1
|
Koletzko S, Le Thi TG, Zhelyazkova A, Osterman A, Wichert SP, Breiteneicher S, Koletzko L, Schwerd T, Völk S, Jebrini T, Horak J, Tuschen M, Choukér A, Hornung V, Keppler OT, Koletzko B, Török HP, Adorjan K. A prospective longitudinal cohort study on risk factors for COVID-19 vaccination failure (RisCoin): methods, procedures and characterization of the cohort. Clin Exp Med 2023; 23:4901-4917. [PMID: 37659994 PMCID: PMC10725370 DOI: 10.1007/s10238-023-01170-6] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/11/2023] [Indexed: 09/04/2023]
Abstract
The primary objective of the RisCoin study was to investigate the interplay of genetic, metabolic, and lifestyle factors as well as stress levels on influencing the humoral immune response after at least two COVID-19 vaccinations, primarily with mRNAs, and the risk of SARS-CoV-2 breakthrough infections during follow-up. Here, we describe the study design, procedures, and study population. RisCoin is a prospective, monocentric, longitudinal, observational cohort study. Between October and December 2021, 4515 participants with at least two COVID-19 vaccinations, primarily BNT162b2 and mRNA-1273, were enrolled at the LMU University Hospital of Munich, thereof > 4000 healthcare workers (HCW), 180 patients with inflammatory bowel disease under immunosuppression, and 119 patients with mental disorders. At enrollment, blood and saliva samples were collected to measure anti-SARS-CoV-2 antibodies, their neutralizing capacity against Omicron-BA.1, stress markers, metabolomics, and genetics. To ensure the confidential handling of sensitive data of study participants, we developed a data protection concept and a mobile application for two-way communication. The application allowed continuous data reporting, including breakthrough infections by the participants, despite irreversible anonymization. Up to 1500 participants attended follow-up visits every two to six months after enrollment. The study gathered comprehensive data and bio-samples of a large representative HCW cohort and two patient groups allowing analyses of complex interactions. Our data protection concept combined with the mobile application proves the feasibility of longitudinal assessment of anonymized participants. Our concept may serve as a blueprint for other studies handling sensitive data on HCW.
Collapse
Affiliation(s)
- Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany.
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium, Medicum University of Warmia and Mazury, Olsztyn, Poland.
| | - Thu Giang Le Thi
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Ana Zhelyazkova
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Munich, Germany
| | - Andreas Osterman
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Sven P Wichert
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | | | - Leandra Koletzko
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
| | - Tobias Schwerd
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Stefanie Völk
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Tarek Jebrini
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Jeannie Horak
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Marina Tuschen
- Department of Anesthesiology, Laboratory of Translational Research Stress and Immunity, LMU University Hospital, LMU Munich, Munich, Germany
| | - Alexander Choukér
- Department of Anesthesiology, Laboratory of Translational Research Stress and Immunity, LMU University Hospital, LMU Munich, Munich, Germany
| | - Veit Hornung
- Gene Center and Department of Biochemistry, LMU Munich, Munich, Germany
| | - Oliver T Keppler
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Berthold Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Helga P Török
- Department of Medicine II, LMU University Hospital, LMU Munich, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany.
- Institute of Psychiatric Phenomics and Genomics (IPPG), LMU University Hospital, LMU Munich, Munich, Germany.
- Center for International Health (CIH), LMU Munich, Munich, Germany.
| |
Collapse
|
2
|
Unterweger AL, Rüscher A, Seuß M, Winkelmann P, Beigel F, Koletzko L, Breiteneicher S, Siebeck M, Gropp R, Aszodi A. NOD/scid IL-2Rγ null mice reconstituted with peripheral blood mononuclear cells from patients with Crohn's disease reflect the human pathological phenotype. Immun Inflamm Dis 2021; 9:1631-1647. [PMID: 34499803 PMCID: PMC8589348 DOI: 10.1002/iid3.516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022]
Abstract
Introduction Crohn's disease (CD) is characterized by pronounced intestinal fibrosis and severe mucosal damage and conventional animal models are limited to reflect these pathological manifestations. The aim of this study was to examine whether the combination of patient immune‐profiling and preclinical studies in a mouse model based on NOD/scid IL‐2Rγnull (NSG) reconstituted with peripheral blood mononuclear cells (PBMC) from CD patients has the capacity to harmonize ex vivo human and in vivo animal studies. Methods Immunological profiles of CD (n = 24) and ulcerative colitis (UC) patients (n = 47) were established by flow cytometry of subgroups of immune cells and subjected to hierarchical cluster and estimation graphics analyses. Pathological phenotypes of NSG mice, which were reconstituted with PBMC from CD, UC, and non‐IBD donors (NSG‐CD, NSG‐UC, and NSG‐non‐IBD) were compared. Readouts were the clinical, colon, and histological scores; subtypes of immune cells from spleen and colon; and levels of inflammatory markers, such as c‐reactive protein (CRP), monocyte chemotactic protein (MCP)‐3, transforming growth factor‐beta (TGFß), and hepatocyte growth factor (HGF). Fibrocytes were identified by immunohistochemistry in colonic sections. Results CD patients were significantly clustered in a group characterized by increased levels of TH1, TH2 cells, and decreased levels of CD14+ CD163+ monocytes (p = .003). In contrast to NSG‐UC mice, NSG‐CD mice exhibited an immune‐remodeling phenotype characterized by enhanced collagen deposition, elevated levels of CD14+ CD163+ monocytes, HGF, and TGFß. This phenotype was further corroborated by the presence of human fibrocytes as components of fibrotic areas. Conclusion The NSG‐CD model partially reflects the human disease and allows for studying the development of fibrosis.
Collapse
Affiliation(s)
- Anna-Lena Unterweger
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Alena Rüscher
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Marietta Seuß
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Paula Winkelmann
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the LMU, Munich, München, Germany
| | - Leandra Koletzko
- Department of Medicine II, Hospital of the LMU, Munich, München, Germany
| | | | - Matthias Siebeck
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral and Transplantation Surgery, Hospital of the LMU, Munich, Germany
| | - Attila Aszodi
- Department of Experimental Surgery and Regenerative Medicine, Hospital of the LMU, Planegg, Germany
| |
Collapse
|
3
|
Jodeleit H, Winkelmann P, Caesar J, Sterz S, Holdt LM, Beigel F, Stallhofer J, Breiteneicher S, Bartnik E, Leeuw T, Siebeck M, Gropp R. Head-to-head study of oxelumab and adalimumab in a mouse model of ulcerative colitis based on NOD/Scid IL2Rγnull mice reconstituted with human peripheral blood mononuclear cells. Dis Model Mech 2021; 14:dmm.046995. [PMID: 33293281 PMCID: PMC7847261 DOI: 10.1242/dmm.046995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
This study's aim was to demonstrate that the combination of patient immune profiling and testing in a humanized mouse model of ulcerative colitis (UC) might lead to patient stratification for treatment with oxelumab. First, immunological profiles of UC patients and non-UC donors were analyzed for CD4+ T cells expressing OX40 (CD134; also known as TNFRSF4) and CD14+ monocytes expressing OX40L (CD252; also known as TNFSF4) by flow cytometric analysis. A significant difference was observed between the groups for CD14+ OX40L+ (UC: n=11, 85.44±21.17, mean±s.d.; non-UC: n=5, 30.7±34.92; P=0.02), whereas no significant difference was detected for CD4+ OX40+. CD14+ OX40L+ monocytes were correlated significantly with T helper 1 and 2 cells. Second, NOD/Scid IL2Rγ null mice were reconstituted with peripheral blood mononuclear cells from UC donors exhibiting elevated levels of OX40L, and the efficacy of oxelumab was compared with that of adalimumab. The clinical, colon and histological scores and the serum concentrations of IL-6, IL-1β and glutamic acid were assessed. Treatment with oxelumab or adalimumab resulted in significantly reduced clinical, colon and histological scores, reduced serum concentrations of IL-6 and reduced frequencies of splenic human effector memory T cells and switched B cells. Comparison of the efficacy of adalimumab and oxelumab by orthogonal partial least squares discrimination analysis revealed that oxelumab was slightly superior to adalimumab; however, elevated serum concentrations of glutamic acid suggested ongoing inflammation. These results suggest that oxelumab addresses the pro-inflammatory arm of inflammation while promoting the remodeling arm and that patients exhibiting elevated levels of OX40L might benefit from treatment with oxelumab. Summary: The combination of patient profiling and testing in a NOD/Scid IL2Rγnull mouse model of ulcerative colitis (UC) validates oxelumab as a potential therapeutic in UC.
Collapse
Affiliation(s)
- Henrika Jodeleit
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Paula Winkelmann
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Janina Caesar
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Sebastian Sterz
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilian-University Munich, 81377 Munich, Germany
| | - Lesca M Holdt
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilian-University Munich, 81377 Munich, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Johannes Stallhofer
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Simone Breiteneicher
- Department of Medicine II, Hospital of the Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Eckart Bartnik
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, 65926 Frankfurt am Main, Germany
| | - Thomas Leeuw
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, 65926 Frankfurt am Main, Germany
| | - Matthias Siebeck
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Roswitha Gropp
- Department of General, Visceral and Transplantation Surgery, Hospital of the Ludwig-Maximilian-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| |
Collapse
|
4
|
Jodeleit H, Caesar J, Villarroel Aguilera C, Sterz S, Holdt L, Beigel F, Stallhofer J, Breiteneicher S, Bartnik E, Siebeck M, Gropp R. The Combination of Patient Profiling and Preclinical Studies in a Mouse Model Based on NOD/Scid IL2Rγ null Mice Reconstituted With Peripheral Blood Mononuclear Cells From Patients With Ulcerative Colitis May Lead to Stratification of Patients for Treatment With Adalimumab. Inflamm Bowel Dis 2020; 26:557-569. [PMID: 31782956 PMCID: PMC7054775 DOI: 10.1093/ibd/izz284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/06/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND To date, responsiveness to tumor necrosis factor alpha inhibitors in ulcerative colitis (UC) patients is not predictable. This is partially due to a lack of understanding of the underlying inflammatory processes. The aim of this study was to identify immunological subgroups of patients with UC and to test responsiveness to adalimumab in these subgroups in the mouse model of ulcerative colitis (UC), which is based on NOD/scid IL-2Rγ null (NSG) mice reconstituted with peripheral blood mononuclear cells (PBMCs; NSG-UC). METHODS The immunological profiles of 40 UC patients and 16 non-UC donors were determined by flow cytometric analysis of PBMCs in a snapshot and longitudinal study and analyzed by principal component, orthogonal partial least square discrimination (oPLS-DA), and hierarchical clustering analysis. NSG mice were reconstituted 5 times at consecutive time points with PBMCs from a single donor and were analyzed for frequencies of human leukocytes and histological phenotype. The response to adalimumab of 2 identified subgroups was tested in the NSG-UC model. We used the clinical, colon, and histological score, serum levels of glutamic and aspartic acid, and IL-6 and IL-1ß. Response was analyzed by oPLS-DA. RESULTS Analysis revealed a distinction between UC and non-UC donors. Hierarchical clustering identified 2 major subgroups in UC patients. Group I was characterized by TH17 and M1 monocytes, group II by TH2/TH1, and switched B cells. These subgroups reflect the dynamics of inflammation as patients. NSG-UC mice achieved an immunological phenotype reflecting the patient's immunological phenotype. oPLS-DA revealed that NSG-UC mice reconstituted with PBMCs from group II responded better to adalimumab. CONCLUSIONS The combination of profiling and testing of therapeutics in the NSG-UC model may lead to individualized and phase-dependent therapies.
Collapse
Affiliation(s)
- Henrika Jodeleit
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany,Present affiliation: IPEC, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Janina Caesar
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Christina Villarroel Aguilera
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Sebastian Sterz
- Institute of Laboratory Medicine, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Florian Beigel
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Johannes Stallhofer
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Simone Breiteneicher
- Department of Medicine II, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Eckart Bartnik
- Immunology and Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Matthias Siebeck
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany
| | - Roswitha Gropp
- Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, München, Germany,Address correspondence to: Roswitha Gropp, PhD, Department of General, Visceral und Transplantation Surgery, Hospital of the Ludwig Maximilian University of Munich, Nussbaumstr. 20, 80336 Munich, Germany ()
| |
Collapse
|
5
|
Beigel F, Deml M, Schnitzler F, Breiteneicher S, Göke B, Ochsenkühn T, Brand S. Rate and predictors of mucosal healing in patients with inflammatory bowel disease treated with anti-TNF-alpha antibodies. PLoS One 2014; 9:e99293. [PMID: 24932476 PMCID: PMC4059645 DOI: 10.1371/journal.pone.0099293] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/13/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Mucosal healing (MH) is an important treatment goal in patients with inflammatory bowel disease (IBD), but factors predicting MH under medical therapy are largely unknown. In this study, we aimed to characterize predictive factors for MH in anti-TNF-alpha antibody-treated IBD patients. METHODS We retrospectively analyzed 248 IBD patients (61.3% CD, 38.7% UC) treated with anti-TNF-alpha antibodies (infliximab and/or adalimumab) for MH, defined as macroscopic absence of inflammatory lesions (Mayo endoscopy score 0 or SES-CD score 0) in colonoscopies which were analyzed before and after initiation of an anti-TNF-alpha antibody treatment. RESULTS In patients treated with only one anti-TNF-alpha antibody ("TNF1 group", n = 202), 56 patients (27.7%) achieved complete MH at follow-up colonoscopy (median overall follow-up time: 63 months). In a second cohort (n = 46), which comprised patients who were consecutively treated with two anti-TNF-alpha antibodies ("TNF2 group"), 13 patients (28.3%) achieved complete MH (median overall follow-up time: 64.5 months). Compared to patients without MH, CRP values at follow-up colonoscopy were significantly lower in patients with MH (TNF1 group: p = 8.35×10-5; TNF2 group: p = 0.002). Multivariate analyses confirmed CRP at follow-up colonoscopy as predictor for MH in the TNF1 group (p = 0.012). Overall need for surgery was lower in patients with MH (TNF1 group: p = 0.01; TNF2 group: p = 0.03). CONCLUSIONS We identified low serum CRP level at follow-up colonoscopy as predictor for MH, while MH was an excellent negative predictor for the need for surgery.
Collapse
MESH Headings
- Adalimumab
- Adolescent
- Adult
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- C-Reactive Protein/analysis
- Child
- Colonoscopy
- Digestive System Surgical Procedures/statistics & numerical data
- Drug Therapy, Combination
- Female
- Gastrointestinal Agents/administration & dosage
- Gastrointestinal Agents/pharmacology
- Gastrointestinal Agents/therapeutic use
- Hospitalization
- Humans
- Inflammatory Bowel Diseases/blood
- Inflammatory Bowel Diseases/drug therapy
- Inflammatory Bowel Diseases/pathology
- Inflammatory Bowel Diseases/surgery
- Infliximab
- Intestinal Mucosa/drug effects
- Intestinal Mucosa/pathology
- Male
- Middle Aged
- Retrospective Studies
- Time Factors
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Young Adult
Collapse
Affiliation(s)
- Florian Beigel
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
| | - Matthias Deml
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Fabian Schnitzler
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Simone Breiteneicher
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Burkhard Göke
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | | | - Stephan Brand
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
6
|
Beigel F, Steinborn A, Schnitzler F, Tillack C, Breiteneicher S, John JM, Van Steen K, Laubender RP, Göke B, Seiderer J, Brand S, Ochsenkühn T. Risk of malignancies in patients with inflammatory bowel disease treated with thiopurines or anti-TNF alpha antibodies. Pharmacoepidemiol Drug Saf 2014; 23:735-44. [PMID: 24788825 DOI: 10.1002/pds.3621] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 01/08/2014] [Accepted: 03/10/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE We aimed to analyse malignancy rates and predictors for the development of malignancies in a large German inflammatory bowel disease (IBD) cohort treated with thiopurines and/or anti-tumour necrosis factor (TNF) antibodies. METHODS De novo malignancies in 666 thiopurine-treated and/or anti-TNF-treated IBD patients were analysed. Patients (n = 262) were treated with thiopurines alone and never exposed to anti-TNF antibodies (TP group). In addition, patients (n = 404) were exposed to anti-TNF antibodies (TNF+ group) with no (7.4%), discontinued (80.4%) or continued (12.1%) thiopurine therapy. RESULTS In the TP group, 20 malignancies were observed in 18 patients compared with 8 malignancies in 7 patients in the TNF+ group (hazard ratio 4.15; 95% CI 1.82-9.44; p = 0.0007; univariate Cox regression). Moreover, 18.2% of all patients in the TP group ≥50 years of age developed a malignancy, compared with 3.8% of all patients <50 years of age (p = 0.0008). In the TNF+ group, 6.5% of all patients ≥50 years of age developed malignancies compared with 0.3% of all patients <50 years of age (p = 0.0007). In both groups combined, thiopurine treatment duration ≥4 years was associated with the risk for skin cancer (p = 0.0024) and lymphoma (p = 0.0005). CONCLUSIONS Our data demonstrate an increased risk for the development of malignancies in IBD patients treated with thiopurines in comparison with patients treated with anti-TNF antibodies with or without thiopurines.
Collapse
Affiliation(s)
- Florian Beigel
- Department of Medicine II, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Beigel F, Löhr B, Laubender RP, Tillack C, Schnitzler F, Breiteneicher S, Weidinger M, Göke B, Seiderer J, Ochsenkühn T, Brand S. Iron status and analysis of efficacy and safety of ferric carboxymaltose treatment in patients with inflammatory bowel disease. Digestion 2012; 85:47-54. [PMID: 22179489 DOI: 10.1159/000333091] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/13/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS We analyzed iron deficiency and the therapeutic response following intravenous ferric carboxymaltose in a large single-center inflammatory bowel disease (IBD) cohort. METHODS 250 IBD patients were retrospectively analyzed for iron deficiency and iron deficiency anemia. A subgroup was analyzed regarding efficacy and side effects of iron supplementation with ferric carboxymaltose. RESULTS In the cohort (n = 250), 54.4% of the patients had serum iron levels ≤60 μg/dl, 81.2% had ferritin ≤100 ng/ml, and 25.6% had hemoglobin (Hb) of ≤12 g/dl (females) or ≤13 g/dl (males). In the treatment subcohort (n = 80), 83.1% of the patients had iron ≤60 μg/dl, 90.4% had ferritin ≤100 ng/ml, and 66.7% had Hb ≤12/13 g/dl before ferric carboxymaltose treatment. After a median dose of 500 mg ferric carboxymaltose, 74.7% of the patients reached iron >60 μg/dl, 61.6% had ferritin >100 ng/ml, and 90.7% reached Hb >12/13 g/dl at follow-up (p < 0.0001 for all parameters vs. pretreatment values). The most frequent adverse event was a transient increase of liver enzymes with male gender as risk factor (p = 0.008, OR 8.62, 95% CI 1.74-41.66). CONCLUSIONS Iron deficiency and anemia are frequent in IBD patients. Treatment with ferric carboxymaltose is efficious, safe and well tolerated in iron-deficient IBD patients.
Collapse
Affiliation(s)
- Florian Beigel
- Department of Medicine II, University Hospital Munich-Grosshadern, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|