1
|
Bjørlykke KH, Jahnsen J, Brynskov J, Molander P, Eberhardson M, Davidsdottir LG, Sipponen T, Hjortswang H, Goll GL, Syversen SW, Langholz E, Jørgensen KK, Steenholdt C. Therapeutic drug monitoring in inflammatory bowel disease: implementation, utilization, and barriers in clinical practice in Scandinavia. Scand J Gastroenterol 2023; 58:25-33. [PMID: 35996928 DOI: 10.1080/00365521.2022.2108684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Therapeutic drug monitoring (TDM) may optimize biologic and thiopurine therapies in inflammatory bowel disease (IBD). The study aimed to investigate implementation and utilization of TDM in Scandinavia. METHODS A web-based questionnaire on the use of TDM was distributed to Scandinavian gastroenterologists via the national societies. RESULTS In total, 297 IBD physicians prescribing biologic therapies, equally distributed between community and university hospitals, were included (response rate 42%) (Norway 118 (40%), Denmark 86 (29%), Sweden 50 (17%), Finland 33 (11%), Iceland 10 (3%)). Overall, TDM was applied during biologic therapies by 87%, and for TNF-inhibitors >90%. Among the users, reactive and proactive TDM were utilized by 90% and 63%, respectively. Danish physicians were significantly less inclined to use TDM compared to other Scandinavian countries; (58% vs 98%); OR 0.03 [0.01-0.09], p < 0.001). Reactive TDM was commonly applied at primary (74%) and secondary (99%) treatment failure. Proactive TDM was used by 80% during maintenance therapy and 56% during induction and more commonly utilized in Norway (p < 0.001), and by physicians managing >10 IBD patients/week (p = 0.005). TDM scenarios were interpreted in accord with available evidence but with discrepancies for proactive TDM. The main barriers to TDM were lack of guidelines (51%) and time lag between sampling and results (49%). TDM of thiopurines was routinely used by 87%. CONCLUSION TDM of biologic and thiopurine therapies has been broadly implemented into clinical practice in Scandinavia. However, physicians call for TDM guidelines detailing indications and interpretations of test results along with improved test response times.
Collapse
Affiliation(s)
- Kristin H Bjørlykke
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jørgen Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jørn Brynskov
- Department of Gastroenterology, Herlev Hospital, Herlev, Denmark
| | - Pauliina Molander
- Abdominal Center, Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Michael Eberhardson
- Department of Gastroenterology, University Hospital, Linköping, Sweden and Karolinska Institutet, Stockholm, Sweden
| | - Loà G Davidsdottir
- Department of Gastroenterology, Landspítali, University Hospital of Iceland, Reykjavik, Iceland
| | - Taina Sipponen
- Abdominal Center, Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henrik Hjortswang
- Department of Gastroenterology, University Hospital, Linköping, Sweden and Karolinska Institutet, Stockholm, Sweden
| | - Guro Løvik Goll
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Silje Watterdal Syversen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev Hospital, Herlev, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristin K Jørgensen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | | |
Collapse
|
2
|
Eronen H, Kolehmainen S, Koffert J, Koskinen I, Oksanen P, Jussila A, Huhtala H, Sipponen T, Ilus T. Combining biological therapies in patients with inflammatory bowel disease: a Finnish multi-centre study. Scand J Gastroenterol 2022; 57:936-941. [PMID: 35238727 DOI: 10.1080/00365521.2022.2045350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Therapy with two concomitant biologicals targeting different inflammatory pathways has emerged as a new therapy option for treatment refractory inflammatory bowel disease (IBD). Data on the efficacy and safety of dual biological therapy (DBT) are scarce and are investigated in this study. MATERIALS AND METHODS Data on all patients treated with a combination of two biologicals in four Finnish tertiary centres were collected and analysed. Remission was assessed by a physician on the basis of biomarkers, endoscopic evaluation and alleviation of symptoms. RESULTS A total of 16 patients with 22 trials of DBT were included. Fifteen patients had Crohn's disease. The most common combination of DBT was adalimumab (ADA) and ustekinumab (USTE; 36%) with median follow-up of nine months (range 2-31). Altogether seven (32%) patients were in remission at the end of follow-up and in two trials response to DBT was assessed to be partial with the relief of patient symptoms. In a total of four trials DBT reduced the need for corticosteroids. The majority of patients achieving a response to DBT were treated with the combination of ADA and USTE (56%). At the end of follow-up all nine (41%) patients responding to DBT continued treatment. Infection complications occurred in three patients (19%). CONCLUSION DBT is a promising alternative treatment for refractory IBD, and half of our patients benefitted from it. More data on the efficacy and safety of DBT are needed especially in long-term follow up.
Collapse
Affiliation(s)
- Heli Eronen
- Department of Gastroenterology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | | | - Jukka Koffert
- Department of Gastroenterology, Turku University Hospital, Turku, Finland
| | - Inka Koskinen
- Department of Internal Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, and University of Tampere, Tampere, Finland
| | - Airi Jussila
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Taina Sipponen
- Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuire Ilus
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
3
|
Buhl S, Steenholdt C, Brynskov J, Christensen KR, Dorn-Rasmussen M, Thomsen OØ, Bendtzen K, Klausen TW, Dahlerup JF, Thorsgaard N, Jahnsen J, Molazahi A, Pedersen N, Kjeldsen J, Almer S, Dahl EE, Vind I, Cannon AG, Marsal J, Sipponen T, Agnholt JS, Kievit HAL, Aure SL, Martinsen L, Meisner S, Hansen JM, Ainsworth MA. Discontinuation of Infliximab Therapy in Patients with Crohn's Disease. NEJM Evid 2022; 1:EVIDoa2200061. [PMID: 38319804 DOI: 10.1056/evidoa2200061] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Infliximab Discontinuation in Patients with Crohn's DiseaseThis randomized controlled trial explores infliximab withdrawal in patients with Crohn's disease in clinical, biochemical, and endoscopic remission with long-term infliximab maintenance therapy. Time to relapse was significantly shorter among patients who discontinued infliximab than among those who continued therapy.
Collapse
Affiliation(s)
- Sine Buhl
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Casper Steenholdt
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Jørn Brynskov
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | | | - Maria Dorn-Rasmussen
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Ole Østergaard Thomsen
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Klaus Bendtzen
- Institute for Inflammation Research IRR, Rigshospitalet University Hospital, Copenhagen
| | | | - Jens Frederik Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Thorsgaard
- Department of Medical Diseases, Herning Regional Hospital, Herning, Denmark
| | - Jørgen Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Akbar Molazahi
- Department of Medical Diseases, Nykøbing F. Regional Hospital, Nykøbing, Denmark
| | - Natalia Pedersen
- Department of Gastroenterology, Slagelse Regional Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
| | - Sven Almer
- Inflammatory Bowel Disease Unit, Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
- Departement of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Eva Efsen Dahl
- Department of Gastroenterology K, Copenhagen University Hospital-Bispebjerg, Frederiksberg, Denmark
| | - Ida Vind
- Department of Gastroenterology, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Jan Marsal
- Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Taina Sipponen
- Gastroenterology, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki
| | - Jørgen Steen Agnholt
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Synnøve Louise Aure
- Department of Gastroenterology, Akershus University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Lars Martinsen
- Department of Medical Diseases, Nykøbing F. Regional Hospital, Nykøbing, Denmark
| | - Svetlana Meisner
- Department of Gastroenterology, Slagelse Regional Hospital, Slagelse, Denmark
| | - Jane Møller Hansen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
| | - Mark Andrew Ainsworth
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
| |
Collapse
|
4
|
Lamberg T, Sipponen T, Valtanen S, Eklund KK, Mälkönen T, Aalto K, Mikola K, Kolho KL, Leinonen S, Isomäki P, Mäkinen H, Vidqvist KL, Kokko A, Huilaja L, Kyllönen M, Keskitalo P, Sard S, Vähäsalo P, Koskela R, Kröger L, Lahtinen P, Haapala AM, Korkatti K, Sokka-Isler T, Jokiranta TS. Short interruptions of TNF-inhibitor treatment can be associated with treatment failure in patients with immune-mediated diseases. Autoimmunity 2022; 55:275-284. [PMID: 35481450 DOI: 10.1080/08916934.2022.2067985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The prevalence of immune-mediated diseases has increased in the past decades and despite the use of biological treatments all patients do not achieve remission. The aim of this study was to characterise the reasons for short interruptions during treatment with two commonly used TNF-inhibitors infliximab and adalimumab and to analyse the possible effects of the interruptions on immunisation and switching the treatment. MATERIAL AND METHODS This case-control study was based on retrospective analyses of patient records and a questionnaire survey to clinicians. A total of 370 patients (194 immunised cases and 172 non-immunised controls, 4 excluded) were enrolled from eight hospitals around Finland. Eleven different diagnoses were represented, and the largest patient groups were those with inflammatory bowel or rheumatic diseases. RESULTS Treatment interruptions were associated with immunisation in patients using infliximab (p < .001) or adalimumab (p < .000001). Patients with treatment interruptions were more likely to have been treated with more than one biological agent compared to those without treatment interruptions. This was particularly prominent among patients with a rheumatic disease (p < .00001). The most frequent reason for a treatment interruption among the cases was an infection, whereas among the control patients it was remission. The median length of one interruption was one month (interquartile range 1-3 months). CONCLUSION Our results suggest that the interruptions of the treatment with TNF-inhibitors expose patients to immunisation and increase the need for drug switching. These findings stress the importance of careful judgement of the need for a short interruption in the biological treatment in clinical work, especially during non-severe infections.
Collapse
Affiliation(s)
- Tea Lamberg
- United Medix Laboratories, Helsinki, Finland
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Sipponen
- Department of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Valtanen
- United Medix Laboratories, Helsinki, Finland
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari K Eklund
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Orton Orthopedic Hospital Helsinki, Helsinki, Finland
| | - Tarja Mälkönen
- Department of Dermatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristiina Aalto
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katriina Mikola
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaija-Leena Kolho
- Pediatric Gastroenterology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Leinonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Pia Isomäki
- Centre for Rheumatology, Tampere University Hospital, Tampere, Finland
| | - Heidi Mäkinen
- Centre for Rheumatology, Tampere University Hospital, Tampere, Finland
| | | | - Arto Kokko
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Laura Huilaja
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Dermatology and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Minna Kyllönen
- Department of Rheumatology, Oulu University Hospital, Oulu, Finland
| | - Paula Keskitalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sirja Sard
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Paula Vähäsalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ritva Koskela
- Department of Gastroenterology, Oulu University Hospital, Oulu, Finland
| | - Liisa Kröger
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Perttu Lahtinen
- Department of Gastroenterology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Anna-Maija Haapala
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Katja Korkatti
- Department of Pediatrics, Central Ostrobothnia Central Hospital, Kokkola, Finland
| | | | - T Sakari Jokiranta
- United Medix Laboratories, Helsinki, Finland
- Medicum, University of Helsinki, Helsinki, Finland
- Tammer BioLab Ltd, Tampere, Finland
| | | |
Collapse
|
5
|
Xu M, Leskinen K, Gritti T, Groma V, Arola J, Lepistö A, Sipponen T, Saavalainen P, Söderlund-Venermo M. Prevalence, Cell Tropism, and Clinical Impact of Human Parvovirus Persistence in Adenomatous, Cancerous, Inflamed, and Healthy Intestinal Mucosa. Front Microbiol 2022; 13:914181. [PMID: 35685923 PMCID: PMC9171052 DOI: 10.3389/fmicb.2022.914181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Parvoviruses are single-stranded DNA viruses, infecting many animals from insects to humans. Human parvovirus B19 (B19V) causes erythema infectiosum, arthropathy, anemia, and fetal death, and human bocavirus (HBoV) 1 causes respiratory tract infections, while HBoV2-4 are enteric. Parvoviral genomes can persist in diverse non-permissive tissues after acute infection, but the host-cell tropism and the impact of their tissue persistence are poorly studied. We searched for parvoviral DNA in a total of 427 intestinal biopsy specimens, as paired disease-affected and healthy mucosa, obtained from 130 patients with malignancy, ulcerative colitis (UC), or adenomas, and in similar intestinal segments from 55 healthy subjects. Only three (1.6%) individuals exhibited intestinal HBoV DNA (one each of HBoV1, 2, and 3). Conversely, B19V DNA persisted frequently in the intestine, with 50, 47, 31, and 27% detection rates in the patients with malignancy, UC, or adenomas, and in the healthy subjects, respectively. Intra-individually, B19V DNA persisted significantly more often in the healthy intestinal segments than in the inflamed colons of UC patients. The highest loads of B19V DNA were seen in the ileum and colon specimens of two healthy individuals. With dual-RNAscope in situ hybridization and immunohistochemistry assays, we located the B19V persistence sites of these intestines in mucosal B cells of lymphoid follicles and vascular endothelial cells. Viral messenger RNA transcription remained, however, undetected. RNA sequencing (RNA-seq) identified 272 differentially expressed cellular genes between B19V DNA-positive and -negative healthy ileum biopsy specimens. Pathway enrichment analysis revealed that B19V persistence activated the intestinal cell viability and inhibited apoptosis. Lifelong B19V DNA persistence thus modulates host gene expression, which may lead to clinical outcomes.
Collapse
Affiliation(s)
- Man Xu
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Katarzyna Leskinen
- Research Programs Unit, Department of Immunobiology, University of Helsinki, Helsinki, Finland
| | - Tommaso Gritti
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Valerija Groma
- Joint Laboratory of Electron Microscopy, Riga Stradin,s University, Riga, Latvia
| | - Johanna Arola
- Department of Pathology, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Anna Lepistö
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
- Applied Tumor Genomics, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Taina Sipponen
- HUCH Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Saavalainen
- Research Programs Unit, Department of Immunobiology, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Maria Söderlund-Venermo
- Department of Virology, University of Helsinki, Helsinki, Finland
- *Correspondence: Maria Söderlund-Venermo,
| |
Collapse
|
6
|
Kolehmainen S, Ylisaukko-Oja T, Jokelainen J, Koivusalo M, Jokiranta TS, Sipponen T. Benefit of measuring vedolizumab concentrations in inflammatory bowel disease patients in a real-world setting. Scand J Gastroenterol 2021; 56:906-913. [PMID: 34154506 DOI: 10.1080/00365521.2021.1938206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We set out to determine the reasons for serum vedolizumab (VDZ) trough concentration (TC) measurements in inflammatory bowel disease (IBD) patients and to evaluate treatment modifications after therapeutic drug measurement (TDM). We also evaluated the effect of increased dosing on patients' response to VDZ therapy. METHODS We performed a retrospective cohort study of IBD patients who received VDZ therapy at Helsinki University Hospital and whose VDZ levels were measured between June 2014 and December 2018. RESULTS Altogether, 90 patients (32 Crohn's disease and 58 ulcerative colitis) and 141 VDZ TC measurements were included. 24.1% of measurements took place during induction and 75.9% during the maintenance phase. During induction, 64.7% reached the target TC >20µg/ml. During maintenance therapy, 82.2% of VDZ TCs were within or exceeded the suggested target range of 5-15µg/ml. Reasons for TDM were: secondary nonresponse (44.0%), assessment of adequate VDZ TC (25.5%), primary nonresponse (12.8%), adverse events (6.4%), and other (11.3%). No treatment changes occurred after 60.3% of VDZ measurements. Increased dose frequency was used after 25.5% of VDZ measurements and 33.3% of these patients experienced improvement. Altogether, 31 (34.4%) patients discontinued the therapy due to inadequate treatment response. No anti-vedolizumab antibodies were detected. CONCLUSIONS During the maintenance of VDZ therapy, the majority of VDZ TCs were within the suggested range. Measurement of VDZ TC did not lead to any treatment changes in two-thirds of patients. Dose optimization occurred in a quarter of patients and a third of them benefited from it.
Collapse
Affiliation(s)
| | - Tero Ylisaukko-Oja
- MedEngine Oy, Helsinki, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- MedEngine Oy, Helsinki, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | - T Sakari Jokiranta
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Tammer BioLab Ltd, Tampere, Finland
| | - Taina Sipponen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
7
|
Ventin-Holmberg R, Eberl A, Saqib S, Korpela K, Virtanen S, Sipponen T, Salonen A, Saavalainen P, Nissilä E. Bacterial and Fungal Profiles as Markers of Infliximab Drug Response in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:1019-1031. [PMID: 33300552 DOI: 10.1093/ecco-jcc/jjaa252] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 02/06/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases [IBDs], Crohn's disease [CD] and ulcerative colitis [UC], are globally increasing chronic gastro-intestinal inflammatory disorders associated with altered gut microbiota. Infliximab [IFX], a tumour necrosis factor [TNF]-alpha blocker, is used to treat IBD patients successfully, though one-third of the patients do not respond to therapy. No reliable biomarkers are available for prediction of IFX response. Our aims were to investigate the faecal bacterial and fungal communities during IFX therapy and find predictors for IFX treatment response in IBD patients. METHODS A total of 72 IBD patients [25 CD and 47 UC] started IFX therapy and were followed for 1 year or until IFX treatment was discontinued. An amplicon sequencing approach, targeting the bacterial 16S rRNA gene and fungal ITS 1 region separately, was used to determine the microbiota profiles in faecal samples collected before IFX therapy and 2, 6, and 12 weeks and 1 year after initiation of therapy. The response to IFX was evaluated by colonoscopy and clinically at 12 weeks after initiation. RESULTS Both faecal bacterial and fungal profiles differed significantly between response groups before start of IFX treatment. Non-responders had lower abundances of short chain fatty acid producers, particularly of the class Clostridia, and higher abundances of pro-inflammatory bacteria and fungi, such as the genus Candida, compared with responders. This was further indicated by bacterial taxa predicting the response in both CD and UC patients [area under the curve >0.8]. CONCLUSIONS Faecal bacterial and fungal microbiota composition could provide a predictive tool to estimate IFX response in IBD patients.
Collapse
Affiliation(s)
| | - Anja Eberl
- Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Schahzad Saqib
- Human Microbiome Research Program, University of Helsinki, Helsinki, Finland
| | - Katri Korpela
- Human Microbiome Research Program, University of Helsinki, Helsinki, Finland
| | - Seppo Virtanen
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Sipponen
- Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, University of Helsinki, Helsinki, Finland
| | - Päivi Saavalainen
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Eija Nissilä
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| |
Collapse
|
8
|
Sipponen T, Af Björkesten CG, Hallinen T, Ilus T, Soini E, Eberl A, Heikura M, Kellokumpu M, Koskela R, Nielsen C, Nuutinen H, Heikkinen M, Suhonen UM, Tillonen J, Wennerström ECM, Borsi A, Koivunen MR. A nationwide real-world study on dynamic ustekinumab dosing and concomitant medication use among Crohn's disease patients in Finland. Scand J Gastroenterol 2021; 56:661-670. [PMID: 33820465 DOI: 10.1080/00365521.2021.1906315] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Real-world evidence to support optimal ustekinumab dosing for refractory Crohn's disease (CD) patients remains limited. Data from a retrospective nationwide chart review study was utilized to explore ustekinumab dosing dynamics and optimization, identify possible clinical predictors of dose intensification, and to evaluate ustekinumab trough concentrations (TCs) and concomitant medication use in Finland. METHODS Information gathered from17 Finnish hospitals included clinical chart data from 155 adult CD patients who received intravenous ustekinumab induction during 2017-2018. Data on ustekinumab dosing and TCs, concomitant corticosteroid and immunosuppressant use, and antiustekinumab antibodies were analyzed in a two-year follow-up, subject to availability. RESULTS Among 140 patients onustekinumab maintenance therapy, dose optimization was required in 55(39%) of the patients, and 41/47 dose-intensified patients (87%) persisted on ustekinumab. At baseline, dose-intensified patient group had significantly higher C-reactive protein (CRP) levels, and at week 16, significantly lower ustekinumab TCs than in patients without dose intensification. Irrespective of dose optimization, a statistically significant reduction in the use of corticosteroids was observed at both 16 weeks and one year, coupled with an increased proportion of patients on ustekinumab monotherapy. Antiustekinumab antibodies were undetectable in all 28 samples from 25 patients collected throughout the study period. CONCLUSIONS Nearly a third of all CD patients on ustekinumab maintenance therapy, with a history of treatment-refractory and long-standing disease, required dose intensification. These patients persisted on ustekinumab and had significant reduction of corticosteroid use. Increased baseline CRP was identified as the sole indicator of dose intensification. TRIAL REGISTRATION EUPAS30920.
Collapse
Affiliation(s)
- Taina Sipponen
- Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Tuire Ilus
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | | | - Anja Eberl
- Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Heikura
- Department of Gastroenterology, North Karelia Central Hospital, Joensuu, Finland
| | - Mikko Kellokumpu
- Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland
| | - Ritva Koskela
- Department of Medicine, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland
| | - Christian Nielsen
- Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
| | - Heikki Nuutinen
- Division of Gastroenterology, Department of Medicine, Turku University Hospital, Turku, Finland
| | - Markku Heikkinen
- Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Ulla-Maija Suhonen
- Department of Internal Medicine, Kainuu Central Hospital, Kajaani, Finland
| | - Jyrki Tillonen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - E Christina M Wennerström
- Medical Affairs, Janssen Cilag AB, Solna, Sweden.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Andras Borsi
- Janssen Cilag Limited, EMEA HEMAR, High Wycombe, United Kingdom
| | | | | |
Collapse
|
9
|
Pohju A, Pakarinen M, Sipponen T. Longitudinal evolution of nutritional status, and markers of kidney and liver function in finnish adults with intestinal failure. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Huoponen S, Eberl A, Räsänen P, Roine RP, Sipponen T, Arkkila P, Blom M. Health-related quality of life and costs of switching originator infliximab to biosimilar one in treatment of inflammatory bowel disease. Medicine (Baltimore) 2020; 99:e18723. [PMID: 31914087 PMCID: PMC6959900 DOI: 10.1097/md.0000000000018723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Effectiveness, efficacy and safety of biosimilar infliximab (CT-P13) in inflammatory bowel disease (IBD) patients has been shown in previous studies. Limited data exist on health-related quality of life (HRQoL) of switching originator to biosimilar infliximab (IFX) in IBD patients. The objective of this study was to evaluate impact of switching originator to biosimilar IFX on HRQoL, disease activity, and health care costs in IBD maintenance treatment.In this single-center prospective observational study, all IBD patients receiving maintenance IFX therapy were switched to biosimilar IFX. HRQoL was measured using the generic 15D health-related quality of life instrument (15D) utility measurement and the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ). Crohn Disease Activity Index (CDAI) or Partial Mayo Score (pMayo), and fecal calprotectin (FC) served for evaluation of disease activity. Data were collected at time of switching and 3 and 12 months after switching. Patients' characteristics, clinical background information and costs were collected from patient records and the hospital's electronic database.Fifty-four patients were included in the analysis. No statistically significant changes were observed in 15D, CDAI, pMayo, and FC during 1-year follow-up. IBDQ scores were higher (P = .018) in Crohn disease 3 months after switching than at time of switching. Costs of biosimilar IFX were one-third of costs of originator one. Total costs related to secondary health care (excluding costs of IFX), were similar before and after the onset of biosimilar IFX.HRQoL and disease activity were after switching from originator to biosimilar IFX comparable, but the costs of biosimilar IFX were only one-third of those of the originator one.
Collapse
Affiliation(s)
| | - Anja Eberl
- University of Helsinki, Helsinki
- Helsinki University Hospital, Helsinki
| | - Pirjo Räsänen
- University of Helsinki, Helsinki
- Helsinki University Hospital, Helsinki
| | - Risto P. Roine
- Helsinki University Hospital, Helsinki
- University of Eastern Finland, Kuopio, Finland
| | - Taina Sipponen
- University of Helsinki, Helsinki
- Helsinki University Hospital, Helsinki
| | - Perttu Arkkila
- University of Helsinki, Helsinki
- Helsinki University Hospital, Helsinki
| | | |
Collapse
|
11
|
Abstract
Background and aims: A multicentre, retrospective, non-interventional, patient chart review study was conducted to investigate deep (DR) and histological remission rates during maintenance therapy with biological agents in inflammatory bowel disease (IBD).Methods: We reviewed clinical, endoscopic, and histological findings, and laboratory markers such as C-reactive protein (CRP) and faecal calprotectin (FC) on average of nine years after the initiation of anti-TNF-therapy. DR was defined as no clinical symptoms (The physicians' global assessment scores; PGA = 0) with endoscopic remission (the Simple Endoscopic Score for Crohn's Disease [SES-CD] ≤ 2 or Mayo endoscopic subscore ≤1). Histological activity was defined as normal if only architectural alterations without cellularity changes occurred.Results: Of 117 IBD patients on maintenance therapy, 72 (62%; CD n = 55 [56%], UC n = 17 [85%]) patients were in DR. Of patients in DR, 76% were also in histological remission. 77% of patients remained on initiated biological treatment. UC patients achieved DR significantly more often than CD patients (p = .016). Both median CRP and FC levels were significantly lower in patients with DR.Conclusion: Reassuringly, almost two thirds of the IBD patients on maintenance therapy with biological agents maintained DR in the long-term, and more than two thirds of patients in DR achieved also histological remission. CD patients in DR had fewer surgical operations due to CD than patients not achieving DR.
Collapse
Affiliation(s)
- Pauliina Molander
- Abdominal Center, Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Helena Kemppainen
- Department of Medicine, Division of Gastroenterology, Turku University Central Hospital, Turku, Finland
| | - Tuire Ilus
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Taina Sipponen
- Abdominal Center, Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
12
|
Pohju A, Pakarinen M, Bergman P, Sipponen T. SUN-PO052: Prevalence and Characteristics of Adult Intestinal Failure in Finland. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
13
|
Eberl A, Hallinen T, Af Björkesten CG, Heikkinen M, Hirsi E, Kellokumpu M, Koskinen I, Moilanen V, Nielsen C, Nuutinen H, Suhonen UM, Utriainen K, Vihriälä I, Soini E, Wennerström C, Nissinen R, Borsi A, Koivunen M, Tillonen J, Sipponen T. Ustekinumab for Crohn's disease: a nationwide real-life cohort study from Finland (FINUSTE). Scand J Gastroenterol 2019; 54:718-725. [PMID: 31184512 DOI: 10.1080/00365521.2019.1624817] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Ustekinumab (UST), a human anti-IL12/23p40 monoclonal antibody, has been approved for treatment of Crohn's Disease (CD) since the end of 2016. This nationwide noninterventional, retrospective chart review explored real-life data in patients receiving UST to provide guidance in UST treatment in the era of increasing prevalence of CD. Methods: The study assessed UST treatment patterns such as dosing frequency, concomitant medication and persistence in 48 CD patients commencing UST therapy in 12 Finnish hospitals during 2017. Clinical remission and response rates were explored using a modified Harvey-Bradshaw index (mHBI) and endoscopic response via the simple endoscopic score for Crohn's disease (SES-CD) as proportions of patients at week 16 and at the end of follow-up. Results: Forty patients (83%) continued UST-treatment at the end of follow-up. At week 16, clinical response and endoscopic healing was observed, where data were available; mHBI decreased from 9 to 3 (p = .0001) and SES-CD from 12 to 3 (p = .009). Clinical benefit was achieved by 83% (19/23) at week 16 and by 76% (16/21) at the end of follow-up. The proportion of patients using corticosteroids decreased from 48% to 25% at week 16 and to 13% at the end of the follow-up. Conclusion: UST showed to be effective and persistent, inducing short-term clinical benefit and endoscopic response in this real-life nationwide study of CD patients. Significant corticosteroid tapering in patients with highly treatment refractory and long-standing CD was observed.
Collapse
Affiliation(s)
- Anja Eberl
- Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | | | - Markku Heikkinen
- Department of Internal Medicine, Kuopio University Hospital , Kuopio , Finland
| | - Eija Hirsi
- Department of Internal Medicine, South Karelia Central Hospital , Lappeenranta , Finland
| | - Mikko Kellokumpu
- Department of Internal Medicine, Lapland Central Hospital , Rovaniemi , Finland
| | - Inka Koskinen
- Department of Internal Medicine, Central Finland Central Hospital , Jyväskylä , Finland
| | - Veikko Moilanen
- Department of Internal Medicine, Satakunta Central Hospital , Pori , Finland
| | - Christian Nielsen
- Department of Internal Medicine, Vaasa Central Hospital , Vaasa , Finland
| | - Heikki Nuutinen
- Division of Gastroenterology, Department of Medicine, Turku University Hospital , Turku , Finland
| | - Ulla-Maija Suhonen
- Department of Internal Medicine, Kainuu Central Hospital , Kajaani , Finland
| | - Karri Utriainen
- Division of Gastroenterology, Department of Medicine, Turku University Hospital/Salo Hospital , Salo , Finland
| | - Ilkka Vihriälä
- Department of Internal Medicine, Central Ostrobothnia Central Hospital Kokkola , Finland
| | | | - Christina Wennerström
- Medical Affairs, Janssen Cilag AB Solna , Sweden.,Department of Epidemiology Research, Statens Serum Institut , Denmark Copenhagen
| | | | - Andras Borsi
- Janssen Cilag Limited, EMEA HEMAR , High Wycombe , United Kingdom
| | | | - Jyrki Tillonen
- Department of Internal Medicine, Päijät Häme Central Hospital , Lahti Finland
| | - Taina Sipponen
- Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| |
Collapse
|
14
|
Abstract
Objectives: Parenteral support (PS) is the first-line therapy for intestinal failure (IF). Optimal patient outcomes require experienced multidisciplinary teams adhering to structured protocols. As practices to provide long-term PS for adult IF patients in Finland are unknown, this cross-sectional nationwide study aimed to evaluate current management of PS for adult IF across the country. Materials and methods: An internet-based survey was emailed to all Finnish hospitals and hospital-at-home services with the potential to provide PS for adult IF. The survey included 20 items addressing the provision of long-term PS for adult IF patients (aged ≥18 years). Data were analysed using descriptive statistics. Results: Overall, 52 (47%) of the 111 identified units responded. Of responding units, 38 (73%) had at some point provided long-term (≥120 days) PS for adult IF, and 23 (44%) had done so during the preceding year. Only three units currently managed ≥3 adult patients. Most (65%) of the respondents worked in a hospital and were either physicians (38%) or dietitians (39%). Only 65% of respondents reported that their unit had an assigned physician responsible for PS provision, and 28% reported that a team was responsible for long-term PS. Only 26% of respondents reported having a written protocol to guide PS management. Conclusions: Health care providers with very limited experience and a fragmented approach manage most Finnish adult IF patients. Evidence-based protocols and multidisciplinary teams are scarce. The care for adult IF patients on long-term PS needs to be improved in Finland.
Collapse
Affiliation(s)
- Anne Pohju
- a Clinical Nutrition Unit, Internal Medicine and Rehabilitation , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Mikko P Pakarinen
- b Section of Pediatric Surgery, Pediatric Liver and Gut Research Group , Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Taina Sipponen
- c Department of Gastroenterology , Abdominal Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| |
Collapse
|
15
|
Kopylov U, Verstockt B, Biedermann L, Sebastian S, Pugliese D, Sonnenberg E, Steinhagen P, Arebi N, Ron Y, Kucharzik T, Roblin X, Ungar B, Shitrit ABG, Ardizzone S, Molander P, Coletta M, Peyrin-Biroulet L, Bossuyt P, Avni-Biron I, Tsoukali E, Allocca M, Katsanos K, Raine T, Sipponen T, Fiorino G, Ben-Horin S, Eliakim R, Armuzzi A, Siegmund B, Baumgart DC, Kamperidis N, Maharshak N, Maaser C, Mantzaris G, Yanai H, Christodoulou DK, Dotan I, Ferrante M. Effectiveness and Safety of Vedolizumab in Anti-TNF-Naïve Patients With Inflammatory Bowel Disease-A Multicenter Retrospective European Study. Inflamm Bowel Dis 2018; 24:2442-2451. [PMID: 29788318 DOI: 10.1093/ibd/izy155] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab (VDZ) is effective for treatment of ulcerative colitis (UC) and Crohn's disease (CD). In GEMINI trials, anti-tumor necrosis factor (anti-TNF)-naïve patients had a superior response compared with anti-TNF-exposed patients. In real-world experience (RWE), the number of included anti-TNF-naïve patients was low. We aimed to evaluate the effectiveness and safety of VDZ in anti-TNF-naïve patients in an RWE setting. METHODS This retrospective multicenter European pooled cohort study included consecutive active anti-TNF-naïve IBD patients treated with VDZ. The primary end point was clinical response at week 14. Patients with follow-up beyond week 14 and those discontinuing VDZ at any time were included for maintenance outcomes analysis. RESULTS Since January 2015, 184 anti-TNF-naïve patients from 23 centers initiated VDZ treatment (Crohn's disease [CD], 50; ulcerative colitis [UC], 134). In CD, 42/50 (82%) patients responded by week 14 and 32 (64%) were in clinical remission; 26/50 (52%) achieved corticosteroid-free remission (CSFR). At last follow-up (44 weeks; interquartile range [IQR], 30-52 weeks), 27/35 (77.1%) patients with available data responded to treatment; 24/35 (68.6%) were in clinical remission, 21/35 (60%) were in CSFR. For UC, 116/134 (79.1%) responded to treatment by week 14, including 53 (39.5%) in clinical remission; 49/134 (36.6%) achieved CSFR. At last follow-up (42.5 weeks; IQR, 30-52 weeks), 79/103 (76.7%) patients responded to treatment, 69/103 (67.0%) were in remission, and 61/103 (59.2%) were in CSFR. Adverse effects were reported in 20 (11%) of the patients, leading to treatment discontinuation in 6 (3.3%). CONCLUSIONS VDZ is similarly effective in ant-TNF-naïve CD and UC patients. The efficacy is higher than reported in anti-TNF-experienced patients and is comparable to that of anti-TNF biologics in this population.
Collapse
Affiliation(s)
- Uri Kopylov
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Luc Biedermann
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Shaji Sebastian
- IBD Unit, Hull & East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
| | - Daniela Pugliese
- IBD Unit, Presidio Columbus Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Elena Sonnenberg
- Department of Medicine (Gastroenterology, Infectious DIseases, Rheumatology), Campus Benjamin Franklin, Charité-Universitätsmedizin, Berlin, Germany
| | - Peter Steinhagen
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Harrow, London, United Kingdom
| | - Yulia Ron
- IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Xavier Roblin
- CHU de Saint-Etienne, Gastroenterology, Saint Etiennne, France
| | - Bella Ungar
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Sandro Ardizzone
- Department of Gastroenterology, DIBIC, ASST Fatebenefratelli Sacco, Milan University, Milan, Italy
| | - Pauliina Molander
- Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marina Coletta
- Department of Pathophysiology and Transplantation, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,Università degli Studi di Milano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Peter Bossuyt
- Imelda GI Clinical Research Center, Gastroenterology, Bonheiden, Belgium
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Emmanouela Tsoukali
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Konstantinos Katsanos
- Division of Gastroenterology, School of Health Sciences and Univeristy Hospital of Ioannina, Ioannina, Greece
| | - Tim Raine
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Taina Sipponen
- Department of Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Shomron Ben-Horin
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Rami Eliakim
- Sheba Medical Center, Gastroenterology, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus Fondazione Policlinico Gemelli Università Cattolica, Rome, Italy
| | - Britta Siegmund
- Department of Medicine (Gastroenterology, Infectious DIseases, Rheumatology), Campus Benjamin Franklin, Charité-Universitätsmedizin, Berlin, Germany
| | - Daniel C Baumgart
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Nikolaos Kamperidis
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Harrow, London, United Kingdom
| | - Nitsan Maharshak
- IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Christian Maaser
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Gerassimos Mantzaris
- Department of Gastroenterology, "Evaggelismos-Ophthalmiatreion Athinon-Polycliniki, Athens, Greece
| | - Henit Yanai
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Dimitrious K Christodoulou
- Division of Gastroenterology, School of Health Sciences and Univeristy Hospital of Ioannina, Ioannina, Greece
| | - Iris Dotan
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| |
Collapse
|
16
|
Haapamäki J, Heikkinen E, Sipponen T, Roine RP, Arkkila P. The impact of an adaptation course on health-related quality of life and functional capacity of patients with inflammatory bowel disease. Scand J Gastroenterol 2018; 53:1074-1078. [PMID: 30175636 DOI: 10.1080/00365521.2018.1500639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) has a substantial impact on patients health-related quality of life (HRQoL). In this study, we examined the impact of adaptation courses on HRQoL, psychological well-being, depression and number of sick-leave days of IBD patients. METHODS The study recruited 142 IBD patients attending an adaptation course of 5-12 days. The courses were specially designed for IBD patients and included multidisciplinary information about IBD, peer support, group activities and encouragement for adequate physical exercise. The participants completed the study questionnaire at the beginning and the end of the course and after six and 12 months of follow-up. HRQoL was assessed with the generic 15-dimensional (15D) tool and depression with Beck's Depression Inventory (BDI). Utilization of health care services and work absenteeism was also assessed. Visual analog scales were used for assessing psychological functioning. RESULTS 15D, BDI scores and scores describing psychological well-being were significantly better at the end of the course when compared to baseline (15D 0.82 vs. 0.84, p < .001; BDI 11.8 vs. 8.5, p < .001). Positive results were maintained during follow up. The percentage of patients receiving peer support rose from 32 to 70% and those with peer support had better HRQoL at the 12-month follow-up (p = .01). No significant change in health care utilization or number of sick-leave days was observed. CONCLUSION Adaptation training appears to have a positive impact on the psychological well-being of IBD patients. Peer support appears to be an important factor.
Collapse
Affiliation(s)
- Johanna Haapamäki
- a Helsinki University Hospital , Helsinki University , Helsinki , Finland
| | - Erjastiina Heikkinen
- b Kaisankoti Rehabilitation centre , Espoo , Finland.,c Social and Health Services, City of Helsinki , Helsinki , Finland
| | - Taina Sipponen
- a Helsinki University Hospital , Helsinki University , Helsinki , Finland
| | - Risto P Roine
- d Faculty of Health Sciences, University of Eastern Finland , Kuopio , Finland
| | - Perttu Arkkila
- a Helsinki University Hospital , Helsinki University , Helsinki , Finland
| |
Collapse
|
17
|
Voutilainen M, Hutri-Kähönen N, Tossavainen P, Sipponen T, Pitkänen N, Laitinen T, Jokinen E, Rönnemaa T, Viikari JSA, Raitakari OT, Juonala M. Low childhood high density lipoprotein cholesterol levels and subsequent risk for chronic inflammatory bowel disease. Dig Liver Dis 2018; 50:348-352. [PMID: 29426615 DOI: 10.1016/j.dld.2018.01.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/21/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Several genetic and environmental risk factors have been linked to chronic inflammatory bowel disease (IBD). The incidence of IBD has significantly increased in developed countries during last decades. The aim of the present study was to examine childhood risk factors for subsequent IBD diagnosis in a longitudinal cohort study of children and adolescents. METHODS A Finnish study population consisting of 3551 children and adolescents originally evaluated as part of the Cardiovascular Risk in Young Finns study in 1980. At baseline, participant BMI, insulin, lipid, C-reactive protein and blood pressure levels, socioeconomic position, dietary habits, and physical activity, were evaluated. In addition, information was gathered on rural residency, severe infections, breast feeding, parental smoking and birth weight. Subsequent IBD diagnosis status was evaluated based on nationwide registries on hospitalisations and drug imbursement decisions. RESULTS Altogether, 49 participants (1.4%) had IBD diagnosed during the 34 years of register follow-up, of which 31 had ulcerative colitis, 12 Crohn's disease and 6 undetermined colitis. In univariate analyses, significant correlations were observed between childhood HDL-cholesterol (risk ratio (95% CI) for 1-SD change (0.58 (0.42-0.79)) and CRP concentrations (1.20 (1.01-1.43)) with IBD. The inverse association between HDL-cholesterol and IBD remained significant (0.57 (0.39-0.82)) in a multivariable model including data on age, sex and CRP. In addition, a weighted genetic z-score of 71 single nucleotide polymorphisms associated with elevated HDL-cholesterol levels was significantly lower in IBD patients, P=0.01). CONCLUSION Low childhood HDL-cholesterol levels are associated with subsequent IBD diagnosis. In addition, a genetic risk score associated with low HDL-cholesterol levels predict later IBD suggesting that HDL-cholesterol metabolism might have a role in the pathogenesis of IBD.
Collapse
Affiliation(s)
- Markku Voutilainen
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland.
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Taina Sipponen
- Department of Medicine, Division of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Niina Pitkänen
- Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku, Turku, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Eero Jokinen
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Tapani Rönnemaa
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Division of Medicine, Turku University Hospital, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| |
Collapse
|
18
|
Ylisaukko-Oja T, Aaltonen J, Nuutinen H, Blomster T, Jussila A, Pajala M, Salminen K, Moilanen V, Hakala K, Kellokumpu M, Toljamo K, Rautiainen H, Kuisma J, Peräaho M, Molander P, Silvennoinen J, Liukkonen V, Henricson H, Tillonen J, Esterinen M, Nielsen C, Hirsi E, Lääne M, Suhonen UM, Vihriälä I, Mäkelä P, Puhto M, Punkkinen J, Sulonen H, Herrala S, Jokelainen J, Tamminen K, Sipponen T. High treatment persistence rate and significant endoscopic healing among real-life patients treated with vedolizumab - a Finnish Nationwide Inflammatory Bowel Disease Cohort Study (FINVEDO) . Scand J Gastroenterol 2018; 53:158-167. [PMID: 29258369 DOI: 10.1080/00365521.2017.1416160] [Citation(s) in RCA: 21] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The efficacy and tolerability of vedolizumab in the treatment of inflammatory bowel diseases (IBD) has been demonstrated in an extensive GEMINI clinical trial programme. Clinical trials represent highly selected patient populations and, therefore, it is important to demonstrate effectiveness in real-life clinical practice. We set out to assess real-world treatment outcomes of vedolizumab in a nationwide cohort of treatment refractory Finnish Crohn's disease (CD) and ulcerative colitis (UC) patients. METHODS This was a nationwide, retrospective, non-interventional, multi-centre chart review study. All adult patients from 27 Finnish gastroenterology centers with a diagnosis of UC or CD who had at least one vedolizumab infusion since the availability of the product in Finland, were included in the study. Data were collected retrospectively from medical charts at baseline, week 14, and month 6. The primary outcome measure was treatment persistence 24 weeks post-vedolizumab initiation. RESULTS A total of 247 patients were included (108 CD, 139 UC). A total of 75.0% (n = 81) of all CD patients and 66.2% (n = 92) of all UC patients, were persistent on vedolizumab therapy for 6 months post treatment initiation. At month 6, 41.8% (28/67) of the treatment persistent CD patients and 73.3% (63/86) of the treatment persistent UC patients achieved clinical remission. Significant improvement in endoscopic scores were observed among treatment persistent patients (CD, n = 17, ΔSES-CD=-5.5, p = .008; UC, n = 26, ΔMayo endoscopic score =-0.5, p = .003) at month 6. CONCLUSIONS Vedolizumab provides an effective and well-tolerated treatment option in real-world clinical practice even among treatment refractory IBD patients.
Collapse
Affiliation(s)
- Tero Ylisaukko-Oja
- a Takeda Oy , Helsinki , Finland.,b MedEngine Oy , Helsinki , Finland.,c Faculty of Medicine , Center for Life Course Health Research University of Oulu , Oulu , Finland
| | | | - Heikki Nuutinen
- d Division of Gastroenterology, Department of Medicine , Turku University Hospital , Turku , Finland
| | - Timo Blomster
- e Division of Gastroenterology, Department of Medicine , Oulu University Hospital , Oulu , Finland
| | - Airi Jussila
- f Department of Gastroenterology and Alimentary Tract Surgery , Tampere University Hospital , Tampere , Finland
| | - Markku Pajala
- g Department of Internal Medicine , Kuopio University Hospital , Kuopio , Finland
| | - Kimmo Salminen
- d Division of Gastroenterology, Department of Medicine , Turku University Hospital , Turku , Finland
| | - Veikko Moilanen
- h Department of Internal Medicine , Satakunta Central Hospital , Pori , Finland
| | - Kalle Hakala
- i Department of Internal Medicine , Kanta-Häme Central Hospital , Hämeenlinna , Finland
| | - Mikko Kellokumpu
- j Department of Internal Medicine , Lapland Central Hospital , Rovaniemi , Finland
| | - Kari Toljamo
- k Department of Internal Medicine , TYKS Salo Hospital , Salo , Finland
| | - Henna Rautiainen
- l Department of Gastroenterology , Helsinki University Hospital/Jorvi Hospital , Espoo , Finland
| | - Juha Kuisma
- m Department of Internal Medicine , HUS Hyvinkää Hospital , Hyvinkää , Finland
| | - Markku Peräaho
- n Department of Internal Medicine , Central Hospital of Central Finland , Jyväskylä , Finland
| | - Pauliina Molander
- o Department of Gastroenterology , Helsinki University Hospital/Peijas Hospital , Vantaa , Finland
| | - Jouni Silvennoinen
- p Department of Gastroenterology , North Karelia Central Hospital , Joensuu , Finland
| | - Ville Liukkonen
- p Department of Gastroenterology , North Karelia Central Hospital , Joensuu , Finland
| | - Hans Henricson
- q Department of Internal Medicine , Hospital Pietarsaari , Pietarsaari , Finland
| | - Jyrki Tillonen
- r Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - Mirva Esterinen
- s Department of Internal Medicine , Savonlinna Central Hospital , Savonlinna , Finland
| | - Christian Nielsen
- t Department of Internal Medicine , Vaasa Central Hospital , Vaasa , Finland
| | - Eija Hirsi
- u Department of Internal Medicine , South Karelia Central Hospital , Lappeenranta , Finland
| | - Margus Lääne
- v Department of Internal Medicine , Seinäjoki Central Hospital , Seinäjoki , Finland
| | - Ulla-Maija Suhonen
- w Department of Internal Medicine , Kainuu Central Hospital , Kajaani , Finland
| | - Ilkka Vihriälä
- x Department of Internal Medicine , Central Ostrobothnia Central Hospital , Kokkola , Finland
| | - Petri Mäkelä
- y Department of Internal Medicine , Turku City Hospital , Turku , Finland
| | - Mika Puhto
- z Department of Internal Medicine , Mikkeli Central Hospital , Mikkeli , Finland
| | - Jari Punkkinen
- aa Department of Internal Medicine , HUS Porvoo Hospital , Porvoo , Finland
| | - Hannu Sulonen
- ab Department of Internal Medicine , Forssa Hospital , Forssa , Finland
| | | | - Jari Jokelainen
- b MedEngine Oy , Helsinki , Finland.,c Faculty of Medicine , Center for Life Course Health Research University of Oulu , Oulu , Finland.,ac Unit of Primary Health Care , Oulu University Hospital , Oulu , Finland
| | | | - Taina Sipponen
- ad Department of Gastroenterology , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| |
Collapse
|
19
|
Eberl A, Huoponen S, Pahikkala T, Blom M, Arkkila P, Sipponen T. Switching maintenance infliximab therapy to biosimilar infliximab in inflammatory bowel disease patients. Scand J Gastroenterol 2017; 52:1348-1353. [PMID: 28838273 DOI: 10.1080/00365521.2017.1369561] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical use of biosimilar infliximab (CT-P13) in inflammatory bowel diseases (IBDs) is based on extrapolation of indication from clinical studies performed in rheumatological diseases. Only few data exist of behaviour of infliximab trough levels (TLs) and anti-drug antibodies (ADAs) during switching. AIM The objective of this study was to evaluate changes in TLs, ADA formation and disease activity after switching from originator infliximab to biosimilar one. METHODS All our IBD patients receiving maintenance infliximab therapy were switched to biosimilar infliximab. TLs and ADAs were measured before the last originator infusion and before the third biosimilar infusion. Laboratory values, disease activity indices (partial Mayo score and Harvey-Bradshaw index) and demographic data were collected from patient records. RESULTS A total of 62 patients were included in the final analysis (32 Crohn's disease, 30 ulcerative colitis (UC) or IBD-unclassified). No significant changes in median TLs before (5.5 mg/l) and after switching (5.5 mg/l, p = .05) occurred in the entire study group or in the Crohn's disease (CD) subgroup (5.75 and 6.5 mg/l, p = .68). However, in the subgroup of ulcerative colitis, the change in median TL was significantly different (from 5.2 to 4.25 mg/l, p = .019). Two patients developed ADAs after switching. No changes in disease activity were detected during switching and no safety concerns occurred. CONCLUSIONS Switching from originator to biosimilar infliximab resulted in statistically significant differences in infliximab TLs in patients with UC but not in patients with Crohn's disease. The clinical significance for this difference is doubtful and in neither group changes in disease activity occurred.
Collapse
Affiliation(s)
- Anja Eberl
- a Department of Gastroenterology , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Saara Huoponen
- b Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy , University of Helsinki , Helsinki , Finland
| | - Tapio Pahikkala
- c Department of Future Technologies , University of Turku , Turku , Finland
| | - Marja Blom
- b Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy , University of Helsinki , Helsinki , Finland
| | - Perttu Arkkila
- a Department of Gastroenterology , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Taina Sipponen
- a Department of Gastroenterology , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| |
Collapse
|
20
|
Molander P, Färkkilä M, Kemppainen H, Blomster T, Jussila A, Mustonen H, Sipponen T. Long-term outcome of inflammatory bowel disease patients with deep remission after discontinuation of TNFα-blocking agents. Scand J Gastroenterol 2017; 52:284-290. [PMID: 27806638 DOI: 10.1080/00365521.2016.1250942] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little data exist on the long-term prognosis of patients with inflammatory bowel disease (IBD) after stopping TNFα-blocking therapy in deep remission. Existing data indicate that approximately 50% of patients on combination therapy who discontinued TNFα-blockers are still in remission 24 months later. The aims of this follow-up analysis were to evaluate the long-term remission rate after cessation of TNFα-blocking therapy, the predicting factors of a relapse and the response to restarting TNFα blockers. METHODS The first follow-up data of 51 IBD patients (17 Crohn's disease [CD], 30 ulcerative colitis [UC] and four inflammatory bowel disease type unclassified [IBDU]) in deep remission at the time of cessation of TNFα-blocking therapy have been published earlier. The long-term data was collected retrospectively after the first follow-up year to evaluate the remission rate and risk factors for the relapse after a median of 36 months. RESULTS After the first relapse-free year, 14 out of the remaining 34 IBD patients relapsed (41%; 5/12 [42%] CD and 9/22 [41%] UC/IBDU). Univariate analysis indicated no associations with any predictive factors. Re-treatment was effective in 90% (26/29) of patients. CONCLUSION Of IBD patients in deep remission at the time of cessation of TNFα-blocking therapy, up to 60% experience a clinical or endoscopic relapse after a median follow-up time of 36 months (95% CI 31-41 months). No individual risk factors predicting relapse could be identified. However, the initial response to a restart of TNFα-blockers seems to be effective and well tolerated.
Collapse
Affiliation(s)
- Pauliina Molander
- a Department of Gastroenterology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| | - Martti Färkkilä
- a Department of Gastroenterology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| | | | | | - Airi Jussila
- d Department of Gastroenterology and Alimentary Tract Surgery , Tampere University Hospital , Tampere , Finland
| | - Harri Mustonen
- e Department of Surgery , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| | - Taina Sipponen
- a Department of Gastroenterology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| |
Collapse
|
21
|
Sipponen T, Isomäki P, Leinonen S, Mälkönen T, Jokiranta S. [Exemplary cases of individualization of biological therapy]. Duodecim 2016; 132:387-390. [PMID: 27017791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The use of biological drugs consisting of large molecules has in recent years expanded to new indications and new specialties. These drugs are most commonly proteins possessing the structure of an antibody or a receptor, and treatment with them is significantly more expensive than that carried out with conventional small molecule drugs. Determination of drug levels and emerging antibodies form the basis of individualization. They will enable better treatment results with simultaneous avoidance of unnecessary medications, excessive doses--and extra costs. We demonstrate the individualization of TNF-α blocker therapy through patient cases in various situations.
Collapse
|
22
|
Abstract
OBJECTIVE Abdominal bloating is reported by a majority of irritable bowel syndrome (IBS) patients. Excess colonic fermentation may cause gaseous symptoms. Several foodstuffs contain oligosaccharides with an α-galactosidic linkage that is resistant to mammalian hydrolases. Assisted hydrolysis by exogenous α-galactosidase enzyme (AG) could offer a way of controlling IBS symptoms by reducing colonic fermentation and gas production. The aim of this study was to assess the effect of AG on symptom severity and quality of life in IBS patients with abdominal bloating or flatulence. METHODS A total of 125 subjects with IBS received AG or placebo at meals for 12 weeks. IBS-Symptom Severity Score (IBS-SSS) and quality of life (QoL) were assessed at baseline, during the treatment and at 4-week follow-up. RESULTS AG showed a trend toward a more prominent decrease in IBS-SSS. The responder rate at week 16 was higher for the AG group. No difference was detected in QoL between AG and placebo groups. A total of 25 patients (18 in AG group and 7 in placebo group, p = 0.016) withdrew from the study. Abdominal pain and diarrhea were more often reported as reason for withdrawal in AG group. CONCLUSIONS We found no evidence to support the use of AG routinely in IBS patients. Improvement of clinical response at 4-week follow-up may suggest a long-term effect of unknown mechanism, but could also be attributed to non-responder drop out. Gastrointestinal (GI) side effects may be a coincidence in this study, but irritation of GI tract by AG administration cannot be excluded.
Collapse
Affiliation(s)
- Markku Hillilä
- a 1 Aava Gastroenterology Clinic , Helsinki, Finland.,b 2 Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Martti A Färkkilä
- b 2 Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Taina Sipponen
- a 1 Aava Gastroenterology Clinic , Helsinki, Finland.,b 2 Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Janne Rajala
- a 1 Aava Gastroenterology Clinic , Helsinki, Finland
| | - Jari Koskenpato
- a 1 Aava Gastroenterology Clinic , Helsinki, Finland.,b 2 Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| |
Collapse
|
23
|
Hukkinen M, Merras-Salmio L, Sipponen T, Mutanen A, Rintala RJ, Mäkisalo H, Pakarinen MP. Surgical rehabilitation of short and dysmotile intestine in children and adults. Scand J Gastroenterol 2015; 50:153-61. [PMID: 25421304 DOI: 10.3109/00365521.2014.962607] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS This is a descriptive study aiming to compare outcomes of intestinal rehabilitation surgery among pediatric and adult intestinal failure (IF) patients with either primary intestinal motility disorders or short bowel syndrome (SBS) treated by our nationwide program. METHODS Medical records of IF patients (n = 31, 71% children) having undergone autologous intestinal reconstructions (AIR) (n = 25), intestinal transplantation (ITx) (n = 5), or being listed for ITx (n = 2) between 1994 and 2014 were reviewed. RESULTS At surgery, median age was 3.4 (interquartile range, 1.0-22.1) in SBS (n = 22) and 16.5 (3.2-26.7) years in dysmotility patients (n = 9) who received median 60% and 83% of energy requirement parenterally, respectively. Median small bowel length was shorter in SBS than dysmotility patients (34 versus 157 cm, p < 0.001). Following AIR, none of the dysmotility patients achieved permanent intestinal autonomy, whereas 68% of SBS patients weaned off parenteral nutrition (PN) (p = 0.022) and none required listing for ITx. Five dysmotility patients who underwent ITx achieved intestinal autonomy. Regarding both AIR and ITx procedures, no significant difference in PN weaning was observed between the two subgroups. At last follow-up, 3.3 (0.6-8.0) years postoperatively, median plasma bilirubin was 6 (4-16) µmol/l, while liver biopsy showed fibrosis (Metavir stage 1-2) in 50% and cholestasis in 8%. Proportion of PN energy requirement had reduced significantly (p = 0.043) among PN-dependent SBS (n = 7) but not among dysmotility patients (n = 5). Overall survival was 90%. CONCLUSION AIR surgery was beneficial among selected SBS patients, whereas in intestinal dysmotility disorders, permanent PN weaning was only achieved by ITx.
Collapse
Affiliation(s)
- Maria Hukkinen
- Pediatric Liver and Gut Research Group, University of Helsinki , Helsinki , Finland
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
The fecal neutrophil-derived biomarker calprotectin has several features of an ideal noninvasive test for detecting intestinal inflammation: it is simple, reliable, and low in cost. Its utility in differentiating inflammatory bowel diseases (IBDs) from functional conditions such as irritable bowel syndrome is well documented. Fecal calprotectin (FC) correlates closely with endoscopic activity of IBD. Emerging evidence suggest its usefulness in serial monitoring of disease activity and of therapy success in IBD. A low FC concentration predicts persistence of clinical remission especially in non-symptomatic ulcerative colitis and Crohn's colitis. Here, an overview is given to the current role of FC in diagnosis and clinical assessment of IBD.
Collapse
Affiliation(s)
- Taina Sipponen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital , Helsinki , Finland
| | | |
Collapse
|
25
|
Molander P, Färkkilä M, Ristimäki A, Salminen K, Kemppainen H, Blomster T, Koskela R, Jussila A, Rautiainen H, Nissinen M, Haapamäki J, Arkkila P, Nieminen U, Kuisma J, Punkkinen J, Kolho KL, Mustonen H, Sipponen T. Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission? J Crohns Colitis 2015; 9:33-40. [PMID: 25052347 DOI: 10.1016/j.crohns.2014.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS This prospective multicenter study examined whether elevated fecal calprotec tin (FC) concentrations after stopping TNFα-blocking therapy can predict clinical or endoscopic relapse. In addition, we evaluated the impact of histological remission on the relapse risk. METHODS We enrolled inflammatory bowel disease (IBD) patients who were in clinical, endoscopic, and FC-based (< 100 μg/g) remission after a minimum 11 months of TNFα-blocking therapy. The patients were followed-up for 12 months after the discontinuation of TNFα-blocking therapy. FC was collected monthly for the first 6 months and thereafter every second month. Ileocolonoscopy was performed at inclusion, at 4 months, at the study end, and at the time of clinical relapse. RESULTS Of 52 enrolled patients, 49 (16 Crohn's disease, 33 ulcerative colitis/IBD unclassified) provided the stool samples requested and comprised the study group. During the follow-up, 15/49 (31%) relapsed, whereas 34 (69%) remained in remission. Patients relapsing showed constantly elevated FC levels for a median of 94 (13-317) days before the relapse. Significant increase in median FC levels was seen 2 (p = 0.0014), 4 (p = 0.0056), and 6 (p = 0.0029) months before endoscopic relapse. Constantly normal FC concentrations during the follow-up were highly predictive for clinical and endoscopic remission. Normal FC concentrations in patients with remission were associated with histological remission. CONCLUSION FC seems to increase and remain elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker for predicting and identifying patients requiring close follow-up in clinical practice.
Collapse
Affiliation(s)
- Pauliina Molander
- Maria Helsinki City Hospital and University of Helsinki, Helsinki, Finland
| | - Martti Färkkilä
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland University of Helsinki, Institute of Clinical Medicine, Department of Medicine, Division of Gastroenterology, Helsinki, Finland
| | - Ari Ristimäki
- Department of Pathology, HUSLAB and Haartman Institute, Helsinki University Central Hospital and Genome-Scale Biology, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Kimmo Salminen
- Department of Medicine, Division of Gastroenterology, Turku University Central Hospital, Turku, Finland
| | - Helena Kemppainen
- Department of Medicine, Division of Gastroenterology, Turku University Central Hospital, Turku, Finland
| | - Timo Blomster
- Department of Medicine, Division of Gastroenterology, Oulu University Central Hospital, Oulu, Finland
| | - Ritva Koskela
- Department of Medicine, Division of Gastroenterology, Oulu University Central Hospital, Oulu, Finland
| | - Airi Jussila
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Henna Rautiainen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland
| | - Markku Nissinen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Peijas Hospital, Vantaa, Finland
| | - Johanna Haapamäki
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| | - Perttu Arkkila
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| | - Urpo Nieminen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Kuisma
- Department of Medicine, Hyvinkää Hospital, Hyvinkää, Finland
| | - Jari Punkkinen
- Department of Medicine, Porvoo Hospital, Porvoo, Finland
| | - Kaija-Leena Kolho
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland University of Helsinki, Institute of Clinical Medicine, Department of Medicine, Division of Gastroenterology, Helsinki, Finland
| | - Harri Mustonen
- Helsinki University Central Hospital, Department of Surgery, Biomedicum Helsinki, Finland
| | - Taina Sipponen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
26
|
Nieminen JK, Sipponen T, Färkkilä M, Vaarala O. Monocyte-derived dendritic cells from Crohn's disease patients exhibit decreased ability to activate T helper type 17 responses in memory cells. Clin Exp Immunol 2014; 177:190-202. [PMID: 24635023 DOI: 10.1111/cei.12326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 12/20/2022] Open
Abstract
An increased activation of interleukin (IL)-17A-producing immune cells is a well-established feature of Crohn's disease (CD). Mechanisms that contribute to this aberrant immune activation are, however, less clear. Given that an enhanced induction of innate-immunity associated cytokines IL-6 and IL-23, which promote IL-17 immunity, is also clearly implicated in CD, we hypothesized that monocyte-derived dendritic cells (moDCs) of CD patient origin would mount exaggerated IL-17A responses in T cells. However, we found a significantly attenuated up-regulation of the IL-17A response in allogeneic T helper memory cells in the presence of culture media from lipopolysaccharide (LPS)-stimulated moDCs of CD patients when compared with moDCs of control subjects (median fold-increase in IL-17A mRNA expression 1·09 versus 1·44, P = 0·038). This was accompanied by a lower expression of IL-1β and IL-6 transcripts in the LPS-treated moDCs (median 9·55 versus 13·9 relative units, P = 0·042, and 2·66 versus 9·06 relative units, P = 0·049, respectively). In addition, the up-regulation of autophagy-related LC3 transcripts was decreased in moDCs of CD patients (median fold-increase in mRNA expression 1·22 versus 1·52, P = 0·029). Our findings reveal similar immunological aberrancies in CD in the general population as reported in CD patients with mutated intracellular bacterial sensor NOD2, namely attenuated activation of innate cytokines and impaired autophagy, combined with a reduced capacity to up-regulate the T helper type 17 (Th17) response. The results presented here emphasize a defective anti-microbial response in the pathogenesis of CD. The increased mucosal Th1 and Th17 responses, which may contribute to the pathogenesis, could be the consequences of primary defects in the innate immunity.
Collapse
Affiliation(s)
- J K Nieminen
- Immune Response Unit, Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | | | | | | |
Collapse
|
27
|
Mälkönen T, Wikström A, Heiskanen K, Merras-Salmio L, Mustonen H, Sipponen T, Kolho KL. Skin reactions during anti-TNFα therapy for pediatric inflammatory bowel disease: a 2-year prospective study. Inflamm Bowel Dis 2014. [PMID: 24918318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Although the development of therapy-related skin reactions is common along with an increase in the number of adult patients receiving anti-TNFα, there are few studies on pediatric inflammatory bowel disease; hence, this prospective study focuses on skin reactions related to infliximab therapy. METHODS All pediatric patients with inflammatory bowel disease undergoing infliximab therapy were prospectively screened for the presence of skin manifestations at the time of each infusion between March 1, 2011 and March 31, 2011 at Children's Hospital, Helsinki, Finland. Blood inflammatory markers and fecal calprotectin levels were measured at the time of infusions. RESULTS During the study period, 84 children with inflammatory bowel disease (Crohn's n = 64) received infliximab infusions (the median duration of therapy 12.2 mo). Almost every other patient (n = 40; 47.6%) presented chronic skin reactions, 23% with lesions considered severe. Most commonly, the patient's ear lobes and scalp were affected with psoriasis-like manifestations, followed by their eyelids, perioral and pubic area, trunk, and the extremities. However, an HLA-Cw*0602 genotype associating with psoriasis was rare. Interestingly, most patients with skin reactions had a low degree of intestinal inflammation based on their fecal calprotectin levels (median level, 133 μg/g versus 589 in unaffected patients; P < 0.016). Seven patients (8.3% of all patients but 17% of those with skin lesions) discontinued the given therapy due to a skin reaction. CONCLUSIONS Skin reactions are common during maintenance therapy with infliximab in pediatric patients. For most patients, skin reactions seem to correlate with a low level of intestinal inflammation. Although potentially harsh, skin lesions mostly allow continuation of infliximab.
Collapse
Affiliation(s)
- Tarja Mälkönen
- *Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland; †Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; ‡Department of Surgery, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; and §Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | | | | | |
Collapse
|
28
|
Mälkönen T, Wikström A, Heiskanen K, Merras-Salmio L, Mustonen H, Sipponen T, Kolho KL. Skin reactions during anti-TNFα therapy for pediatric inflammatory bowel disease: a 2-year prospective study. Inflamm Bowel Dis 2014; 20:1309-15. [PMID: 24918318 DOI: 10.1097/mib.0000000000000088] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the development of therapy-related skin reactions is common along with an increase in the number of adult patients receiving anti-TNFα, there are few studies on pediatric inflammatory bowel disease; hence, this prospective study focuses on skin reactions related to infliximab therapy. METHODS All pediatric patients with inflammatory bowel disease undergoing infliximab therapy were prospectively screened for the presence of skin manifestations at the time of each infusion between March 1, 2011 and March 31, 2011 at Children's Hospital, Helsinki, Finland. Blood inflammatory markers and fecal calprotectin levels were measured at the time of infusions. RESULTS During the study period, 84 children with inflammatory bowel disease (Crohn's n = 64) received infliximab infusions (the median duration of therapy 12.2 mo). Almost every other patient (n = 40; 47.6%) presented chronic skin reactions, 23% with lesions considered severe. Most commonly, the patient's ear lobes and scalp were affected with psoriasis-like manifestations, followed by their eyelids, perioral and pubic area, trunk, and the extremities. However, an HLA-Cw*0602 genotype associating with psoriasis was rare. Interestingly, most patients with skin reactions had a low degree of intestinal inflammation based on their fecal calprotectin levels (median level, 133 μg/g versus 589 in unaffected patients; P < 0.016). Seven patients (8.3% of all patients but 17% of those with skin lesions) discontinued the given therapy due to a skin reaction. CONCLUSIONS Skin reactions are common during maintenance therapy with infliximab in pediatric patients. For most patients, skin reactions seem to correlate with a low level of intestinal inflammation. Although potentially harsh, skin lesions mostly allow continuation of infliximab.
Collapse
Affiliation(s)
- Tarja Mälkönen
- *Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland; †Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; ‡Department of Surgery, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; and §Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | | | | | |
Collapse
|
29
|
Kolho KL, Sipponen T. The long-term outcome of anti-tumor necrosis factor-α therapy related to fecal calprotectin values during induction therapy in pediatric inflammatory bowel disease. Scand J Gastroenterol 2014; 49:434-41. [PMID: 24597837 DOI: 10.3109/00365521.2014.886719] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Monitoring fecal calprotectin (FC) could assist in the assessment of the therapeutic response of inflammatory bowel disease (IBD). There are few studies on long-term prognosis related to the FC value response to infliximab induction therapy, thus providing the aim of this study on pediatric patients. METHODS FC levels were measured during the induction and maintenance phase of infliximab therapy (5 mg/kg) in 76 pediatric IBD patients introduced to maintenance therapy. The long-term outcomes and clinical disease activity were retrospectively related to the FC response to induction. RESULTS The median pretreatment FC level of 817 μg/g stool (range <5-24,000) declined to 372 μg/g (range 5-2430) by week 6, with a low level (<100 μg/g) in 35% (pooled comparable data for ulcerative colitis and Crohn's). Clinical activity indices showed remission in 59% (pediatric Crohn's disease activity index: <10, n = 33; pediatric ulcerative colitis activity index: <10 n = 12). In 49 patients (64%), infliximab therapy was discontinued (inadequate effect/surgery = 27; remission/bridging to azathioprine = 12; adverse effect = 6; antibodies to infliximab n = 4) during the study period with a median follow up of 1.1 years (interquartile range [IQR]: 0.71-4.4). Those who discontinued the therapy within the first year due to an inadequate effect had higher median FC level during induction than the other patients (median 633 µg/g, IQR: 197-819 and median 219 µg/g, IQR: 71-508, respectively; p < 0.025) and were less frequently in clinical remission at week 6 (p < 0.01). CONCLUSIONS The long-term prognosis of infliximab therapy is related to the response to induction therapy in pediatric IBD and reflected in low FC values between weeks 2 and 6 and clinical remission.
Collapse
Affiliation(s)
- Kaija-Leena Kolho
- Children's Hospital, Helsinki University Central Hospital , Helsinki, FIN-00029 , Finland
| | | |
Collapse
|
30
|
Sipponen T, Färkkilä M, Kolho KL. [New treatment options for inflammatory bowel diseases]. Duodecim 2014; 130:1391-1398. [PMID: 25158578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Ulcerative colitis and Crohn's disease are incurable diseases sharing common features in pathogenesis but usually presenting a different clinical picture. Current medications are effective for some patients only, and an already achieved response can be lost. Better knowledge of inflammatory mechanisms has enabled the development of new treatments, and new drugs are entering clinical application. Patients unresponsive to TNFalpha blockage continue to be specially challenging, as good and effective treatment options for them are scarce.
Collapse
|
31
|
Abstract
Crohn's disease (CD), ulcerative colitis (UC), and colitis unclassified, collectively defined as inflammatory bowel disease (IBD), are the consequence of chronic inflammatory reactions in the gastrointestinal tissue. Endoscopy with biopsies is the mainstay in the diagnosis of this inflammation and is also important in the assessment of disease activity and monitoring of treatment. Furthermore, mucosal healing is increasingly becoming a therapeutic target for treatment of IBD and the golden standard of assessing it is endoscopy. However, due to the costs, invasiveness, and to limited endoscopic capacity, the need is strong for reliable surrogate markers of intestinal inflammation. Bowel contents, being in close contact with intestinal mucosa, can take up molecules that are measurable from stool samples and thus can serve as markers of inflammation. The fecal neutrophil-derived biomarkers, especially calprotectin and lactoferrin, have several features of an ideal test for detecting intestinal inflammation: they are noninvasive, simple, and low in cost. The utility of these biomarkers in distinguishing IBD from noninflammatory conditions such as irritable bowel syndrome is well documented. They correlate closely with endoscopic activity both in CD and UC. They allow serial monitoring of disease activity and of treatment success, and can even serve in predicting clinical relapse in unsymptomatic patients or sustained remission after induction with TNF-α-blocking agents. In this review an overview will be given to the role of fecal neutrophil-derived biomarkers calprotectin and lactoferrin in diagnostics and prognostics of IBD.
Collapse
Affiliation(s)
- Taina Sipponen
- Department of Medicine, Clinic of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
32
|
Molander P, Sipponen T, Kemppainen H, Jussila A, Blomster T, Koskela R, Nissinen M, Rautiainen H, Kuisma J, Kolho KL, Färkkilä M. Achievement of deep remission during scheduled maintenance therapy with TNFα-blocking agents in IBD. J Crohns Colitis 2013. [PMID: 23182163 DOI: 10.1016/j.crohns.2012.10.018] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Deep remission, meaning clinical remission with mucosal healing (MH), with anti-tumor necrosis factor-alpha (TNF-α) agents is a new target for therapy in inflammatory bowel disease (IBD). Our aim was to study how often patients on TNF-α blocking therapy actually achieve deep remission. METHODS The total of 252 IBD patients retrospectively included (183 Crohn's disease (CD), 62 ulcerative colitis (CU) or 7 inflammatory bowel disease unclassified-type colitis (IBDU)) received TNFα-antagonists (177 infliximab, 75 adalimumab) for at least 11 months and underwent ileocolonoscopy. We reviewed endoscopic and histological findings, clinical symptoms, C-reactive protein (CRP), and fecal calprotectin (FC) levels, and data on TNF-α blocking therapy. Defining deep remission as no clinical symptoms with endoscopic remission (the simple endoscopic score for Crohn's disease, SES-CD 0-2 or Mayo endoscopic subscore 0-1). RESULTS Of the 252 patients, 168 (67%) were in clinical remission and 122 (48%) in deep remission after a median of 23 months of maintenance therapy. Of the 183 CD patients, 117 (64%) reached clinical remission and 79 (43%) deep remission. Of the UC patients, 52 (75%) were in clinical remission and 43 (62%) in deep remission. The majority of patients in deep remission (n=99, 81%) also had histologically inactive disease. Both median CRP and FC levels were significantly lower in patients with deep remission. CONCLUSION Reassuringly, half of the IBD patients on the TNFα-blocking maintenance therapy achieved deep remission. The majority of patients in deep remission also achieved histological remission.
Collapse
|
33
|
Nieminen JK, Niemi M, Sipponen T, Salo HM, Klemetti P, Färkkilä M, Vakkila J, Vaarala O. Dendritic cells from Crohn's disease patients show aberrant STAT1 and STAT3 signaling. PLoS One 2013; 8:e70738. [PMID: 23950992 PMCID: PMC3737363 DOI: 10.1371/journal.pone.0070738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/26/2013] [Indexed: 12/31/2022] Open
Abstract
Abnormalities of dendritic cells (DCs) and STAT proteins have been reported in Crohn’s disease (CD). Studies on JAK/STAT signaling in DCs are, however, lacking in CD. We applied a flowcytometric single-cell-based phosphoepitope assay to evaluate STAT1 and STAT3 pathways in DC subsets from CD patients. In addition, circulating DC counts were determined, together with the activation-related immunophenotype. We found that IL-6- and IFN-α-induced STAT3 phosphorylation and IFN-α-induced STAT1 phosphorylation were impaired in plasmacytoid DCs (pDCs) from CD patients (P = 0.005, P = 0.013, and P = 0.006, respectively). In myeloid DCs (mDCs), IFN-α-induced STAT1 and STAT3 phosphorylation were attenuated (P<0.001 and P = 0.048, respectively), but IL-10-induced STAT3 phosphorylation was enhanced (P = 0.026). IFN-γ-induced STAT1 signaling was intact in both DC subtypes. Elevated plasma IL-6 levels were detected in CD (P = 0.004), which strongly correlated with disease activity (ρ = 0.690, P<0.001) but not with IL-6-induced STAT3 phosphorylation. The numbers of pDCs and BDCA3+ mDCs were decreased, and CD40 expression on CD1c+ mDCs was increased in CD. When elucidating the effect of IL-6 signaling on pDC function, we observed that IL-6 treatment of healthy donor pDCs affected the maturation of and modified the T-cell priming by pDCs, favoring Th2 over Th1 type of response and the expression of IL-10 in T cells. Our results implicate DC signaling in human CD. Reduced IL-6 responsiveness in pDCs, together with the attenuated IFN-α-induced signaling in both DC subtypes, may contribute to the immunological dysregulation in CD patients.
Collapse
Affiliation(s)
- Janne K Nieminen
- Immune Response Unit, Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
af Björkesten CG, Nieminen U, Sipponen T, Turunen U, Arkkila P, Färkkilä M. Mucosal healing at 3 months predicts long-term endoscopic remission in anti-TNF-treated luminal Crohn's disease. Scand J Gastroenterol 2013; 48:543-51. [PMID: 23477356 DOI: 10.3109/00365521.2013.772230] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Studies performed on patient and disease characteristics predicting the treatment response in tumor necrosis factor alpha antibody (anti-TNF)-treated Crohn's disease (CD) have generally been based on clinical data. Only a few studies have assessed the role of endoscopy as a predictor for long-term response for anti-TNF therapy. Our aim was to evaluate the role of early endoscopy in predicting the long-term endoscopic response to anti-TNF in active luminal CD in a clinical setting. PATIENTS AND METHODS Forty-two patients with active luminal CD, treated for at least 3 months with anti-TNF, either adalimumab (52%) or infliximab (48%), were included in this prospective study. Data on the simple endoscopic score for Crohn's disease (SES-CD) at 3 months after therapy commencement, and either data on the SES-CD or surgery after 1 year, were available for all patients. Endoscopic remission was defined as SES-CD 0-2. RESULTS At 3 months after commencing anti-TNF therapy, 10 patients (24%) were in endoscopic remission. Thirty-three patients continued anti-TNF as maintenance therapy. At 1 year, endoscopic remission (11/33, 33%) was significantly more common in those patients who had been in endoscopic remission at 3 months, compared with those with endoscopically active disease at 3 months (7/10, 70% vs. 4/23, 17%, p = 0.01). The 3-month SES-CD had a sensitivity of 88%, and specificity of 64%, to predict 1-year endoscopic remission in patients who received anti-TNF maintenance therapy. CONCLUSIONS In anti-TNF-treated active luminal CD mucosal healing at 3 months is a strong predictor for long-term endoscopic response.
Collapse
Affiliation(s)
- Clas-Göran af Björkesten
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVE To study serum infliximab (s-IFX) levels in pediatric patients with inflammatory bowel disease (IBD). SUBJECTS AND METHODS s-IFX trough levels were measured in a total of 133 blood samples of 37 pediatric IBD patients (Crohn's disease, 23): 48 during the induction phase (weeks 2 and 6) and 85 during maintenance treatment. Antibodies to infliximab (ATI) were determined in 93 samples (30 patients). s-IFX values were related to fecal calprotectin (FC) and serum markers of inflammation. RESULTS During induction (5 mg/kg) and maintenance therapy, the median s-IFX levels were 17.6 μg/ml (range 0-48 μg/ml) and 3.55 μg/ml (range 0-40 μg/ml), respectively. The IFX levels were similar in ulcerative colitis and Crohn's disease (e.g. during maintenance median 3.2 vs. 2.8 μg/ml, p = 0.718), thus the data are pooled. During induction, the s-IFX level was associated with the total dose of IFX, that is, young children with lower body weight had lower levels (p < 0.001 at week 2 and p < 0.05 at week 6). Shorter administration interval resulted in higher trough levels (p < 0.005). All samples with undetectable s-IFX (6.8%) levels presented ATI. High inflammation (FC >1000 µg/g) during induction was associated with lower s-IFX levels (median 4.0 μg/ml, range 0.47-25 compared to median 20 μg/ml, range 0-48 when FC <1000 µg/g, p < 0.005). There was no significant association between the ESR or values of C-reactive protein and s-IFX levels during induction. CONCLUSIONS In pediatric IBD, lower body weight and higher level of intestinal inflammation are associated to s-IFX levels during induction but relation to therapeutic response is unclear.
Collapse
Affiliation(s)
- Anssi Hämäläinen
- Children´s Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | | | | |
Collapse
|
36
|
Sipponen T, Kolho KL. [Application of TNF-alpha blocker concentration assays in the treatment of inflammatory bowel diseases]. Duodecim 2013; 129:499-505. [PMID: 23520893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Application of TNF-alpha blocker concentration assays in the treatment of inflammatory bowel diseases Concentration assays for the biological drugs infliximab and adalimumab have proven useful in optimizing drug therapy in inflammatory bowel diseases as well as in rheumatic diseases. Drug dosing can be controlled and a better response strived for by determining the drug level especially in cases of unsatisfactory treatment response. To support the treatment decision, antibody assays of biological drug therapy seem to be beneficial when contemplating a change of medication.
Collapse
|
37
|
Lehtonen HJ, Sipponen T, Tojkander S, Karikoski R, Järvinen H, Laing NG, Lappalainen P, Aaltonen LA, Tuupanen S. Segregation of a missense variant in enteric smooth muscle actin γ-2 with autosomal dominant familial visceral myopathy. Gastroenterology 2012; 143:1482-1491.e3. [PMID: 22960657 DOI: 10.1053/j.gastro.2012.08.045] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [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: 04/18/2012] [Revised: 08/13/2012] [Accepted: 08/28/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Familial visceral myopathy (FVM) is a rare inherited form of myopathic pseudo-obstruction; little is known about the genetic factors that cause this disorder. FVM is characterized by impaired functions of enteric smooth muscle cells, resulting in abnormal intestinal motility, severe abdominal pain, malnutrition, and even death. We searched for genetic factors that might cause this disorder. METHODS We performed whole-exome sequence analysis of blood samples from 2 individuals in a family that had 7 members diagnosed with FVM. Sanger sequencing was used to analyze additional family members and 280 individuals without this disorder (controls). Intestinal tissue samples from 4 patients and 2 controls were analyzed by immunohistochemistry. Functional studies, including immunofluorescence, cell contractility, and actomyosin structure analyses, were performed using CRL-1976 and U2OS sarcoma cell lines. RESULTS Whole-exome sequence analysis of DNA from 2 siblings identified 83 gene variants that were shared between the siblings and considered as possible disease-causing changes. A heterozygous variant, R148S in enteric smooth muscle actin γ-2 (ACTG2), segregated with disease phenotype. Intestinal smooth muscle (muscularis propria) from individuals with FVM had reduced levels of cytoplasmic ACTG2 and abnormal accumulation of the protein into intracellular inclusions compared with controls. Sarcoma cells that expressed exogenous ACTG2(R148S) incorporated reduced amounts of this protein into actin filaments compared with cells expressing ACTG2(wt) (P < .001). ACTG2(R148S) also interfered with actin cytoskeleton organization and the contractile activities of the cells, indicating a dominant-negative effect. These findings, along with the site of the variation in the protein, indicate that ACTG2 R148S interferes with actin filament assembly. CONCLUSIONS We identified the R148S variant in ACTG2 as a cause of FVM in one family. The altered ACTG2 protein appears to aggregate, rather than form actin filaments, in intestinal smooth muscle tissue. This defect could impair contraction of the visceral smooth muscle cells and reduce bowel motility.
Collapse
Affiliation(s)
- Heli J Lehtonen
- Department of Medical Genetics, Genome-Scale Biology Research Program, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Molander P, af Björkesten CG, Mustonen H, Haapamäki J, Vauhkonen M, Kolho KL, Färkkilä M, Sipponen T. Fecal calprotectin concentration predicts outcome in inflammatory bowel disease after induction therapy with TNFα blocking agents. Inflamm Bowel Dis 2012; 18:2011-7. [PMID: 22223566 DOI: 10.1002/ibd.22863] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 11/29/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fecal calprotectin (FC) concentration is a useful surrogate marker for mucosal healing (MH) during tumor necrosis factor alpha (TNFα)-blocking therapy for inflammatory bowel disease (IBD). Our aim was to evaluate whether a normal FC after induction therapy with TNFα antagonist predicts the outcome of IBD patients during maintenance therapy. METHODS Sixty IBD patients (34 Crohn's disease [CD], 26 ulcerative colitis [UC]), treated with TNFα antagonists, either infliximab (n = 42) or adalimumab (n = 18), and having a documented FC level at baseline and after induction therapy were included. Disease activity was evaluated by partial Mayo score without endoscopy or Harvey-Bradshaw index at baseline, after induction, and at 12 months during maintenance therapy. RESULTS After induction, FC was normalized (≤ 100 μg/g) in 31 patients (52%, median 42 μg/g, range 0-97), whereas the level remained elevated in 29 patients (48%, median 424 μg/g, range 116-5859). At ≈12 months, 26/31 (84%, 18 CD, 8 UC) of the patients with normal FC after induction were in clinical remission, whereas only 11/29 (38%, 9 CD, 2 UC) of those with an elevated (≥ 100 μg/g) postinduction FC were in clinical remission, P < 0.0001. After induction therapy with TNFα antagonists, a cutoff concentration of 139 μg/g for FC had a sensitivity of 72% and a specificity of 80% to predict a risk of clinically active disease after 1 year. CONCLUSIONS A normal FC after induction therapy with TNFα antagonists predicts sustained clinical remission in the majority of patients on scheduled therapy with active luminal disease.
Collapse
Affiliation(s)
- Pauliina Molander
- Maria Helsinki City Hospital and University of Helsinki, Helsinki, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Sipponen T, Haapamäki J, Savilahti E, Alfthan H, Hämäläinen E, Rautiainen H, Koskenpato J, Nuutinen H, Färkkilä M. Fecal calprotectin and S100A12 have low utility in prediction of small bowel Crohn's disease detected by wireless capsule endoscopy. Scand J Gastroenterol 2012; 47:778-84. [PMID: 22519419 DOI: 10.3109/00365521.2012.677953] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Data on fecal calprotectin and S100A12 in predicting wireless capsule endoscopy (WCE) findings in suspicion of Crohn's disease (CD) are scarce. Our aim was to study the role of calprotectin and S100A12 in predicting inflammatory lesions of small bowel in patients undergoing WCE. MATERIAL AND METHODS 84 patients undergoing WCE (77 for suspicion of CD and 7 CD patients for evaluation of disease extent) were prospectively recruited. WCE findings were scored. Patients provided a stool sample for measurements of biomarkers. Patients underwent an esophagogastroduodenoscopy and ileocolonoscopy before WCE. RESULTS WCE was abnormal in 35 (42%) of 84 patients: 14 patients with CD, 8 with NSAID enteropathies, 8 with angioectasias, 4 with polyps or tumors, and 1 with ischemic stricture. Median calprotectin concentration in the study population was 22 μg/g (range 2-342) and S100A12 concentration 0.048 μg/g (range 0.003-1.215). Fecal calprotectin was significantly higher in CD patients (median 91, range 2-312) compared with those with normal WCE or other abnormalities (p = 0.008), whereas fecal S100A12 (0.087 μg/g, range 0.008-0.896) did not differ between the groups (p = 0.166). In detecting inflammatory small bowel lesions, sensitivity, specificity, positive predictive value, and negative predictive value for fecal calprotectin (cutoff 50 μg/g) were 59%, 71%, 42%, and 83%, and for S100A12 (cutoff 0.06 μg/g) these were 59%, 66%, 38%, and 82%. CONCLUSIONS In predicting small bowel inflammatory changes, fecal biomarkers calprotectin and S100A12 have moderate specificity, but low sensitivity. Neither fecal calprotectin nor S100A12 can be used for screening or excluding small bowel CD.
Collapse
Affiliation(s)
- Taina Sipponen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, P.O.B 340, 00029 HUS, Helsinki, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Hölttä V, Sipponen T, Westerholm-Ormio M, Salo HM, Kolho KL, Färkkilä M, Savilahti E, Vaarala O, Klemetti P. In Crohn's Disease, Anti-TNF-α Treatment Changes the Balance between Mucosal IL-17, FOXP3, and CD4 Cells. ISRN Gastroenterol 2012; 2012:505432. [PMID: 22778976 PMCID: PMC3384926 DOI: 10.5402/2012/505432] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 04/18/2012] [Indexed: 01/28/2023]
Abstract
Aim. In Crohn's disease (CD), anti-TNF-α treatment is a potent medication. We aimed to characterize the effect of anti-TNF-α treatment on T effector and regulatory cells. Material and Methods.
We studied T-effector and regulatory cells on cellular and mRNA levels in intestinal biopsy samples from 13 Crohn's disease patient. Biopsies were obtained at baseline and 3 months after anti-TNF-α treatment, and from 14 inflammation-free control subjects. Results. Patients had higher numbers of ileal IL-17+ and forkhead box P3 (FOXP3)+ cells than did control subjects, both before ( P ≤ 0.001 and P ≤ 0.05, resp.) and after the anti-TNF-α treatment (P ≤ 0.01, P ≤ 0.01). Intestinal interferon-γ and IL-17 mRNA expression was higher in Crohn's disease and remained elevated after anti-TNF-α treatment. The ratio of IL-17+ cells to CD4+ cells decreased (P ≤ 0.05) and compared to baseline the ratio of IL-17+ cells to FOXP3+ was lower after treatment (P ≤ 0.05). Conclusions. TNF-α-blocking agents improved intestinal balance between IL-17+ T-effector and regulatory T cells, although intestinal IL-17 upregulation remained elevated.
Collapse
Affiliation(s)
- Veera Hölttä
- Immune Response Unit, Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Haartmaninkatu 8, 00290 Helsinki, Finland
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Patients with Crohn's disease are often investigated using MRI enteroclysis which may provide better visual quality than MRI enterography, but exposes patients to radiation. Only few data exist of the radiation dose used in fluoroscopy prior to MRI enteroclysis. SUBJECTS AND METHODS During the 12-month study period, all 95 patients (40 men) undergoing MRI enteroclysis with nasojejunal intubation using fluoroscopy for suspicion or evaluation of Crohn's disease were included. Average age at the time of MRI was 40.1 years (range 17-79). Conversion factors from dose-area product to effective dose were determined with a Monte Carlo-based software PCXMC. The conversion factors were determined for a standard-sized adult phantom for posterior-anterior and right-posterior-oblique projections. RESULTS The average total time of fluoroscopy was 3 min 17 s (range 0 min 7 s to 31 min). The average effective dose of ionizing radiation was 0.21 mSv (range 0.01-2.67). The average dose is equivalent to 10 PA chest x-rays. Standard deviation was 0.41 mSv. The highest effective dose of a single patient was 2.67 mSv. In comparison, a standard abdominal CT scan causes an effective dose of 12 mSv. CONCLUSIONS The effective dose of ionizing radiation with nasojejunal intubation is relatively small in the majority of patients. When repeated imaging is necessary, it seems advisable to consider imaging techniques, which do not subject patients to ionizing radiation. Also if a previous nasojejunal intubation has been difficult, a different imaging technique is recommended.
Collapse
Affiliation(s)
- Lauri Puustinen
- Division of Gastroenterology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | |
Collapse
|
42
|
af Björkesten CG, Nieminen U, Turunen U, Arkkila P, Sipponen T, Färkkilä M. Surrogate markers and clinical indices, alone or combined, as indicators for endoscopic remission in anti-TNF-treated luminal Crohn's disease. Scand J Gastroenterol 2012; 47:528-37. [PMID: 22356594 DOI: 10.3109/00365521.2012.660542] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Endoscopically confirmed mucosal healing has become an important therapeutic goal in the treatment of Crohn's disease (CD). The role of clinical indices, such as the Crohn's disease activity index (CDAI) and the Harvey-Bradshaw index (HBI), and surrogate markers, such as C-reactive protein (CRP) and fecal calprotectin, to indicate remission determined by endoscopy needs to be clarified. We analyzed the role of surrogate markers and clinical indices, separately and in combination, by comparing them with endoscopically scored disease activity in biologically treated CD patients. MATERIAL AND METHODS Prospectively collected data of all patients with inflammatory bowel disease treated with tumor necrosis factor alpha antibodies in a tertiary center between 2007 and 2010. Altogether 210 endoscopies in 64 CD patients were analyzed. The simple endoscopic score for Crohn's disease (SES-CD) was used for scoring disease activity and compared with available data on concurrent CDAI, HBI, CRP, and calprotectin. RESULTS Endoscopic activity demonstrated a stronger correlation with calprotectin and CRP than with the clinical indices. Neither the clinical indices nor CRP was reliable at identifying endoscopic remission. However, calprotectin alone identified endoscopic remission with a sensitivity of 84% and specificity of 74%, but was beaten, although not statistically significantly, by a combined index, based on calprotectin and the HBI. CONCLUSIONS Clinical scores commonly used in the assessment of disease activity are unreliable at differentiating endoscopic remission from active CD. Despite this, a score based on a combination of fecal calprotectin and the HBI is a new promising tool for identifying endoscopic remission.
Collapse
Affiliation(s)
- Clas-Göran af Björkesten
- Division of Gastroenterology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
43
|
Hämäläinen A, Sipponen T, Kolho KL. Infliximab in pediatric inflammatory bowel disease rapidly decreases fecal calprotectin levels. World J Gastroenterol 2011; 17:5166-71. [PMID: 22215940 PMCID: PMC3243882 DOI: 10.3748/wjg.v17.i47.5166] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/23/2011] [Accepted: 05/30/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the response to infliximab in pediatric inflammatory bowel disease (IBD), as reflected in fecal calprotectin levels.
METHODS: Thirty-six pediatric patients with IBD [23 Crohn’s disease (CD), 13 ulcerative colitis (UC); median age 14 years] were treated with infliximab. Fecal calprotectin was measured at baseline, and 2 and 6 wk after therapy, and compared to blood inflammatory markers. Maintenance medication was unaltered until the third infusion but glucocorticoids were tapered off if the patient was doing well.
RESULTS: At introduction of infliximab, median fecal calprotectin level was 1150 μg/g (range 54-6032 μg/g). By week 2, the fecal calprotectin level had declined to a median 261 μg/g (P < 0.001). In 37% of the patients, fecal calprotectin was normal (< 100 μg/g) at 2 wk. By week 6, there was no additional improvement in the fecal calprotectin level (median 345 μg/g). In 22% of the patients, fecal calprotectin levels increased by week 6 to pretreatment levels or above, suggesting no response (or a loss of early response). Thus, in CD, the proportion of non-responsive patients by week 6 seemed lower, because only 9% showed no improvement in their fecal calprotectin level when compared to the respective figure of 46% of the UC patients (P < 0.05).
CONCLUSION: When treated with infliximab, fecal calprotectin levels reflecting intestinal inflammation normalized rapidly in one third of pediatric patients suggesting complete mucosal healing.
Collapse
|
44
|
Sipponen T, Turunen U, Lautenschlager I, Nieminen U, Arola J, Halme L. Human herpesvirus 6 and cytomegalovirus in ileocolonic mucosa in inflammatory bowel disease. Scand J Gastroenterol 2011; 46:1324-33. [PMID: 21879802 DOI: 10.3109/00365521.2011.605466] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Reactivation of a latent cytomegalovirus (CMV) may occur in inflammatory bowel disease (IBD). Data of human herpesvirus 6 (HHV-6)--a close relative to CMV--in active IBD are scarce. The aim of this study was to detect HHV-6 and CMV antigens in the mucosa of active and inactive IBD. MATERIAL AND METHODS 79 IBD patients (47 ulcerative colitis (UC) and 32 Crohn's disease (CD)) were recruited and endoscopic and histological disease activity was scored. Control group consisted of 15 non-IBD patients with normal colonoscopy. Immunohistochemical stainings for HHV-6B and CMV antigens were performed on biopsy specimens from the ileum and colorectum. The intensity of HHV-6B and CMV expression was graded as negative, mild, moderate, or intense. RESULTS HHV-6B antigen was positive in 35 (44%) and CMV in 64 (81%). Of controls, 6 (40%) were mildly positive for HHV-6 and 6 (40%) for CMV. In IBD, both CMV and HHV-6B intensity correlated with endoscopic disease severity (CMV p = 0.010 and HHV-6 p = 0.048). Simultaneous HHV-6B and CMV antigen expression occurred in 29 (37%) and associated with endoscopic activity (p = 0.006) and to a number of immunosuppressives (p = 0.033). A significant difference in HHV-6B positivity was found between endoscopically active and inactive UC (p = 0.040). Both CMV and HHV-6B intensity correlated with histological severity in the rectal biopsy specimens (for CMV p = 0.040 and for HHV-6B p = 0.027). CONCLUSIONS Both viruses occurred ubiquitously in the IBD mucosa. Coexistence of viruses was common and associated with disease activity and use of immunosuppressives. HHV-6B intensity correlated with endoscopic severity in UC.
Collapse
Affiliation(s)
- Taina Sipponen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
45
|
Nuutinen H, Kolho KL, Salminen P, Rintala R, Koskenpato J, Koivusalo A, Sipponen T, Färkkilä M. Capsule endoscopy in pediatric patients: technique and results in our first 100 consecutive children. Scand J Gastroenterol 2011; 46:1138-43. [PMID: 21615227 DOI: 10.3109/00365521.2011.584900] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Capsule endoscopy (CE) offers noninvasive methods to assess small bowel pathology but only limited data are available on the feasibility, safety, and findings in children. In this study, we report our results of 100 consecutive CE in children. MATERIAL AND METHODS Single center retrospective study. All pediatric patients (mean age 119 months, range from 8 to 188 months) undergoing CE were included until 100 investigations were completed. The indications for CE were: suspicion or evaluation of Crohn's disease (n = 35) or ulcerative colitis (n = 24), gastrointestinal bleeding (n = 18), and miscellaneous (n = 23). RESULTS The youngest patients able to swallow the capsule were 84 months old. When the patient was unable to swallow the capsule (n = 51), it was guided into the duodenum with endoscope. In two patients, the capsule remained in the stomach during the 8 h of recording and in 23 cases the capsule failed to reach the cecum. The capsule was expelled naturally in all except one patient. In 39% of the patients, CE revealed a significant finding (multiple ulcers, bleeding, tumors, strictures). In patients examined for bleeding or for a suspicion of Crohn's disease, the respective proportions were 50% and 60%. CONCLUSIONS This study shows that CE is a feasible diagnostic method to study the small intestine in pediatric patients and that CE can be done in children as young as 8 months old. The diagnostic yield is highest in cases with bleeding or a high suspicion of Crohn's disease.
Collapse
Affiliation(s)
- Hannu Nuutinen
- Clinic of Gastroenterology, Helsinki University Central Hospital, University of Helsinki, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Rahier JF, Papay P, Salleron J, Sebastian S, Marzo M, Peyrin-Biroulet L, Garcia-Sanchez V, Fries W, van Asseldonk DP, Farkas K, de Boer NK, Sipponen T, Ellul P, Louis E, Peake STC, Kopylov U, Maul J, Makhoul B, Fiorino G, Yazdanpanah Y, Chaparro M. H1N1 vaccines in a large observational cohort of patients with inflammatory bowel disease treated with immunomodulators and biological therapy. Gut 2011; 60:456-62. [PMID: 21270121 DOI: 10.1136/gut.2010.233981] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Safety data are lacking on influenza vaccination in general and on A (H1N1)v vaccination in particular in patients with inflammatory bowel disease (IBD) receiving immmunomodulators and/or biological therapy. AIMS AND METHODS The authors conducted a multicentre observational cohort study to evaluate symptoms associated with influenza H1N1 adjuvanted (Pandemrix, Focetria, FluvalP) and non-adjuvanted (Celvapan) vaccines and to assess the risk of flare of IBD after vaccination. Patients with stable IBD treated with immunomodulators and/or biological therapy were recruited from November 2009 until March 2010 in 12 European countries. Harvey-Bradshaw Index and Partial Mayo Score were used to assess disease activity before and 4 weeks after vaccination in Crohn's disease (CD) and ulcerative colitis (UC). Vaccination-related events up to 7 days after vaccination were recorded. RESULTS Of 575 patients enrolled (407 CD, 159 UC and nine indeterminate colitis; 53.9% female; mean age 40.3 years, SD 13.9), local and systemic symptoms were reported by 34.6% and 15.5% of patients, respectively. The most common local and systemic reactions were pain in 32.8% and fatigue in 6.1% of subjects. Local symptoms were more common with adjuvanted (39.3%) than non-adjuvanted (3.9%) vaccines (p < 0.0001), whereas rates of systemic symptoms were similar with both types (15.0% vs 18.4%, p = 0.44). Among the adjuvanted group, Pandemrix more often induced local reactions than FluvalP and Focetria (51.2% vs 27.6% and 15.4%, p < 0.0001). Solicited adverse events were not associated with any patient characteristics, specific immunomodulatory treatment, or biological therapy. Four weeks after vaccination, absence of flare was observed in 377 patients with CD (96.7%) and 151 with UC (95.6%). CONCLUSION Influenza A (H1N1)v vaccines are well tolerated in patients with IBD. Non-adjuvanted vaccines are associated with fewer local reactions. The risk of IBD flare is probably not increased after H1N1 vaccination.
Collapse
Affiliation(s)
- Jean-François Rahier
- Gastroenterology Unit, Cliniques Universitaires UCL Mont-Godinne, Yvoir, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
af Björkesten CG, Nieminen U, Turunen U, Arkkila PE, Sipponen T, Färkkilä MA. Endoscopic monitoring of infliximab therapy in Crohn's disease. Inflamm Bowel Dis 2011; 17:947-53. [PMID: 20860048 DOI: 10.1002/ibd.21439] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/24/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND So far, infliximab (IFX) therapy for the treatment of Crohn's disease (CD) has generally been guided by clinical symptoms. Data on treatment response as ascertained by endoscopy in IFX therapy are scarce. The aims of this study were to measure the endoscopic response rate during IFX induction and maintenance therapy in luminal CD, and also evaluate the role of endoscopy in monitoring IFX therapy. METHODS Data obtained from 71 patients with active luminal CD and treated with IFX were analyzed retrospectively. The endoscopy findings were scored according to mucosal activity as: 0 (remission), 1-2 (mild), 3-4 (moderate), and 5-6 (severe). A positive endoscopic response was determined by a decrease in score of at least two points and mucosal healing was assigned a score of between 0-2. RESULTS At baseline all patients presented with moderate or severe luminal inflammation. A positive endoscopic response occurred in 73% of patients at 3 months and when IFX was continued, the endoscopic response was maintained in 77% of these patients at 12 months. Mucosal healing at first follow-up endoscopy was documented in 45% of patients and was highly predictive for its persistence at 12 months, maintained in 90% of patients, when IFX was continued. CONCLUSIONS Endoscopy at 3 months from the start of IFX therapy helps to predict responders to IFX for maintenance therapy in active luminal CD.
Collapse
Affiliation(s)
- Clas-Göran af Björkesten
- Division of Gastroenterology, Department of Medicine, Helsinki University Central Hospital, Helsinki Finland.
| | | | | | | | | | | |
Collapse
|
48
|
Sipponen T, Kolho KL. [Faecal calprotectin in inflammatory bowel disease]. Duodecim 2011; 127:2631-2637. [PMID: 22320105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Calprotectin is a protein released especially from neutrophilic leukocytes and secreted into the intestine during inflammation of the intestinal mucosa. It can be assayed from the feces. Faecal calprotectin has proven to be a useful marker in the diagnostics and monitoring of inflammatory bowel diseases, and application of the assay has been extended from pediatric patients also to adults. Faecal calprotectin is highly elevated in active inflammatory bowel disease, and elevated values in symptomless patients seem to be predictive of exacerbation especially in ulcerative colitis and in Crohn's disease colitis.
Collapse
|
49
|
Abstract
AIM: To study whether immune-activation stage in serum of adult Crohn’s disease (CD) patients correlates with disease activity and with treatment response to anti-tumor necrosis factor-α (TNF-α) therapy.
METHODS: Serum samples were obtained from 15 adult CD patients introduced to anti-TNF-α therapy. The individual stage of immune activation was studied applying our new in vitro assay, in which target cells (donor derived peripheral blood mononuclear cells) were cultured with patient serum and the T-cell activation induced by the patient serum was studied using a panel of markers for effector [interferon γ (IFNγ), interleukin (IL)-5] and regulatory T-cells [forkhead transcription factor 3 (FOXP3) and glucocorticoid-induced tumour necrosis factor receptor (GITR)]. The endoscopic disease activity was assessed with the Crohn’s disease endoscopic index of severity (CDEIS) before and 3 mo after therapy with an anti-TNF-α agent.
RESULTS: Low induction of FOXP3 and GITR in target cells cultured in the presence of patient serum was associated with high disease activity i.e. CDEIS assessed before therapy (r = -0.621, P = 0.013 and r = -0.625, P = 0.013, respectively). FOXP3 expression correlated inversely with pre-treatment erythrocyte sedimentation rate (r = -0.548, P = 0.034). Low serum induced FOXP3 (r = -0.600, P = 0.018) and GITR (r = -0.589, P = 0.021) expression and low IFNγ secretion from target cells (r = -0.538, P = 0.039) associated with treatment response detected as a decrease in CDEIS.
CONCLUSION: The immune-activation potency in the patient serum prior to anti-TNF-α therapy reflected intestinal inflammation and the therapeutic response.
Collapse
|
50
|
Abstract
BACKGROUND Few data exist of prospective parallel scoring of the validated endoscopic scores in Crohn's disease (CD), Crohn's Disease Index of Severity (CDEIS), and Simple Endoscopic Score for Crohn's Disease (SES-CD). METHODS Both the CDEIS and the SES-D were scored immediately after each endoscopy of 86 CD patients referred for ileocolonoscopy in a cross-sectional study. Furthermore, after CD therapy, 32 CD patients underwent a follow-up endoscopy with scoring of the CDEIS and SES-CD. Endoscopic scorings were graded as inactive, mild, moderate, or severe. Clinical activity was assessed with the Crohn's Disease Activity Index (CDAI) and serum C-reactive protein (CRP) was measured. RESULTS The SES-CD correlated with the CDEIS significantly (Spearman's r = 0.938, P < 0.0001). Weaker correlations were detected between the SES-CD and the CDAI (r = 0.473) or CRP (r = 0.525, both P < 0.0001). Grading of SES-CD from inactive to severe correlated significantly with grading of the CDEIS (r = 0.859, P < 0.0001). Changes between baseline and follow-up endoscopy scores correlated significantly (r = 0.828 between delta-CDEIS and delta-SES-CD, P < 0.001), but failed to correlate with delta-CDAI or delta-CRP (all P > 0.05). CONCLUSIONS Both validated endoscopic scores, the CDEIS and SES-CD, and their changes during CD therapy demonstrated a close correlation. For scoring of endoscopic activity in clinical routine, the SES-CD could replace the CDEIS.
Collapse
Affiliation(s)
- Taina Sipponen
- Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | |
Collapse
|