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Vieujean S, Laharie D, Buisson A, Roblin X, Fumery M, Nancey S, Wils P, Altwegg R, Seidel L, Caron B, Peyrin-Biroulet L. Histological healing induced by tofacitinib in ulcerative colitis: A multicentre study. Dig Liver Dis 2024; 56:613-621. [PMID: 38065698 DOI: 10.1016/j.dld.2023.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/13/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 03/25/2024]
Abstract
BACKGROUND While the efficacy of tofacitinib to induce and maintain clinical and endoscopic remission is well established in ulcerative colitis (UC), little is known about its efficacy to induce histological remission. METHODS We conducted a retrospective multicentric cohort study. UC patients ≥ 16 years treated by tofacitinib in whom histological activity has been evaluated before and after induction were eligible. The primary endpoint was the histological remission at the end of induction, assessed by the Nancy index and the epithelial neutrophilic infiltrate. RESULTS A total of 42 patients with UC (93% previously exposed to an anti-TNF and 81% to vedolizumab) were included between July 2018 and April 2022 and were followed for a median duration of 84 weeks [IQR, 35-134]. At the end of induction period (whether prolonged or not), 19% and 24% of patients achieved histological remission, using the Nancy index and the epithelial neutrophilic infiltrate, respectively. Survival without tofacitinib discontinuation was significantly longer in patients without epithelial neutrophilic infiltrate at the end of induction (whether prolonged or not) compared with patients with epithelial neutrophilic infiltrate (p = 0.036). CONCLUSION Tofacitinib induced histological remission in one fifth to one quarter of patients with UC who have previously failed anti-TNF or/and vedolizumab after induction (whether prolonged or not).
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - David Laharie
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm, CHU Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mathurin Fumery
- Gastroenterology Unit, Amiens University Hospital and PeriTox, Université de Picardie Jules Verne, Amiens UMR-IO1, France
| | - Stephane Nancey
- Gastroenterology Department CHU Lyon-Sud, Hospices Civils de Lyon, University Claude Bernard Lyon 1, INSERM U1111 - CIRI, Lyon, France
| | - Pauline Wils
- Univ. Lille, Inserm, CHU Lille, U1286 - Institute for Translational Research in Inflammation, Lille F-59000, France
| | - Romain Altwegg
- Hepato-gastroenterology Department, CHU Montpellier, Montpellier, France
| | - Laurence Seidel
- Biostatistics and medico-economic information department, Liège, Belgium
| | - Bénédicte Caron
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy F-54500, France; INSERM, NGERE, University of Lorraine, Nancy F-54000, France; NFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy F-54500, France; FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy F-54500, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy F-54500, France; INSERM, NGERE, University of Lorraine, Nancy F-54000, France; NFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy F-54500, France; FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy F-54500, France; Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD centre, Neuilly sur Seine 92200, France; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada.
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Dragoni G, Innocenti T, Amiot A, Castiglione F, Melotti L, Festa S, Savarino EV, Truyens M, Argyriou K, Noviello D, Molnar T, Bouillon V, Bezzio C, Eder P, Fernandes S, Kagramanova A, Armuzzi A, Oliveira R, Viola A, Ribaldone DG, Drygiannakis I, Viganò C, Calella F, Gravina AG, Pugliese D, Chaparro M, Ellul P, Vieujean S, Milla M, Caprioli F. Rates of Adverse Events in Patients With Ulcerative Colitis Undergoing Colectomy During Treatment With Tofacitinib vs Biologics: A Multicenter Observational Study. Am J Gastroenterol 2024:00000434-990000000-01014. [PMID: 38305302 DOI: 10.14309/ajg.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/28/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Patients with ulcerative colitis (UC) receiving immunosuppressive drugs are at substantial risk of colectomy. We aimed to assess the risk of postoperative complications of tofacitinib exposure before colectomy in comparison with biologics. METHODS A multicenter, retrospective, observational study was conducted in patients with UC who underwent total colectomy for medically refractory disease, exposed to tofacitinib or a biologic before surgery. Primary outcome was the occurrence of any complication within 30 (early) and 90 (late) days after surgery. Secondary outcomes were the occurrence of infections, sepsis, surgical site complications, venous thromboembolic events (VTE), hospital readmissions, and redo surgery within the same timepoints. RESULTS Three hundred one patients (64 tofacitinib, 162 anti-tumor necrosis factor-α agents, 54 vedolizumab, and 21 ustekinumab) were included. No significant differences were reported in any outcome, except for a higher rate of early VTE with anti-tumor necrosis factor-α agents ( P = 0.047) and of late VTE with vedolizumab ( P = 0.03). In the multivariate analysis, drug class was not associated with a higher risk of any early and late complications. Urgent colectomy increased the risk of any early (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.06-3.48) complications, early hospital readmission (OR 4.79, 95% CI 1.12-20.58), and early redo surgery (OR 7.49, 95% CI 1.17-47.85). A high steroid dose increased the risk of any early complications (OR 1.96, 95% CI 1.08-3.57), early surgical site complications (OR 2.03, 95% CI 1.01-4.09), and early redo surgery (OR 7.52, 95% CI 1.42-39.82). Laparoscopic surgery decreased the risk of any early complications (OR 0.54, 95% CI 0.29-1.00), early infections (OR 0.39, 95% CI 0.18-0.85), and late hospital readmissions (OR 0.34, 95% CI 0.12-1.00). DISCUSSION Preoperative tofacitinib treatment demonstrated a postoperative safety profile comparable with biologics in patients with UC undergoing colectomy.
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Affiliation(s)
- Gabriele Dragoni
- IBD Referral Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Tommaso Innocenti
- IBD Referral Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Aurelién Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, Paris Est-Creteil University, Creteil, France
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Laura Melotti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Marie Truyens
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | | | - Daniele Noviello
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Tamas Molnar
- Department of Gastroenterology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Vincent Bouillon
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine-Poznań University of Medical Sciences, Heliodor Święcicki University Hospital, Poznań, Poland
| | - Samuel Fernandes
- Department of Gastroenterology and Hepatology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
- Clínica Universitária da Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Anna Kagramanova
- Moscow Clinical Scientific Center named after A.S. Loginov, Moscow, Russian Federation
| | | | - Raquel Oliveira
- Gastroenterology Department, Algarve University Hospital Centre-Portimão Unit, Algarve, Portugal
| | - Anna Viola
- IBD-Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Ioannis Drygiannakis
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Greece
| | - Chiara Viganò
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Francesca Calella
- SOC Gastroenterologia ed endoscopia digestiva, Azienda USL Toscana Centro, Ospedale "San Giuseppe," Empoli, Italy
| | - Antonietta Gerarda Gravina
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Daniela Pugliese
- CEMAD, IBD Unit, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - María Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Monica Milla
- IBD Referral Centre, Careggi University Hospital, Florence, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Vieujean S, Gillard R, Delanaye P, Seidel L, Bequet E, Salée C, Meuwis MA, Massot C, Pierre N, Meunier P, Cavalier E, Louis E. Matrix gla protein, a potential marker of tissue remodelling and physiological ageing of the gut in crohn's disease. Scand J Gastroenterol 2024; 59:296-303. [PMID: 38411457 DOI: 10.1080/00365521.2023.2286913] [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: 07/07/2023] [Accepted: 11/19/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND The inactive dephosphorylated and uncarboxylated form of the matrix Gla protein (dp-ucMGP) has been shown to be increased in plasma of inflammatory bowel disease (IBD) patients. Our aim was to assess if the plasmatic level of dp-ucMGP could reflect disease endoscopic activity, presence of strictures and cumulative structural bowel damage in Crohn's disease (CD) patients. METHODS The plasmatic level of dp-ucMGP was measured in a monocentric cohort of prospectively recruited patients. The analysis was done by chemiluminescent immunoassay on blood samples collected the day of a planned ileocolonoscopy. In addition to classical clinical data (gender, age, body mass index (BMI), disease duration, current treatment), endoscopic data (disease location, Crohn's Disease Endoscopic Index of Severity (CDEIS), mucosal healing (MH), presence of 9 CD lesion types) and biological markers (faecal calprotectin and C-reactive protein (CRP)) were collected. The association between dp-ucMGP level and Lémann index was also investigated. Univariate linear regression was used to investigate the relationship between dp-ucMGP level and different parameters collected. RESULTS A total of 82 ileocolonoscopies and dp-ucMGP assays were performed in 75 CD patients (45 females; 37 ileocolonic, 19 ileal and 19 colonic diseases) between October 2012 and November 2019. A total of 24 patients (29.3%) showed MH. The dp-ucMGP levels were not associated with MH, CDEIS, faecal calprotectin or CRP levels. Plasmatic dp-ucMGP levels increased significantly with age (p = 0.0032), disease duration (p = 0.0033), corticosteroids use (p = 0.019) and tended to increase in patients with intestinal strictures (p = 0.086) but not with the Lémann index. CONCLUSION The significant increase of plasmatic dp-ucMGP levels with age, disease duration and the trend observed in patients with non-ulcerated strictures may suggest that this extracellular matrix protein could be a marker of tissue remodelling and physiological ageing of the gut.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Romain Gillard
- Department of Radiology, University Hospital CHU of Liège, Liège, Belgium
| | - Pierre Delanaye
- Department of Dialysis-Nephrology-Transplantation, University Hospital CHU of Liège, Liège, Belgium
| | - Laurence Seidel
- Biostatistics and Medico-economic Information Department, University of Liège, Liège, Belgium
| | - Emeline Bequet
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Citadelle Hospital and University Hospital of Liège & University of Liège, Liège, Belgium
| | - Catherine Salée
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Marie-Alice Meuwis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Charlotte Massot
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Nicolas Pierre
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
| | - Paul Meunier
- Department of Radiology, University Hospital CHU of Liège, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, Liège, Belgium
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liège University, Liège, Belgium
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Loly JP, Vieujean S, Reenaers C, Van Kemseke C, Seidel ScD L, Louis E, Somja J. In-Depth Assessment of Endoscopic Remission in Inflammatory Bowel Disease Treated by Anti-TNF or Vedolizumab. Inflamm Bowel Dis 2024; 30:240-246. [PMID: 37042951 DOI: 10.1093/ibd/izad066] [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: 11/28/2022] [Indexed: 04/13/2023]
Abstract
BACKGROUND AND AIMS Confocal endomicroscopy is a technique allowing the in vivo assessment of the superficial layers of the mucosa. Preliminary studies have already suggested its added value in the assessment of endoscopic remission in inflammatory bowel disease. However, most of these studies were performed on patients still having incomplete mucosal healing. Our aim was to disclose persisting endomicroscopic anomalies in patients with full endoscopic remission and to compare them between vedolizumab- and anti-tumor necrosis factor-treated patients. METHODS We screened patients with Crohn's disease (CD) or ulcerative colitis (UC) treated for more than 6 months with biologic therapy, and being in steroid-free clinical and biological remission. White light endoscopy and probe-based confocal laser endomicroscopy (pCLE) analysis were performed in the ileum, right colon, transverse colon, left colon, and rectum. Full endoscopic remission was defined by a Mayo endoscopic score of 0 in UC and no remaining ulcer or erosion in CD. Patients were prospectively followed up and clinical relapses were recorded. RESULTS Seventy-two CD and UC patients treated by biologic therapy and in clinical and biological remission were screened. A total of 37 were also in full endoscopic remission and were included in our study; 183 intestinal segments were analyzed. We found residual pCLE anomalies in most of the patients. These anomalies were not significantly associated with any demographic or clinical characteristic including the treatment received, nor were they associated with histological parameters, levels of C-reactive protein or fecal calprotectin. Among the 37 patients, 7 (18.9%) relapsed over a median follow-up of 33.7 months. The risk of relapse was not associated with any clinical, biological, histologic, or pCLE feature at baseline. CONCLUSION Despite endoscopic, biological, and even histological remission, we found a high prevalence of endomicroscopic abnormalities, which were not different between anti-tumor necrosis factor- and vedolizumab-treated patients. The clinical significance of these anomalies remains to be clarified.
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Affiliation(s)
| | | | | | | | | | - Edouard Louis
- Department of Gastroenterology, CHU Liège, Liège, Belgium
| | - Joan Somja
- Department of Pathology, CHU Liège, Liège, Belgium
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Parigi TL, Vieujean S, Paridaens K, Dalgaard K, Peyrin-Biroulet L, Danese S. Efficacy, Safety, and Concerns on Microbiota Modulation, Antibiotics, Probiotics, and Fecal Microbial Transplant for Inflammatory Bowel Disease and Other Gastrointestinal Conditions: Results from an International Survey. Microorganisms 2023; 11:2806. [PMID: 38004817 PMCID: PMC10672996 DOI: 10.3390/microorganisms11112806] [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: 10/26/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The gut microbiota play a pivotal role in human health. Dysbiosis, alterations in microbiota composition and function, is associated with gastrointestinal disorders, including inflammatory bowel disease (IBD). This international survey aimed to assess physicians' experiences, perceptions, and practices related to microbiome modulation for gastrointestinal conditions, with a focus on IBD. Results from 142 healthcare professionals, predominantly gastroenterologists, confirmed a consensus on the relevance of the gut microbiota in IBD pathogenesis. However, the utilization of microbial composition analysis and probiotics in clinical practice was limited, primarily due to the lack of standardized guidelines and supporting evidence. Physicians held conflicting views on antibiotics, recognizing their potential for inducing remission but also causing flares in IBD. Respondents also had varying opinions on the efficacy of fecal microbiota transplantation (FMT) for different gastrointestinal conditions, with higher confidence in FMT effectiveness for irritable bowel syndrome with diarrhea, pouchitis, and ulcerative colitis. Concerns on FMT included uncertainty about effect duration, administration intervals, and conflicting evidence. Donor selection was believed to be a crucial factor in FMT outcomes. This survey highlights the need for further research and evidence-based guidelines to optimize the use of microbiome-based therapies in clinical practice. As our understanding of the gut microbiome continues to evolve, these insights will contribute to more informed and personalized approaches to managing gastrointestinal disorders.
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Affiliation(s)
- Tommaso Lorenzo Parigi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
- Division of Immunology, Transplantation and Infectious Disease, Università Vita Salute San Raffele, 20132 Milan, Italy
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, 4000 Liège, Belgium
| | | | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Groupe Hospitalier Privé Ambroise Paré–Hartmann, Paris IBD Center, F-92200 Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Silvio Danese
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
- Division of Immunology, Transplantation and Infectious Disease, Università Vita Salute San Raffele, 20132 Milan, Italy
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Ribaldone DG, Testa G, Verstockt B, Molnar T, Savarino E, Schmidt C, Vieujean S, Teich N, Meianu C, Juillerat P, Grellier N, Lobaton T. Treatment of antibiotic refractory chronic pouchitis with JAK inhibitors and S1P receptor modulators: an ECCO CONFER Multicentre Case Series. J Crohns Colitis 2023:jjad194. [PMID: 37965867 DOI: 10.1093/ecco-jcc/jjad194] [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: 10/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND AIMS Data regarding effectiveness and safety of JAK inhibitors and S1P receptor modulators in antibiotic refractory chronic pouchitis (CARP) are lacking. METHODS This ECCO-CONFER project retrospectively collected JAK inhibitors or S1P receptor modulators treatments for CARP with at least 3-months follow up. The outcomes included corticosteroid and antibiotics-free clinical response and remission at three and twelve months, trend in mPDAI, endoscopic PDAI, CRP and calprotectin. RESULTS Seventeen treatments in 15 patients were collected. Previous pouchitis treatments included infliximab (5/15), adalimumab (4/15), vedolizumab (9/15), and ustekinumab (5/15). Pooling data on JAK inhibitors (8 tofacitinib, 1 filgotinib and 6 upadacitinib), after 3 months (T3), steroid and antibiotics-free clinical response was achieved in 53.3% (8/15), steroid and antibiotics-free clinical remission was achieved in 40% (6/15). Of the patients with at least 12 months of follow-up, steroid and antibiotics-free clinical response was achieved in 50% (3/6) and remission in one patient (16.7%), endoscopic response in 50% (3/6), endoscopic remission in 50% (3/6). Of the two ozanimod treatments at T3, steroid and antibiotics-free clinical response was achieved in one patient, without remission; both discontinued ozanimod before T12. No side effects reported. CONCLUSIONS Small molecules may represent a suitable option for CARP refractory to multiple biologics, deserving further investigation.
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Affiliation(s)
| | - Giulia Testa
- Gastroenterology-U, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | | | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Carsten Schmidt
- Medical Clinic II, Hospital Fulda, Fulda, Germany
- Medical Faculty of the Friedrich Schiller University, Jena, Germany
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Niels Teich
- Medical Faculty of the Friedrich Schiller University, Jena, Germany
- Gastroenterology Practice, Leipzig, Germany
| | - Corina Meianu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Department of Gastroenterology, Bern University Hospital
- Crohn and Colitis Center, Gastro-enterologie Beaulieu SA, Lausanne, Switzerland
| | - Nathan Grellier
- Hepato-Gastroenterology Department, University Hospital of Poitiers, Poitiers, France
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
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Pierre N, Vieujean S, Peyrin-Biroulet L, Meuwis MA, Louis E. Defining Biological Remission in Crohn's Disease: Interest, Challenges and Future Directions. J Crohns Colitis 2023; 17:1698-1702. [PMID: 37208498 DOI: 10.1093/ecco-jcc/jjad086] [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: 01/17/2023] [Indexed: 05/21/2023]
Abstract
In Crohn's disease, the treat-to-target strategy has been greatly encouraged and has become a standard of care. In this context, defining the target [remission] constitutes a major stake and is fuelling the literature. Currently, clinical remission [symptom control] is no longer the only objective of treatments since it does not allow to closely control inflammation-induced tissue damage. The introduction of endoscopic remission as a therapeutic target clearly represented progress but this examination remains invasive, costly, not well accepted by patients and does not allow tight control of disease activity. More fundamentally, morphological techniques [e.g. endoscopy, histology, ultrasonography] are limited since they do not evaluate the biological activity of the disease but only its consequences. Besides, emerging evidence suggests that biological signs of disease activity could better guide treatment decisions than clinical parameters. In this context, we stress the necessity to define a novel treatment target: biological remission. Based on our previous work, we propose a conceptual definition of biological remission which goes beyond the classical normalization of inflammatory markers [C-reactive protein and faecal calprotectin]: absence of biological signs associated with the risk of short-term relapse and mid-/long-term relapse. The risk of short-term relapse seems essentially to be characterized by a persistent inflammatory state while the risk of mid-/long-term relapse implies a more heterogeneous biology. We discuss the value of our proposal [guiding treatment maintenance, escalation or de-escalation] but also the fact that its clinical implementation would require overcoming major challenges. Finally, future directions are proposed to better define biological remission.
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Affiliation(s)
- Nicolas Pierre
- Laboratory of Translational Gastroenterology, GIGA Institute, University of Liège, Liège, Belgium
| | - Sophie Vieujean
- Laboratory of Translational Gastroenterology, GIGA Institute, University of Liège, Liège, Belgium
- Departement of Hepato-Gastroenterology and Digestive Oncology, Liège University Hospital, Liège, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Marie-Alice Meuwis
- Laboratory of Translational Gastroenterology, GIGA Institute, University of Liège, Liège, Belgium
- Departement of Hepato-Gastroenterology and Digestive Oncology, Liège University Hospital, Liège, Belgium
| | - Edouard Louis
- Laboratory of Translational Gastroenterology, GIGA Institute, University of Liège, Liège, Belgium
- Departement of Hepato-Gastroenterology and Digestive Oncology, Liège University Hospital, Liège, Belgium
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Vieujean S, Lindsay JO, D'Amico F, Ahuja V, Silverberg MS, Sood A, Yamamoto-Furusho JK, Nagahori M, Watanabe M, Koutroubakis IE, Foteinogiannopoulou K, Avni Biron I, Walsh A, Outtier A, Nordestgaard RLM, Abreu MT, Dubinsky M, Siegel C, Louis E, Dotan I, Reinisch W, Danese S, Rubin DT, Peyrin-Biroulet L. Analysis of Clinical Trial Screen Failures in Inflammatory Bowel Diseases (IBD): Real World Results from the International Organization for the study of IBD. J Crohns Colitis 2023:jjad180. [PMID: 37864829 DOI: 10.1093/ecco-jcc/jjad180] [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: 07/04/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Recruitment for randomized controlled trials (RCTs) in IBD have substantially dropped over time. This study aimed to assess reasons why IBD patients are not included in sponsored multicenter phase IIb-III RCTs. METHODS All IOIBD members (n=58) were invited to participate. We divided barriers to participation as follow: 1) reasons patients with active IBD were not deemed appropriate for a RCT; 2) reasons qualified patients did not wish to participate; 3) reasons for screen failure (SF) in patients agreeing to participate. We assess those in a 4-week prospective study including, consecutively, all patients with symptomatic disease for whom a treatment change was required. In addition, we performed a 6-month retrospective study to further evaluate reasons for SF. RESULTS A total of 106 patients (60 male (56.6%), 63 Crohn's disease [CD] (59.4%)), from 10 centers across the world, were included in the prospective study. A RCT has not been proposed to 65 of them (mainly due to eligibility criteria). Of the 41 patients to whom a RCT was offered, 8 refused (mainly due to reluctance to receive placebo) and 28 agreed to participate. Among these 28 patients, 5 failed their screening and 23 were finally included in a RCT. A total of 107 patients (61 male (57%), 67 CD (62.6%)), from 13 centers worldwide, were included in our retrospective study of SFs. The main reason was insufficient disease activity. CONCLUSION This first multicenter study analyzing reasons for non-enrollment in IBD RCTs shown that we lose patients at each step. Eligibility criteria, the risk of placebo assignment and insufficient disease activity were part of the main barriers.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - James O Lindsay
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London,UK
| | - Ferdinando D'Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiāna, Punjab, India
| | - Jesus K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpa, Mexico
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ioannis E Koutroubakis
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Irit Avni Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alissa Walsh
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust and NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - An Outtier
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Maria T Abreu
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology and Nutrition, Icahn School of Medicine, Mount Sinai, New York, New York
| | - Corey Siegel
- Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD center, 92200 Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
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Muller M, Broséus J, Guilloteau A, Wasse S, Thiéblemont C, Nancey S, Cadiot G, Amiot A, Laharie D, Vieujean S, Bouhnik Y, Martineau C, Michiels C, Hebuterne X, Savoye G, Franchimont D, Seksik P, Beaugerie L, Maynadié M, Feugier P, Peyrin-Biroulet L. Lymphoma In Patients With Inflammatory Bowel Disease: A Multicenter Collaborative Study Between Getaid And Lysa. J Crohns Colitis 2023:jjad177. [PMID: 37850555 DOI: 10.1093/ecco-jcc/jjad177] [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: 07/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND IBD is associated with an increased risk of developing lymphoma. Although recent data clarifies lymphoma epidemiology in IBD patients, clinical and pathological characteristics of lymphoma occurring in IBD remain ill-known. METHODS Patients with IBD and lymphoma were retrospectively identified in the framework of a national collaborative study including the Groupe d'Étude Thérapeutique des Affections Inflammatoires du Tube Digestif (GETAID) and the Lymphoma Study Association (LYSA). We characterized clinical and prognostic features for the 3 most frequent lymphoma subtypes occurring in IBD. We performed a multicentric case-control study. Controls (lymphoma de novo) were matched (5:1) to cases on gender, age at diagnosis, lymphoma subtype, year of diagnosis, IPI/FLIPI indexes. Overall survival (OS) and progression free survival were compared between cases and controls. RESULTS 133 IBD patients with lymphoma were included (males = 62.4 %, median age at lymphoma diagnosis = 49 years in males ; 42 in females). Most had Crohn's disease (73.7 %) and were exposed to thiopurines (59.4 %). The most frequent lymphoma subtypes were diffuse large B cell lymphoma (DLBCL, 45.1 %), Hodgkin lymphoma (HL, 18.8 %), and follicular lymphoma (FL, 10.5 %). When matched with 365 controls, prognosis was improved in IBD patients with DLBCL compared to controls (p = 0.0064, hazard ratio = 0.36) or similar (HL and FL). CONCLUSION Lymphomas occurring in IBD patients do not seem to have a worse outcome than in patients without IBD. Due to the scarcity of this situation, those patients should be managed in expert centers.
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Affiliation(s)
- Marie Muller
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Julien Broséus
- University of Lorraine, Inserm U1256 « Nutrition - Genetics and exposure to environmental risks - NGERE », F-54000, Nancy, France
- University of Lorraine, CHRU-Nancy Hematology Laboratory, Laboratory department, F-54000 Nancy, France
| | - Adrien Guilloteau
- Registre des hemopathies Malignes de Côte d'Or, Inserm U1231, University of Burgundy and Dijon University Hospital, Dijon, France
| | - Stéphane Wasse
- Registre des hemopathies Malignes de Côte d'Or, Inserm U1231, University of Burgundy and Dijon University Hospital, Dijon, France
| | | | - Stéphane Nancey
- Department of Gastroenterology, University Claude Bernard Lyon 1, Hospices Civils de Lyon, CHU Lyon-Sud, Lyon, France
| | - Guillaume Cadiot
- Department of Hepato-Gastro-Enterology, Reims University Hospital, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, AP-HP, Paris Est Créteil University, Créteil, France
| | - David Laharie
- Department of Hepato-Gastro-Enterology, Bordeaux University Hospital, Pessac, France
| | - Sophie Vieujean
- Department of Hepato-Gastroenterology, University Hospital CHU of Liège, Liège, Belgium
| | - Yoram Bouhnik
- Institut National de la Santé et Recherche Médicale et Université Paris Diderot, Paris Hôpital Beaujon, AP-HP, Paris, France
| | - Chloé Martineau
- Department of Gastroenterology, Hôpital Européen George Pompidou, AP-HP, Paris, France
| | | | - Xavier Hebuterne
- Department of Hepato-Gastro-Enterology, Nice University Hospital, France
| | - Guillaume Savoye
- Department of Hepato-Gastro-Enterology, Rouen University Hospital, France
| | - Denis Franchimont
- Department of Hepato-Gastro-Enterology, Erasme University Hospital, Brussels, Belgium
| | - Philippe Seksik
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, F75012, Paris, France
| | - Laurent Beaugerie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, F75012, Paris, France
| | - Marc Maynadié
- Registre des hemopathies Malignes de Côte d'Or, Inserm U1231, University of Burgundy and Dijon University Hospital, Dijon, France
| | - Pierre Feugier
- University of Lorraine, Inserm U1256 « Nutrition - Genetics and exposure to environmental risks - NGERE », F-54000, Nancy, France
- Department of Clinical Hematology, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, Nancy, France
- University of Lorraine, Inserm U1256 « Nutrition - Genetics and exposure to environmental risks - NGERE », F-54000, Nancy, France
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Vieujean S, Kotze PG, Netter P, Germain A, Louis E, Danese S, Peyrin-Biroulet L. Stemming the tide with ileocecal Crohn's disease: when is pharmacotherapy enough? Expert Opin Pharmacother 2023; 24:1595-1607. [PMID: 37401098 DOI: 10.1080/14656566.2023.2232726] [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: 09/13/2022] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Crohn's disease (CD) mostly affects the terminal ileum and ileocecal region and up to 80% of patients end up requiring surgery. Previously reserved for complicated or refractory forms, surgery is now considered as an alternative to medical treatment in localized ileocecal disease. AREAS COVERED This review examines factors associated with response to medical treatment and those associated with the need for surgery in ileocecal CD to identify the patients' profile for whom pharmacotherapy might be enough. Factors associated with the recurrence and the postoperative complications are also reviewed to help the clinician identify patients for whom medical therapy might be preferred. EXPERT’S OPINION LIR!C study long-term follow-up data show that 38% of infliximab-treated patients were still treated with infliximab at the end of their follow-up, while 14% had switched to another biologic or had received immunomodulator or corticosteroid and 48% had CD-related surgery. Only the combination with an immunomodulator was associated with a greater likelihood of continuing infliximab. Patients with ileocecal CD for whom pharmacotherapy might be sufficient are probably those with no risk factors for CD-related surgery.In addition, patients with high risk of recurrence or of post-operative complications may benefit more from medical treatment than from surgery.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil
| | - Patrick Netter
- Université de Lorraine, CNRS, Laboratoire IMoPa, Nancy, France
| | - Adeline Germain
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-Les-Nancy, France
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University of Lorraine, CHRU-Nancy, Nancy, France
- University of Lorraine, INSERM, NGERE, Nancy, France
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11
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D'Amico F, Vieujean S, Caron B, Peyrin-Biroulet L, Danese S. Risk-Benefit of IBD Drugs: A Physicians and Patients Survey. J Clin Med 2023; 12:jcm12093094. [PMID: 37176535 PMCID: PMC10179123 DOI: 10.3390/jcm12093094] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Treatment choices for patients with inflammatory bowel disease (IBD) are based on the balance between risks and benefits. Our AI was to compare the perspectives of patients and physicians in evaluating the risks and benefits before initiating therapy for IBD. METHODS An anonymous survey was conducted between March and August 2022. All patients with confirmed IBD and all physicians who attended an IBDscope webinar were invited to participate. RESULTS In total, 367 patients and 146 physicians participated. For most patients (71.4%) and physicians (89.0%), efficacy and safety were equally important. Clinical improvement and clinical remission were the most relevant outcomes for patients (90.9 and 88.4), while clinical remission and endoscopic remission were for physicians (90.0 and 87.6). The main factors in the benefit-risk assessment were quality of life (95.1%), disease activity (87.5%), and presence of comorbidities (84.5%) for patients, and presence of comorbidities (99.3%), disease activity (97.9%), and prior failure to biologics/small molecules (96.6%) for physicians. Based on patients' and physicians' opinions, the risk of serious infections, malignancies, cardiovascular events, death, relapse, all infections, surgery, and hospitalization should be included in the benefit-risk assessment. CONCLUSION Physicians and patients have different priorities in evaluating the benefit-risk balance of a new therapy.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, 4000 Liège, Belgium
| | - Benedicte Caron
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
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12
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Bonsack O, Caron B, Baumann C, Heba AC, Vieujean S, Arnone D, Netter P, Danese S, Quilliot D, Peyrin-Biroulet L. Food avoidance and fasting in patients with inflammatory bowel disease: Experience from the Nancy IBD nutrition clinic. United European Gastroenterol J 2023; 11:361-370. [PMID: 37078395 PMCID: PMC10165321 DOI: 10.1002/ueg2.12385] [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: 11/24/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) consider that their diet is important for controlling symptoms and frequently ask their physician for additional guidance on this matter. The objectives of the present study of patients with IBD were to characterize the prevalence of exclusion diets and fasting and to identify associated risk factors. METHODS Using an anonymous questionnaire, we screened patients attending our IBD nutrition clinic between November 2021 and April 2022 for exclusion diets. The avoidance of a food category completely was defined as total exclusion and avoidance most of the time was defined as partial exclusion. We also asked patients whether they fasted totally, intermittently, or partially. RESULT A total of 434 patients with IBD were included. On inclusion, 159 patients (36.6%) totally excluded at least one food category and 271 (62.4%) partially excluded at least one food. Intermittent, total, or partial fasting was reported by 30.8% of the patients. Disease activity (odds ratio (OR) [95% confidence interval] = 1.7 [1.1-2.7], p = 0.0130) and treatment with a small-molecule or an investigational drug (OR = 4.0 [1.5-10.6], p = 0.0059) were independently associated with an exclusion diet. A history of stenosis (OR = 2.0 [1.2-3.2], p = 0.0063) and active disease (OR = 1.9 [1.2-3.1], p = 0.0059) were associated with fasting. CONCLUSION In this real-world study, approximately two-thirds of our patients with IBD reported the partial or total exclusion of at least one food category and one third reported fasting. A systematic nutritional evaluation might improve clinical management and quality of care for patients with IBD both Crohn's disease and ulcerative colitis.
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Affiliation(s)
- Olivier Bonsack
- Department of Gastroenterology, University of Lorraine, Nancy University Hospital, Nancy, France
- University of Lorraine, INSERM, NGERE, Nancy, France
| | - Bénédicte Caron
- Department of Gastroenterology, University of Lorraine, Nancy University Hospital, Nancy, France
- University of Lorraine, INSERM, NGERE, Nancy, France
- DRCI, Nancy University Hospital, Nancy, France
| | - Cedric Baumann
- Unit of Methodology, Data Management and Statistics, Nancy University Hospital, Nancy, France
| | | | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Djesia Arnone
- University of Lorraine, INSERM, NGERE, Nancy, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy
| | - Didier Quilliot
- Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University of Lorraine, Nancy University Hospital, Nancy, France
- University of Lorraine, INSERM, NGERE, Nancy, France
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Lovinfosse P, Vieujean S, Louis E, Hustinx R. Commentary to "[ 68 Ga]Ga-FAPI-04 PET/CT on assessing Crohn's disease intestinal lesions" by Chen and colleagues. Eur J Nucl Med Mol Imaging 2023; 50:1278-1279. [PMID: 36764967 DOI: 10.1007/s00259-023-06135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- Pierre Lovinfosse
- Division of Nuclear Medicine and Oncological Imaging, CHU of Liège, Liège, Belgium.
| | - Sophie Vieujean
- Division of Hepato-Gastroenterology and Digestive Oncology, CHU of Liège, Liège, Belgium
| | - Edouard Louis
- Division of Hepato-Gastroenterology and Digestive Oncology, CHU of Liège, Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, CHU of Liège, Liège, Belgium
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Vieujean S, Louis E, Danese S, Peyrin-Biroulet L. A critical review of ustekinumab for the treatment of active ulcerative colitis in adults. Expert Rev Gastroenterol Hepatol 2023; 17:413-430. [PMID: 36949608 DOI: 10.1080/17474124.2023.2194632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Ustekinumab is a humanized monoclonal antibody, targeting the p40 subunit common to both human interleukin 12 and 23, approved by the European Medicines Agency and US Food and Drug Administration for the treatment of moderate-to-severe ulcerative colitis. AREAS COVERED In this review, the results of the phase 3 UNIFI and the real-world studies assessing the efficacy and safety of ustekinumab in moderate-to-severe ulcerative colitis are discussed, as well as limitations of these studies. Predictive factors of response, the interest of therapeutic drug monitoring and the positioning of ustekinumab in specific situations are also addressed. Finally, in the light of data presented, the positioning of ustekinumab in the therapeutic algorithm of ulcerative colitis will also be considered. EXPERT OPINION Ustekinumab has been shown to be effective to induce and maintain clinical, endoscopic and histologic remission in moderate-to-severe ulcerative colitis both in phase 3 and real-world studies, with a favorable safety profile. Overall, its favorable risk-benefit ratio, its efficacy on extra-intestinal manifestations and in biologics failure patients make ustekinumab an ideal candidate as first, second or third-line therapy in ulcerative colitis.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- CHRU-Nancy, Department of Gastroenterology, University of Lorraine, Nancy, F54000 France
- Inserm, NGERE University of Lorraine, NGERE, Nancy, F-54000 France
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Ribaldone DG, Vieujean S, Julsgaard M, Armandi A, Zingone F, Savarino E, Cañete F, Aratari A, Imperatore N, Ramos L, Plaza R, Pugliese D, Barberio B, Drobne D, Chaparro M. Non-hepatic solid organ transplant in patients with inflammatory bowel disease: an ECCO CONFER Multicentre Case Series. J Crohns Colitis 2023:7055182. [PMID: 36815684 DOI: 10.1093/ecco-jcc/jjad030] [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: 09/23/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND AIMS Solid organ transplantation, with the exception of liver, has rarely been reported in patients affected by inflammatory bowel diseases (IBD). METHODS This is an ECCO-CONFER project collecting cases of solid organ transplants (with the exclusion of liver) that were performed in IBD patients. We evaluated the change in the IBD therapy, need for bowel resection due to medically refractory IBD, or need for hospitalization due to IBD relapse ("severe IBD course") before and after transplantation. RESULTS Thirty-four organ transplantations (28 kidney, five heart, one lung) in 33 IBD patients were collected (67% male; 55% Crohn's disease, mean age 53 ± 16 years). The median follow-up was 4.3 years (IQR 3.2 - 10.7). Twenty-nine patients (87.9%) were treated with tacrolimus, 25 (76%) with systemic steroids, 22 (67%) with mycophenolate mofetil, 11 (33%) with everolimus, six with cyclosporine (18%). One patient was treated with infliximab, two patients with adalimumab, two patients with vedolizumab, one patient with ustekinumab. Overall, a severe IBD course was observed in three (9.3%) patients before transplantation and in four (11.7%) in the post-transplant setting (p = 0.26). Three cases of cancer (excluding skin non-melanoma) (9.1%) were recorded in post-transplantation period versus two in the pre-transplant (6.1%, p = 0.04).Six patients (18.2%) died during the period of observation. No deaths were associated with IBD or complications of the transplant. CONCLUSIONS In IBD patients, solid organ transplantation does not seem to impact on the IBD severity. However, the risk of malignancy needs further investigation.
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Affiliation(s)
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Mette Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Angelo Armandi
- Department of Medical Sciences, Division of Gastroenterology, University of Turin, Turin, Italy
| | - Fabiana Zingone
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Fiorella Cañete
- IBD Unit. Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | | | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli of Naples, Naples, Italy
| | - Laura Ramos
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Rocio Plaza
- Gastroenterology Department, Hospital Universitario Infanta Leonor, Vallecas, 28031 Madrid, Spain
| | - Daniela Pugliese
- CEMAD, IBD CENTER, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - María Chaparro
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Vieujean S, De Vos M, D'Amico F, Paridaens K, Daftary G, Dudkowiak R, Peyrin-Biroulet L, Danese S. Inflammatory bowel disease meets fertility: A physician and patient survey. Dig Liver Dis 2023:S1590-8658(23)00160-3. [PMID: 36697343 DOI: 10.1016/j.dld.2023.01.149] [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: 11/22/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) can affect patients during their childbearing years. Literature evidence is scarce regarding the level of knowledge among health care professionals (HCPs) and patients about the impact of IBD on fertility. The aim of this survey was to investigate HCPs' and patients' knowledge on fertility, pregnancy, and sexual function, to evaluate how HCPs approach this topic and to report patients' reproductive outcomes. METHODS Subjects were invited to anonymously complete an online questionnaire collecting data on demographics, patients' disease characteristics, Crohn's and colitis pregnancy-specific disease-related knowledge (CCPKnow), family planning, reason of childlessness, pregnancy outcomes, need for assisted reproductive technology, impact on sexual function, and availability of patients' information regarding IBD and pregnancy. RESULTS A total of 257 HCPs from 40 countries and 793 patients (615 females, 176 males and 2 who preferred not to disclose their gender; 396 (50%) with ulcerative colitis, 381 (48%) with Crohn's disease, 14 (1.8%) with undetermined IBD) from 4 countries completed the survey. In total, 98.4% of HCPs had good or very good pregnancy-specific knowledge according to CCPKnow score, compared to only 29.3% of patients. Of the women surveyed, 56.3% had no children (14.1% due to a voluntary choice). A total of 427 pregnancies and 401 live births were reported in 266 women. Twenty-four pregnancies (5.6%) in 22 women required assisted reproductive technologies (ART). There were no more complications in pregnancies resulting from ART compared with spontaneous conception (5/24; 20.8% vs 81/401; 20.2%). Three quarters of IBD patients (75.6%) had breastfed. An impaired sexual function was found in one-fifth (21.9%) of men with IBD, while two-thirds (66.1%) of the women reported sexual function impairment. Surprisingly, 63% of patients reported not having received any information about IBD and pregnancy, and only 10% of patients had received information from their IBD specialist. In addition, 42.1% and 36% of HCPs had already referred a patients to a medically assisted reproduction center to receive general information about their reproductive health and about options of fertility preservation (e.g., cryopreservation), respectively. CONCLUSION IBD patients have a poor knowledge about the impact of IBD on fertility and pregnancy and HCPs do not sufficiently inform their patients. More information on these topics is needed for IBD patients.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Michel De Vos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - Ferdinando D'Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Gaurang Daftary
- Ferring Pharmaceuticals A/S - International PharmaScience Center, Kastrup, Denmark
| | - Robert Dudkowiak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University of Lorraine, CHRU-Nancy, Nancy, France; University of Lorraine, Inserm, NGERE, Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy.
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17
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Vieujean S, Louis E. Precision medicine and drug optimization in adult inflammatory bowel disease patients. Therap Adv Gastroenterol 2023; 16:17562848231173331. [PMID: 37197397 PMCID: PMC10184262 DOI: 10.1177/17562848231173331] [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: 12/23/2022] [Accepted: 04/16/2023] [Indexed: 05/19/2023] Open
Abstract
Inflammatory bowel diseases (IBD) encompass two main entities including ulcerative colitis and Crohn's disease. Although having a common global pathophysiological mechanism, IBD patients are characterized by a significant interindividual heterogeneity and may differ by their disease type, disease locations, disease behaviours, disease manifestations, disease course as well as treatment needs. Indeed, although the therapeutic armamentarium for these diseases has expanded rapidly in recent years, a proportion of patients remains with a suboptimal response to medical treatment due to primary non-response, secondary loss of response or intolerance to currently available drugs. Identifying, prior to treatment initiation, which patients are likely to respond to a specific drug would improve the disease management, avoid unnecessary side effects and reduce the healthcare expenses. Precision medicine classifies individuals into subpopulations according to clinical and molecular characteristics with the objective to tailor preventative and therapeutic interventions to the characteristics of each patient. Interventions would thus be performed only on those who will benefit, sparing side effects and expense for those who will not. This review aims to summarize clinical factors, biomarkers (genetic, transcriptomic, proteomic, metabolic, radiomic or from the microbiota) and tools that could predict disease progression to guide towards a step-up or top-down strategy. Predictive factors of response or non-response to treatment will then be reviewed, followed by a discussion about the optimal dose of drug required for patients. The time at which these treatments should be administered (or rather can be stopped in case of a deep remission or in the aftermath of a surgery) will also be addressed. IBD remain biologically complex, with multifactorial etiopathology, clinical heterogeneity as well as temporal and therapeutic variabilities, which makes precision medicine especially challenging in this area. Although applied for many years in oncology, it remains an unmet medical need in IBD.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
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18
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Chevet E, Bassal F, Beq S, Bonhomme B, Boisteau E, Calloch J, Cazals-Hatem D, Delom F, Fessart D, Evrard S, Hrstka R, Hupp T, Lièvre A, Louis E, Mariau J, Meuwis MA, Ogier-Denis E, Paradis V, Pernot S, Pineau R, Treton X, Velasco V, Vieujean S. AGR2 protein expression in colorectal tumour epithelialcompartment. Gut 2022; 72:gutjnl-2022-328739. [PMID: 36591613 PMCID: PMC10715535 DOI: 10.1136/gutjnl-2022-328739] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/01/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Eric Chevet
- U1242, INSERM, Rennes, France
- Centre de Lutte Contre le Cancer Eugene Marquis, Rennes, France
- University of Rennes, Rennes, France
| | - F Bassal
- Thabor Therapeutics, Paris, France
| | | | | | - Emeric Boisteau
- U1242, INSERM, Rennes, France
- Department of Gastroenterology, CHU Rennes, Rennes, France
| | | | - Dominique Cazals-Hatem
- Gastroenterology, IBD and intestinal failure department, Beaujon Hospital, Clichy, France
| | - Frederic Delom
- Bordeaux II University, Talence, France
- U1312, INSERM, Bordeaux, France
| | - Delphine Fessart
- Bordeaux II University, Talence, France
- U1312, INSERM, Bordeaux, France
| | - Serge Evrard
- Institut Bergonié, Bordeaux, France
- Bordeaux II University, Talence, France
| | - Roman Hrstka
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ted Hupp
- University of Edinbhurg, Edinburgh, UK
| | - Astrid Lièvre
- Department of Gastroenterology, CHU Rennes, Rennes, France
| | - Edouard Louis
- Hepato-gastroenterology and digestive oncology, University Hospital CHU of Liège and laboratory of translational gastroenterology, GIGA institute, ULiège, Liège, Belgium
| | | | - Marie-Alice Meuwis
- Hepato-gastroenterology and digestive oncology, University Hospital CHU of Liège and laboratory of translational gastroenterology, GIGA institute, ULiège, Liège, Belgium
| | - Eric Ogier-Denis
- U1242, INSERM, Rennes, France
- Centre de Lutte Contre le Cancer Eugene Marquis, Rennes, France
- University of Rennes, Rennes, France
| | - Valerie Paradis
- Pathology, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | | | - R Pineau
- U1242, INSERM, Rennes, France
- Centre de Lutte Contre le Cancer Eugene Marquis, Rennes, France
- University of Rennes, Rennes, France
| | - Xavier Treton
- Gastroenterology Department, Hôpital Beaujon, MICI et Assistance Nutritive, APHP, Paris, France
| | | | - Sophie Vieujean
- Hepato-gastroenterology and digestive oncology, University Hospital CHU of Liège and laboratory of translational gastroenterology, GIGA institute, ULiège, Liège, Belgium
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19
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Vieujean S, De Vos M, Paridaens K, Daftary GS, Danese S, Peyrin-Biroulet L. Fertility and assisted reproductive technologies outcomes of women with non-surgically managed inflammatory bowel diseases: a systematic review. J Crohns Colitis 2022; 17:614-632. [PMID: 36322700 DOI: 10.1093/ecco-jcc/jjac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM In view of their frequent onset during childbearing years, the impact of inflammatory bowel diseases (IBD) on reproductive health is of important concern to young women and to the IBD physician. This study aims to assess the fertility and assisted reproductive technologies outcomes in non-surgically treated IBD female. METHODS A systematic review was conducted using MEDLINE, SCOPUS and EMBASE (until March 2022) to identify studies assessing fertility and assisted reproductive technologies outcomes in women with non-operated IBD, compared to non-IBD patients. Two reviewers independently selected studies, assessed risk of bias and extracted study data. RESULTS A total of 14 studies encompassing 18 012 patients with ulcerative colitis (UC) and 14 353 patients with Crohn's disease (CD) were included for analysis. The fertility rate in UC patients and in the general population was comparable, but UC patients tended to have fewer children, mainly by choice. On the contrary, the fertility of CD patients appeared to be reduced. Although a deliberate component cannot be not excluded, the disease itself could affect fertility. Disease activity was associated with reduced fertility in both UC and CD patients. In CD, the colonic involvement of the disease and perianal damage could be associated with subfertility, but data are less consistent. According to the only study reporting the assisted reproductive technologies outcomes, pregnancy rates after in vitro fertilization in subfertile non-operated UC patients and non-IBD patients were similar. CONCLUSION There is low-quality evidence from observational studies that patients with CD and relapsing UC may have impaired fertility. After assisted reproductive technologies, pregnancy rates of subfertile nonoperated UC patients were similar to those of the general population, although this observation requires further scrutiny in larger studies that should include UC and CD patients.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Michel De Vos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - Kristine Paridaens
- Ferring International Center S.A. Ch. De la Vergognausaz 50, 1162 Saint-Prex, Switzerland
| | - Gaurang S Daftary
- Ferring Pharmaceuticals A/S - International PharmaScience Center, Amager Strandvej 405, 2770 Kastrup, Denmark
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele Milano Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology NGERE (INSERM U1256), Nancy University Hospital, University of Lorraine, Vandœuvre-lès-Nancy, France
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20
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Vieujean S, Moens A, Hassid D, Rothfuss K, Savarino E, Vavricka SR, Reenaers C, Jacobsen B, Allez M, Ferrante M, Rahier JF. Pneumocystis jirovecii pneumonia in patients with inflammatory bowel disease - A case series. J Crohns Colitis 2022; 17:472-479. [PMID: 36223253 DOI: 10.1093/ecco-jcc/jjac153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Pneumocystis jirovecii pneumonia (PJP) is a very rare, potentially life-threatening pulmonary fungal infection that occurs in immunocompromised individuals including patients with inflammatory bowel disease (IBD). Our aim was to describe immunosuppressive treatment exposure as well as the outcome in IBD patients with PJP. METHODS PJP cases were retrospectively collected through the COllaborative Network For Exceptionally Rare case reports of the European Crohn's and Colitis Organization. Clinical data were provided through a case report form. RESULTS 18 PJP episodes were reported in 17 IBD patients (10 ulcerative colitis and 7 Crohn's disease). The median age on PJP diagnosis was 55 years (IQR, 40-68 years). Two PJP (11.1%) occurred in patients on triple immunosuppression, 10 patients (55.6%) had double immunosuppressive treatment, 4 patients (22.2%) had monotherapy and 2 PJP occurred in absence of immunosuppressive treatment (one in a human immunodeficiency virus patient and one in a patient with a history of autologous stem cell transplantation). Immunosuppressive therapies included steroids (n=12), thiopurines (n=10), infliximab (n=4), ciclosporin (n=2), methotrexate (n=1) and tacrolimus (n=1). None of the patients diagnosed with PJP had received prophylaxis. All patients were treated by trimethoprim/sulfamethoxazole or atovaquone and an ICU stay was required in 7 cases. Two patients (aged 71 and 32 years) died, and one patient had a recurrent episode 16 months after initial treatment. Evolution was favourable for the others. CONCLUSION This case series reporting potentially fatal PJP highlights the need for adjusted prophylactic therapy in patients with IBD on immunosuppressive therapy.
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Affiliation(s)
- S Vieujean
- Department of Gastroenterology, University Hospital of Liège, Liège, Belgium
| | - A Moens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - D Hassid
- Department of Gastroenterology, University of Paris, AP-HP Hôpital Saint-Louis, Paris, France
| | - K Rothfuss
- Department of Gastroenterology and Hepatology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - E Savarino
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - S R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - C Reenaers
- Department of Gastroenterology, University Hospital of Liège, Liège, Belgium
| | - B Jacobsen
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - M Allez
- Department of Gastroenterology, University of Paris, AP-HP Hôpital Saint-Louis, Paris, France
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - J F Rahier
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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21
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Vieujean S, D’Amico F, Netter P, Danese S, Peyrin‐Biroulet L. Landscape of new drugs and targets in inflammatory bowel disease. United European Gastroenterol J 2022; 10:1129-1166. [PMID: 36112543 PMCID: PMC9752289 DOI: 10.1002/ueg2.12305] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 01/13/2023] Open
Abstract
Although the therapeutic armamentarium of Inflammatory bowel diseases (IBD) physicians has expanded rapidly in recent years, a proportion of patients remain with a suboptimal response to medical treatment due to primary no response, loss of response or intolerance to currently available drugs. Our growing knowledges of IBD pathophysiology has led to the development of a multitude of new therapies over time, which may, 1 day, be able to address this unmet medical need. This review aims to provide physicians an update of emerging therapies in IBD by focusing on drugs currently in phase 3 clinical trials. Among the most promising molecules are anti-IL-23, JAK-inhibitors, anti-integrins and S1P modulators. While the results in terms of efficacy and safety are fairly clear for some classes, the question of safety remains more uncertain for other classes. Molecules at a more preliminary stage of development (phase 1 and 2), one of which may 1 day offer an optimal benefit-risk ratio, will also be presented as well as their respective mechanisms of action.
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Affiliation(s)
- Sophie Vieujean
- Hepato‐Gastroenterology and Digestive OncologyUniversity Hospital CHU of LiègeLiègeBelgium
| | - Ferdinando D’Amico
- Department of Gastroenterology and EndoscopyIRCCS San Raffaele Hospital and Vita‐Salute San Raffaele UniversityMilanItaly,Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanItaly
| | | | - Silvio Danese
- Department of Gastroenterology and EndoscopyIRCCS San Raffaele Hospital and Vita‐Salute San Raffaele UniversityMilanItaly
| | - Laurent Peyrin‐Biroulet
- Department of GastroenterologyUniversity of LorraineCHRU‐NancyNancyFrance,University of LorraineInserm, NGERENancyFrance
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22
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Vieujean S, Caron B, Jairath V, Benetos A, Danese S, Louis E, Peyrin-Biroulet L. Is it time to include older adults in inflammatory bowel disease trials? A call for action. Lancet Healthy Longev 2022; 3:e356-e366. [PMID: 36098310 DOI: 10.1016/s2666-7568(22)00060-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
The therapeutic management of older patients with inflammatory bowel disease (IBD) is challenging, particularly because of the absence of evidence-based guidelines for these patients, who seem to frequently be excluded from clinical trials. In this systematic review we investigated the exclusion of older patients with IBD from phase 3 studies registered on PubMed and ClinicalTrials.gov, by assessing the upper limit of age exclusion criteria and the percentage of patients older than 65 years included in the trials. Exclusion criteria other than age were also recorded, and comorbidities were analysed separately. Our review of 222 phase 3 studies shows that older patients are frequently excluded from IBD clinical trials because of their age, which was used as an exclusion criterion in 129 (58%) of the 222 assessed trials. Of the 32 trials that detailed the percentage of included patients who were 65 years or older, only 763 (5·4%) patients of the 14 124 patients included were older than 65 years. In addition to age, patients were also excluded because of comorbidities (mainly renal, hepatic, and cardiovascular, and used as an exclusion criterion in 76% of trials), a history of dysplasia (45% of trials), and previous treatment for IBD (19% of trials). We propose a three-step process that should enable the inclusion of all older patients in IBD clinical trials, regardless of their age, comorbidities, and frailty.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Vipul Jairath
- Department of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Alimentiv, London, ON, Canada
| | - Athanase Benetos
- Inserm, DCAC, University of Lorraine, Vandoeuvre-lès-Nancy, France; CHRU-Nancy Brabois, Department of Clinical Geriatrics, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France.
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23
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Vieujean S, Loly JP, Boutaffala L, Meunier P, Reenaers C, Briquet A, Lechanteur C, Baudoux E, Beguin Y, Louis E. Mesenchymal Stem Cell Injection in Crohn's Disease Strictures: A Phase I-II Clinical Study. J Crohns Colitis 2022; 16:506-510. [PMID: 34473270 DOI: 10.1093/ecco-jcc/jjab154] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIM Mesenchymal stem cells [MSCs] have anti-inflammatory and anti-fibrotic properties and could be a potential therapy for Crohn's disease [CD] strictures. In this phase I-II pilot trial, we assessed safety and efficacy of local MSC injection to treat CD strictures. METHODS CD patients with a short [less than 5 cm in length] non-passable stricture accessible by ileocolonoscopy were included. Allogenic bone-marrow derived MSCs were injected in the four quadrants of the stricture. Adverse events and clinical scores were evaluated at each follow-up visit and endoscopy and magnetic resonance enterography were performed at baseline, Week [W]12 and W48. The main judgement criterion for efficacy was the complete [defined by the ability to pass the ileocolonoscope] or partial [defined by a diameter increase] resolution of the stricture at W12. Second efficacy criteria included assessment of the stricture at W48 and evolution of clinical scores at W12 and W48. RESULTS We performed 11 MSC injections in 10 CD patients [three primary and seven anastomotic strictures; one stricture injected twice]. MSC injections were well tolerated but four hospitalisations for occlusion were reported. At W12, five patients presented a complete or partial resolution of the stricture [two complete and three partial]. Seven patients were re-evaluated at W48 [one dilated, one operated, and one lost to follow-up] and four patients had a complete resolution. The evolution of clinical scores between W0, W12, and W48 was not statistically significant. CONCLUSIONS MSCs injection in CD stricture was well tolerated and may offer a benefit.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Jean-Philippe Loly
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Layla Boutaffala
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Paul Meunier
- Department of Radiology, University Hospital CHU of Liège, Liège, Belgium
| | - Catherine Reenaers
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Alexandra Briquet
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium
| | - Chantal Lechanteur
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium
| | - Etienne Baudoux
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium
| | - Yves Beguin
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium.,Department of Hematology, University Hospital CHU of Liège and University of Liège, Liège, Belgium
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
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24
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Moreau AC, Seidel L, Vieujean S, Reenaers C, Louis E. [Clinical impact of small bowell capsule endoscopy in obscure gastrointestinal bleeding : retrospective single-center study]. Rev Med Liege 2022; 77:25-31. [PMID: 35029337] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The small-bowel capsule endoscopy (VCE) has been validated in the investigation of obscure gastrointestinal bleeding (OGIB). The aim of this study was to evaluate the clinical impact of VCE for OGIB in routine practice, in terms of subsequent management and the risk of rebleeding. METHODS Our retrospective study analyzed the VCE at the CHU of Liège from March 2016 to December 2019 (cohort of 110 patients with OGIB). RESULTS We found a diagnostic yield of 58 %, a change in therapeutic attitude in 39 % of patients and a recurrence rate of 22.5 % (out of 102 patients followed at 2 years). The rate of rebleeding was particularly low in patients with normal VCE and in those for whom a therapeutic modification was made. Finally, about 45 % of patients did not have any change in therapeutic attitude nor recurrence. CONCLUSION VCE leads to a therapeutic modification in about 40 % of patients with a low risk of relapse. However, VCE could be avoided in some patients as evidenced by a subgroup representing 45 % of patients for whom there was no therapeutic modification nor recurrence.
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Affiliation(s)
- A C Moreau
- Service de Gastro-Entérologie, CHU Liège, Belgique
| | - L Seidel
- Service de Gastro-Entérologie, CHU Liège, Belgique
| | - S Vieujean
- Service de Gastro-Entérologie, CHU Liège, Belgique
| | - C Reenaers
- Service de Gastro-Entérologie, CHU Liège, Belgique
| | - E Louis
- Service de Gastro-Entérologie, CHU Liège, Belgique
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25
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Pierre N, Salée C, Vieujean S, Bequet E, Merli AM, Siegmund B, Meuwis MA, Louis E. Review article: distinctions between ileal and colonic Crohn's disease: from physiology to pathology. Aliment Pharmacol Ther 2021; 54:779-791. [PMID: 34297423 DOI: 10.1111/apt.16536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/27/2021] [Revised: 05/15/2021] [Accepted: 07/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ileal and colonic Crohn's disease seem to be two separate entities. AIMS To describe the main physiological distinctions between the small and the large intestine and to analyse the differences between ileal and colonic Crohn's disease. METHODS The relevant literature was critically examined and synthesised. RESULTS The small and large intestine have fundamental distinctions (anatomy, cellular populations, immune defence, microbiota). The differences between ileal and colonic Crohn's disease are highlighted by a heterogeneous body of evidence including clinical features (natural history of the disease, efficacy of treatments, and monitoring), epidemiological data (smoking status, age, gender) and biological data (genetics, microbiota, immunity, mesenteric fat). However, the contribution of these factors to disease location remains poorly understood. CONCLUSION The classification of ileal and colonic Crohn's disease as distinct subphenotypes is well supported by the literature. Understanding of these differences could be exploited to develop more individualised patient care.
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Affiliation(s)
- Nicolas Pierre
- Laboratory of Translational Gastroenterology, GIGA-Institute, University of Liège, Liège, Belgium
| | - Catherine Salée
- Laboratory of Translational Gastroenterology, GIGA-Institute, University of Liège, Liège, Belgium
| | - Sophie Vieujean
- Laboratory of Translational Gastroenterology, GIGA-Institute, University of Liège, Liège, Belgium.,Hepato-Gastroenterology and Digestive Oncology Department, Liège University Hospital, Liège, Belgium
| | - Emeline Bequet
- Laboratory of Translational Gastroenterology, GIGA-Institute, University of Liège, Liège, Belgium.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Liège University Hospital, Liège, Belgium
| | - Angela-Maria Merli
- Laboratory of Translational Gastroenterology, GIGA-Institute, University of Liège, Liège, Belgium
| | - Britta Siegmund
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Marie-Alice Meuwis
- Laboratory of Translational Gastroenterology, GIGA-Institute, University of Liège, Liège, Belgium.,Hepato-Gastroenterology and Digestive Oncology Department, Liège University Hospital, Liège, Belgium
| | - Edouard Louis
- Laboratory of Translational Gastroenterology, GIGA-Institute, University of Liège, Liège, Belgium.,Hepato-Gastroenterology and Digestive Oncology Department, Liège University Hospital, Liège, Belgium
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26
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Vieujean S, Hu S, Bequet E, Salee C, Massot C, Bletard N, Pierre N, Quesada Calvo F, Baiwir D, Mazzucchelli G, De Pauw E, Coimbra Marques C, Delvenne P, Rieder F, Louis E, Meuwis MA. Potential Role of Epithelial Endoplasmic Reticulum Stress and Anterior Gradient Protein 2 Homologue in Crohn's Disease Fibrosis. J Crohns Colitis 2021; 15:1737-1750. [PMID: 33822017 PMCID: PMC8861373 DOI: 10.1093/ecco-jcc/jjab061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Intestinal fibrosis is a common complication of Crohn's disease [CD]. It is characterised by an accumulation of fibroblasts differentiating into myofibroblasts secreting excessive extracellular matrix. The potential role of the intestinal epithelium in this fibrotic process remains poorly defined. METHODS We performed a pilot proteomic study comparing the proteome of surface epithelium, isolated by laser-capture microdissection, in normal and fibrotic zones of resected ileal CD strictures [13 zones collected in five patients]. Proteins of interests were validated by immunohistochemistry [IHC] in ileal and colonic samples of stricturing CD [n = 44], pure inflammatory CD [n = 29], and control [n = 40] subjects. The pro-fibrotic role of one selected epithelial protein was investigated through in-vitro experiments using HT-29 epithelial cells and a CCD-18Co fibroblast to myofibroblast differentiation model. RESULTS Proteomic study revealed an endoplasmic reticulum [ER] stress proteins increase in the epithelium of CD ileal fibrotic strictures, including anterior gradient protein 2 homologue [AGR2] and binding-immunoglobulin protein [BiP]. This was confirmed by IHC. In HT-29 cells, tunicamycin-induced ER stress triggered AGR2 intracellular expression and its secretion. Supernatant of these HT-29 cells, pre-conditioned by tunicamycin, led to a myofibroblastic differentiation when applied on CCD-18Co fibroblasts. By using recombinant protein and blocking agent for AGR2, we demonstrated that the secretion of this protein by epithelial cells can play a role in the myofibroblastic differentiation. CONCLUSIONS The development of CD fibrotic strictures could involve epithelial ER stress and particularly the secretion of AGR2.
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Affiliation(s)
- Sophie Vieujean
- Corresponding author: Sophie Vieujean, MD, Laboratory of Translational Gastroenterology, University of Liège, GIGA-Research, +2, B34, Avenue de l’hôpital 1, 4000 Liège, Belgium. Tel.: +32-4-3667256; fax: +32-4-3667889; mail:
| | | | - Emeline Bequet
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium,Division of Hepato-Gastroenterology, Department of Paediatrics, University Hospital of Liège, Liège, Belgium
| | - Catherine Salee
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
| | - Charlotte Massot
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
| | - Noëlla Bletard
- Pathological Anatomy and Cytology, University Hospital CHU of Liège, Liège, Belgium
| | - Nicolas Pierre
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
| | | | | | - Gabriel Mazzucchelli
- MolSys Research Unit, Laboratory of Mass Spectrometry, University of Liège, Liège, Belgium
| | - Edwin De Pauw
- MolSys Research Unit, Laboratory of Mass Spectrometry, University of Liège, Liège, Belgium
| | | | - Philippe Delvenne
- Pathological Anatomy and Cytology, University Hospital CHU of Liège, Liège, Belgium
| | - Florian Rieder
- Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH, USA
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Vieujean S, Dauby M, Remacle G, Kridelka F, Dewandre PY, Capelle X. [Spontaneous rupture of a splenic artery aneurysm during the third trimester of pregnancy]. Rev Med Liege 2021; 76:18-22. [PMID: 33443324] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report the case of a 24-year-old female patient with spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy. Pregnancy, throughout the physiological and hormonal changes it imposes, promotes the occurrence of aneurysm of the splenic artery and its rupture. Although this is a rare complication, its prognosis is severe and its typical clinical picture associating abdominal pain, hypotension and anemia is misleading for the clinician who likelier evokes a retroplacental hematoma or an uterine rupture. The maternal and foetal survival depends on rapid diagnosis and multidisciplinary management. Thus, it's important for the clinician to consider this differential diagnosis when abdominal pain or hemoperitoneum occurs in pregnant woman, particularly during the third trimester of pregnancy.
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Affiliation(s)
- S Vieujean
- Service de Gastroentérologie, CHU Liège, Belgique
| | - M Dauby
- Service de Gynécologie-Obstétrique, CHU Liège, Belgique
| | - G Remacle
- Service de Chirurgie abdominale, CHU Liège, Belgique
| | - F Kridelka
- Service de Gynécologie-Obstétrique, CHU Liège, Belgique
| | - P Y Dewandre
- Service d'Anesthésie-Réanimation, CHU Liège, Belgique
| | - X Capelle
- Service de Gynécologie-Obstétrique, CHU Liège, Belgique
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Monin L, Dubois S, Reenaers C, Van Kemseke C, Latour P, Van Daele D, Vieujean S, Seidel L, Louis E. Ustekinumab in bio-naïve and bio-failure Crohn's disease patients: Results from a « real-life » monocentric cohort. Dig Liver Dis 2021; 53:72-78. [PMID: 33221330 DOI: 10.1016/j.dld.2020.10.040] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The pivotal clinical trials have largely demonstrated the efficacy and safety of ustekinumab in Crohn's disease. Real-life cohorts published so far only include very few bio-naïve patients. This study assesses effectiveness and safety of ustekinumab in bio-naïve and bio-failure patients treated with ustekinumab in routine practice and look for predictors of response. METHODS We performed a retrospective monocentric study. Initial response was assessed by maintenance therapy beyond week 16. Sustained response was assessed by the continuation or cessation of therapy over time for another reason than stopping in sustained remission. Treatment persistence was assessed by Kaplan Meier curves and predictors of treatment persistence were studied by univariate and multivariate Cox model. RESULTS Out of 156 recorded patients, three patients were still in their induction phase at time of analysis and 5 patients were lost to follow-up, leaving 148 patients for clinical effectiveness analyses, including 35 bio-naïve when starting ustekinumab. A maintenance therapy was initiated in 79.7%. At one year, the probability to be still treated with ustekinumab was 73.8%. Treatment cessation increased with smoking in multivariate analysis. Previous biologic failure (as a whole), CRP and fecal calprotectin baseline levels did not influence initial response and treatment persistence. CONCLUSION A large proportion of CD patients initially respond to ustekinumab and continue this treatment beyond one year. Treatment persistence is as high in bio-failure as in bio-naïve patients.
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Affiliation(s)
- L Monin
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium
| | - S Dubois
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium
| | - C Reenaers
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium
| | - C Van Kemseke
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium
| | - P Latour
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium
| | - D Van Daele
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium
| | - S Vieujean
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium
| | - L Seidel
- Department of Biostatistics, University Hospital, CHU Liège, Belgium
| | - E Louis
- Department of Gastroenterology, University Hospital, CHU Liège, Belgium.
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Merli AM, Vieujean S, Massot C, Blétard N, Quesada Calvo F, Baiwir D, Mazzucchelli G, Servais L, Wéra O, Oury C, de Leval L, Sempoux C, Manzini R, Bluemel S, Scharl M, Rogler G, De Pauw E, Coimbra Marques C, Colard A, Vijverman A, Delvenne P, Louis E, Meuwis MA. Solute carrier family 12 member 2 as a proteomic and histological biomarker of dysplasia and neoplasia in ulcerative colitis. J Crohns Colitis 2020; 15:jjaa168. [PMID: 32920643 DOI: 10.1093/ecco-jcc/jjaa168] [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: 04/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Ulcerative colitis (UC) patients have a greater risk of developing colorectal cancer through inflammation-dysplasia-carcinoma sequence of transformation. The histopathological diagnosis of dysplasia is therefore of critical clinical relevance, but dysplasia may be difficult to distinguish from inflammatory changes. METHODS A proteomic pilot study on 5 UC colorectal dysplastic patients highlighted proteins differentially distributed between paired dysplastic, inflammatory and normal tissues. The best candidate marker was selected and immunohistochemistry confirmation was performed on AOM/DSS mouse model lesions, 37 UC dysplasia, 14 UC cancers, 23 longstanding UC, 35 sporadic conventional adenomas, 57 sporadic serrated lesions and 82 sporadic colorectal cancers. RESULTS Differential proteomics found 11 proteins significantly more abundant in dysplasia compared to inflammation, including Solute carrier family 12 member 2 (SLC12A2) which was confidently identified with 8 specific peptides and was below the limit of quantitation in both inflammatory and normal colon. SLC12A2 immunohistochemical analysis confirmed the discrimination of preneoplastic and neoplastic lesions from inflammatory lesions in mice, UC and in sporadic contexts. A specific SLC12A2 staining pattern termed "loss of gradient" reached 89% sensitivity, 95% specificity and 92% accuracy for UC-dysplasia diagnosis together with an inter-observer agreement of 95.24% (multirater κfree of 0.90; IC95%: 0.78 - 1.00). Such discrimination could not be obtained by Ki67 staining. This specific pattern was also associated with sporadic colorectal adenomas and cancers. CONCLUSIONS We found a specific SLC12A2 immunohistochemical staining pattern in precancerous and cancerous colonic UC-lesions which could be helpful for diagnosing dysplasia and cancer in UC and non-UC patients.
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Affiliation(s)
- Angela-Maria Merli
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
| | - Sophie Vieujean
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Charlotte Massot
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Noella Blétard
- Pathological Anatomy and Cytology, University Hospital CHU of Liège, Liège, Belgium
| | | | | | | | - Laurence Servais
- Laboratory of Cardiology, GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Odile Wéra
- Laboratory of Cardiology, GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Cécile Oury
- Laboratory of Cardiology, GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Laurence de Leval
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Roberto Manzini
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sena Bluemel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Edwin De Pauw
- Laboratory of Mass Spectrometry, University of Liège, Liège, Belgium
| | - C Coimbra Marques
- Abdominal Surgery Department, University Hospital CHU of Liège, Liège, Belgium
| | - Arnaud Colard
- Department of Gastroenterology, CHC Clinique Saint-Joseph, Liège, Belgium
| | - Anne Vijverman
- Department of Gastroenterology, CHR Citadelle, Liège, Belgium
| | - Philippe Delvenne
- Pathological Anatomy and Cytology, University Hospital CHU of Liège, Liège, Belgium
| | - Edouard Louis
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Equally contributed to this work
| | - Marie-Alice Meuwis
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Equally contributed to this work
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Vieujean S, Coibion C, Seidel L, Louis E, Meunier P. Magnetic resonance enterography perfusion parameters reveal complex changes in affected and unaffected segments in Crohn's disease. Scand J Gastroenterol 2020; 55:1041-1048. [PMID: 32757858 DOI: 10.1080/00365521.2020.1802773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare dynamic contrast-enhanced (DCE)-MRI parameters in affected and unaffected segments of CD patients with those of a control group, and to assess the correlation between DCE-MRI parameters and clinical index of activity (HBI) as well as biomarkers (CRP and faecal calprotectin). METHODS We performed a single-center prospective study of CD patients and control subjects who underwent DCE-MRI. Regions of interest were drawn in segments and the program (Olea Medical - Canon) provided values for transfer constant (Ktrans), fractional volume of extravascular-extracellular space (Ve), slope of enhancement (SoE), time to maximum enhancement (TME), maximum enhancement (ME) and enhancement ratio (ER) which were determined and compared. RESULTS Fifteen CD patients (mean age 42 years; 10 women) and 7 healthy subjects (mean age 40.4 years; 6 women) were included. Paired comparisons of affected and unaffected segments in CD showed a significant increase of all parameters in affected segments, except for ER and TME. When comparing to controls, the affected segments did not show any significant difference, while a significant decrease in most of the parameters (except for ER and TME) was observed when comparing unaffected segments of CD patients to controls. In CD, significant correlations between DCE-MRI parameters and biomarkers (CRP, faecal calprotectin) were more frequent in unaffected segments than in affected segments. CONCLUSIONS Significant differences in perfusion parameters were observed between affected and unaffected segments of CD patients and between unaffected segments and those of control subjects. This suggests complex perfusion changes in both unaffected and affected intestinal segments in CD.
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Affiliation(s)
- Sophie Vieujean
- Department of Gastroenterology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Caroline Coibion
- Department of Radiology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Laurence Seidel
- Biostatistics and medico-economic information department, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Edouard Louis
- Department of Gastroenterology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Paul Meunier
- Department of Radiology, CHU Sart-Tilman, University of Liège, Liege, Belgium
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