G, Mendolaro M, Milla M, Mocci G, Monteleone G, Bortoluzzi FN, Pagnini C, Pastorelli L, Pica R, Piergallini S, Privitera A, Renna S, Ribaldone DG, Ricci C, Rispo A, Rocca R, Romano C, Romano M, Russo G, Sablich R, Saibeni S, Savarino E, Scribano ML, Spagnuolo R, Stasi E, Terpin MM, Testa A, Valpiani D, Variola A, Vernia P, Vitale G, Zoli G. Use of biosimilars in inflammatory bowel disease: a position update of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2019; 51:632-639. [PMID: 30872085 DOI: 10.1016/j.dld.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/16/2019] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
The first infliximab biosimilar for the treatment of inflammatory bowel disease (IBD) was introduced in 2013, and today eight anti-TNF alpha biosimilars (three for infliximab and five for adalimumab) have been approved and licensed by the European Medicines Agency. Biosimilars present great potential in terms of cost saving and possible consequential reinvestment in the health care system. The increasing knowledge about the process of biosimilar development and use in IBD and the publication of many prospective clinical studies and real-life clinical experiences have progressively changed the point of view of IBD physicians. In the present position paper, the Italian Group for the Study of Inflammatory Bowel Disease present and discuss their updated statements and positions on this topic, with emphasis on the concepts of biosimilarity and extrapolation across indications, safety and immunogenicity, interchangeability and switching, automatic substitution, and, finally, patient education about biosimilars.
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Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Organ Transplantation (DETO), Policlinico Universitario, Bari, Italy
| | - Angelo Viscido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Ambrogio Orlando
- IBD Unit, A.O. Osp. Riuniti "Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | | | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | | | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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Viola A, Pugliese D, Renna S, Furfaro F, Caprioli F, D'Incà R, Bossa F, Mazza S, Costantino G, Fantini MC, Fiorino G, Alibrandi A, Orlando A, Armuzzi A, Fries W. Outcome in ulcerative colitis after switch from adalimumab/golimumab to infliximab: A multicenter retrospective study. Dig Liver Dis 2019; 51:510-515. [PMID: 30472389 DOI: 10.1016/j.dld.2018.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Received: 07/13/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anti-TNF therapies infliximab (IFX), adalimumab (ADA), and golimumab (GOL) are approved for treating moderate to severe ulcerative colitis (UC). In UC, only the switch from IFX to ADA has been investigated, reaching no more than 10-43% remission rates at 12 months. AIM Of the present study was to investigate disease outcome after a switch from subcutaneous (SC) agents to the intravenous (IV) agent (IFX). METHODS In this retrospective multicentre study, we analysed the charts of UC patients unresponsive/intolerant or with secondary loss of response (LOR) to ADA or GOL who were switched to IFX. We evaluated clinical response and remission together with adverse events at 3, 6, and 12 months follow-up. RESULTS Seventy-six patients were included; 38 patients started ADA and 38 started GOL for a mean therapy duration of 6 ± 6 months. Indications for switch were adverse events in 3%, primary failure in 79%, and LOR in 18% of patients. Clinical remission was reached by 47%, 50%, and 77% of patients, respectively. Patients that switched for LOR did numerically, but not statistically, better than patients who switched for primary failure. CONCLUSIONS Our data show a superior remission rate in SC to IV anti-TNF switch in UC compared to the IV to SC switch reported in literature.
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Affiliation(s)
- Anna Viola
- Clinical Unit for Chronic Bowel Disorders, Dept. of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Daniela Pugliese
- IBD-Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | - Sara Renna
- IBD-Unit, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Federica Furfaro
- Humanitas Research Hospital, Rozzano, IBD Center, Department of Gastroenterology, Milan, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Renata D'Incà
- Gastroenterology Unit, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabrizio Bossa
- Div. of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Costantino
- Clinical Unit for Chronic Bowel Disorders, Dept. of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Gionata Fiorino
- Humanitas Research Hospital, Rozzano, IBD Center, Department of Gastroenterology, Milan, Italy
| | | | - Ambrogio Orlando
- IBD-Unit, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Alessandro Armuzzi
- IBD-Unit Complesso Integrato Columbus, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | - Walter Fries
- Clinical Unit for Chronic Bowel Disorders, Dept. of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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Armuzzi A, Fiorino G, Variola A, Manetti N, Fries W, Orlando A, Maconi G, Bossa F, Cappello M, Biancone L, Cantoro L, Costa F, D'Incà R, Lionetti P, Principi M, Castiglione F, Annunziata ML, Di Sabatino A, Di Girolamo M, Terpin MM, Cortelezzi CC, Saibeni S, Amato A, Ardizzone S, Guidi L, Danese S, Massella A, Ventra A, Rizzuto G, Massari A, Perri F, Annese V, Tari R, Petruzzellis C, Meucci G, Imperiali G, Guglielmi FW, Mazzuoli S, Caserta L, Caterina Parodi M, Colli A, Ronchetti A, Pugliese D, Geccherle A, Rogai F, Milani S, Renna S, Cassinotti A, Andriulli A, Martino G, Scrivo B, Troncone E, Kohn A, Bertani L, Lorenzon G, Ghione S, Nardone O, Vecchi M, Bertani A, Bosani MA, Bezzio C, Salerno R. The PROSIT Cohort of Infliximab Biosimilar in IBD: A Prolonged Follow-up on the Effectiveness and Safety Across Italy. Inflamm Bowel Dis 2019; 25:568-579. [PMID: 30137352 DOI: 10.1093/ibd/izy264] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 06/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND We report a prospective, nationwide cohort evaluating the safety and effectiveness of CT-P13. METHODS A structured database was used to record serious adverse events (SAEs), clinical remission/response, inflammatory biomarkers (CRP and calprotectin), and endoscopic findings. RESULTS Eight hundred ten patients with inflammatory bowel disease (IBD) (452 Crohn's disease [CD]) were enrolled. Four hundred fifty-nine patients were naïve to anti-TNFα (group A), 196 had a previous exposure (group B), and the remaining 155 were switched to CT-P13 (group C). All patients were included in the safety evaluation with a mean follow-up of 345 ± 215 days and a total number of 6501 infusions. One hundred fifty-four SAEs were reported (19%), leading to cessation of the biosimilar in 103 subjects (12.7%). Infusion reactions were 71, leading to cessation of the biosimilar in 53 subjects (6.5%), being significantly more frequent in patients pre-exposed to anti-TNFα (P = 0.017). The efficacy of therapy was calculated in 754 IBD patients, with a mean follow-up of 329 ± 202 days. Forty-eight patients had a primary failure (6.4%), and 188 (25.6%) lost response during follow-up. Six hundred twenty-eight (364 CD) and 360 IBD patients (222 CD) completed the follow-up at 6 and 12 months, respectively. At 12 months, patients without loss of response were 71%, 64%. and 82% in groups A, B, and C, respectively (log rank P = 0.01). Clinical/endoscopic scores and inflammatory biomarkers dropped significantly in CD and UC patients (P = 0.01 and P < 0.0001) compared with baseline. CONCLUSIONS In this large prospective cohort, no further signals of difference in safety and effectiveness of CT-P13 in IBD has been observed.
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Affiliation(s)
- Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Gionata Fiorino
- Humanitas Research Hospital and University, Gastroenterology and IBD Center, Rozzano, Italy
| | - Angela Variola
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Walter Fries
- University of Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy
| | - Ambrogio Orlando
- Riuniti Villa Sofia-Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Giovanni Maconi
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Fabrizio Bossa
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Livia Biancone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Roma
| | - Laura Cantoro
- S. Camillo-Forlanini Hospital, Gastroenterology, Rome, Italy
| | | | - Renata D'Incà
- University of Padova, Gastroenterology, Padova, Italy
| | - Paolo Lionetti
- Meyer Children's Hospital, Gastroenterology and Nutrition, Florence, Italy
| | | | | | | | - Antonio Di Sabatino
- First Department of Medicine, S. Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Maria M Terpin
- U.O.C. Gastroenterologia ed Endoscopia Digestiva ASST Ovest Milanese, Legnano, Italy
| | | | - Simone Saibeni
- ASST Rhodense, Rho Hospital, Gastroenterology Unit, Rho, Italy
| | | | - Sandro Ardizzone
- Department of Biochemical and Clinical Science "L. Sacco" ASST Fatebenefratelli Sacco-University of Milan, Italy
| | - Luisa Guidi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Silvio Danese
- Humanitas Research Hospital and University, Gastroenterology and IBD Center, Rozzano, Italy
| | - Arianna Massella
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Agostino Ventra
- University of Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy
| | - Giulia Rizzuto
- Riuniti Villa Sofia-Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Alessandro Massari
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Francesco Perri
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | - Vito Annese
- AOU Careggi, Gastroenterology, Florence, Italy
| | | | | | - Carlo Petruzzellis
- Istituto Fondazione Poliambulanza Hospital, Department of Medicine, Gastroenterology and Digestive Endoscopy, Brescia, Italy
| | | | | | | | | | - Luigi Caserta
- IRCCS AOU San Martino IST Gastroenterology Genova, Italy
| | | | | | | | - Daniela Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Andrea Geccherle
- Centro Malattie retto-intestinali, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | | | - Sara Renna
- Riuniti Villa Sofia–Cervello Hospital, Internal Medicine 2, IBD Unit Palermo, Italy
| | - Andrea Cassinotti
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Angelo Andriulli
- IRCCS-CSS Hospital, Gastroenterology, San Giovanni Rotondo, Italy
| | | | - Barbara Scrivo
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Edoardo Troncone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Roma
| | - Anna Kohn
- S. Camillo-Forlanini Hospital, Gastroenterology, Rome, Italy
| | | | | | - Silvia Ghione
- Meyer Children’s Hospital, Gastroenterology and Nutrition, Florence, Italy
| | - Olga Nardone
- University of Bari, Gastroenterology, Bari, Italy
| | - Maurizio Vecchi
- Federico II University, Gastroenterology, Naples, Italy
- Gastroenterology and Endoscopy Unit, IRCCS Ca’ Granda Ospedale Maggiore Foundation, Milan, Itay
| | | | - Matteo A Bosani
- U.O.C. Gastroenterologia ed Endoscopia Digestiva ASST Ovest Milanese, Legnano, Italy
| | - Cristina Bezzio
- ASST Rhodense, Rho Hospital, Gastroenterology Unit, Rho, Italy
| | - Raffaele Salerno
- Department of Biochemical and Clinical Science “L. Sacco” ASST Fatebenefratelli Sacco–University of Milan, Italy
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Macaluso FS, Fries W, Privitera AC, Cappello M, Siringo S, Inserra G, Magnano A, Di Mitri R, Mocciaro F, Belluardo N, Scarpulla G, Magrì G, Trovatello A, Carroccio A, Genova S, Bertolami C, Vassallo R, Romano C, Citrano M, Accomando S, Ventimiglia M, Renna S, Orlando R, Rizzuto G, Porcari S, Ferracane C, Cottone M, Orlando A. A Propensity Score-matched Comparison of Infliximab and Adalimumab in Tumour Necrosis Factor-α Inhibitor-naïve and Non-naïve Patients With Crohn's Disease: Real-Life Data From the Sicilian Network for Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:209-217. [PMID: 30295785 DOI: 10.1093/ecco-jcc/jjy156] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS There is an unmet need to better understand the effectiveness of different biologics in inflammatory bowel diseases. We aimed at performing a multicentre, real-life comparison of the effectiveness of infliximab [IFX] and adalimumab [ADA] in Crohn's disease [CD]. METHODS Data of consecutive patients with CD treated with IFX and ADA from January 2013 to May 2017 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease. We used propensity score-matching accounting for the main baseline characteristics in TNF-α inhibitor-naïve and non-naïve patients. RESULTS A total of 632 patients [735 total treatments] were included. Among naïve patients, a clinical benefit [the sum of steroid-free remission plus clinical response] was achieved in 81.8% patients treated with ADA and in 77.6% patients treated with IFX (adjusted odds ratio [OR]: 1.23, 95% CI 0.63-2-44, p = 0.547] at 12 weeks; after 1 year, a clinical benefit was achieved in 69.2% of patients treated with ADA and in 64.5% patients treated with IFX [adjusted OR: 1.10, 95% CI 0.61-1.96, p = 0.766]. Among non-naïve patients, a clinical benefit was achieved in 61.7% of patients treated with ADA and in 68.1% of patients treated with IFX [adjusted OR: 0.72, 95% CI 0.21-2.44, p = 0.600] at 12 weeks; after 1 year, a clinical benefit was achieved in 48.9% of patients treated with ADA and in 40.4% patients treated with IFX [adjusted OR: 1.23, 95% CI 0.54-2.86, p = 0.620]. CONCLUSIONS In this propensity score-matched comparison of ADA and IFX in CD, both drugs showed high rates of clinical benefit, without significant differences between them.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico 'G. Martino', Messina, Italy
| | | | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico 'G. Giaccone', Palermo, Italy
| | | | - Gaetano Inserra
- Internal Medicine Unit, A.O.U. Policlinico 'Vittorio Emanuele', Catania, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico 'Vittorio Emanuele', Catania, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. 'Civico Di Cristina Benfratelli', Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. 'Civico Di Cristina Benfratelli', Palermo, Italy
| | | | - Giuseppe Scarpulla
- Gastroenterology Unit, A.O.O.R. 'S. Elia- M. Raimondi', Caltanissetta, Italy
| | - Giovanni Magrì
- Gastroenterology Unit, A.O. 'Santa Marta e S. Venera', Acireale, Italy
| | | | | | - Salvatore Genova
- Gastroenterology and Endoscopy Unit, A.O. 'S. Antonio Abate', Trapani, Italy
| | | | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, A.O. 'Buccheri La Ferla Fatebenefratelli', Palermo, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, A.O.U. Policlinico 'G. Martino', Messina, Italy
| | - Michele Citrano
- Pediatric Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy
| | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy
| | - Serena Porcari
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico 'G. Martino', Messina, Italy
| | | | - Mario Cottone
- Inflammatory Bowel Disease Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy
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Macaluso FS, Cappello M, Giuffrida E, Fries W, Centritto A, Privitera AC, Inserra G, Vassallo R, Magnano A, Vinci E, Garufi S, Ventimiglia M, Renna S, Orlando R, Rizzuto G, Cottone M, Orlando A. Letter: SPOSIB SB2-a Sicilian prospective observational study of IBD patients treated with infliximab biosimilar SB2. Aliment Pharmacol Ther 2019; 49:234-236. [PMID: 30589969 DOI: 10.1111/apt.15071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/26/2022]
Affiliation(s)
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Andrea Centritto
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | | | - Gaetano Inserra
- Internal Medicine Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, A.O. "Buccheri La Ferla Fatebenefratelli", Palermo, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Elisa Vinci
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Mario Cottone
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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Macaluso FS, Orlando R, Fries W, Scolaro M, Magnano A, Pluchino D, Cappello M, Morreale GC, Siringo S, Privitera AC, Ferracane C, Belluardo N, Alberghina N, Ventimiglia M, Rizzuto G, Renna S, Cottone M, Orlando A. The real-world effectiveness of vedolizumab on intestinal and articular outcomes in inflammatory bowel diseases. Dig Liver Dis 2018; 50:675-681. [PMID: 29576495 DOI: 10.1016/j.dld.2018.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effectiveness of vedolizumab in real-world practice is under evaluation, while its role in inflammatory bowel disease-associated spondyloarthritis is still unclear. AIMS To report real-world data about the effectiveness of vedolizumab on intestinal and articular symptoms after 10 and 22 weeks of treatment. METHODS Web-based data from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) were extracted to perform a prospective multicentre observational study. RESULTS 163 patients (84 with Crohn's disease and 79 with ulcerative colitis) were included. At week 10, a steroid-free remission was achieved in 71 patients (43.6%), while at week 22 a steroid-free remission was obtained in 40.8% of patients. A response on articular symptoms was reported after 10 weeks of treatment in 17 out of 43 (39.5%) patients with active spondyloarthritis at baseline, and in 10 out of 22 (45.4%) patients at week 22. The only factor associated with articular response was the coexistence of clinical benefit on intestinal symptoms (at week 10: OR 8.471, p = 0.05; at week 22: OR 5.600, p = 0.08). CONCLUSIONS Vedolizumab showed good effectiveness after 10 and 22 weeks of treatment. A subset of patients reported improvement also on articular symptoms, probably as a consequence of the concomitant control of gut inflammation.
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Affiliation(s)
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Mariangela Scolaro
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Dario Pluchino
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "P. Giaccone", Palermo, Italy
| | | | | | | | | | | | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Mario Cottone
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Orlando R, Renna S, Sapienza C, Ventimiglia M, Rizzuto G, Cottone M, Orlando A. Letter: the addition of an immunosuppressant in patients with unsatisfactory response to vedolizumab. Aliment Pharmacol Ther 2018. [PMID: 29512915 DOI: 10.1111/apt.14541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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)
- F S Macaluso
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - R Orlando
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - S Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - C Sapienza
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - M Ventimiglia
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - G Rizzuto
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - M Cottone
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - A Orlando
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Sapienza C, Ventimiglia M, Renna S, Rizzuto G, Orlando R, Di Pisa M, Affronti M, Orlando E, Cottone M, Orlando A. The Addition of an Immunosuppressant After Loss of Response to Anti-TNFα Monotherapy in Inflammatory Bowel Disease: A 2-Year Study. Inflamm Bowel Dis 2018; 24:394-401. [PMID: 29361087 DOI: 10.1093/ibd/izx010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 06/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The addition of an immunosuppressant (IM) after loss of response to anti-TNFα monotherapy is an emerging strategy of therapeutic optimization in patients with inflammatory bowel disease (IBD). However, few clinical data have been reported to date. We aimed to evaluate the efficacy and safety of this selective combination therapy in patients with IBD. METHODS All consecutive patients with loss of response to anti-TNFα monotherapy despite an intensive dose optimization who added an IM from October 2014 to October 2016 were entered into a prospective database. RESULTS Among 630 patients treated with anti-TNFα agents during the study period, 46 (7.3%) added an IM. A total of 31 patients (67.4%) were treated with an intravenous anti-TNFα (infliximab, as originator or biosimilar), while 15 (32.6%) were treated with a subcutaneous anti-TNFα agent (10 adalimumab and 5 golimumab). The mean duration of follow-up was 12.8 ± 7.3 months. Twenty-one patients (45.7%) remained on combination therapy at the end of follow-up: 15 (32.6%) maintained a steroid-free remission, and 6 (13.0%) achieved a clinical response. In patients who experienced treatment success, the median value of C-reactive protein decreased from baseline to the end of follow-up (13.2 vs 3.0, P = 0.01; normal values <5 mg/L). Adverse events leading to treatment discontinuation were reported in 8 out of 46 patients (17.4%). CONCLUSIONS In the largest cohort on this argument reported to date, the addition of an IM was an effective and safe optimization strategy after loss of response to anti-TNFα monotherapy. Low doses of IM were sufficient to achieve a clinical response.
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Affiliation(s)
| | | | | | - Sara Renna
- Division of Internal Medicine, University of Palermo, Italy
| | - Giulia Rizzuto
- Division of Internal Medicine, University of Palermo, Italy
| | | | - Marta Di Pisa
- Gastroenterology and Endoscopy Unit, ''Villa Sofia-Cervello'' Hospital, Palermo, Italy
| | - Marco Affronti
- Division of Internal Medicine, University of Palermo, Italy
| | | | - Mario Cottone
- Division of Internal Medicine, University of Palermo, Italy
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Macaluso FS, Renna S, Maida M, Dimarco M, Sapienza C, Affronti M, Orlando E, Rizzuto G, Orlando R, Ventimiglia M, Cottone M, Orlando A. Tolerability profile of thiopurines in inflammatory bowel disease: a prospective experience. Scand J Gastroenterol 2017; 52:981-987. [PMID: 28554266 DOI: 10.1080/00365521.2017.1333626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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
OBJECTIVES The occurrence of thiopurine-related adverse events (AEs) may complicate the management of patients with inflammatory bowel disease (IBD). We aimed to evaluate the tolerability of thiopurines in a current IBD setting. MATERIALS AND METHODS All consecutive patients who started a treatment with azathioprine (AZA) from January 2010 to March 2016 were entered in a prospectively maintained database, and the AEs which led to the permanent discontinuation of the drug were reported. RESULTS Two hundred and fifty three patients were included. Median total follow-up was 32 months (range: 0.2-75 months). At the end of the study, AZA was discontinued in 160 patients (63.2%). The main reason leading to drug withdrawal was the occurrence of AEs (109/160 patients [68.1%]; cumulative incidence among the entire cohort: 43.1%). Overall, the most frequent AEs leading to treatment withdrawal were nausea (31/253 patients, 12.3%) and subjective symptoms, i.e., poorly defined side effects such as fatigue, headache and muscle pain (20/253 patients, 7.9%). Among the 109 AZA-intolerant patients, a switch to 6-mercaptopurine (6-MP) was performed in 44 cases (40.4%). At the end of follow-up, 6-MP was discontinued in 35/44 patients (79.5%), mostly due to AEs (29/35 patients, 82.8%). Azathioprine-induced hepatic and pancreatic toxicity was associated with male gender (p = .01 and p = .03, respectively), and occurrence of nausea with Crohn's disease (p = .04). CONCLUSIONS Our real-life prospective cohort showed the higher cumulative incidence of thiopurine withdrawal due to AEs reported to date. Switching from AZA to 6-MP was often ineffective.
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Affiliation(s)
- Fabio Salvatore Macaluso
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Sara Renna
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Marcello Maida
- b Gastroenterology and Endoscopy Unit , "Villa Sofia-Cervello" Hospital , Palermo , Italy
| | - Mariangela Dimarco
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Chiara Sapienza
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Marco Affronti
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Emanuele Orlando
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Giulia Rizzuto
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Rosalba Orlando
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Marco Ventimiglia
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Mario Cottone
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
| | - Ambrogio Orlando
- a Di.Bi.M.I.S., Division of Internal Medicine , "Villa Sofia-Cervello" Hospital, University of Palermo , Palermo , Italy
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Biancone L, Annese V, Ardizzone S, Armuzzi A, Calabrese E, Caprioli F, Castiglione F, Comberlato M, Cottone M, Danese S, Daperno M, D'Incà R, Frieri G, Fries W, Gionchetti P, Kohn A, Latella G, Milla M, Orlando A, Papi C, Petruzziello C, Riegler G, Rizzello F, Saibeni S, Scribano ML, Vecchi M, Vernia P, Meucci G, Bossa F, Cappello M, Cassinotti A, Chiriatti A, Fiorino G, Formica V, Guidi L, Losco A, Mocciaro F, Onali S, Pastorelli L, Pica R, Principi M, Renna S, Ricci C, Rispo A, Rogai F, Sarmati L, Scaldaferri F, Spina L, Tambasco R, Testa A, Viscido A. Safety of treatments for inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2017; 49:338-358. [PMID: 28161290 DOI: 10.1016/j.dld.2017.01.141] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/19/2016] [Accepted: 01/07/2017] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel diseases are chronic conditions of unknown etiology, showing a growing incidence and prevalence in several countries, including Italy. Although the etiology of Crohn's disease and ulcerative colitis is unknown, due to the current knowledge regarding their pathogenesis, effective treatment strategies have been developed. Several guidelines are available regarding the efficacy and safety of available drug treatments for inflammatory bowel diseases. Nevertheless, national guidelines provide additional information adapted to local feasibility, costs and legal issues related to the use of the same drugs. These observations prompted the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) to establish Italian guidelines on the safety of currently available treatments for Crohn's disease and ulcerative colitis. These guidelines discuss the use of aminosalicylates, systemic and low bioavailability corticosteroids, antibiotics (metronidazole, ciprofloxacin, rifaximin), thiopurines, methotrexate, cyclosporine A, TNFα antagonists, vedolizumab, and combination therapies. These guidelines are based on current knowledge derived from evidence-based medicine coupled with clinical experience of a national working group.
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Affiliation(s)
- Livia Biancone
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy.
| | - Vito Annese
- AOU Careggi, Gastroenterology, Florence, Italy
| | - Sandro Ardizzone
- Gastrointestinal Unit, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Emma Calabrese
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda,Ospedale Policlinico di Milano, Milan, Italy
| | | | - Michele Comberlato
- Department of Gastroenterology and Digestive Endoscopy, Central Hospital, Bolzano, Italy
| | - Mario Cottone
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Silvio Danese
- Humanitas Research Hospital and Humanitas University, Rozzano (Milan), Italy
| | - Marco Daperno
- Hospital "Ordine Mauriziano di Torino", Turin, Italy
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy
| | - Giuseppe Frieri
- University of L'Aquila, Gastroenterology Unit, L'Aquila, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, Clinical Unit for Chroric Bowel Disorders, University of Messina, Messina, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Kohn
- San Camillo-Forlanini Hospital, IBD Unit, Rome, Italy
| | | | | | - Ambrogio Orlando
- Division of Internal Medicine 2, IBD Unit, Hospital "Riuniti Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | - Carmelina Petruzziello
- Gastroenterology Unit, University of Rome "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | - Gabriele Riegler
- U.O. of Gastroenterology C.S. - University della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | | | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato and University of Milan, San Donato Milanese, Milan, Italy
| | - Piero Vernia
- Gastroenterology Unit, Sapienza, University of Rome, Rome, Italy
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Macaluso FS, Maida M, Renna S, Orlando E, Affronti M, Sapienza C, Dimarco M, Orlando R, Rizzuto G, Cottone M, Orlando A. Mycophenolate mofetil is a valid option in patients with inflammatory bowel disease resistant to TNF-α inhibitors and conventional immunosuppressants. Dig Liver Dis 2017; 49:157-162. [PMID: 27876682 DOI: 10.1016/j.dld.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/25/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies investigated the role of mycophenolate mofetil in inflammatory bowel disease, and none of them had specifically focused on patients with previous multiple intolerances and/or nonresponses to conventional immunosuppressants and biologics. AIMS To evaluate clinical benefit and tolerability profile of mycophenolate mofetil in patients with inflammatory bowel disease and limited treatment options. METHODS All consecutive patients with previous multiple intolerances and/or nonresponses to immunosuppressants and biologics who started an off-label treatment with mycophenolate mofetil from January 2014 to February 2016 were entered in a prospectively maintained database. RESULTS Twenty-four patients were included. Four weeks after initiation of mycophenolate mofetil therapy, a steroid-free remission was achieved in 4 patients (16.7%), while a clinical response in 13 (54.1%). At the end of follow-up, 12 patients (50.0%) remained on mycophenolate mofetil. Six achieved and maintained steroid-free remission throughout the study period (25.0%), and a further 6 patients (25.0%) achieved a clinical response with complete discontinuation of steroids. Twelve patients (50.0%) were considered as treatment failure, and five of them underwent surgery. CONCLUSIONS This is the first experience reporting a clinical benefit and tolerability of mycophenolate mofetil in patients with inflammatory bowel disease and multiple previous failures to other immunosuppressants and/or biologics.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy.
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Emanuele Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Marco Affronti
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Chiara Sapienza
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Mariangela Dimarco
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Rosalba Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Giulia Rizzuto
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Mario Cottone
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Ambrogio Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
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Orlando A, Orlando R, Ciccia F, Renna S, Rizzo A, Cottone M, Macaluso FS. Clinical benefit of vedolizumab on articular manifestations in patients with active spondyloarthritis associated with inflammatory bowel disease. Ann Rheum Dis 2017; 76:e31. [PMID: 28096071 DOI: 10.1136/annrheumdis-2016-211011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 12/27/2016] [Accepted: 12/28/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Ambrogio Orlando
- Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Rosalba Orlando
- Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Francesco Ciccia
- Di.Bi.M.I.S., Section of Rheumatology, University of Palermo, Palermo, Italy
| | - Sara Renna
- Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Aroldo Rizzo
- Department of Pathology, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Mario Cottone
- Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Affiliation(s)
| | - Sara Renna
- Di.Bi.M.I.S., Division of Internal Medicine, ‘Villa Sofia-Cervello’ Hospital, Palermo, Italy
| | - Ambrogio Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, ‘Villa Sofia-Cervello’ Hospital, Palermo, Italy
| | - Mario Cottone
- Di.Bi.M.I.S., Division of Internal Medicine, ‘Villa Sofia-Cervello’ Hospital, Palermo, Italy
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Orlando A, Renna S, Mocciaro F, Cappello M, Giunta M, Mendolaro M, Mazza M, Rizzuto G, Orlando E, Affronti M, Dimarco M, Di Mitri R, Craxì A, Cottone M. Six year adalimumab efficacy in steroid-dependent Crohn's disease patients: A prospective single-center real life study. Dig Liver Dis 2016; 48:1314-1317. [PMID: 27578212 DOI: 10.1016/j.dld.2016.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/07/2016] [Revised: 07/16/2016] [Accepted: 07/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Adalimumab is effective in the treatment of Crohn's disease. We have already reported data on the efficacy of adalimumab in 110 steroid-dependent patients. At the end of the study 90 patients (64.5%) maintained clinical remission. AIMS To assess efficacy and safety of adalimumab after 6 years in patients of the original cohort who responded to treatment. METHODS The present study is an extension of the published paper on 90/110 patients. We report results on clinical remission and safety of 6 year maintenance therapy with adalimumab. RESULTS Of the original cohort 90 patients completed the study, 17 were lost to follow-up and 3 died. At the end of follow-up (74.16±10.3 months) 37/90 patients (41%) maintained clinical remission. Of these, 32 (86%) continued adalimumab and 5 (13%) discontinued treatment due to clinical remission and mucosal healing. Of the remaining 53/90 patients, 47 (52%) discontinued adalimumab due to clinical failure and 6 (7%) to adverse events. We obtained endoscopy data in 31/32 patients in clinical remission continuing adalimumab: 11 (36%) did not improve, 6 (19%) worsened, 14 (45%) improved. At univariable analysis no variables were related to treatment outcome. CONCLUSIONS This "real life" prospective study shows that adalimumab is a long-term effective and safe maintenance treatment in steroid-dependent Crohn's disease patients.
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Affiliation(s)
- Ambrogio Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy.
| | - Sara Renna
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Maria Cappello
- DiBiMis, Department of Gastroenterology and Hepatology, Palermo University, Palermo, Italy
| | - Marco Giunta
- Gastroenterology and Endoscopy Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Marco Mendolaro
- DiBiMis, Department of Gastroenterology and Hepatology, Palermo University, Palermo, Italy
| | - Marta Mazza
- DiBiMis, Department of Gastroenterology and Hepatology, Palermo University, Palermo, Italy
| | - Giulia Rizzuto
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - Emanuele Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - Marco Affronti
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - Mariangela Dimarco
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Antonio Craxì
- DiBiMis, Department of Gastroenterology and Hepatology, Palermo University, Palermo, Italy
| | - Mario Cottone
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
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Biancone L, Armuzzi A, Scribano ML, D'Inca R, Castiglione F, Papi C, Angelucci E, Daperno M, Mocciaro F, Riegler G, Fries W, Meucci G, Alvisi P, Spina L, Ardizzone S, Petruzziello C, Ruffa A, Kohn A, Vecchi M, Guidi L, Di Mitri R, Renna S, Emma C, Rogai F, Rossi A, Orlando A, Pallone F. Inflammatory Bowel Disease Phenotype as Risk Factor for Cancer in a Prospective Multicentre Nested Case-Control IG-IBD Study. J Crohns Colitis 2016; 10:913-24. [PMID: 26933032 DOI: 10.1093/ecco-jcc/jjw048] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/09/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Cancer risk in inflammatory bowel disease [IBD] is still debated. In a prospective, multicentre, nested case-control study, we aimed to characterise incident cases of cancer in IBD. The role of immunomodulators vs clinical characteristics of IBD as risk factors for cancer was also investigated. MATERIALS AND METHODS From January 2012 to December 2014, each IBD patient with incident cancer was matched with two IBD patients without cancer for: IBD type, gender, and age. Risk factors were assessed by multivariate regression analysis. RESULTS IBD patients considered numbered 44619: 21953 Crohn's disease [CD], 22666 ulcerative colitis [UC]. Cancer occurred in 174 patients: 99 CD [CD-K], 75 UC [UC-K]. Controls included 198 CD [CD-C], 150 UC [UC-C]. Cancer incidence in IBD was 3.9/1000, higher in CD (4.5/1000 [99/21,953]) than in UC (3.3/1000 [75/22,666]; p = 0.042). Cancers involved: digestive system [36.8%], skin [13.2%], urinary tract [12.1%], lung [8.6%], breast [8%], genital tract [6.9%], thyroid [4.6%], lymphoma [3.5%], others [6.3%]. In CD, penetrating behaviour and combined thiopurines and tumour necrosis factor alpha [TNFα] antagonists were risk factors for cancer overall: odds ratio [OR] (95% confidence interval [CI] 2.33 [1.01-5.47]); 1.97 [1.1-3.5]; and for extracolonic cancers 3.9 [1.56-10.1]; 2.15 [1.17-4.1], respectively. In UC, risk factors were pancolitis and disease-related surgery for cancer overall (OR: 2.52 [1.26-5.1]; 5.09 [1.73-17.1]); disease-related surgery for colorectal cancer [CRC] (OR 3.6 [1.0-12]); and extensive and left-sided vs distal UC for extracolonic cancers (OR: 2.55 [1.15-5.9]; 2.6 [1.04-6.6]), respectively. CONCLUSIONS In a multicentre study, penetrating CD and extensive UC were risk factors for cancer overall. Cancer incidence was higher in CD than in UC.
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Affiliation(s)
- Livia Biancone
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Alessandro Armuzzi
- Department of Internal Medicine, Division of Gastroenterology, Columbus, Catholic University and IBD Unit, Rome, Italy
| | | | - Renata D'Inca
- Department of Gastroenterology, U.O. Gastroenterology, University of Padua, Padua, Italy
| | | | | | - Erika Angelucci
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Marco Daperno
- GI Unit, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | | | - Walter Fries
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Luisa Spina
- Department of Biomedical Sciences for Health, University of Milan, and GI Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Carmelina Petruzziello
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Alessandra Ruffa
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Anna Kohn
- GI Unit, A.O. San Camillo-Forlanini, IBD Unit, Rome, Italy
| | - Maurizio Vecchi
- Department of Biomedical Sciences for Health, University of Milan, and GI Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luisa Guidi
- Department of Internal Medicine, Division of Gastroenterology, Columbus, Catholic University and IBD Unit, Rome, Italy
| | | | - Sara Renna
- Division of Internal Medicine 'Villa Sofia-Cervello' Hospital, University of Palermo, Palermo, Italy
| | - Calabrese Emma
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
| | - Francesca Rogai
- Department of Medical and Surgical Specialties, Gastroenterology SOD2, A.O. Universitaria Careggi, Florence, Italy
| | - Alessandra Rossi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ambrogio Orlando
- Division of Internal Medicine 'Villa Sofia-Cervello' Hospital, University of Palermo, Palermo, Italy
| | - Francesco Pallone
- Department of Systems Medicine, Gastroenterology Unit, University 'Tor Vergata', Rome, Italy
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Renna S, Orlando E, Macaluso FS, Maida M, Affronti M, Giunta M, Sapienza C, Rizzuto G, Orlando R, Dimarco M, Cottone M, Orlando A. Letter: a prospective real life comparison of the efficacy of adalimumab vs. golimumab in moderate to severe ulcerative colitis. Aliment Pharmacol Ther 2016; 44:310-1. [PMID: 27375103 DOI: 10.1111/apt.13692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/13/2022]
Affiliation(s)
- S Renna
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - E Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - F S Macaluso
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Maida
- Gastroenterology and Endoscopy Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - M Affronti
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Giunta
- Gastroenterology and Endoscopy Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - C Sapienza
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - G Rizzuto
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - R Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Dimarco
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Cottone
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - A Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy.
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Macaluso FS, Renna S, Cottone M, Orlando A. The METEOR Trial: The Burial of Methotrexate in Ulcerative Colitis? Gastroenterology 2016; 151:211-2. [PMID: 27243641 DOI: 10.1053/j.gastro.2016.02.085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/15/2016] [Accepted: 02/24/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Fabio Salvatore Macaluso
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Sara Renna
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Mario Cottone
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Ambrogio Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
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Orlando A, Renna S, Rizzuto G, Orlando E, Affronti M, Cottone M. Selective Use of Combination Therapy in Patients With Infliximab-resistant Inflammatory Bowel Disease: Data From a Tertiary Referral Center. Clin Gastroenterol Hepatol 2016; 14:914. [PMID: 26707682 DOI: 10.1016/j.cgh.2015.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Ambrogio Orlando
- DiBiMis, Division of Internal Medicine, ''Villa Sofia-Cervello'' Hospital, Palermo University, Palermo, Italy
| | - Sara Renna
- DiBiMis, Division of Internal Medicine, ''Villa Sofia-Cervello'' Hospital, Palermo University, Palermo, Italy
| | - Giulia Rizzuto
- DiBiMis, Division of Internal Medicine, ''Villa Sofia-Cervello'' Hospital, Palermo University, Palermo, Italy
| | - Emanuele Orlando
- DiBiMis, Division of Internal Medicine, ''Villa Sofia-Cervello'' Hospital, Palermo University, Palermo, Italy
| | - Marco Affronti
- DiBiMis, Division of Internal Medicine, ''Villa Sofia-Cervello'' Hospital, Palermo University, Palermo, Italy
| | - Mario Cottone
- DiBiMis, Division of Internal Medicine, ''Villa Sofia-Cervello'' Hospital, Palermo University, Palermo, Italy
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Macaluso FS, Criscuoli V, Orlando E, Rizzuto G, Renna S, Cottone M, Orlando A. Letter: switching from one to another anti-tumour necrosis factor alpha agent, and the risks of an overlap of exposure. Aliment Pharmacol Ther 2016; 43:1019-20. [PMID: 27040168 DOI: 10.1111/apt.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/08/2022]
Affiliation(s)
- F S Macaluso
- Division of Internal Medicine, Di.Bi.M.I.S., "Villa Sofia-Cervello" Hospital, University of Palermo, Italy.
| | - V Criscuoli
- Division of Internal Medicine, Di.Bi.M.I.S., "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - E Orlando
- Division of Internal Medicine, Di.Bi.M.I.S., "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - G Rizzuto
- Division of Internal Medicine, Di.Bi.M.I.S., "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - S Renna
- Division of Internal Medicine, Di.Bi.M.I.S., "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - M Cottone
- Division of Internal Medicine, Di.Bi.M.I.S., "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - A Orlando
- Division of Internal Medicine, Di.Bi.M.I.S., "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
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Orlando A, Mocciaro F, Renna S, Scimeca D, Rispo A, Lia Scribano M, Testa A, Aratari A, Bossa F, Tambasco R, Angelucci E, Onali S, Cappello M, Fries W, D'Incà R, Martinato M, Castiglione F, Papi C, Annese V, Gionchetti P, Rizzello F, Vernia P, Biancone L, Kohn A, Cottone M. Early post-operative endoscopic recurrence in Crohn's disease patients: data from an Italian Group for the study of inflammatory bowel disease (IG-IBD) study on a large prospective multicenter cohort. J Crohns Colitis 2014; 8:1217-21. [PMID: 24630485 DOI: 10.1016/j.crohns.2014.02.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 12/30/2013] [Revised: 02/15/2014] [Accepted: 02/16/2014] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The incidence of endoscopic recurrence (ER) in Crohn's disease following curative resection is up to 75% at 1 year. Endoscopy is the most sensitive method to detect the earliest mucosal changes and the severe ER at 1 year seems to predict a clinical relapse. METHODS The aim of this prospective study was to evaluate the incidence of early ER 6 months after curative resection. Secondary outcome was to evaluate the role of 5-aminosalicylic acid (5-ASA) in the prevention of ER at 6 months. A total of 170 patients were included in the study. They were carried-out from the evaluation of the appearance of ER during a trial performed to assess the role of azathioprine vs. 5-ASA as early treatment of severe ER. All the patients started 5-ASA treatment 2 weeks after surgery. RESULTS Six months after surgery ER was observed in 105 patients (62%). The endoscopic score was reported as severe in 78.1% of them (82 out of 105). At univariable analysis only ileo-colonic disease influenced the final outcome associating to a lower risk of severe ER (p=0.04; OR 0.52, 95% CI 0.277-0.974). CONCLUSION In this prospective Italian multicenter IG-IBD study a great proportion of ER occur within 6 months from ileo-colonic resection, with a significant rate of severe ER. Furthermore this study confirms the marginal role of 5-ASA in the prevention of ER. This suggests that post-surgical endoscopic evaluation should be performed at 6 months instead of 1 year to allow an adequate early treatment.
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Affiliation(s)
- Ambrogio Orlando
- Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy.
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy
| | - Sara Renna
- Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Daniela Scimeca
- Department of Gastroenterology, IRCCS, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
| | - Antonio Rispo
- Department of Gastroenterology, Federico II University, Naples, Italy
| | | | - Anna Testa
- Department of Gastroenterology, Federico II University, Naples, Italy
| | - Annalisa Aratari
- Department of Gastroenterology, San Filippo Neri Hospital, Rome, Italy
| | - Fabrizio Bossa
- Department of Gastroenterology, IRCCS, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
| | - Rosy Tambasco
- Department of Internal Medicine, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Erika Angelucci
- Department of Gastroenterology, Sapienza University, Rome, Italy
| | - Sara Onali
- Department of Gastroenterology, Tor Vergata University, Rome, Italy
| | - Maria Cappello
- Department of Gastroenterology, Palermo University, Palermo, Italy
| | - Walter Fries
- Department of Gastroenterology, Messina University, Messina, Italy
| | - Renata D'Incà
- Department of Gastroenterology, Padua University, Padua, Italy
| | | | | | - Claudio Papi
- Department of Gastroenterology, San Filippo Neri Hospital, Rome, Italy
| | - Vito Annese
- Gastroenterology Unit II, AOU Careggi, Florence, Italy
| | - Paolo Gionchetti
- Department of Internal Medicine, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Fernando Rizzello
- Department of Internal Medicine, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Piero Vernia
- Department of Gastroenterology, Sapienza University, Rome, Italy
| | - Livia Biancone
- Department of Gastroenterology, Tor Vergata University, Rome, Italy
| | - Anna Kohn
- Gastroenterology Unit, San Camillo Forlanini, Rome, Italy
| | - Mario Cottone
- Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy
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