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Harnik S, Ungar B, Loebstein R, Ben-Horin S. A Gastroenterologist's guide to drug interactions of small molecules for inflammatory bowel disease. United European Gastroenterol J 2024. [PMID: 38532266 DOI: 10.1002/ueg2.12559] [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: 10/24/2023] [Accepted: 01/21/2024] [Indexed: 03/28/2024] Open
Abstract
Small molecule drugs are becoming increasingly used in the treatment of inflammatory bowel diseases (IBD). However, unlike monoclonal antibody drugs, which have few interactions with other medications, the pharmacokinetics of small molecule drugs are complex and may be influenced by a myriad of drug-drug interactions (DDI) as well as by patient characteristics and food intake. This review aims to provide a concise practical guide to small molecule drug interactions for the use of IBD physicians. It starts with a brief overview of the main metabolizing enzymes and transporters involved in drug interactions and the Food and Drug Administration's (FDA) approach to determining drug-interaction hazard thresholds. It is then followed by a more detailed review of the pharmacokinetics of four novel small molecules approved in IBD: Tofacitinib, Upadacitinib, Filgotinib, and Ozanimod, including their known interactions and specific warnings. This review will also inform readers on challenges in determining the actual magnitude of interactions and their clinical relevance, including the arbitrary nature of some hazard thresholds, the inference of the impact on metabolizing enzymes and transporters from single-drug assays which may not reflect poly-pharmaceutical regimens, and other challenges in this field which the IBD physician needs to be cognizant of. In practice, before administering a small molecule drug, it is advisable to evaluate any potential interactions with other medications the patient is receiving. An increased awareness by health care professionals and patients, may reduce the possible risks associated with DDI of small molecule IBD drugs.
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Affiliation(s)
- Sivan Harnik
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Ronen Loebstein
- Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center Tel Hashomer Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
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Harnik S, Abitbol CM, Haj Natour O, Yavzori M, Fudim E, Picard O, Naftali T, Broide E, Hirsch A, Selinger L, Shachar E, Yablecovitch D, Albshesh A, Coscas D, Kopylov U, Eliakim R, Ben-Horin S, Ungar B. Prospective Observational Evaluation of the Time-Dependency of Adalimumab Immunogenicity and Drug Concentration in Ulcerative Colitis Patients: the POETIC II Study. J Crohns Colitis 2024; 18:341-348. [PMID: 37691574 DOI: 10.1093/ecco-jcc/jjad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/20/2023] [Accepted: 09/08/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND AIMS Home self-injection of the human anti-tumour necrosis alpha [anti-TNFα] monoclonal adalimumab complicates prospective serial-sampling studies. Although a recent study examined adalimumab levels and immunogenicity in Crohn's disease [CD] patients, prospective real-world data from ulcerative colitis [UC] patients are lacking. METHODS A three-monthly home-visit programme from induction was established prospectively for UC patients. Clinical scores were determined at each visit, and sera were obtained for assessment of drug and anti-adalimumab antibody levels. Calprotectin was measured using a smartphone-based app. This cohort was compared to a parallel prospective cohort of adalimumab-treated CD patients [POETIC1]. RESULTS Fifty UC patients starting adalimumab [median follow-up 28 weeks] were compared to 98 adalimumab-treated CD patients [median follow-up 44 weeks]. Only 11/50 UC patients [22%] continued treatment to the end of the follow-up compared with 50/98 [51%] CD patients (odds ratio [OR] = 0.27, p = 0.001). Loss of response was significantly more common in UC patients [OR = 3.2, p = 0.001]. Seventeen patients [34%] in the UC cohort developed anti-adalimumab antibodies, 9/17 [52.9%] as early as week 2. There was no difference between patient cohorts in the overall development of anti-adalimumab antibodies [34% vs 30.6%, respectively, OR = 1.67, p = 0.67], nor was there a difference in early immunogenicity [OR = 1.39, p = 0.35]. There was no difference in low drug levels [<3 µg/mL] between the two cohorts [OR = 0.87, p = 0.83]. CONCLUSIONS Loss of response to adalimumab therapy was significantly more common in the UC compared to the CD cohort and was driven by a higher rate of non-immunogenic, pharmacodynamic parameters.
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Affiliation(s)
- Sivan Harnik
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Chaya M Abitbol
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ola Haj Natour
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Miri Yavzori
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ella Fudim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit Picard
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Timna Naftali
- Department of Gastroenterology, Meir Medical Center, Kfar Saba, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Efrat Broide
- The Kamila Gonczarowski Institute of Gastroenterology, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayal Hirsch
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Selinger
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Shachar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Doron Yablecovitch
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ahmad Albshesh
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Daniel Coscas
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Schreiber S, D'Haens G, Cummings F, Irving PM, Ye BD, Ben-Horin S, Kim DH, Jeong AL, Reinisch W. Switching from intravenous to subcutaneous infliximab maintenance therapy in inflammatory bowel disease: Post hoc longitudinal analysis of a randomized trial. Dig Liver Dis 2024:S1590-8658(23)01121-0. [PMID: 38365502 DOI: 10.1016/j.dld.2023.12.013] [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: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/21/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Pharmacokinetic non-inferiority of subcutaneous (SC) to intravenous (IV) CT-P13 maintenance therapy was demonstrated in a randomized trial (NCT02883452). This post hoc analysis evaluated longitudinal clinical outcomes with the two infliximab treatment strategies. METHODS Patients with Crohn's disease or ulcerative colitis received CT‑P13 IV loading doses (5 mg/kg; Week [W] 0 and W2) before randomization (1:1) to receive CT-P13 SC (body weight-based dosing every 2 weeks [Q2W]; W6-54; 'SC maintenance group') or CT‑P13 IV (5 mg/kg Q8W; W6-22) then CT-P13 SC (Q2W; W30-54; 'IV-to-SC switch group'). Paired W30/W54 patient-level data were analyzed. RESULTS Fifty-three (IV-to-SC switch) and fifty-nine (SC maintenance) patients were analyzed. Median trough serum CT-P13 concentrations were significantly higher at W54 versus W30 in the IV-to-SC switch group (20.4 versus 2.3 µg/mL; p < 0.00001), while remaining consistent in the SC maintenance group. Statistically significant improvements in pharmacokinetics, efficacy, fecal calprotectin levels, and quality of life were seen following switch to SC administration at W30 in the IV-to-SC switch group; safety findings were similar pre- and post-switch. CONCLUSION Formulation switching from IV to SC infliximab maintenance therapy was well tolerated and may provide additional clinical improvements. Findings require confirmation in larger prospective studies.
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Affiliation(s)
- Stefan Schreiber
- Department for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel University, Arnold-Heller Straße 3, 24105 Kiel, Germany
| | - Geert D'Haens
- Department of Gastroenterology, Amsterdam University Medical Centers, De Boelelaan 1117, HV 1081, Amsterdam, The Netherlands
| | - Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; School of Immunology and Microbial Sciences, King's College London, Great Maze Pond, London SE1 1UL, UK
| | - Byong Duk Ye
- Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Shomron Ben-Horin
- Gastroenterology Department, Chaim Sheba Medical Center, Tel Aviv University, 2 Derech Sheba, Tel-Hashomer 5261900, Israel
| | - Dong-Hyeon Kim
- Medical Division, Celltrion Healthcare Co., Ltd, Academy-ro 51beon-gil, Yeonsu-gu, Incheon 22014, South Korea
| | - Ae Lee Jeong
- Medical Division, Celltrion Healthcare Co., Ltd, Academy-ro 51beon-gil, Yeonsu-gu, Incheon 22014, South Korea
| | - Walter Reinisch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
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Ben-Horin S, Salomon N, Karampekos G, Viazis N, Lahat A, Ungar B, Eliakim R, Kuperstein R, Kriger-Sharabi O, Reiss-Mintz H, Yanai H, Dotan I, Zittan E, Maharshak N, Hirsch A, Weitman M, Mantzaris GJ, Kopylov U. Curcumin-QingDai Combination for Patients With Active Ulcerative Colitis: A Randomized, Double-Blinded, Placebo-Controlled Trial. Clin Gastroenterol Hepatol 2024; 22:347-356.e6. [PMID: 37302449 DOI: 10.1016/j.cgh.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND & AIMS We evaluated the efficacy of herbal combination of curcumin-QingDai (CurQD) in active ulcerative colitis (UC). METHODS Part I was an open-label trial of CurQD in patients with active UC, defined by a Simple Clinical Colitis Activity Index score of 5 or higher and a Mayo endoscopic subscore of 2 or higher. Part II was a placebo-controlled trial conducted in Israel and Greece, randomizing active UC patients at a 2:1 ratio to enteric-coated CurQD 3 g/d or placebo for 8 weeks. The co-primary outcome was clinical response (reduction in the Simple Clinical Colitis Activity Index of ≥3 points) and an objective response (Mayo endoscopic subscore improvement of ≥1 or a 50% fecal calprotectin reduction). Responding patients continued either maintenance curcumin or placebo alone for an additional 8 weeks. Aryl-hydrocarbon receptor activation was assessed by cytochrome P450 1A1 (CYP1A1) mucosal expression. RESULTS In part I, 7 of 10 patients responded and 3 of 10 achieved clinical remission. Of 42 patients in part II, the week 8 co-primary outcome was achieved in 43% and 8% of CurQD and placebo patients, respectively (P = .033). Clinical response was observed in 85.7% vs 30.7% (P < .001), clinical remission in 14 of 28 (50%) vs 1 of 13 (8%; P = .01), a 50% calprotectin reduction in 46.4% vs 15.4% (P = .08), and endoscopic improvement in 75% vs 20% (P = .036) in the CurQD and placebo groups, respectively. Adverse events were comparable between groups. By week 16, curcumin-maintained clinical response, clinical remission, and clinical biomarker response rates were 93%, 80%, and 40%, respectively. CurQD uniquely up-regulated mucosal CYP1A1 expression, which was not observed among patients receiving placebo, mesalamine, or biologics. CONCLUSIONS In this placebo-controlled trial, CurQD was effective for inducing response and remission in active UC patients. The aryl-hydrocarbon receptor pathway may merit further study as a potential UC treatment target. CLINICALTRIALS gov ID: NCT03720002.
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Affiliation(s)
- Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Nir Salomon
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel.
| | - Georgios Karampekos
- Department of Gastroenterology, Evangelismos-Polykliniki General Hospital of Athens, Athens, Greece
| | - Nikos Viazis
- Department of Gastroenterology, Evangelismos-Polykliniki General Hospital of Athens, Athens, Greece
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rafael Kuperstein
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Hilla Reiss-Mintz
- Gastroenterology Department, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Henit Yanai
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Iris Dotan
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Eran Zittan
- Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel; The Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel
| | - Nitsan Maharshak
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Ayal Hirsch
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Michal Weitman
- MS Unit, Chemistry Department, Bar llan University, Ramat-Gan, Israel
| | - Gerassimos J Mantzaris
- Department of Gastroenterology, Evangelismos-Polykliniki General Hospital of Athens, Athens, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Levartovsky A, Ben-Horin S, Kopylov U, Klang E, Barash Y. Towards AI-Augmented Clinical Decision-Making: An Examination of ChatGPT's Utility in Acute Ulcerative Colitis Presentations. Am J Gastroenterol 2023; 118:2283-2289. [PMID: 37611254 DOI: 10.14309/ajg.0000000000002483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023]
Abstract
This study explores the potential of OpenAI's ChatGPT as a decision support tool for acute ulcerative colitis presentations in the setting of an emergency department. We assessed ChatGPT's performance in determining disease severity using TrueLove and Witts criteria and the necessity of hospitalization for patients with ulcerative colitis, comparing results with those of expert gastroenterologists. Of 20 cases, ChatGPT's assessments were found to be 80% consistent with gastroenterologist evaluations and indicated a high degree of reliability. This suggests that ChatGPT could provide as a clinical decision support tool in assessing acute ulcerative colitis, serving as an adjunct to clinical judgment.
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Affiliation(s)
- Asaf Levartovsky
- Department of Gastroenterology, Sheba Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
- DeepVision Lab, Sheba Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
- DeepVision Lab, Sheba Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
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Granot M, Braun T, Efroni G, Picard O, Fudim E, Yavzori M, Haj O, Weiss B, Ben-Horin S, Kopylov U, Haberman Y. Baseline Peripheral Blood Mononuclear Cell Transcriptomics Before Ustekinumab Treatment Is Linked With Crohn's Disease Clinical Response at 1 Year. Clin Transl Gastroenterol 2023; 14:e00635. [PMID: 37655708 PMCID: PMC10749706 DOI: 10.14309/ctg.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Ustekinumab, a monoclonal antibody to the p40 subunit of interleukin (IL)-12 and IL-23, is used for Crohn's disease (CD), and the documented clinical remission rate after 1 year was observed in approximately 50% of patients. We aimed to identify predictors for a clinical response using peripheral blood obtained from patients with CD just before ustekinumab treatment initiation. METHODS RNA extraction from peripheral blood mononuclear cells was followed by mRNA paired-end sequencing. Differential gene expression was performed using DESeq2. RESULTS We processed samples from 36 adults with CD (13 men, 36%) obtained at baseline before starting ustekinumab treatment. Twenty-two of 36 (61%) were defined as responders and 14/36 (39%) as nonresponders after 1 year based on Physician Global Assessment. Differential gene expression between responders (n = 22) and nonresponders (n = 14) did not show a gene expression signature that passed false discovery rate (FDR) correction. However, the analyses identified 68 genes, including CXCL1/2/3, which were induced in nonresponders vs responders with P < 0.05 and fold change above 1.5. Functional annotation enrichments of these 68 genes using ToppGene indicated enrichment for cytokine activity (FDR = 1.98E-05), CXCR chemokine receptor binding (FDR = 2.11E-05), IL-10 signaling (FDR = 5.03E-07), genes encoding secreted soluble factors (FDR = 1.73E-05), and myeloid dendritic cells (FDR = 1.80E-08). DISCUSSION No substantial differences were found in peripheral blood mononuclear cell transcriptomics between responders and nonresponders. However, among the nonresponders, we noted an increased inflammatory response enriched for pathways linked with cytokine activity and chemokine receptor binding and innate myeloid signature. A larger cohort is required to validate and further explore these findings.
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Affiliation(s)
- Maya Granot
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Tzipi Braun
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Gilat Efroni
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Picard
- Department of Gastroenterology, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Ella Fudim
- Department of Gastroenterology, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Miri Yavzori
- Department of Gastroenterology, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Ola Haj
- Department of Gastroenterology, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Batia Weiss
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Haberman
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Tel-Aviv, Israel
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Savin E, Ben-Shabat N, Levartovsky A, Lahat A, Omar M, Gendelman O, Lidar M, Watad A, Ben-Horin S, Kopylov U, Sharif K. Biologic Treatment Modification Efficacy in Concurrent Inflammatory Bowel Disease and Ankylosing Spondylitis: A Retrospective Cohort Study at a Single Tertiary Center. J Clin Med 2023; 12:7151. [PMID: 38002764 PMCID: PMC10672021 DOI: 10.3390/jcm12227151] [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: 10/14/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The link between ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) is well-established, with concurrent prevalence estimates ranging from 5-10%. However, there are still significant gaps in our understanding, and a comprehensive treatment guideline for these co-diagnosed patients has yet to be established. Our objective was to explore patterns of treatment alterations following the diagnosis of AS in patients previously diagnosed with IBD, and vice versa. Additionally, we sought to determine how these modifications influence clinical outcomes in both conditions. METHODS This retrospective data-based cohort study included patients with coexisting IBD and AS that were diagnosed between the years 2009-2022 and were followed by the gastroenterology and the rheumatology units of the Sheba Medical Center, Israel. The data were extracted from the electronic health record and included demographic information, medication history, treatment modification at the time of second diagnosis, and the characteristics and activity of both IBD and AS at the index time and at the 3-month mark. RESULTS The study included a total of 68 patients, with a male predominance (40 patients, 59%). The median age was 43 years (IQR 31-55) and 78% had Crohn's disease (CD). The median duration between the diagnosis of the first disease to the second one was 4 years (IQR 1-9.5). A significant proportion of patients (85%) underwent treatment modification at their second diagnosis. Out of the total cohort, 28% initiated biological therapy, 17.6% switched their biologic regimen, and 16.2% discontinued NSAIDS. Patients who underwent biologic modifications at time of the second diagnosis (the initiation/switch/augmentation of a concurrent regimen) experienced significantly higher rates of clinical improvement in either IBD or AS at the 90-day follow-up compared to patients who did not (68% vs. 32%, p = 0.004), and biologic modification was found to be an independent predictor for clinical improvement (OR 3.69, CI 1.08-12.58, p = 0.037). CONCLUSIONS Our findings suggest that biologic therapy modification at the time of the second diagnosis was associated with a higher rate of improvement in AS/IBD at the 90-day follow-up.
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Affiliation(s)
- Einat Savin
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
| | - Niv Ben-Shabat
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
| | - Asaf Levartovsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Adi Lahat
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Mahmud Omar
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
| | - Omer Gendelman
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Merav Lidar
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Abdulla Watad
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Shomron Ben-Horin
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Uri Kopylov
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Kassem Sharif
- Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.S.); (N.B.-S.); (M.O.); (O.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel (A.L.); (M.L.); (S.B.-H.); (U.K.)
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
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8
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Kopylov U, Burisch J, Ben-Horin S, Braegger F, Fernández-Nistal A, Lara N, Heinrich HS, Vavricka SR. Impact of Vedolizumab on Extraintestinal Manifestations in Inflammatory Bowel Disease: Results From a Descriptive, Retrospective, Real-world Study. Inflamm Bowel Dis 2023; 29:1713-1722. [PMID: 37158585 PMCID: PMC10628928 DOI: 10.1093/ibd/izad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, may develop extraintestinal manifestations (EIMs). The EMOTIVE study aimed to analyze the effect of vedolizumab on EIMs in a real-world cohort of patients with IBD. METHODS This multicenter, descriptive, retrospective study was conducted in Belgium, Denmark, Israel, the Netherlands, and Switzerland in adults with moderately to severely active IBD and concurrent active EIMs at vedolizumab initiation (index date), with a ≥6-month follow-up after the index date. The primary endpoint was resolution of all EIMs within 6 months of vedolizumab initiation. RESULTS In 99 eligible patients, the most frequent EIMs were arthralgia (69.7%), peripheral spondyloarthritis (21.2%), and axial spondyloarthritis (10.1%). Within 6 and 12 months of vedolizumab initiation, 19.2% and 25.3% of patients reported resolution of all EIMs, while 36.5% and 49.5% of all EIMs were reported to be improved (combination of resolution and partial response), respectively. Vedolizumab treatment persistence at 12 months was 82.8%. Adverse events were reported in 18.2% of patients, with the most frequent being arthralgia (4.0%). CONCLUSIONS This real-world study showed resolution of all EIMs in up to one-fourth of patients with IBD and improvement in up to half of EIMs within 12 months of vedolizumab treatment. Overall, vedolizumab was effective on EIMs in patients with IBD and showed a good safety profile.
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Affiliation(s)
- Uri Kopylov
- Gastroenterology Institute, Sheba Medical Center, Tel HaShomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center, Tel HaShomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fiona Braegger
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | | | - Nuria Lara
- IQVIA, Real World Evidence Solutions, Barcelona, Spain
| | - Henriette Sophie Heinrich
- Gastroenterology and Hepatology, Clarunis–Universitäres Bauchzentrum Basel, Basel, Switzerland
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
- Center for Gastroenterology and Hepatology AG, Zürich, Switzerland
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Yablecovitch D, Mahajna H, Horesh N, Katz E, Picard O, Yavzori M, Fudim E, Saker T, Ben-Horin S, Laish I. Serum matrix metalloproteinase-7: a potential biomarker in patients with Lynch Syndrome. Mol Biol Rep 2023; 50:7471-7477. [PMID: 37480510 DOI: 10.1007/s11033-023-08614-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND AIMS The expression of tissue and serum matrix metalloproteinase-7 (MMP-7) was shown to be elevated both in colon cancer and dysplastic lesions. We aimed to evaluate, for the first time, its role as a diagnostic marker in Lynch syndrome (LS) carriers, a hereditary syndrome with predisposition to colon cancer. METHODS This was a case control study. Baseline serum MMP-7 levels were determined by ELISA in 40 colon cancer patients, 62 LS-carriers and 60 healthy controls. Retrieved data from medical files included demographics, background diseases, clinical data regarding tumor characteristics and genetic data. We assessed the association of serum MMP-7 levels with different variables in the study cohort using linear regression model adjusted for potential confounders. RESULTS In crude analysis, serum MMP-7 levels were significantly higher in colon cancer group compared to LS-carriers and controls [median (IQR) 4.1 ng/ml (2.7-6.0), 2.3 ng/ml (1.7-3.1), 2.5 ng/ml (1.5-3.7), respectively; p value - p < 0.001) while there was no difference between the two last groups (p value = 0.583). However, after adjusting for age and gender, LS-carriers' patients had 18% higher concentrations of serum MMP-7 compared to healthy controls (p value = 0.037), while colon cancer patients had 50% higher serum MMP-7 level in comparison to healthy controls (p value < 0.001). Additionally, age was positively associated with higher serum MMP-7 levels across all study groups (r = 0.67, p value < 0.001). In contrast, no correlation was observed between serum MMP-7 and either tumor staging and gene mutation. CONCLUSIONS Age-adjusted serum MMP-7 levels in asymptomatic LS carriers are higher than its levels in healthy population. While in colon cancer, MMP-7 higher level probably reflects the tumor burden and may have a prognostic effect, its significance and clinical applicability as a biomarker for tumorigenesis in LS is less clear and should be elucidated.
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Affiliation(s)
- Doron Yablecovitch
- Institute of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hussein Mahajna
- Institute of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of Surgery and Transplantations B/C, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Katz
- Department of Surgery and Transplantations B/C, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Picard
- Institute of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Yavzori
- Institute of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ella Fudim
- Institute of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Saker
- Shalvata Mental Health Center, Hod Hasharon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Institute of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laish
- Institute of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Yanai H, Salomon N, Ben-Horin S, Kopylov U. Letter: Chinese herbal medicine Curcumin-QingDai (CurQD)-A good treatment option for active ulcerative colitis? Authors' reply. Aliment Pharmacol Ther 2023; 58:641. [PMID: 37632277 DOI: 10.1111/apt.17655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
LINKED CONTENTThis article is linked to Yanai et al papers. To view these articles, visit https://doi.org/10.1111/apt.17538 and https://doi.org/10.1111/apt.17647
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Affiliation(s)
- Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Salomon
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Shomron Ben-Horin
- School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Uri Kopylov
- School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
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11
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Amitai MM, Kanaan N, Soffer S, Alper L, Rozendorn N, Harrington DJ, Kopylov U, Lahat A, Yablecovitch D, Eliakim R, Ben-Horin S, Klang E. Jejunal Inflammation in Crohn's Disease: Comparison between Diffusion Weighted Magnetic Resonance Imaging and Video Capsule Endoscopy. Isr Med Assoc J 2023; 25:559-563. [PMID: 37574895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Jejunal disease is associated with worse prognosis in Crohn's disease. The added value of diffusion weighted imaging for evaluating jejunal inflammation related to Crohn's Disease is scarce. OBJECTIVES To compare diffusion weighted imaging, video capsule endoscopy, and inflammatory biomarkers in the assessment of Crohn's disease involving the jejunum. METHODS Crohn's disease patients in clinical remission were prospectively recruited and underwent magnetic resonance (MR)-enterography and video capsule endoscopy. C-reactive protein and fecal-calprotectin levels were obtained. MR-enterography images were evaluated for restricted diffusion, and apparent diffusion coefficient values were measured. The video capsule endoscopy-based Lewis score was calculated. Associations between diffusion weighted imaging, apparent diffusion coefficient, Lewis score, and inflammatory biomarkers were evaluated. RESULTS The study included 51 patients, and 27/51 (52.9%) with video capsule endoscopies showed jejunal mucosal inflammation. Sensitivity and specificity of restricted diffusion for video capsule endoscopy mucosal inflammation were 59.3% and 37.5% for the first reader, and 66.7% and 37.5% for the second reader, respectively. Diffusion weighted imaging was not statistically associated with jejunal video capsule endoscopy inflammation (P = 0.813). CONCLUSIONS Diffusion weighted imaging was not an effective test for evaluation of jejunal inflammation as seen by video capsule endoscopy in patients with quiescent Crohn's disease.
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Affiliation(s)
- Michal M Amitai
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel, Department of Deep Vision Laboratory, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadin Kanaan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lee Alper
- Department of Deep Vision Laboratory, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rozendorn
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Yablecovitch
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ukashi O, Yablecovitch D, Lahat A, Selinger L, Neuman S, Eliakim R, Ben-Horin S, Kopylov U. Middle small-bowel segment Lewis score may predict long-term outcomes among patients with quiescent Crohn's disease. Therap Adv Gastroenterol 2023; 16:17562848231188587. [PMID: 37533708 PMCID: PMC10392190 DOI: 10.1177/17562848231188587] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/02/2023] [Indexed: 08/04/2023] Open
Abstract
Background Video capsule endoscopy (VCE) has been proven to accurately diagnose small-bowel inflammation and predict flares among patients with quiescent Crohn's disease (CD). However, data regarding its predictive role in this population over an extended follow-up are scarce. Objectives To predict clinical exacerbation and to assess the yield of Lewis score in identifying CD patients with future clinical exacerbation during an extended follow-up (>24 months). Design A post hoc analysis study. Methods Adult patients with quiescent small-bowel CD who were followed with VCE, inflammatory biomarkers and magnetic resonance enterography in a prospective study (between 2013 and 2018). We extracted extended clinical data (up to April 2022). The primary composite outcome (i.e. clinical exacerbation) was defined as intestinal surgery, endoscopic dilation, CD-related admission, corticosteroid administration, or biological/immunomodulator treatment change during follow-up. Results Of the 61 patients in the study [median age 29 (24-37) years, male 57.4%, biologic treatment 46.7%], 18 patients met the primary outcome during an extended follow-up [median 58.0 (34.5-93.0) months]. On univariable analysis, complicated [hazard ratio (HR) 7.348, p = 0.002] and stricturing disease phenotype (HR 5.305, p = 0.001) were associated with higher risk for clinical exacerbation during follow-up. A baseline VCE middle small-bowel segment Lewis score (midLS) ⩾ 135 identified patients with future exacerbation [AUC (area under the curve) 0.767, 95% confidence interval (CI) 0.633-0.902, p = 0.001, HR 6.317, 93% negative predictive value], whereas the AUC of the conventional Lewis score was 0.734 (95% CI: 0.589-0.879, p = 0.004). Sensitivity analysis restricted to patients with either complicated (n = 34) or stricturing (n = 26) disease phenotype revealed that midLS still predicted clinical exacerbation during follow-up (AUC 0.747/0.753, respectively), in these patients. Conclusion MidLS predicts treatment failure in quiescent CD patients (median follow-up of 5 years) independently of disease phenotype.
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Affiliation(s)
| | - Doron Yablecovitch
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Selinger
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sandra Neuman
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Braun T, Sosnovski KE, Amir A, BenShoshan M, VanDussen KL, Karns R, Levhar N, Abbas-Egbariya H, Hadar R, Efroni G, Castel D, Avivi C, Rosen MJ, Grifiths AM, Walters TD, Mack DR, Boyle BM, Ali SA, Moore SR, Schirmer M, Xavier RJ, Kugathasan S, Jegga AG, Weiss B, Mayer C, Barshack I, Ben-Horin S, Ulitsky I, Beucher A, Ferrer J, Hyams JS, Denson LA, Haberman Y. Mucosal transcriptomics highlight lncRNAs implicated in ulcerative colitis, Crohn's disease, and celiac disease. JCI Insight 2023; 8:e170181. [PMID: 37261910 PMCID: PMC10443795 DOI: 10.1172/jci.insight.170181] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023] Open
Abstract
Ulcerative colitis (UC), Crohn's disease (CD), and celiac disease are prevalent intestinal inflammatory disorders with nonsatisfactory therapeutic interventions. Analyzing patient data-driven cohorts can highlight disease pathways and new targets for interventions. Long noncoding RNAs (lncRNAs) are attractive candidates, since they are readily targetable by RNA therapeutics, show relative cell-specific expression, and play key cellular functions. Uniformly analyzing gut mucosal transcriptomics from 696 subjects, we have highlighted lncRNA expression along the gastrointestinal (GI) tract, demonstrating that, in control samples, lncRNAs have a more location-specific expression in comparison with protein-coding genes. We defined dysregulation of lncRNAs in treatment-naive UC, CD, and celiac diseases using independent test and validation cohorts. Using the Predicting Response to Standardized Pediatric Colitis Therapy (PROTECT) inception UC cohort, we defined and prioritized lncRNA linked with UC severity and prospective outcomes, and we highlighted lncRNAs linked with gut microbes previously implicated in mucosal homeostasis. HNF1A-AS1 lncRNA was reduced in all 3 conditions and was further reduced in more severe UC form. Similarly, the reduction of HNF1A-AS1 ortholog in mice gut epithelia showed higher sensitivity to dextran sodium sulfate-induced colitis, which was coupled with alteration in the gut microbial community. These analyses highlight prioritized dysregulated lncRNAs that can guide future preclinical studies for testing them as potential targets.
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Affiliation(s)
- Tzipi Braun
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Katya E. Sosnovski
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amnon Amir
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Marina BenShoshan
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kelli L. VanDussen
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rebekah Karns
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nina Levhar
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haya Abbas-Egbariya
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rotem Hadar
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Gilat Efroni
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - David Castel
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Camila Avivi
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Michael J. Rosen
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Pediatric IBD and Celiac Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - David R. Mack
- Children’s Hospital of East Ontario, Ottawa, Ontario, Canada
| | | | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sean R. Moore
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | | | - Ramnik J. Xavier
- Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anil G. Jegga
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Computer Science, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Engineering, Cincinnati, Ohio, USA
| | - Batya Weiss
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Mayer
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Barshack
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Ulitsky
- Departments of Biological Regulation and Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - Anthony Beucher
- Section of Genetics and Genomics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Jorge Ferrer
- Section of Genetics and Genomics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Regulatory Genomics and Diabetes, Centre for Genomic Regulation, the Barcelona Institute of Science and Technology, Barcelona, Spain
- Centro de Investigación Biomédica en red Diabetes y enfermedades metabólicas asociadas (CIBERDEM), Spain
| | - Jeffrey S. Hyams
- Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Lee A. Denson
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Yael Haberman
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Yanai H, Salomon N, Lahat A, Ungar B, Eliakim R, Kriger-Sharabi O, Reiss-Mintz H, Koslowsky B, Shitrit ABG, Tamir-Degabli N, Dotan I, Zittan E, Maharshak N, Hirsch A, Ben-Horin S, Kopylov U. Real-world experience with Curcumin-QingDai combination for patients with active ulcerative colitis: A retrospective multicentre cohort study. Aliment Pharmacol Ther 2023; 58:175-181. [PMID: 37157131 DOI: 10.1111/apt.17538] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/06/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Curcumin and QingDai (QD, Indigo) have been shown to be effective for treating active ulcerative colitis (UC). AIM To evaluate the real-world experience with the Curcumin-QingDai (CurQD) herbal combination to induce remission in active UC. METHODS A retrospec-tive multicentre adult cohort study from five tertiary academic centres (2018-2022). Active UC was defined as a Simple Clinical Colitis Activity Index (SCCAI) ≥ 3. Patients were induced by CurQD. The primary outcome was clinical remission at weeks 8-12, defined as SCCAI ≤2 and a decrease ≥3 points from baseline. Secondary outcomes were clinical response (SCCAI decrease ≥3 points), corticosteroid-free remission, faecal calprotectin (FC) response (reduction ≥50%), FC normalisation (FC ≤100 μg/g for patients with FC ≥300 μg/g at baseline), and safety. All outcomes were analysed for patients who were maintaining stable treatment. RESULTS Eighty-eight patients were included; 50% were biologics/small molecules experienced, and 36.5% received ≥2 biologics/small molecules. Clinical remission was achieved in 41 (46.5%), and clinical response in 53 (60.2%). Median SCCAI decreased from 7 (IQR:5-9) to 2 (IQR:1-3); p < 0.0001. Of the 26 patients on corticosteroids at baseline, seven achieved corticosteroid-free remission. Among 43 biologics/small molecules experienced patients, clinical remission was achieved in 39.5% and clinical response in 58.1%. FC normalisation and response were achieved in 17/29 and 27/33, respectively. Median FC decreased from 1000 μg/g (IQR:392-2772) at baseline to 75 μg/g (IQR:12-136) at the end of inductions (n = 30 patients with paired samples); p < 0.0001. No overt safety signals emerged. CONCLUSION In this real-world cohort, CurQD effectively induced clinical and biomarker remission in patients with active UC, including patients who were biologics/small molecules experienced.
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Affiliation(s)
- Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Salomon
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Adi Lahat
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Bella Ungar
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Rami Eliakim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | | | - Hilla Reiss-Mintz
- Department of Gastroenterology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Benjamin Koslowsky
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Natalie Tamir-Degabli
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine E, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Zittan
- Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
- The Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
| | - Nitsan Maharshak
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Ayal Hirsch
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Uri Kopylov
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
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15
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Shani U, Klang E, Lassman S, Ungar B, Ben-Horin S, Kopylov U. Outcome of inflammatory bowel disease patients with prior malignancy. Ann Gastroenterol 2023; 36:405-411. [PMID: 37396000 PMCID: PMC10304530 DOI: 10.20524/aog.2023.0803] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/13/2023] [Indexed: 07/04/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) treatment options, such as anti-tumor necrosis factor (TNF) agents and thiopurines, are associated with an increased risk of certain malignancies. However, the management of IBD patients with prior malignancy is not well defined and the literature is scarce. The main aim of this study was to describe the outcome of IBD patients with prior malignancy, or malignancy before first exposure to IBD-related biologic or immunosuppressive treatment. Methods The study cohort included adult IBD patients followed in a tertiary academic center, with at least one malignancy diagnosed before IBD diagnosis or before initiation of IBD-related treatment. The main outcome of interest was a relapse of the previous malignancy or development of a second malignancy. Results Our database included 1112 patients with both IBD and malignancy. Of these, 86 (9%) who had their malignancy diagnosed before IBD-related treatment initiation were identified, while 10/86 patients (9%) were further diagnosed with a second primary malignancy. Twenty patients, (20/86, 23%) had recurrence of a previous malignancy, most commonly non-melanoma skin cancer (NMSC), found in 9/20 patients (45%). Treatment with infliximab was found to be significantly associated with recurrence of NMSC (P=0.003). Conclusions Anti-TNF treatment may be associated with an increased risk of NMSC recurrence. This underscores the importance of rigorous dermatological follow up in IBD patients with previous NMSC treated with anti-TNFs.
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Affiliation(s)
- Uria Shani
- Internal Medicine B, Sheba Medical Center, and Faculty of Medicine (Uria Shani)
| | - Eyal Klang
- Sheba ARC, Sheba Medical Center, and Faculty of Medicine (Eyal Klang)
| | - Simon Lassman
- Arrow Project for Medical Research, Sheba Medical Center, and Faculty of Medicine (Simon Lassman)
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, and Faculty of Medicine (Bella Ungar, Shomron Ben-Horin, Uri Kopylov), Tel Aviv University, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, and Faculty of Medicine (Bella Ungar, Shomron Ben-Horin, Uri Kopylov), Tel Aviv University, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, and Faculty of Medicine (Bella Ungar, Shomron Ben-Horin, Uri Kopylov), Tel Aviv University, Israel
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16
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Kellerman R, Bleiweiss A, Samuel S, Margalit-Yehuda R, Aflalo E, Barzilay O, Ben-Horin S, Eliakim R, Zimlichman E, Soffer S, Klang E, Kopylov U. Spatiotemporal analysis of small bowel capsule endoscopy videos for outcomes prediction in Crohn's disease. Therap Adv Gastroenterol 2023; 16:17562848231172556. [PMID: 37440929 PMCID: PMC10333642 DOI: 10.1177/17562848231172556] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Deep learning techniques can accurately detect and grade inflammatory findings on images from capsule endoscopy (CE) in Crohn's disease (CD). However, the predictive utility of deep learning of CE in CD for disease outcomes has not been examined. Objectives We aimed to develop a deep learning model that can predict the need for biological therapy based on complete CE videos of newly-diagnosed CD patients. Design This was a retrospective cohort study. The study cohort included treatment-naïve CD patients that have performed CE (SB3, Medtronic) within 6 months of diagnosis. Complete small bowel videos were extracted using the RAPID Reader software. Methods CE videos were scored using the Lewis score (LS). Clinical, endoscopic, and laboratory data were extracted from electronic medical records. Machine learning analysis was performed using the TimeSformer computer vision algorithm developed to capture spatiotemporal characteristics for video analysis. Results The patient cohort included 101 patients. The median duration of follow-up was 902 (354-1626) days. Biological therapy was initiated by 37 (36.6%) out of 101 patients. TimeSformer algorithm achieved training and testing accuracy of 82% and 81%, respectively, with an Area under the ROC Curve (AUC) of 0.86 to predict the need for biological therapy. In comparison, the AUC for LS was 0.70 and for fecal calprotectin 0.74. Conclusion Spatiotemporal analysis of complete CE videos of newly-diagnosed CD patients achieved accurate prediction of the need for biological therapy. The accuracy was superior to that of the human reader index or fecal calprotectin. Following future validation studies, this approach will allow for fast and accurate personalization of treatment decisions in CD.
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Affiliation(s)
| | | | | | - Reuma Margalit-Yehuda
- Department of Gastroenterology, Sheba Medical
Center, Tel Hashomer, Israel and Tel Aviv University, Tel Aviv, Israel
| | | | - Oranit Barzilay
- Department of Internal Medicine F, Sheba
Medical Center, Tel Hashomer, Israel and Tel Aviv University, Tel Aviv,
Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical
Center, Tel Hashomer, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical
Center, Tel Hashomer, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Sheba ARC and Hospital Management, Sheba
Medical Center, Tel Hashomer, Israel and Tel Aviv University, Tel Aviv,
Israel
| | - Shelly Soffer
- Department of Internal Medicine B, Assuta
Medical Center, 7747629, Ashdod, Israel
- Ben-Gurion University of the Negev, Be’er
Sheva, Israel
| | - Eyal Klang
- Sheba ARC, Sheba Medical Center, Tel Hashomer,
Israel and Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical
Center, Tel Hashomer, Israel and Tel Aviv University, Tel Aviv, Israel
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17
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Ukashi O, Soffer S, Klang E, Eliakim R, Ben-Horin S, Kopylov U. Capsule Endoscopy in Inflammatory Bowel Disease: Panenteric Capsule Endoscopy and Application of Artificial Intelligence. Gut Liver 2023:gnl220507. [PMID: 37305947 DOI: 10.5009/gnl220507] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 06/13/2023] Open
Abstract
Video capsule endoscopy (VCE) of the small-bowel has been proven to accurately diagnose small-bowel inflammation and to predict future clinical flares among patients with Crohn's disease (CD). In 2017, the panenteric capsule (PillCam Crohn's system) was introduced for the first time, enabling a reliable evaluation of the whole small and large intestines. The great advantage of visualization of both parts of the gastrointestinal tract in a feasible and single procedure, holds a significant promise for patients with CD, enabling determination of the disease extent and severity, and potentially optimize disease management. In recent years, applications of machine learning, for VCE have been well studied, demonstrating impressive performance and high accuracy for the detection of various gastrointestinal pathologies, among them inflammatory bowel disease lesions. The use of artificial neural network models has been proven to accurately detect/classify and grade CD lesions, and shorten the VCE reading time, resulting in a less tedious process with a potential to minimize missed diagnosis and better predict clinical outcomes. Nevertheless, prospective, and real-world studies are essential to precisely examine artificial intelligence applications in real-life inflammatory bowel disease practice.
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Affiliation(s)
- Offir Ukashi
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Shelly Soffer
- Deep Vision Lab, Sheba Medical Center, Tel Hashomer, Israel
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Deep Vision Lab, Sheba Medical Center, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - Rami Eliakim
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Gastroenterology Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Levartovsky A, Cohen I, Abitbol CM, Yavzori M, Fudim E, Picard O, Kopylov U, Ben-Horin S, Ungar B. Do Vedolizumab trough Levels Predict the Outcome of Subsequent Therapy in Inflammatory Bowel Disease? Biomedicines 2023; 11:1553. [PMID: 37371648 PMCID: PMC10295644 DOI: 10.3390/biomedicines11061553] [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: 03/30/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Vedolizumab trough serum levels have been associated with clinical and endoscopic response in patients with inflammatory bowel disease (IBD). A recent study demonstrated that higher trough levels before dose escalation are associated with favorable outcomes. Objectives: We aimed to identify whether vedolizumab trough levels predict outcome of subsequent therapy. Methods: This retrospective study included IBD patients consecutively receiving vedolizumab therapy between November 2014 and June 2021. Only patients with a loss of response (LOR) to vedolizumab and available trough drug levels prior to therapy cessation were included. Clinical and endoscopic scores were recorded at 6 and 12 months post switching therapy. Results: Overall, 86 IBD patients (51 Crohn's disease, 35 ulcerative colitis) who discontinued vedolizumab were included; of those, 72 (83.7%) were due to LOR. Upon vedolizumab discontinuation, 66.3% of patients were switched to another biologic therapy. Trough vedolizumab levels at discontinuation due to LOR did not differ between patients with clinical response and LOR regarding subsequent therapy at 6 months [median 33.8 μg/mL (IQR 13.2-51.6) versus 31.7 μg/mL (IQR 9.1-64.8), p = 0.9] and at 12 months [median 29.6 μg/mL (IQR 14.3-51.6) versus 34.1 μg/mL (IQR 12.2-64.7), p = 0.6]. Patients progressing to subsequent surgery had numerically lower vedolizumab trough levels at LOR compared with patients who were treated with an additional medical therapy (median 14.3, IQR 4-28.2 μg/mL versus 33.5, IQR 13-51.6 μg/mL, p = 0.08). Conclusions: Vedolizumab trough levels upon LOR do not predict response to subsequent medical therapy; however, lower drug levels may suggest a more aggressive disease pattern and future need for surgery.
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Affiliation(s)
- Asaf Levartovsky
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Affliated to Sackler Medical School, Tel Aviv University, Tel Aviv 69978, Israel
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19
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D'Haens G, Reinisch W, Schreiber S, Cummings F, Irving PM, Ye BD, Kim DH, Yoon S, Ben-Horin S. Subcutaneous Infliximab Monotherapy Versus Combination Therapy with Immunosuppressants in Inflammatory Bowel Disease: A Post Hoc Analysis of a Randomised Clinical Trial. Clin Drug Investig 2023; 43:277-288. [PMID: 37004656 PMCID: PMC10066948 DOI: 10.1007/s40261-023-01252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Whether benefits and risks of intravenous (IV) infliximab combotherapy with immunosuppressants versus infliximab monotherapy apply to subcutaneous (SC) infliximab is unknown. This post hoc analysis of a pivotal randomised CT-P13 SC 1.6 trial aimed to compare SC infliximab monotherapy with combotherapy in inflammatory bowel disease (IBD). METHODS Biologic-naïve patients with active Crohn's disease or ulcerative colitis received CT-P13 IV 5 mg/kg at Week (W) 0 and 2 (dose-loading phase). At W6, patients were randomised (1:1) to receive CT-P13 SC 120 or 240 mg (patients < 80 or ≥ 80 kg) every 2 weeks until W54 (maintenance phase), or to continue CT-P13 IV every 8 weeks until switching to CT-P13 SC from W30. The primary endpoint-non-inferiority of trough serum concentrations-was assessed at W22. We report a post hoc analysis comparing pharmacokinetic, efficacy, safety and immunogenicity outcomes up to W54 for patients randomised to CT-P13 SC, stratified by concomitant immunosuppressant use. RESULTS Sixty-six patients were randomised to CT-P13 SC (37 monotherapy, 29 combotherapy). At W54, there were no significant differences in the proportions of patients achieving target exposure (5 µg/mL; 96.6% monotherapy vs 95.8% combotherapy; p > 0.999) or meeting efficacy or biomarker outcomes including clinical remission (62.9% vs 74.1%; p = 0.418). Monotherapy and combotherapy groups had comparable immunogenicity (anti-drug antibodies [ADAs]: 65.5% vs 48.0% [p = 0.271], neutralising antibodies [in ADA-positive patients]: 10.5% vs 16.7% [p = 0.630], respectively). CONCLUSIONS Pharmacokinetics, efficacy and immunogenicity were potentially comparable between SC infliximab monotherapy and combotherapy in biologic-naïve IBD patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT02883452.
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Affiliation(s)
- Geert D'Haens
- Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Stefan Schreiber
- Department for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' Hospital, London, UK
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Byong Duk Ye
- Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyeon Kim
- Medical Department, Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - SangWook Yoon
- Medical Department, Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Shomron Ben-Horin
- Gastroenterology Department, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Tel-Hashomer, Israel.
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20
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Albshesh A, Bannon L, Sharar Fischler T, Truyens M, Vavricka SR, Tepes K, Pugliese D, Savarino EV, Zittan E, Drobne D, Roblin X, Bar-Gil Shitrit A, Armuzzi A, Lobaton T, Maharshak N, Yanai H, Ben-Horin S, Kopylov U. Comparison of Short- and Long-Term Effectiveness between Anti-TNF and Ustekinumab after Vedolizumab Failure as First-Line Therapy in Crohn’s Disease: A Multi-Center Retrospective Cohort Study. J Clin Med 2023; 12:jcm12072503. [PMID: 37048587 PMCID: PMC10095015 DOI: 10.3390/jcm12072503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The effectiveness of anti-TNF or ustekinumab (UST) as a second-line biologic after vedolizumab (VDZ) failure has not yet been described. Aims and Methods: In this retrospective multicenter cohort study, We aim to investigate the effectiveness of anti-TNF and UST as second-line therapy in patients with Crohn’s disease (CD) who failed VDZ as a first-line treatment. The primary outcome was clinical response at week 16–22. Secondary outcomes included the rates of clinical remission, steroid-free clinical remission, CRP normalization, and adverse events. Results: Fifty-nine patients who failed on VDZ as a first-line treatment for CD were included; 52.8% patients received anti-TNF and 47.2% UST as a second-line therapy. In initial period (Week 16–22), the clinical response and remission rate was similar between both groups: 61.2% vs. 68%, p = 0.8 and 48.3% vs. 56%, p = 0.8 on anti-TNF and UST therapy, respectively. Furthermore, in the maintenance period the rate was similar: 75% vs. 82.3%, p = 0.8 and 62.5% vs. 70.5%, p = 0.8, respectively. Of the patients, 12 out of the 59 stopped the therapy, without a significant difference between the two groups (p = 0.6). Conclusion: Second-line biological therapy after VDZ failure therapy was effective in >60% of the patients with CD. No differences in effectiveness were detected between the use of anti-TNF and UST as a second line.
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21
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Louis E, Resche-Rigon M, Laharie D, Satsangi J, Ding N, Siegmund B, D'Haens G, Picon L, Bossuyt P, Vuitton L, Irving P, Viennot S, Lamb CA, Pollok R, Baert F, Nachury M, Fumery M, Gilletta C, Almer S, Ben-Horin S, Bouhnik Y, Colombel JF, Hertervig E. Withdrawal of infliximab or concomitant immunosuppressant therapy in patients with Crohn's disease on combination therapy (SPARE): a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol 2023; 8:215-227. [PMID: 36640794 PMCID: PMC9908559 DOI: 10.1016/s2468-1253(22)00385-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The combination of infliximab and immunosuppressant therapy is a standard management strategy for patients with Crohn's disease. Concerns regarding the implications of long-term combination therapy provided the rationale for a formal clinical trial of treatment de-escalation. Our aim was to compare the relapse rate and the time spent in remission over 2 years between patients continuing combination therapy and those stopping infliximab or immunosuppressant therapy. METHODS This multicentre, open-label, randomised controlled trial was performed in 64 hospitals in seven countries in Europe and Australia. Adult patients with Crohn's disease in steroid-free clinical remission for more than 6 months, on combination therapy of infliximab and immunosuppressant therapy for at least 8 months were randomly assigned (1:1:1) to either continue combination therapy (combination group), discontinue infliximab (infliximab withdrawal group), or discontinue immunosuppressant therapy (immunosuppressant withdrawal group). Randomisation was stratified according to disease duration before start of first anti-TNF treatment (≤2 or >2 years), failure of immunosuppressant therapy before start of infliximab, and presence of ulcers at baseline endoscopy. The patient number and group of each stratum were assigned by a central online randomisation website. Treatment was optimised or resumed in case of relapse in all groups. Participants, those assessing outcomes, and those analysing the data were not masked to group assignment. The coprimary endpoints were the relapse rate (superiority analysis) and time in remission over 2 years (non-inferiority analysis, non-inferiority margin 35 days). Analyses were done on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, NCT02177071, and with EU Clinical Trials Register, EUDRACT 2014-002311-41. The trial was completed in April, 2021. FINDINGS Between Nov 2, 2015, and April 24, 2019, 254 patients were screened. Of these, 211 were randomised and 207 were included in the final analysis (n=67 in the combination group, n=71 in the infliximab withdrawal group, and n=69 in the immunosuppressant withdrawal group). 39 patients had a relapse (eight [12%] of 67 in the combination group, 25 [35%] of 71 in the infliximab withdrawal group, six [9%] of 69 in the immunosuppressant withdrawal group). 2-year relapse rates were 14% (95% CI 4-23) in the combination group, 36% (24-47) in the infliximab withdrawal group, and 10% (2-18) in the immunosuppressant withdrawal group (hazard ratio [HR] 3·45 [95% CI 1·56-7·69], p=0·003, for infliximab withdrawal vs combination, and 4·76 [1·92-11·11], p=0·0004, for infliximab withdrawal vs immunosuppressant withdrawal). Of 28 patients who had a relapse and were retreated or optimised according to protocol, remission was achieved in 25 patients (one of two in the combination group, 22 of 23 in the infliximab withdrawal group, and two of three in the immunosuppressant withdrawal group). The mean time spent in remission over 2 years was 698 days (95% CI 668-727) in the combination group, 684 days (651-717) in the infliximab withdrawal group, and 706 days (682-730) in the immunosuppressant withdrawal group. The difference in restricted mean survival time in remission was -14 days (95% CI -56 to 27) between the infliximab withdrawal group and the combination group and -22 days (-62 to 16) between the infliximab withdrawal group and the immunosuppressant withdrawal group. The 95% CIs contained the non-inferiority threshold (-35 days). We recorded 31 serious adverse events, in 20 patients, with no difference in frequency between groups. The most frequent serious adverse events were infections (four in the combination group, two in the infliximab withdrawal group, and one in the immunosuppressant withdrawal group) and Crohn's disease exacerbation (three in the combination group, four in the infliximab withdrawal group, and one in the immunosuppressant withdrawal group). No death nor malignancy was recorded. INTERPRETATION In patients with Crohn's disease in sustained steroid-free remission under combination therapy with infliximab and immunosuppressant therapy, withdrawal of infliximab should only be considered after careful assessment of risks and benefits for each patient, whereas withdrawal of immunosuppressant therapy could generally represent a preferable strategy when considering treatment de-escalation. FUNDING European Union's Horizon 2020.
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Affiliation(s)
- Edouard Louis
- Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium.
| | - Matthieu Resche-Rigon
- Université de Paris, ECSTRRA - CRESS UMR1153, INSERM and SBIM, AP-HP, Hôpital Saint-Louis, Paris, France
| | - David Laharie
- Service d'Hépato-gastroentérologie et oncologie digestive CHU de Bordeaux, Hôpital Haut-Lévêque- Université de Bordeaux, Bordeaux, France
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - Nik Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Britta Siegmund
- Medical Department, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Geert D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Laurence Picon
- Hépato-Gastro-Onco-Entérologie, Hôpital Trousseau, Tours, France
| | - Peter Bossuyt
- Imelda GI Clinical Research Center, Imelda General Hospital, Bonheiden, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon Univeristy Hospital, Besançon, France; UMR 1098, Franche-Comté University, Besançon, France
| | - Peter Irving
- IBD Unit, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Stephanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Christopher A Lamb
- Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Richard Pollok
- Gastroenterology, St Georges University Hospital, London, UK
| | | | - Maria Nachury
- U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, Inserm, CHU Lille, Lille, France
| | - Mathurin Fumery
- Department of Gastroenterology, University Hospital of Amiens, Amiens, France; Peritox, University of Picardie, Amiens, France
| | - Cyrielle Gilletta
- Department of Gastroenterology and Pancreatology, University Hospital of Toulouse Rangueil, Toulouse, France
| | - Sven Almer
- IBD-unit, Division of Gastroenterology, Karolinska University hospital, Stockholm, Sweden
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, Israel
| | - Yoram Bouhnik
- Department of Gastroenterology, Beaujon Hospital, APHP, Paris Cité University, Clichy, France
| | - Jean-Frederic Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erik Hertervig
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
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22
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Dan S, Ungar B, Ben-Moshe S, Halpern KB, Yavzori M, Fudim E, Picard O, Abitbol CM, Harnik S, Barshack I, Kopylov U, Ben-Horin S, Itzkovitz S. Distal Fecal Wash Host Transcriptomics Identifies Inflammation Throughout the Colon and Terminal Ileum. Cell Mol Gastroenterol Hepatol 2023; 16:1-15. [PMID: 36791991 DOI: 10.1016/j.jcmgh.2023.02.002] [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: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND & AIMS Noninvasive modalities for assessing active endoscopic and histologic inflammation in Crohn's disease and ulcerative colitis patients are critically needed. Fecal wash host shed-cell transcriptomics has been shown to be a robust classifier of endoscopic and histologic inflammation in inflammatory bowel disease patients with distal colitis. Whether such fecal washes can inform on inflammatory processes occurring in more proximal intestinal segments is currently unknown. METHODS Fifty-nine inflammatory bowel disease patients and 50 controls were prospectively enrolled. Biopsy specimens and fecal washes from the distal colon, proximal colon, and terminal ileum were compared. Host transcriptomics were performed on the biopsy specimens and fecal washes obtained during colonoscopy at predefined locations throughout the colon and terminal ileum and results were associated with concurrent clinical, endoscopic, and histologic parameters. RESULTS We found that host transcriptomics of distal fecal washes robustly classify histologic inflammation in ileal and proximal colonic Crohn's disease, even without distal colonic involvement (area under the receiver operating characteristic curve, 0.94 ± 0.09). We further found that fecal washes consist of modules of co-expressed genes of immune, stromal, and epithelial origin that are indicative of endoscopic disease severity. Fecal wash host transcriptomics also capture expression of gene modules previously associated with a lack of response to biological therapies. CONCLUSIONS Our study establishes the accuracy of distal colonic fecal washes for identifying and scoring inflammatory processes throughout the entire ileal-colonic axis.
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Affiliation(s)
- Stav Dan
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Bella Ungar
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shani Ben-Moshe
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Keren Bahar Halpern
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Miri Yavzori
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ella Fudim
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit Picard
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Chaya Mushka Abitbol
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sivan Harnik
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Iris Barshack
- Department of Pathology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shalev Itzkovitz
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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23
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Livne-Margolin M, Ling D, Attia-Konyo S, Abitbol CM, Haj-Natour O, Ungar B, Ben-Horin S, Kopylov U. Ustekinumab and vedolizumab for extraintestinal manifestations in inflammatory bowel disease - a retrospective study. Dig Liver Dis 2023; 55:223-229. [PMID: 36241535 DOI: 10.1016/j.dld.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Extraintestinal manifestations (EIM) are associated with diminished quality of life. The efficacy of Ustekinumab and vedolizumab for EIM treatment is not well established. The aim was to compare the effectiveness of ustekinumab and vedolizumab for treatment of EIM in IBD. METHODS We included IBD patients treated with vedolizumab or ustekinumab in the Gastroenterology department, Sheba Medical Center, for up to 52 weeks between 2015 and 2021. Patients with active EIM before treatment initiation were included. RESULTS 111 patients were included. 53 patients (48%) were treated with ustekinumab; 88% (n-99) had CD. The most common EIM was arthralgia (95/111, 84%). Patients treated with ustekinumab were more likely to be anti-TNF experienced (n-51/53 [96%] compared with vedolizumab n = 36/58 [62%], p < 0.001). Clinical response of EIM at week 52 was achieved in 36% of patients treated with ustekinumab (n-18/50) and 34% of patients (n-19/54) treated with vedolizumab, with no statistically significant difference (p = 0.9). No statistical significance was achieved for patients presented with arthralgia. Clinical response of arthralgia at week 52 was seen in 34% (n-19/55) and 36% (n-18/46) of the patients treated with vedolizumab and ustekinumab, respectively, (p = 0.3). CONCLUSION In this study, no difference was found between vedolizumab and ustekinumab regarding their effect on EIM in IBD patients for up to 52 weeks.
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Affiliation(s)
- Moran Livne-Margolin
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Daniel Ling
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Attia-Konyo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine E, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Chaya Mushka Abitbol
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ola Haj-Natour
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Bella Ungar
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Veisman I, Oppenheim A, Sub laban Z, Kenig A, Ukashi O, Shacham-Shmueli E, Engel T, Kopylov U, Ben-Horin S, Lang A. Disproportionately Low Albumin and High Neutrophil-to-Lymphocyte Ratio in Small Bowel Adenocarcinoma Patients With Long-Duration Crohn's Disease. Clin Transl Gastroenterol 2023; 14:e00553. [PMID: 36449698 PMCID: PMC9945550 DOI: 10.14309/ctg.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although Crohn's disease (CD) is a known risk factor of small bowel adenocarcinoma (SBA), early diagnosis remains a significant clinical challenge. Identification of biomarkers for SBA may lead to early detection. METHODS This is a retrospective study comparing albumin levels and neutrophil-to-lymphocyte ratio (NLR) of patients with long-standing CD who underwent small bowel resection with and without malignancy. RESULTS Forty-two patients with CD were included in this study (11 with SBA). Median NLR before surgery was 8.5 (interquartile range 6.2-31.3) in patients with SBA and 3.8 (interquartile range 2.8-5.3) for patients without SBA ( P < 0.05). Mean albumin levels before surgery were significantly lower among patients with SBA compared with patients without SBA (2.6 ± 0.6 g/dL vs 3.5 ± 0.6 g/dL, respectively, P < 0.05), despite patients with SBA being under longer total parenteral nutrition treatment duration. DISCUSSION CD patients with SBA diagnosis have increased NLR and lower albumin before surgery compared with CD patients without detection of SBA.
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Affiliation(s)
- Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Oppenheim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Zuheir Sub laban
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Ariel Kenig
- Faculty of Medicine, the Hebrew University, Jerusalem, Israel
- Oncology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tal Engel
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Lang
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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25
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Sosnovski KE, Braun T, Amir A, Moshel D, BenShoshan M, VanDussen KL, Levhar N, Abbas-Egbariya H, Beider K, Ben-Yishay R, Asad Ali S, Moore SR, Kugathasan S, Abramovich I, Saar EG, Weiss B, Barshack I, Gottlieb E, Geiger T, Ben-Horin S, Ulitsky I, Hyams JS, Denson LA, Haberman Y. GATA6-AS1 regulates intestinal epithelial mitochondrial functions, and its reduced expression is linked to intestinal inflammation and less favorable disease course in ulcerative colitis (UC). J Crohns Colitis 2023:6992499. [PMID: 36655602 DOI: 10.1093/ecco-jcc/jjad006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 09/18/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Widespread dysregulation of long non-coding RNAs (lncRNAs) including a reduction in GATA6-AS1 was noted in inflammatory bowel disease (IBD). We previously reported a prominent inhibition of epithelial mitochondrial functions in UC. However, the connection between reduction of GATA6-AS1 expression and attenuated epithelial mitochondrial functions was not yet defined. METHODS Mucosal transcriptomics was used to conform GATA6-AS1 reduction in several treatment naïve independent human cohorts (n=673). RNA pull-down followed by mass-spectrometry was used to determine GATA6-AS1 interactome. Metabolomics and mitochondrial respiration following GATA6-AS1 silencing in Caco-2, were used to elaborate on GATA6-AS1 functions. RESULTS GATA6-AS1 showed predominant expression in gut epithelia using single cell datasets. GATA6-AS1 levels were reduced in Crohn disease (CD) ileum and in ulcerative colitis (UC) rectum in independent cohorts. Reduced GATA6-AS1 lncRNA was further linked to more severe UC form, and to less favorable UC course. GATA6-AS1 interactome showed robust enrichment for mitochondrial proteins, and included TGM2, an autoantigen in celiac disease that is induced in UC, CD, and celiac, in contrast GATA6-AS1 reduction in these cohorts. GATA6-AS1 silencing resulted in induction of TGM2, and this was coupled with reduction in mitochondrial membrane potential and mitochondrial respiration, as well as in reduction of metabolites linked with aerobic respiration relevant to mucosal inflammation. TGM2 knockdown in GATA6-AS1 deficient cells rescued mitochondrial respiration. CONCLUSIONS GATA6-AS1 levels are reduced in UC, CD, and celiac, and in more severe UC forms. We highlight GATA6-AS1 as a target regulating epithelial mitochondrial functions, potentially through controlling TGM2 levels.
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Affiliation(s)
- Katya E Sosnovski
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzipi Braun
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Amnon Amir
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Danielle Moshel
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina BenShoshan
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kelli L VanDussen
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nina Levhar
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haya Abbas-Egbariya
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Beider
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Ben-Yishay
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sean R Moore
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | | | - Ifat Abramovich
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bat Galim, Haifa, Israel
| | - Efrat Glick Saar
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Batya Weiss
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Barshack
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Gottlieb
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bat Galim, Haifa, Israel
| | - Tamar Geiger
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Shomron Ben-Horin
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Igor Ulitsky
- Department of Biological Regulation and Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | | | - Lee A Denson
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yael Haberman
- Sheba Medical Center, Tel-Hashomer, affiliated with the Tel Aviv University, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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26
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Ben-Horin S, Har-Noy O, Katsanos KH, Roblin X, Chen M, Gao X, Schwartz D, Cheon JH, Cesarini M, Bojic D, Protic M, Theodoropoulou A, Abu-Kaf H, Engel T, Tang J, Veyrard P, Lin X, Mao R, Christodoulou D, Karmiris K, Knezevic-Ivanovski T. Corticosteroids and Mesalamine Versus Corticosteroids for Acute Severe Ulcerative Colitis: A Randomized Controlled Trial. Clin Gastroenterol Hepatol 2022; 20:2868-2875.e1. [PMID: 35272029 DOI: 10.1016/j.cgh.2022.02.055] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Corticosteroids are the mainstay of treatment for hospitalized patients with acute severe ulcerative colitis (ASUC). However, whether the addition/continuation of mesalamine with corticosteroids during hospitalization is superior to corticosteroids alone is unknown. METHODS This was a randomized controlled, investigator-blinded, clinical trial conducted in 10 centers in 7 countries. Patients hospitalized with ASUC (Lichtiger score ≥10) were eligible. Patients received corticosteroids alone or corticosteroid + mesalamine (4 g/day mesalamine) by a stratified randomization according to mesalamine use before admission. The primary outcome was the percentage of patients who responded to treatment by day 7, defined by a drop >3 points in the Lichtiger score and an absolute score <10 without the need for rescue medications or colectomy. RESULTS Three hundred forty-six patients were screened, and 149 were included (70/149 female; median age, 41 years). Of these, 73 received corticosteroids + mesalamine, and 76 received corticosteroids alone. For the primary outcome, 53 of 73 patients (72.6%) receiving corticosteroids with mesalamine responded versus 58 of 76 patients (76.3%) on corticosteroids alone (odds ratio, 0.82; 95% confidence interval, 0.39-1.72; P = .60). There was no difference between groups in duration of hospitalization, C-reactive protein normalization rate, or colectomy rate up to day 90. The need for biologics among patients receiving combination of corticosteroids with mesalamine was numerically lower by day 30 (P = .11) and day 90 (P = .07). CONCLUSIONS In this randomized controlled trial, combination of mesalamine with corticosteroids did not benefit hospitalized patients with ASUC more than corticosteroids alone. An exploratory signal for a reduced need for biologics at 90 days in the mesalamine group merits further evaluation. CLINICALTRIALS gov ID: NCT01941589.
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Affiliation(s)
- Shomron Ben-Horin
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Ofir Har-Noy
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Xavier Roblin
- Department of Gastroenterology, University-Hospital of Saint-Etienne, Saint Etienne, France
| | - Minhu Chen
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiang Gao
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Monica Cesarini
- Dipartimento di Medicina Interna e Specialità Mediche, "Sapienza", University of Rome, Rome, Italy
| | - Daniela Bojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | - Marijana Protic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | | | - Heba Abu-Kaf
- Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tal Engel
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jian Tang
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Pauline Veyrard
- Department of Gastroenterology, University-Hospital of Saint-Etienne, Saint Etienne, France
| | - Xiaoqing Lin
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ren Mao
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dimitrios Christodoulou
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
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27
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Livne-Margolin M, Ben-Horin S, Albshesh A. Hardly Ants-ipated Capsule Endoscopy Finding. Gastroenterology 2022; 163:e3-e4. [PMID: 35257722 DOI: 10.1053/j.gastro.2022.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/16/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Moran Livne-Margolin
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shomron Ben-Horin
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Albshesh
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Ben-Horin S, Kopylov U, Salomon N. Curcumin-QingDai Combination as Treatment for Moderate-Severe Ulcerative Colitis. Case Rep Gastroenterol 2022; 16:563-568. [PMID: 36824698 PMCID: PMC9941783 DOI: 10.1159/000526646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Curcumin was shown in placebo-controlled trials to induce remission in mild-moderate ulcerative colitis (UC). QingDai (QD, Indigo), another herbal extract, showed efficacy in two UC trials from Japan, but evidence in the Western population is scant. We report on the use of curcumin-QingDai combination (CurQD) for the treatment of moderate-severe UC. Patient 1 was a 24-year-old male with severe UC refractory to cyclosporine and corticosteroids. He partially responded to infliximab but later lost response to an optimized dose of infliximab in combination with 6-mercaptopurine, presenting with worsening symptoms and severe Mayo 3 mucosal inflammation. Initiation of CurQD 2.5 g/day resulted in rapid cessation of blood per rectum. Complete clinical remission ensued within few weeks. Follow-up endoscopies performed 12 weeks later showed only minimal residual inflammation. Infliximab was later stopped due to reimbursement issues, and the patient was successfully maintained on lower doses of CurQD and 6-mercaptopurine for 31 months. Two flares have responded to a temporary increase in QD component dose. Patient 2 was a 59-year-old female with extensive UC not responding to maximal oral + topical 5-ASA and corticosteroids. Despite severe mucosal ulceration (Mayo 3) found on endoscopy, she refused the recommendation for biologics and opted for a short-term limited trial of CurQD. This was initiated at 2,000 mg/day and induced rapid clinical remission. Lower endoscopies performed after 2 and 5 months on CurQD showed complete mucosal healing, and the patient maintained her clinical remission on low-dose CurQD for 49 months. No adverse events were noted in the 2 patients.
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Affiliation(s)
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Salomon
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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29
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Grinman A, Ungar B, Lahat A, Kopylov U, Eliakim R, Ben-Horin S. Incidentally Diagnosed Asymptomatic Crohn's Disease: A Retrospective Cohort Study of Long-Term Clinical Outcomes. Crohns Colitis 360 2022; 4:otac034. [PMID: 36777419 PMCID: PMC9802454 DOI: 10.1093/crocol/otac034] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Crohn's disease (CD) is occasionally diagnosed in asymptomatic patients who have undergone colonoscopy or imaging for other reasons. The clinical outcome and optimal management of these patients remain poorly defined. Methods This was a retrospective cohort study of asymptomatic patients with incidental diagnosis of CD from the electronic patient registry of the IBD Unit of Sheba Medical Center in Israel. The primary outcome was defined as the occurrence of a clinical flare. Results Of the 2700 CD patients in Sheba IBD registry, 60 asymptomatic patients with incidental diagnosis of CD were identified (31/60 males, median age 50.5, 25%-75% interquartile range [IQR] 43.5-57.25 years, median follow-up 4.5 years, 25-75% IQR 2.5-6.75, range 1-15 years). Most of the patients did not receive any treatment after diagnosis (53/60-88.33%). Of these, 5 patients (9.43%) experienced a flare during follow-up (median 4.5 years, IQR 2.5-6.75, range 1-15 years). Patients with subsequent flare had numerically higher CRP at diagnosis than patients who did not flare (2.2, IQR 2.0-3.0 vs 1.04, IQR 1.0-2.2, P = .09). When comparing the group of patients who received treatment immediately after diagnosis (n = 7) with the group who did not receive treatment (n = 53), there was no difference with respect to the survival time without a flare (P = .3). For other secondary outcomes, 3/40 progressed from B1 phenotype to B2, and 3/53 (6%) patients underwent surgery during the follow-up. Conclusions The majority of patients with an incidental diagnosis of asymptomatic CD can probably be followed-up without immediate treatment. Although most remain asymptomatic and without complications during follow-up, close monitoring for disease progression is prudent.
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Affiliation(s)
- Ana Grinman
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Address correspondence to: Shomron Ben-Horin, MD, Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, 2 Derech Sheba Street, Ramat Gan 52621, Israel ()
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30
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Carter D, Ben-Horin S, Horesh N, Saukhat O. Ultrasound-Tomographic Image Fusion: A Novel Imaging Technique for Follow-Up of Penetrating Complications of Crohn's Disease. Inflamm Bowel Dis 2022; 28:1451-1453. [PMID: 35134965 DOI: 10.1093/ibd/izab363] [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: 11/09/2021] [Indexed: 12/09/2022]
Abstract
We herein report the first use, to our knowledge, of computed tomography-ultrasound (US) fusion technique to follow-up Crohn's disease complications. This novel technique employs real-time reconstructed fusion of previously obtained tomographic images onto the US image software, allowing accurate bedside spatial resolution, localization, and lesion characterization by US.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Olga Saukhat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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31
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Azhari H, King JA, Coward S, Windsor JW, Ma C, Shah SC, Ng SC, Mak JWY, Kotze PG, Ben-Horin S, Loftus EV, Lees CW, Gearry R, Burisch J, Lakatos PL, Calvet X, Bosques Padilla FJ, Underwood FE, Kaplan GG. The Global Incidence of Peptic Ulcer Disease Is Decreasing Since the Turn of the 21st Century: A Study of the Organisation for Economic Co-Operation and Development (OECD). Am J Gastroenterol 2022; 117:1419-1427. [PMID: 35973143 DOI: 10.14309/ajg.0000000000001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/27/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Peptic ulcer disease (PUD) is a common cause of hospitalization worldwide. We assessed temporal trends in hospitalization for PUD in 36 Organisation for Economic Co-operation and Development (OECD) countries since the turn of the 21st century. METHODS The OECD database contains data on PUD-related hospital discharges and mortality for 36 countries between 2000 and 2019. Hospitalization rates for PUD were expressed as annual rates per 100,000 persons. Joinpoint regression models were used to calculate the average annual percent change (AAPC) with 95% confidence intervals (CIs) for each country, which were pooled using meta-analyses. The incidence of PUD was forecasted to 2021 using autoregressive integrated moving average and Poisson regression models. RESULTS The overall median hospitalization rate was 42.4 with an interquartile range of 29.7-60.6 per 100,000 person-years. On average, hospitalization rates (AAPC = -3.9%; 95% CI: -4.4, -3.3) and morality rates (AAPC = -4.7%; 95% CI: -5.6, -3.8) for PUD have decreased from 2000 to 2019 globally. The forecasted incidence of PUD hospitalizations in 2021 ranged from 3.5 per 100,000 in Mexico to 92.1 per 100,000 in Lithuania. Across 36 countries in the OECD, 329,000 people are estimated to be hospitalized for PUD in 2021. DISCUSSION PUD remains an important cause of hospitalization worldwide. Reassuringly, hospitalizations and mortality for PUD have consistently been falling in OECD countries in North America, Latin America, Europe, Asia, and Oceania. Identifying underlying factors driving these trends is essential to sustaining this downward momentum.
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Affiliation(s)
- Hassan Azhari
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - James A King
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta SPOR Support Unit Data Platform, Alberta Health Services, Calgary, Alberta, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Shailja C Shah
- Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA
- GI Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce W Y Mak
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Paulo G Kotze
- Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Charlie W Lees
- The University of Edinburgh, Western General Hospital, Edinburgh, Scotland
| | - Richard Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Johan Burisch
- Gastrounit, medical division, Hvidovre University Hospital, Hvidovre, Denmark
| | - Peter L Lakatos
- Division of Gastroenteorlogy, McGill University, Montreal, Canada
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Xavier Calvet
- Gastroenterology Department, Hospital Universitari Parc Taulí. Sabadell, Catalonia
- Centro de investigación e red de Enfermedades Hepaticas y Digestivas (CiberEHD)
| | - Francisco Javier Bosques Padilla
- Department of Gastroenterology, University Hospital, Autonomous University of Nuevo Leon, Hospital San José Tecnológico de Monterrey
| | - Fox E Underwood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Vande Casteele N, Sandborn WJ, Feagan BG, Vermeire S, Dulai PS, Yarur A, Roblin X, Ben-Horin S, Dotan I, Osterman MT, Rosario M, Osborn TM, Panes J, Lindner D, Agboton C. Real-world multicentre observational study including population pharmacokinetic modelling to evaluate the exposure-response relationship of vedolizumab in inflammatory bowel disease: ERELATE Study. Aliment Pharmacol Ther 2022; 56:463-476. [PMID: 35474325 DOI: 10.1111/apt.16937] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND ERELATE was a phase 4, multinational, retrospective, observational study. AIM To evaluate the relationship between intravenous vedolizumab exposure and treatment outcomes over 52 weeks in adults with ulcerative colitis (UC) or Crohn's disease (CD). METHODS Real-world data from patients with UC or CD treated with intravenous vedolizumab in nine centres in six countries were collected retrospectively. Treatment outcomes were collected at Weeks 14, 26 and 52. An established population pharmacokinetic model (incorporating observed vedolizumab concentrations based on a Bayesian approach) was used to predict individual vedolizumab exposure. Vedolizumab exposure-response relationship was evaluated overall, by indication and based on baseline characteristics. RESULTS The study population (n = 695; UC, n = 304; CD, n = 391) had a median age of 39 years; 47.9% were male and 86.9% had prior tumour necrosis factor antagonist exposure. By Week 14, clinical, endoscopic, deep (clinical plus endoscopic) and biologic remission was achieved by 47.3%, 59.6%, 30.7% and 19.0% of patients respectively. Higher vedolizumab trough concentration early in treatment was consistently associated with clinical remission at later time points. Clinical remission at Week 14 and Week 52 was associated with Week 6 trough concentrations of ≥31.0 and ≥32.0 μg/ml respectively. Importantly, multivariable analysis identified baseline clearance as the only exposure measure predictive of clinical and deep remission at Week 52. CONCLUSIONS In this real-world study, a positive exposure-response relationship was observed for vedolizumab. Vedolizumab concentration during induction may be an important predictor of short- and long-term outcomes, and similarly, vedolizumab baseline clearance may be an important predictor of remission.
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Affiliation(s)
- Niels Vande Casteele
- Division of Gastroenterology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA.,Alimentiv, London, Ontario, Canada
| | - William J Sandborn
- Division of Gastroenterology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | | | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Parambir S Dulai
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andres Yarur
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Xavier Roblin
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel HaShomer, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark T Osterman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Julian Panes
- Department of Gastroenterology, Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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33
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Bar-Yoseph H, Blatt A, Gerassy S, Pressman S, Mousa A, Sabo E, Waterman M, Ungar B, Ben-Horin S, Chowers Y. Differential Serum-intestinal Dynamics of Infliximab and Adalimumab in Inflammatory Bowel Disease Patients. J Crohns Colitis 2022; 16:884-892. [PMID: 34849649 DOI: 10.1093/ecco-jcc/jjab208] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Therapeutic drug monitoring is used to guide anti-tumour necrosis factor [TNF] therapy. However, the associations between serum drug levels [SDL], TNF-bound, and free anti-TNF in the target tissue are incompletely defined. We aimed to assess the interactions between these parameters in inflammatory bowel disease [IBD] patients. METHODS: ENZYME-LINKED IMMUNOSORBENT assays [ELISA assays] were used to detect free drug and TNF-drug complexes in intestinal tissues. Concurrent SDL, anti-drug antibodies [ADA], pharmacotherapy, clinical response, endoscopic appearance, and histological severity were determined. Comparisons between anti-TNFs and paired inflamed/non-inflamed tissue were performed. Variables were correlated and potential interactions detected using multivariate analysis. RESULTS A total of 95 biopsies taken from 49 anti-TNF treated IBD patients [26 receiving infliximab and 23 adalimumab] were studied. Free drug levels were higher in inflamed compared with non-inflamed paired specimens. Tissue free-drug and TNF-drug complexes levels were higher in adalimumab-treated patients. In adalimumab-treated patients, SDL were correlated with free drug, but not TNF-drug complex levels, in both inflamed and non-inflamed segments. In infliximab-treated patients, higher SDL were associated with the presence of tissue free drug in both inflamed and non-inflamed segments, whereas TNF-drug complexes were mostly detected in non-inflamed but not in inflamed tissue. In the presence of ADA, neither free drug nor TNF-infliximab complexes were measured in the tissue. Tissue levels did not correlate well with clinical, endoscopic, or histological scores. CONCLUSIONS SDL correlated with tissue free drug levels; however, different dynamics were observed for TNF-drug complex levels. Infliximab and adalimumab tissue drug dynamics differ. Better understanding of these interactions may allow future therapeutic optimisation.
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Affiliation(s)
- Haggai Bar-Yoseph
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Alexandra Blatt
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Shiran Gerassy
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Sigal Pressman
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Amjad Mousa
- Department of Internal Medicine H, Rambam Health Care Campus, Haifa, Israel
| | - Edmond Sabo
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Department of Pathology, Carmel Medical Center, Haifa, Israel
| | - Matti Waterman
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Bella Ungar
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Clinical Research Institute, Rambam Health Care Campus, Haifa, Israel
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Ukashi O, Pflantzer B, Barash Y, Klang E, Segev S, Yablecovitch D, Kopylov U, Ben-Horin S, Laish I. Risk factors and prediction algorithm for advanced neoplasia on screening colonoscopy for average-risk individuals. Therap Adv Gastroenterol 2022; 15:17562848221101291. [PMID: 35795377 PMCID: PMC9252006 DOI: 10.1177/17562848221101291] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Screening with colonoscopy for all average-risk population is probably not cost-effective due to the limited sources and over-generalization of the risk, and risk stratification can be used to optimize colorectal cancer screening. OBJECTIVES We aimed to assess risk factors for advanced neoplasia (AN) and a classification tree algorithm to predict the risk. DESIGN This is a retrospective cross-sectional study. METHODS This study was composed of consecutive asymptomatic average-risk individuals undergoing first screening colonoscopy between 2008 and 2019. Detailed characteristics including background diseases, habits, and medications were collected. We used multivariable logistic regression to investigate the associations between clinical variables and the presence of AN and built a classification algorithm to predict AN. RESULTS A total of 3856 patients were included (73.2% male, median age 55). Adenoma and AN detection rate were 15.8% and 3.4%, respectively. On multivariable analysis, predictors of AN [odds ratio (OR), 95% confidence interval (CI)] were age (1.04, 1.01-1.06, p = 0.003), male sex (2.69, 1.56-4.64, p < 0.001), and smoking (1.97, 1.38-2.81, p < 0.001). A classification tree algorithm showed that smoking was the most important risk factor for prediction of AN (4.9% versus 2.4%, p < 0.001), followed by age with a cutoff value of 60 in the smokers (8.4% versus 3.8%, p = 0.001) and 50 in the non-smokers (2.9% versus 0.9%, p = 0.004). CONCLUSION Smoking habits, old age, and male gender are highly associated with an increased risk for AN and should be incorporated in the individualized risk-assessment to adapt a screening program.
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Affiliation(s)
| | - Barak Pflantzer
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel,The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel,DeepVision Lab, Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel,DeepVision Lab, Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Institute of Medical Screening, Sheba Medical Center, Tel Hashomer, Israel
| | - Doron Yablecovitch
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Laish
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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35
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Levartovsky A, Yavzori M, Fudim E, Kopylov U, Ben-Horin S, Ungar B. Acute Chest Pain as an Infusion Reaction to Vedolizumab. Case Rep Gastroenterol 2022; 16:430-434. [PMID: 35949229 PMCID: PMC9294963 DOI: 10.1159/000525404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
Vedolizumab-associated adverse effects, including infusion reactions, are generally uncommon. Less than 5% of patients experience an infusion-related reaction. We report a 67-year-old male with ulcerative colitis under prolonged maintenance therapy who presented with recurring chest pain occurring immediately after consecutive vedolizumab infusions. Medical workup of possible etiologies for chest pain were investigated and excluded. Vedolizumab drug trough levels were negative, accompanied by high detectable levels of anti-vedolizumab antibodies. These findings demonstrate an uncommon case of an infusion reaction to vedolizumab infusion.
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He YM, Mao R, Yuan G, Liang RM, Long JY, Ye XQ, Iacucci M, Ghosh S, Ben-Horin S, Kaplan GG, He Y, Sung JJ, Peng S, Wang HB, Chen MH. The hospitalization burden of inflammatory bowel disease in China: a nationwide study from 2013 to 2018. Therap Adv Gastroenterol 2022; 15:17562848221102307. [PMID: 35721841 PMCID: PMC9201315 DOI: 10.1177/17562848221102307] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The past decade has witnessed a dramatic increase in the number of patients with inflammatory bowel disease (IBD) in China. The nationwide burden of hospitalization remains unclear, however. We aimed to address this gap by conducting analysis using a nationwide database. METHODS Population-based hospitalization rates from 2013 to 2018 were calculated by extrapolating the number of patients in the database to the national level. Surgical rates, annual hospital charges, and length of stay were also used for quantification of hospitalization burden. The Poisson regression analysis and the Cochran-Armitage trend test were conducted to analyze temporal trends as expressed as annual percentage of change (APC) with 95% confidential intervals (CIs). RESULTS From 2013 to 2018, the hospitalization rates for Crohn's disease (CD) and ulcerative colitis (UC) in China increased from 2.20 (95% CI = 2.17-2.22) to 3.62 (3.59-3.65) per 100,000 inhabitants (p < 0.0001) with an APC of 10.68% (6.00-15.36%) and from 6.24 (6.20-6.28) to 8.29 (8.23-8.33) per 100,000 inhabitants (p < 0.0001) with an APC of 5.73% (2.32-9.15%), respectively. Surgical rates decreased from 7.96% (7.29-8.63%) to 5.56% (5.11-6.00%) for CD patients (p < 0.0001) with APC of -6.30% (-11.33 to -1.27%) and from 3.54% (3.26-3.82%) to 2.52% (2.32-2.72%) for UC patients (p < 0.0001) with APC of -6.35% (-16.21 to 3.51). In 2018, there were estimated 166,000 IBD patients hospitalized costing a total of $426.37 million ($149.91 + $276.46 million) across the entire China. CONCLUSION The population-based hospitalization rate of IBD increased, whereas the surgical rate decreased from 2013 to 2018 in China.
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Affiliation(s)
| | | | | | | | - Jian-Yan Long
- Clinical Trials Unit, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Xiao-Qi Ye
- Department of Gastroenterology, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy,
National Institute for Health Research (NIHR) Birmingham Biomedical Research
Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
UK
| | - Subrata Ghosh
- College of Medicine and Health, University
College Cork, Cork, Ireland
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical
Center, Tel-Hashomer, and Sackler School of Medicine, Tel-Aviv University,
Tel-Aviv, Israel
| | - Gilaad G. Kaplan
- Departments of Medicine and Community Health
Sciences, University of Calgary, Calgary, AB, Canada
| | - Yao He
- Department of Gastroenterology, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Joseph J.Y. Sung
- Department of Medicine and Therapeutics,
Institute of Digestive Disease, State Key Laboratory of Digestive Diseases,
LKS Institute of Health Science, The Chinese University of Hong Kong, Hong
Kong Special Administrative Region, P.R. China,Institute of Precision Medicine, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, P.R. China,Institute of Precision Medicine, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
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Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022. [DOI: 10.1007/s12325-021-01990-6
expr 982114691 + 941296860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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38
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Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022; 39:2342-2364. [PMID: 34988877 PMCID: PMC8731678 DOI: 10.1007/s12325-021-01990-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has prompted significant changes in patient care in rheumatology and gastroenterology, with clinical guidance issued to manage ongoing therapy while minimising the risk of nosocomial infection for patients and healthcare professionals (HCPs). Subcutaneous (SC) formulations of biologics enable patients to self-administer treatments at home; however, switching between agents may be undesirable. CT-P13 SC is the first SC formulation of infliximab that received regulatory approval and may be termed a biobetter as it offers significant clinical advantages over intravenous (IV) infliximab, including improved pharmacokinetics and a convenient mode of delivery. Potential benefits in terms of reduced immunogenicity have also been suggested. With a new SC formulation, infliximab provides an additional option for dual formulation, which enables patients to transition from IV to SC administration route without changing agent. Before COVID-19, clinical trials supported the efficacy and safety of switching from IV to SC infliximab for patients with rheumatoid arthritis and inflammatory bowel disease (IBD), and SC infliximab may have been selected on the basis of patient and HCP preferences for SC agents. During the pandemic, patients with rheumatic diseases and IBD have successfully switched from IV to SC infliximab, with some clinical benefits and high levels of patient satisfaction. As patients switched to SC therapeutics, the reduction in resource requirements for IV infusion services may have been particularly welcome given the pandemic, facilitating reorganisation and redeployment in overstretched healthcare systems, alongside pharmacoeconomic benefits and a reduction in exposure to nosocomial infection. Telemedicine and contactless healthcare have been pushed to the forefront during the pandemic, and a lasting shift towards remote patient management and community/home-based drug administration is anticipated. SC infliximab supports the implementation of this paradigm for future improvements of healthcare value delivered. The accumulation of real-world data during the pandemic supports the high level of confidence, with patients, physicians, and healthcare systems benefitting from its uptake.
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Affiliation(s)
- Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Rieke Alten
- Department of Internal Medicine II, Rheumatology, Clinical Immunology, Osteology, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
- Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Ken Takeuchi
- Department of Gastroenterology, IBD Center, Tsujinaka Hospital Kashiwanoha, Chiba, Japan
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
| | - Yoorim An
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Dong-Hyeon Kim
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - SangWook Yoon
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Levartovsky A, Ben-Horin S. Anti-TNF Therapy During the SARS-CoV-2 Pandemic: Friend or Foe? J Crohns Colitis 2022; 16:517-518. [PMID: 34626174 DOI: 10.1093/ecco-jcc/jjab167] [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: 02/08/2023]
Affiliation(s)
- Asaf Levartovsky
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
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40
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Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Correction to: Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022; 39:2281. [PMID: 35287234 PMCID: PMC8918596 DOI: 10.1007/s12325-022-02082-9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Rieke Alten
- Department of Internal Medicine II, Rheumatology, Clinical Immunology, Osteology, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
- Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Ken Takeuchi
- Department of Gastroenterology, IBD Center, Tsujinaka Hospital Kashiwanoha, Chiba, Japan
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
| | - Yoorim An
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Dong-Hyeon Kim
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - SangWook Yoon
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Yablecovitch D, Ben-Horin S, Picard O, Yavzori M, Fudim E, Nadler M, Levy I, Sakhnini E, Lang A, Engel T, Lahav M, Saker T, Neuman S, Selinger L, Dvir R, Raitses-Gurevich M, Golan T, Laish I. Serum Syndecan-1: A Novel Biomarker for Pancreatic Ductal Adenocarcinoma. Clin Transl Gastroenterol 2022; 13:e00473. [PMID: 35297817 PMCID: PMC9132524 DOI: 10.14309/ctg.0000000000000473] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Syndecan-1 (SDC1) has multiple functions in tumorigenesis in general and specifically in pancreatic cancer. We aimed to evaluate SDC1 as a diagnostic and prognostic biomarker in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS In this case-control study, patients newly diagnosed with a biopsy-proven PDAC were enrolled alongside healthy individuals in a derivation-validation cohort design. Serum SDC1 was measured by enzyme-linked immunoassay. The diagnostic accuracy of SDC1 levels for diagnosing PDAC was computed. A unified cohort enriched with additional early-stage patients with PDAC was used to evaluate the association of SDC1 with survival outcomes and patient characteristics. RESULTS In the derivation cohort, serum SDC1 levels were significantly higher in patients with PDAC (n = 39) compared with healthy controls (n = 20) (40.1 ng/mL, interquartile range 29.8-95.3 vs 25.6 ng/mL, interquartile range 17.1-29.8, respectively; P < 0.001). The receiver operating characteristic analysis area under the curve was 0.847 (95% confidence interval 0.747-0.947, P < 0.001). These results were replicated in a separate age-matched validation cohort (n = 38 PDAC, n = 38 controls; area under the curve 0.844, 95% confidence interval 0.757-0.932, P < 0.001). In the combined-enriched PDAC cohort (n = 110), using a cutoff of 35 ng/mL, the median overall 5-year survival between patients below and above this cutoff was not significantly different, although a trend for better survival after 1 year was found in the lower level group (P = 0.06). There were 12 of the 110 patients with PDAC (11%) who had normal CA 19-9 in the presence of elevated SDC1. DISCUSSION These findings suggest serum SDC1 as a promising novel biomarker for early blood-based diagnosis of pancreatic cancer.
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Affiliation(s)
- Doron Yablecovitch
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Shomron Ben-Horin
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Orit Picard
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Miri Yavzori
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Ella Fudim
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Moshe Nadler
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Idan Levy
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Emad Sakhnini
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Alon Lang
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Tal Engel
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Maor Lahav
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Talia Saker
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
- Shalvata Mental Health Center, Hod Hasharon, Israel;
| | - Sandra Neuman
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Limor Selinger
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Revital Dvir
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Maria Raitses-Gurevich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Talia Golan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Ido Laish
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
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Ukashi O, Barash Y, Klang E, Zilberman T, Ungar B, Kopylov U, Ben-Horin S, Veisman I. Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection. J Clin Med 2022; 11:jcm11051359. [PMID: 35268450 PMCID: PMC8911438 DOI: 10.3390/jcm11051359] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.
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Affiliation(s)
- Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Correspondence: ; Tel.: +972-35-305-000; Fax: +972-35-304-408
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Tal Zilberman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
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Avinir A, Dar S, Taler M, Haj O, Gothelf D, Kopylov U, Ben-Horin S, Mekori-Domachevsky E. Keeping it simple: mental health assessment in the Gastroenterology Department - using the Hospital Anxiety and Depression Scale (HADS) for IBD patients in Israel. Therap Adv Gastroenterol 2022; 15:17562848211066439. [PMID: 35251306 PMCID: PMC8891839 DOI: 10.1177/17562848211066439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/24/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Depression and anxiety are common among inflammatory bowel disease (IBD) patients. Not only do they worsen quality of life, but also worsen the prognosis of the IBD. Yet, there are no widely accepted guidelines for screening for depression or anxiety in this population. The Hospital Anxiety and Depression Scale (HADS) is a self-administered questionnaire designed to measure anxiety and depression in the physically ill. The purpose of this study was to establish the utility of the HADS as a screening tool in IBD patients. METHODS Seventy-nine IBD patients (age 29.86 ± 8.36, 51.9% female, 77.2% Crohn's disease) were recruited consecutively at the day treatment unit, Gastroenterology Department, Sheba Medical Center. They were asked to complete the HADS, the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). The scores of the HADS depression and anxiety subscales were correlated with the BDI and STAI scores, and the rates of above-threshold scores were calculated and compared between the three questionnaires and findings from previous studies. RESULTS The two HADS subscales significantly correlated with and the BDI (rs = .69, p < 0.001) and STAI state and trait anxiety (rs = .853, p < 0.001; r s = .744, p < 0.001, respectively). The usual HADS cut-off scores yielded adequate rate of anxiety but lower than expected depression rates. CONCLUSIONS Our findings suggest the HADS as a valid screening tool for anxiety and depression in IBD patients. We recommend administering it routinely in gastrointestinal (GI) follow-ups using a lower cut-off score for depression than anxiety (greater than 7 vs greater than 11, respectively).
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Affiliation(s)
- Asia Avinir
- Child and Adolescent Psychiatry Division, Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Shira Dar
- Pediatric Molecular Psychiatry Laboratory, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Taler
- Pediatric Molecular Psychiatry Laboratory, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ola Haj
- Gastroenterology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Doron Gothelf
- Child and Adolescent Psychiatry Division, Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Gastroenterology Department, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lichtenstein L, Koslowsky B, Ben Ya’acov A, Avni-Biron I, Ovadia B, Ben-Bassat O, Naftali T, Kopylov U, Haberman Y, Eran HB, Eliakim R, Lahat-Zok A, Hirsch A, Zittan E, Maharshak N, Waterman M, Israeli E, Goren I, Ollech JE, Yanai H, Ungar B, Avidan B, Ben Hur D, Melamud B, Segol O, Shalem Z, Dotan I, Odes SH, Ben-Horin S, Snir Y, Milgrom Y, Broide E, Goldin E, Delgado S, Ron Y, Cohen NA, Maoz E, Zborovsky M, Odeh S, Abu Freha N, Shachar E, Chowers Y, Engel T, Reiss-Mintz H, Segal A, Zinger A, Bar-Gil Shitrit A. COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience. Vaccines (Basel) 2022; 10:vaccines10030376. [PMID: 35335008 PMCID: PMC8950285 DOI: 10.3390/vaccines10030376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.
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Affiliation(s)
- Lev Lichtenstein
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | - Benjamin Koslowsky
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Ami Ben Ya’acov
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Baruch Ovadia
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel;
| | | | - Timna Naftali
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Meir Medical Center, Kfar Saba, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yael Haberman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hagar Banai Eran
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Adi Lahat-Zok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ayal Hirsch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Zittan
- Inflammatory Bowel Disease Unit, Ha’emek Medical Center, Faculty of Medicine, Israel Institute of Technology, Afula, Israel;
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
| | - Nitsan Maharshak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Matti Waterman
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Israeli
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Wolfson Medical Center, Holon, Israel
| | - Idan Goren
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Jacob E. Ollech
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Bella Ungar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Benjamin Avidan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dana Ben Hur
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bernardo Melamud
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Wolfson Medical Center, Holon, Israel
| | - Ori Segol
- Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel;
| | - Zippora Shalem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Gastroenterology and Liver Diseases Institute, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Selwyn H. Odes
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Shomron Ben-Horin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yf’at Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Yael Milgrom
- Hadassah Medical Center, Jerusalem, Israel; (Y.M.); (A.Z.)
| | - Efrat Broide
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Gastroenterology and Liver Diseases Institute, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Eran Goldin
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Shmuel Delgado
- Assuta Medical Center, Ben-Gurion University, Negev, Be’er Sheva, Israel;
| | - Yulia Ron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Nathaniel Aviv Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Maoz
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | - Maya Zborovsky
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | | | - Naim Abu Freha
- Soroka Medical Center, Be’er Sheva, Israel; (N.A.F.); (A.S.)
| | - Eyal Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yehuda Chowers
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Engel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hila Reiss-Mintz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Arie Segal
- Soroka Medical Center, Be’er Sheva, Israel; (N.A.F.); (A.S.)
| | - Adar Zinger
- Hadassah Medical Center, Jerusalem, Israel; (Y.M.); (A.Z.)
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
- Correspondence:
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Zhao M, Feng R, Ben-Horin S, Zhuang X, Tian Z, Li X, Ma R, Mao R, Qiu Y, Chen M. Systematic review with meta-analysis: environmental and dietary differences of inflammatory bowel disease in Eastern and Western populations. Aliment Pharmacol Ther 2022; 55:266-276. [PMID: 34820868 DOI: 10.1111/apt.16703] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/16/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND While the incidence of inflammatory bowel disease (IBD) has stabilised in the West, it is still increasing in several newly industrialised countries. AIMS To investigate whether the environmental and dietary risk factors for IBD differ between Eastern and Western populations METHODS: We systematically searched PubMed, Embase, and Web of Science for studies published from inception through June 30, 2020. Data were pooled using a random effects model. RESULTS Overall, 255 studies were assessed. We identified 25 risk factors for IBD, seven of which were noted in both Eastern and Western populations: family history of Crohn's disease [CD] or ulcerative colitis [UC], former smoking (CD/UC), smoking (CD), appendicectomy (CD), tonsillectomy (CD), meat and meat products (CD), and vitamin D deficiency (UC). The remaining factors, including urban living, current smoking, antibiotics, oral contraceptives, caesarean section, isotretinoin, total energy, fat, cholesterol, fatty acids and their sub-classifications, eggs, and soft drinks, were associated with an increased risk of IBD in Western or Eastern populations only. We identified 21 protective factors for IBD, among which eight were common in the East and West: farm animals (CD/UC), Helicobacter pylori infection (CD/UC), multiple births (CD), physical activity (CD), history of breastfeeding (CD), pets (UC), current smoking (UC), and coffee intake (UC). Ten factors conferred protection against IBD in Western populations only, whereas eight factors conferred protection against IBD in Eastern populations only. CONCLUSIONS Numerous environmental and dietary factors influenced the development of IBD in both Western and Eastern populations, whereas certain factors influenced IBD risk differently in these populations.
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Affiliation(s)
- Min Zhao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rui Feng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shomron Ben-Horin
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Gastroenterology Department, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Xiaojun Zhuang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhenyi Tian
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaozhi Li
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruiqi Ma
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Edelman-Klapper H, Zittan E, Bar-Gil Shitrit A, Rabinowitz KM, Goren I, Avni-Biron I, Ollech JE, Lichtenstein L, Banai-Eran H, Yanai H, Snir Y, Pauker MH, Friedenberg A, Levy-Barda A, Segal A, Broitman Y, Maoz E, Ovadia B, Golan MA, Shachar E, Ben-Horin S, Perets TT, Ben Zvi H, Eliakim R, Barkan R, Goren S, Navon M, Krugliak N, Werbner M, Alter J, Dessau M, Gal-Tanamy M, Freund NT, Cohen D, Dotan I. Lower Serologic Response to COVID-19 mRNA Vaccine in Patients With Inflammatory Bowel Diseases Treated With Anti-TNFα. Gastroenterology 2022; 162:454-467. [PMID: 34717923 PMCID: PMC8552587 DOI: 10.1053/j.gastro.2021.10.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIM Patients with inflammatory bowel diseases (IBD), specifically those treated with anti-tumor necrosis factor (TNF)α biologics, are at high risk for vaccine-preventable infections. Their ability to mount adequate vaccine responses is unclear. The aim of the study was to assess serologic responses to messenger RNA-Coronavirus Disease 2019 vaccine, and safety profile, in patients with IBD stratified according to therapy, compared with healthy controls (HCs). METHODS Prospective, controlled, multicenter Israeli study. Subjects enrolled received 2 BNT162b2 (Pfizer/BioNTech) doses. Anti-spike antibody levels and functional activity, anti-TNFα levels and adverse events (AEs) were detected longitudinally. RESULTS Overall, 258 subjects: 185 IBD (67 treated with anti-TNFα, 118 non-anti-TNFα), and 73 HCs. After the first vaccine dose, all HCs were seropositive, whereas ∼7% of patients with IBD, regardless of treatment, remained seronegative. After the second dose, all subjects were seropositive, however anti-spike levels were significantly lower in anti-TNFα treated compared with non-anti-TNFα treated patients, and HCs (both P < .001). Neutralizing and inhibitory functions were both lower in anti-TNFα treated compared with non-anti-TNFα treated patients, and HCs (P < .03; P < .0001, respectively). Anti-TNFα drug levels and vaccine responses did not affect anti-spike levels. Infection rate (∼2%) and AEs were comparable in all groups. IBD activity was unaffected by BNT162b2. CONCLUSIONS In this prospective study in patients with IBD stratified according to treatment, all patients mounted serologic response to 2 doses of BNT162b2; however, its magnitude was significantly lower in patients treated with anti-TNFα, regardless of administration timing and drug levels. Vaccine was safe. As vaccine serologic response longevity in this group may be limited, vaccine booster dose should be considered.
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Affiliation(s)
- Hadar Edelman-Klapper
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Zittan
- The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology, Emek Medical Center, Afula, Israel,Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel,Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Keren Masha Rabinowitz
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Idan Goren
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob E. Ollech
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Hagar Banai-Eran
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maor H. Pauker
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Friedenberg
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Adva Levy-Barda
- Biobank, Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - Arie Segal
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yelena Broitman
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maoz
- Clalit Health Services, Tel Aviv, Israel
| | - Baruch Ovadia
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Maya Aharoni Golan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Shomron Ben-Horin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Tsachi-Tsadok Perets
- Gastroenterology Laboratory, Division of Gastroenterology, Rabin Medical Center, Israel,Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Haim Ben Zvi
- Microbiology Lab, Rabin Medical Center, Petah Tikva, Israel
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Revital Barkan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Sophy Goren
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Navon
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noy Krugliak
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Werbner
- Molecular Virology Lab, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Joel Alter
- The Laboratory of Structural Biology of Infectious Diseases, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Moshe Dessau
- The Laboratory of Structural Biology of Infectious Diseases, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Meital Gal-Tanamy
- Molecular Virology Lab, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Natalia T. Freund
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dani Cohen
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ben-Horin S, Novack L, Mao R, Guo J, Zhao Y, Sergienko R, Zhang J, Kobayashi T, Hibi T, Chowers Y, Peyrin-Biroulet L, Colombel JF, Kaplan GG, Chen MH. Efficacy of Biologic Drugs in Short-Duration Versus Long-Duration Inflammatory Bowel Disease: A Systematic Review and an Individual-Patient Data Meta-Analysis of Randomized Controlled Trials. Gastroenterology 2022; 162:482-494. [PMID: 34757139 DOI: 10.1053/j.gastro.2021.10.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 06/05/2021] [Revised: 09/11/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Starting biologic treatment early in the course of inflammatory bowel disease (IBD) may be associated with higher efficacy, especially in Crohn's disease (CD). METHODS This was a systematic review and individual-patient data meta-analysis of all placebo-controlled trials of biologics approved for IBD at study inception (October 2015), using Vivli data-sharing platform. The primary outcome was the proportional biologic/placebo treatment effect on induction of remission in patients with short-duration (≤18 months) vs long-duration disease (>18 months) analyzed separately for CD and ulcerative colitis (UC). We used meta-regression to examine the impact of patients' characteristics on the primary outcome. RESULTS We included 25 trials, testing infliximab, adalimumab, certolizumab, golimumab, natalizumab, or vedolizumab (6168 patients with CD and 3227 patients with UC). In CD, remission induction rates were higher in pooled placebo and patients in active arms with short-duration disease of ≤18 months (41.4% [244 of 589]) compared with disease duration of >18 months (29.8% [852 of 2857], meta-analytically estimated odds ratio, 1.33; 95% confidence interval, 1.09-1.64). The primary outcome, proportional biologic/placebo treatment effect on induction of remission, was not different in short-duration disease of ≤18 months (n = 589, odds ratio, 1.47; 95% confidence interval, 1.01-2.15) compared with longer disease duration (n = 2857, odds ratio, 1.43; 95% confidence interval, 1.19-1.72). In UC trials, both the proportional biologic/placebo remission-induction effect and the pooled biologic-placebo effect were stable, regardless of disease duration. Primary outcome results remained unchanged when tested using alternative temporal cutoffs and when modeled for individual patient's covariates, including prior anti-tumor necrosis factor exposure. CONCLUSIONS There are higher rates of induction of remission with biologics and with placebo in early CD, resulting in a treatment to placebo effect ratio that is similar across disease durations. No such relationships between disease duration and outcomes was found in UC. PROSPERO registration: CRD42018041961.
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Affiliation(s)
- Shomron Ben-Horin
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China; Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ren Mao
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Jing Guo
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Yue Zhao
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jian Zhang
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Taku Kobayashi
- Center for Advanced Inflammatory Bowel Disease Research and Treatment, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced Inflammatory Bowel Disease Research and Treatment, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care Campus, Bruce and Ruth Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | | | - Jean Frederic Colombel
- Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Min-Hu Chen
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China.
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Ben-Horin S, Ungar B. Letter: loss of response to anti-TNFα agents in patients with inflammatory bowel disease depends on treatment duration. Aliment Pharmacol Ther 2022; 55:497-498. [PMID: 35092047 DOI: 10.1111/apt.16713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/11/2023]
Affiliation(s)
| | - Bella Ungar
- Sheba Medical Center and Tel-Aviv University, Israel
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Ungar B, Yavzori M, Fudim E, Picard O, Kopylov U, Eliakim R, Shouval D, Levin Y, Savidor A, Ben-Moshe S, Manco R, Dan S, Egozi A, Bahar Halpern K, Mayer C, Barshack I, Ben-Horin S, Itzkovitz S. Host transcriptome signatures in human faecal-washes predict histological remission in patients with IBD. Gut 2022; 71:gutjnl-2021-325516. [PMID: 35046090 DOI: 10.1136/gutjnl-2021-325516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/08/2021] [Indexed: 12/08/2022]
Abstract
BACKGROUND Colonoscopy is the gold standard for evaluation of inflammation in inflammatory bowel diseases (IBDs), yet entails cumbersome preparations and risks of injury. Existing non-invasive prognostic tools are limited in their diagnostic power. Moreover, transcriptomics of colonic biopsies have been inconclusive in their association with clinical features. AIMS To assess the utility of host transcriptomics of faecal wash samples of patients with IBD compared with controls. METHODS In this prospective cohort study, we obtained biopsies and faecal-wash samples from patients with IBD and controls undergoing lower endoscopy. We performed RNAseq of biopsies and matching faecal-washes, and associated them with endoscopic and histological inflammation status. We also performed faecal mass-spectrometry proteomics on a subset of samples. We inferred cell compositions using computational deconvolution and used classification algorithms to identify informative genes. RESULTS We analysed biopsies and faecal washes from 39 patients (20 IBD, 19 controls). Host faecal-transcriptome carried information that was distinct from biopsy RNAseq and faecal proteomics. Transcriptomics of faecal washes, yet not of biopsies, from patients with histological inflammation were significantly correlated to one another (p=5.3×10-12). Faecal-transcriptome had significantly higher statistical power in identifying histological inflammation compared with transctiptome of intestinal biopsies (150 genes with area under the curve >0.9 in faecal samples vs 10 genes in biopsy RNAseq). These results were replicated in a validation cohort of 22 patients (10 IBD, 12 controls). Faecal samples were enriched in inflammatory monocytes, regulatory T cells, natural killer-cells and innate lymphoid cells. CONCLUSIONS Faecal wash host transcriptome is a statistically powerful biomarker reflecting histological inflammation. Furthermore, it opens the way to identifying important correlates and therapeutic targets that may be obscured using biopsy transcriptomics.
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Affiliation(s)
- Bella Ungar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Miri Yavzori
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Ella Fudim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Orit Picard
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Dror Shouval
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, & Sackler School of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Yishai Levin
- The De Botton Institute for Protein Profiling, The Nancy and Stephen Grand Israel National Center for Personalized Medicine, Weizmann Institute of Science, Rehovot, Israel
| | - Alon Savidor
- The De Botton Institute for Protein Profiling, The Nancy and Stephen Grand Israel National Center for Personalized Medicine, Weizmann Institute of Science, Rehovot, Israel
| | - Shani Ben-Moshe
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Rita Manco
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Stav Dan
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Adi Egozi
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Keren Bahar Halpern
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Chen Mayer
- Department of Pathology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Iris Barshack
- Department of Pathology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Shalev Itzkovitz
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
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Weiss B, Ben-Horin S, Lev A, Broide E, Yavzori M, Lahat A, Kopylov U, Picard O, Eliakim R, Ron Y, Avni-Biron I, Yerushalmy-Feler A, Assa A, Somech R, Bar-Gil Shitrit A. Immune function in newborns with in-utero exposure to anti-TNFα therapy. Front Pediatr 2022; 10:935034. [PMID: 36120653 PMCID: PMC9470929 DOI: 10.3389/fped.2022.935034] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIM Anti-TNFα is measurable in infants exposed in utero up to 12 months of age. Data about the exposure effect on the infant's adaptive immunity are limited. We aimed to prospectively evaluate the distribution and function of T and B cells, in infants of females with inflammatory bowel disease, in utero exposed to anti-TNFα or azathioprine. METHODS A prospective multi-center study conducted 2014-2017. Anti-TNFα levels were measured in cord blood, and at 3 and 12 months. T-cell repertoire and function were analyzed at 3 and 12 months by flow-cytometry, expression of diverse T cell receptors (TCR) and T-cell receptor excision circles (TREC) quantification assay. Serum immunoglobulins and antibodies for inactivated vaccines were measured at 12 months. Baseline clinical data were retrieved, and 2-monthly telephonic interviews were performed regarding child infections and growth. RESULTS 24 pregnant females, age 30.6 (IQR 26.5-34.5) years were recruited, 20 with anti-TNFα (infliximab 8, adalimumab 12), and 4 with azathioprine treatment. Cord blood anti-TNFα was higher than maternal blood levels [4.3 (IQR 2.3-9.2) vs. 2.5 (IQR 1.3-9.7) mcg/ml], declining at 3 and 12 months. All infants had normal number of B-cells (n = 17), adequate levels of immunoglobulins (n = 14), and protecting antibody levels to Tetanus, Diphtheria, Hemophilus influenza-B and hepatitis B (n = 17). All had normal CD4+, CD8+ T-cells, and TREC numbers. TCR repertoire was polyclonal in 18/20 and slightly skewed in 2/20 infants. No serious infections requiring hospitalization were recorded. CONCLUSION We found that T-cell and B-cell immunity is fully mature and immune function is normal in infants exposed in utero to anti-TNFα, as in those exposed to azathioprine. Untreated controls and large-scale studies are needed to confirm these results.
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Affiliation(s)
- Batia Weiss
- Division of Pediatric Gastroenterology and Nutrition, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, Institute of Gastroenterology, Ramat Gan, Israel
| | - Atar Lev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Immunology Laboratory, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Efrat Broide
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Gastroenterology, Assaf-Harofe Medical Center, Ramat Gan, Israel
| | - Miri Yavzori
- Chaim Sheba Medical Center, Institute of Gastroenterology, Ramat Gan, Israel
| | - Adi Lahat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, Institute of Gastroenterology, Ramat Gan, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, Institute of Gastroenterology, Ramat Gan, Israel
| | - Orit Picard
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, Institute of Gastroenterology, Ramat Gan, Israel
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, Institute of Gastroenterology, Ramat Gan, Israel
| | - Yulia Ron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Souraski Medical Center, Institute of Gastroenterology, Tel Aviv, Israel
| | - Irit Avni-Biron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Anat Yerushalmy-Feler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Gastroenterology, Souraski Medical Center, Dana Duek Children's Hospital, Tel Aviv, Israel
| | - Amit Assa
- Schneider Children's Hospital, Institute of Pediatric Gastroenterology, Hepatology and Nutrition, Petah Tikva, Israel.,The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raz Somech
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Immunology Laboratory, Chaim Sheba Medical Center, Ramat Gan, Israel.,Department of Pediatrics A, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Ariella Bar-Gil Shitrit
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.,Medical School, The Hebrew University, Jerusalem, Israel
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