1
|
Sasaki S, Ota K, Iwatsubo T, Sugawara N, Hakoda A, Tanaka H, Mori Y, Takeuchi T, Higuchi K, Nishikawa H. A Case of Refractory Gastroesophageal Reflux Disease Successfully Treated with Endoscopic Anti-gastroesophageal Reflux Mucosal Resection by the ESD-G Method (with video). Intern Med 2024:3305-23. [PMID: 38432985 DOI: 10.2169/internalmedicine.3305-23] [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: 03/05/2024] Open
Abstract
A 70-year-old man who had undergone treatment for gastroesophageal reflux disease (GERD) by a family doctor presented to our hospital with severe heartburn and dysphagia despite taking vonoprazan (20 mg) for 3 months. A diagnosis of vonoprazan-refractory nonerosive reflux disease was made based on esophagogastroduodenoscopy and esophageal function examinations. The patient elected to undergo endoscopic treatment for GERD. Therefore, we performed endoscopic treatment using the endoscopic submucosal dissection (ESD-G) technique developed at our institution. After endoscopic treatment, his GERD symptoms disappeared and he no longer required GERD-related medications. An examination of his esophageal function revealed the improvement of items related to GERD.
Collapse
Affiliation(s)
- Shun Sasaki
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Hiroki Nishikawa
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| |
Collapse
|
2
|
Kato M, Ono S, Kawada K, Dohi O, Kitamura S, Koike T, Hori S, Kanzaki H, Murao T, Yagi N, Sasaki F, Hashiguchi K, Oka S, Katada K, Shimoda R, Mizukami K, Suehiro M, Takeuchi T, Katsuki S, Tsuda M, Naito Y, Kawano T, Haruma K, Mori K, Ishikawa H. Diagnostic performance of linked color imaging for gastric cancer by Helicobacter pylori infection status: A subanalysis of the large-scale, multicenter randomized controlled trial LCI-FIND. Helicobacter 2024; 29:e13080. [PMID: 38671594 DOI: 10.1111/hel.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Linked color imaging (LCI) is a new image enhancement technology that facilitates the recognition of subtle differences in mucosal color. In the large-scale, multicenter randomized controlled trial LCI-FIND, LCI demonstrated good diagnostic performance for the detection of tumor lesions in the upper gastrointestinal tract. The aim of the present study was to exploratively evaluate the diagnostic performance of LCI according to H. pylori infection status as a subanalysis of LCI-FIND trial. METHODS The patients were randomly allocated to receive white light imaging (WLI) first, followed by LCI (WLI group), or vice versa (LCI group), and the two groups were compared for the detection of tumors. Data from this trial were analyzed by the presence/absence of H. pylori infection and further analyzed by successful or unsuccessful eradication in the H. pylori infection group. RESULTS The 752 patients in the WLI group and 750 patients in the LCI group who had participated in the LCI-FIND trial were included. In the successful eradication group, more gastric lesions were detected by primary mode in the LCI group than in the WLI group, indicating that more lesions were missed by WLI. Fisher's exact probability test for the comparison of the WLI and LCI groups yielded a p-value of 0.0068, with missed gastric lesions being detected 0.136 times (95% confidence interval: 0.020-0.923), significantly less with LCI than with WLI. CONCLUSION The current study suggests that LCI should be used for gastric cancer screening, particularly in patients with successful H. pylori eradication.
Collapse
Affiliation(s)
- Mototsugu Kato
- Public Interest Foundation Hokkaido Cancer Society, Sapporo, Hokkaido, Japan
- Department of Gastroenterology, National Hospital organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takahisa Murao
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiro Katada
- Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Shimoda
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | | | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Shinichi Katsuki
- Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Hokkaido, Japan
| | - Momoko Tsuda
- Public Interest Foundation Hokkaido Cancer Society, Sapporo, Hokkaido, Japan
- Department of Gastroenterology, National Hospital organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
| | - Yuji Naito
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Keita Mori
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Osaka, Japan
| |
Collapse
|
3
|
Mori Y, Iwatsubo T, Hakoda A, Kameishi S, Takayama K, Sasaki S, Koshiba R, Nishida S, Harada S, Tanaka H, Sugawara N, Ota K, Kawaguchi S, Kojima Y, Takeuchi T, Higuchi K, Nishikawa H. Red Dichromatic Imaging Improves the Recognition of Bleeding Points During Endoscopic Submucosal Dissection. Dig Dis Sci 2024; 69:216-227. [PMID: 37955761 DOI: 10.1007/s10620-023-08145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Previous studies have indicated that red dichromatic imaging (RDI) improved the visibility of gastrointestinal bleeding. AIMS To investigate the recognition of bleeding points during endoscopic submucosal dissection (ESD) under RDI compared with that under white light imaging (WLI). METHODS Consecutive patients scheduled to undergo esophageal or gastric ESD at a single center were enrolled. Paired videos of active bleeding during ESD under WLI and RDI were created. Six endoscopists identified the virtual hemostasis point on still images after random video viewing. The distance between virtual hemostasis and actual bleeding points was scored in four levels (0-3 points), and the association with the color value was analyzed in both WLI and RDI. RESULTS We evaluated 116 videos for 58 bleeding points. The median visibility score and recognition rate were significantly higher for RDI than for WLI (2.17 vs. 1.42, p < 0.001 and 62.1% vs 27.6%, p < 0.001). Additionally, the recognition rate of trainees in RDI was higher than that of experts in WLI (60.3% vs. 43.1%, p = 0.067). The median color difference of RDI was significantly higher than that of WLI (8.97 vs. 3.69, p < 0.001). Furthermore, the correlation coefficient between the visibility score and color difference was 0.712 (strong correlation). CONCLUSION RDI can provide better recognition of bleeding points than WLI during ESD. Therefore, further studies are warranted to investigate whether RDI improves ESD outcomes.
Collapse
Affiliation(s)
- Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shin Kameishi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kazuki Takayama
- Department of Gastroenterology, First Towakai Hospital, Takatsuki, Osaka, Japan
| | - Shun Sasaki
- Department of Gastroenterology, First Towakai Hospital, Takatsuki, Osaka, Japan
| | - Ryoji Koshiba
- Department of Gastroenterology, Midorigaoka Hospital, Takatsuki, Osaka, Japan
| | - Shinya Nishida
- Department of Gastroenterology, Midorigaoka Hospital, Takatsuki, Osaka, Japan
| | - Satoshi Harada
- Department of Gastroenterology, Katsuragi Hospital, Kishiwada, Osaka, Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Shinpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- Morinomiya Gastrointestinal Endoscopy Fujita Clinic, Osaka, Osaka, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- Kubo Clinic, Osaka, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Hiroki Nishikawa
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| |
Collapse
|
4
|
Nakajima N, Takeuchi T, Hokari R, Narimatsu K, Iijima K, Koizumi S, Kasugai K, Ebi M, Nagahara A, Takeda T, Tomita T, Shinzaki S, Mizukami K, Murakami K, Yagi N, Mukai R, Okumura T, Tanabe H, Tanaka K, Iwamoto J, Irisawa A, Fukushi K, Kataoka H, Nishie H, Fujiwara Y, Otani K, Handa O, Maruyama Y, Uraoka T, Hosaka H, Furuta T, Takagi T, Nakamura M, Nyumura Y, Hakoda A, Sugawara N, Iwatubo T, Ota K, Kawaguchi S, Higuchi K, Nishikawa H. Background factors of idiopathic peptic ulcers and optimal treatment methods: a multicenter retrospective Japanese study. J Clin Biochem Nutr 2024; 74:82-89. [PMID: 38292123 PMCID: PMC10822756 DOI: 10.3164/jcbn.23-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 02/01/2024] Open
Abstract
This study investigated the trends in idiopathic peptic ulcers, examined the characteristics of refractory idiopathic peptic ulcer, and identified the optimal treatment. The characteristics of 309 patients with idiopathic peptic ulcer were examined. We allocated idiopathic peptic ulcers that did not heal after 8 weeks' treatment (6 weeks for duodenal ulcers) to the refractory group and those that healed within this period to the healed group. The typical risk factors for idiopathic peptic ulcer (atherosclerosis-related underlying disease or liver cirrhosis complications) were absent in 46.6% of patients. Absence of gastric mucosal atrophy (refractory group: 51.4%, healed group: 28.4%; p = 0.016), and gastric fundic gland polyps (refractory group: 17.6%, healed group: 5.9%; p = 0.045) were significantly more common in the refractory group compared to the healed group. A history of H. pylori eradication (refractory group: 85.3%, healed group: 66.0%; p = 0.016), previous H. pylori infection (i.e., gastric mucosal atrophy or history of H. pylori eradication) (refractory group: 48.5%, healed group: 80.0%; p = 0.001), and potassium-competitive acid blocker treatment (refractory group: 28.6%, healed group, 64.1%; p = 0.001) were significantly more frequent in the healed group compared to the refractory group. Thus, acid hypersecretion may be a major factor underlying the refractoriness of idiopathic peptic ulcer.
Collapse
Affiliation(s)
- Noriyuki Nakajima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Toshihisa Takeuchi
- Endoscopy Centre, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Saitama 359-0042, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Saitama 359-0042, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Shigeto Koizumi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kunio Kasugai
- Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
| | - Masahide Ebi
- Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Toshihiko Tomita
- Department of Gastroenterology, Faculty of Medicine, Hyogo Medical University, Hyogo 663-8501, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology, Faculty of Medicine, Hyogo Medical University, Hyogo 663-8501, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5503, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5503, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu 500-8523, Japan
| | - Rieko Mukai
- Department of Gastroenterology, Asahi University Hospital, Gifu 500-8523, Japan
| | - Toshikatsu Okumura
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Hiroki Tanabe
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido 078-8510, Japan
| | - Kazuyuki Tanaka
- Department of Gastroenterology, Asahikawa-Kosei General Hospital, Hokkaido 078-8211, Japan
| | - Junichi Iwamoto
- Department of Gastroenterology, Endoscopy Center, Tokyo Medical University Ibaraki Medical Center, Tokyo 300-0395, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0207, Japan
| | - Koh Fukushi
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0207, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi 467-8602, Japan
| | - Hirotada Nishie
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi 467-8602, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Osamu Handa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Yasuhiko Maruyama
- Division of Gastroenterology, Fujieda Municlpal General Hospital, Shizuoka 426-8677, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University, Gunma 371-0034, Japan
| | - Hiroko Hosaka
- Department of Gastroenterology and Hepatology, Gunma University, Gunma 371-0034, Japan
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University Hospital, Shizuoka 431-3192, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Masakatsu Nakamura
- Department of Gastroenterology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Yuya Nyumura
- Department of Surgery, Fuji City General Hospital, Shizuoka 417-8567, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Taro Iwatubo
- Endoscopy Centre, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Kazuhiro Ota
- Endoscopy Centre, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Shinpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| | - Hiroki Nishikawa
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
| |
Collapse
|
5
|
Sugawara N, Iwatsubo T, Tanaka H, Hakoda A, Ota K, Takeuchi T, Nishikawa H. A novel method, gel immersion endoscopic injection sclerotherapy, may make the procedure easier and more accurate. Endoscopy 2023; 55:E926-E927. [PMID: 37500089 PMCID: PMC10374399 DOI: 10.1055/a-2114-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hiroki Nishikawa
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| |
Collapse
|
6
|
Ota K, Takeuchi T, Higuchi K, Sasaki S, Mori Y, Tanaka H, Hakoda A, Sugawara N, Iwatsubo T, Nishikawa H. Frontiers in Endoscopic Treatment for Gastroesophageal Reflux Disease. Digestion 2023; 105:5-10. [PMID: 37591209 DOI: 10.1159/000533200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/05/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The 3rd edition of the evidence-based clinical practice guidelines for gastroesophageal reflux disease (GERD) 2021 from the Japanese Society of Gastroenterology states that the treatment strategy for potassium-competitive acid blocker (PCAB)-refractory GERD remains unclear. Furthermore, even if GERD improves with the administration of an acid secretion inhibitor, it is feared that GERD may flare up after discontinuation of the drug, resulting in some cases in which patients are forced to take vonoprazan semipermanently (the so-called PCAB-dependent cases). From a global perspective, PCAB is not yet used in all countries and regions, and measures that can be taken now for cases in which a conventional proton pump inhibitor (PPI) is inadequately effective need to be devised. SUMMARY Endoscopic treatment for GERD may be effective in cases where conventional proton pump inhibitors are ineffective; however, there are insufficient long-term studies to corroborate this, and its cost effectiveness is unknown. Other treatment options for PCAB or PPI-refractory GERD include surgical procedures (Nissen and Toupet operations), which have a longer history than endoscopic treatment for GERD. However, their long-term results are not as good as those of acid secretion inhibitors, and they are not cost effective. Endoscopic treatment for GERD may fill gaps in inadequate surgical treatment. In April 2022, endoscopic anti-reflux mucosal resections (ARMS [anti-reflux mucosectomy] and ESD-G [endoscopic submucosal dissection for GERD]) were approved for reimbursement, making endoscopic treatment of GERD possible throughout Japan. KEY MESSAGES It is important to identify the background factors in cases in which endoscopic treatments are effective.
Collapse
Affiliation(s)
- Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shun Sasaki
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hiroki Nishikawa
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| |
Collapse
|
7
|
Kawasaki Y, Kakimoto K, Tanaka Y, Shimizu H, Nishida K, Numa K, Kinoshita N, Tatsumi Y, Nakazawa K, Koshiba R, Hirata Y, Ota K, Sakiyama N, Terazawa T, Takeuchi T, Miyazaki T, Goto M, Yokota H, Makizaki Y, Tanaka Y, Nakajima S, Ohno H, Higuchi K, Nakamura S, Nishikawa H. Relationship between Chemotherapy-Induced Diarrhea and Intestinal Microbiome Composition. Digestion 2023; 104:357-369. [PMID: 37231829 PMCID: PMC10614279 DOI: 10.1159/000528282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/31/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND AIM Fluoropyrimidines (FPs) are key drugs in many chemotherapy regimens; however, recipients are often prone to diarrhea due to gastrointestinal toxicity. Disruption of the intestinal epithelial barrier function by FPs leads to dysbiosis, which may exacerbate intestinal epithelial cell damage as a secondary effect and trigger diarrhea. However, despite studies on chemotherapy-induced changes in the intestinal microbiome of humans, the relationship between dysbiosis and diarrhea is unclear. In this study, we aimed to investigate the relationship between chemotherapy-induced diarrhea and the intestinal microbiome. METHODS We conducted a single-center prospective observational study. Twenty-three patients who received chemotherapy, including FPs as first-line chemotherapy for colorectal cancer, were included. Stool samples were collected before the start of chemotherapy and after one cycle of treatment to analyze intestinal microbiome composition and perform PICRUSt predictive metagenomic analysis. RESULTS Gastrointestinal toxicity was observed in 7 of 23 patients (30.4%), diarrhea was observed in 4 (17.4%), and nausea and anorexia were observed in 3 (13.0%). In 19 patients treated with oral FPs, the α diversity of the microbial community decreased significantly following chemotherapy only in the diarrheal group. At the phylum level, the diarrheal group showed a significant decrease in the abundance of Firmicutes and a significant increase in the abundance of Bacteroidetes with chemotherapy (p = 0.013 and 0.011, respectively). In the same groups, at the genus level, Bifidobacterium abundance was significantly decreased (p = 0.019). In contrast, in the non-diarrheal group, Actinobacteria abundance increased significantly with chemotherapy at the phylum level (p = 0.011). Further, Bifidobacterium, Fusicatenibacter, and Dorea abundance significantly increased at the genus level (p = 0.006, 0.019, and 0.011, respectively). The PICRUSt predictive metagenomic analysis revealed that chemotherapy caused significant differences in membrane transport in KEGG pathway level 2 and in 8 KEGG pathway level 3, including transporters and oxidative phosphorylation in the diarrhea group. CONCLUSION Organic-acid-producing bacteria seem to be involved in diarrhea associated with chemotherapy, including FPs.
Collapse
Affiliation(s)
- Yuka Kawasaki
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kazuki Kakimoto
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yasuyoshi Tanaka
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hikaru Shimizu
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Koji Nishida
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Keijiro Numa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Naohiko Kinoshita
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoshihiro Tatsumi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kei Nakazawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryoji Koshiba
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuki Hirata
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kazuhiro Ota
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Naokuni Sakiyama
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Tetsuji Terazawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Toshihisa Takeuchi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takako Miyazaki
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masahiro Goto
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Haruka Yokota
- R&D Center, Biofermin Pharmaceutical Co., Ltd., Kobe, Japan
| | | | - Yoshiki Tanaka
- R&D Center, Biofermin Pharmaceutical Co., Ltd., Kobe, Japan
| | | | - Hiroshi Ohno
- R&D Center, Biofermin Pharmaceutical Co., Ltd., Kobe, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shiro Nakamura
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hiroki Nishikawa
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| |
Collapse
|
8
|
Sasaki S, Ota K, Tanaka R, Imai Y, Kojima Y, Akutagawa H, Iwatsubo T, Sugawara N, Hakoda A, Tanaka H, Mori Y, Lee S, Takeuchi T, Nishikawa H. A case of recurrent massive thickening of the gastric wall caused by pancreatitis of the gastric ectopic pancreas: Detailed pathogenesis based on imaging. DEN Open 2023; 3:e188. [DOI: 10.1002/deo2.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Shun Sasaki
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
- Endoscopy Center Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Ryo Tanaka
- Department of General and Gastroenterological Surgery Osaka Medical and Pharmaceutical University Osaka Japan
| | - Yoshiro Imai
- Department of General and Gastroenterological Surgery Osaka Medical and Pharmaceutical University Osaka Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
- Endoscopy Center Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Hiroshi Akutagawa
- Department of Pathology Osaka Medical and Pharmaceutical University Osaka Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
- Endoscopy Center Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Yosuke Mori
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Sang‐Woong Lee
- Department of General and Gastroenterological Surgery Osaka Medical and Pharmaceutical University Osaka Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
- Endoscopy Center Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Hiroki Nishikawa
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| |
Collapse
|
9
|
Nihei K, Minashi K, Yano T, Shimoda T, Fukuda H, Muto M, Mizuaswa J, Takizawa K, Aoyama I, Ishiyama A, Kawata N, Kikuchi D, Hanaoka N, Oda I, Morita Y, Tajika M, Fujiwara J, Yamamoto Y, Katada C, Hori S, Doyama H, Oyama T, Nebiki H, Amagai K, Kubota Y, Inokuchi Y, Kobayashi N, Suzuki T, Hirasawa K, Takeuchi T, Kadota T. Final Analysis of Diagnostic Endoscopic Resection Followed by Selective Chemoradiotherapy for Stage I Esophageal Cancer: JCOG0508. Gastroenterology 2023; 164:296-299.e2. [PMID: 36240951 DOI: 10.1053/j.gastro.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Keiji Nihei
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
| | - Keiko Minashi
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tadakazu Shimoda
- Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Junki Mizuaswa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Takizawa
- Department of Endoscopy, Koyukai Shin-Sapporo Hospital, Hokkaido, Japan
| | - Ikuo Aoyama
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto
| | - Akiyoshi Ishiyama
- Department of Upper GI Medicine, Cancer Institute Hospital of JFCR, Tokyo
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka
| | | | - Noboru Hanaoka
- Department of Gastroenterology, Osaka Red Cross Hospital, Osaka
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo
| | | | - Junko Fujiwara
- Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo
| | | | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa
| | - Shinichiro Hori
- Department of Gastroenterology, NHO Shikoku Cancer Center, Matsuyama
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka
| | - Kenji Amagai
- Department of Gastroenterology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Ibaraki
| | - Yutaro Kubota
- Department of Gastroenterology, Showa University Hospital, Tokyo
| | | | | | | | - Kingo Hirasawa
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama
| | - Toshihisa Takeuchi
- Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka
| | - Tomohiro Kadota
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Iwatsubo T, Ota K, Takeuchi T. Submucosal Tumor-Like Lesion in Autoimmune Gastritis: A Rare Case of Fundic Gland Type of Gastric Adenocarcinoma. Clin Gastroenterol Hepatol 2023; 21:A19. [PMID: 35850416 DOI: 10.1016/j.cgh.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan; Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan; Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan; Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| |
Collapse
|
11
|
Tanaka H, Takeuchi T, Nishida S, Hongo H, Takii M, Higashino T, Sanomura M, Miyazaki H, Hoshimoto M, Kimura T, Sakaguchi M, Abe T, Hakoda A, Sugawara N, Iwatsubo T, Kawaguchi S, Ota K, Kojima Y, Higuchi K. Examination on Factors Affecting Symptom Change after Drug Withdrawal in Patients with Mild Erosive Gastroesophageal Reflux Disease Undergoing Symptom-Controlled Maintenance Therapy with Acid-Secretion Inhibition Drugs. Digestion 2023:1-13. [PMID: 36649678 DOI: 10.1159/000528418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/03/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION In patients with gastroesophageal reflux disease (GERD) on maintenance therapy with acid-suppressive drugs, it is not clear what background factors allow patients to discontinue the drugs. The aims of this study were to examine the relationship of the changes in the frequency and severity of gastrointestinal symptoms after discontinuation of acid-secretion inhibitors for erosive GERD (eGERD) with possible patient background factors and to identify factors that influence these changes. METHODS This is a multicenter, open-label, interventional, exploratory study. eGERD patients with mild mucosal injury whose symptoms were under control and who were on maintenance therapy with acid-suppressive drugs were withdrawn from the drug treatment for 4 weeks. We examined the relationship of patient backgrounds (sex, age, body mass index, alcohol consumption, smoking habits), esophageal hiatal hernia, Helicobacter pylori infection, pepsinogen I and II concentrations and I/II ratios, blood gastrin levels before and after drug discontinuation with total score change in Frequency Scale for the Symptoms of GERD (FSSG). RESULTS Of the 92 patients whose symptoms could be assessed before and after drug withdrawal, 66 patients (71.7% of the total) had FSSG <8 and no symptom relapse after the withdrawal. Furthermore, patient background factors that may be related to symptom relapse/non-relapse were examined, but no related factors were detected. The maintenance medications before discontinuation in the above 92 patients were a proton pump inhibitor (PPI) and vonoprazan (VPZ, a potassium ion competitive acid blocker). Since PPI and VPZ were administered to about the same number of patients, though incidentally, we additionally examined the relationship between patient background factors and symptom relapse/non-relapse by treatment group. As a result, no relevant background factors were detected in both groups. Although there were no significant differences between the two groups, the severity and frequency of symptom recurrence in the VPZ group tended to be higher than in the PPI group. CONCLUSIONS Consideration of background factors is unlikely to be required in the discontinuation of maintenance therapy for eGERD. There was no significant difference in the extent of disease or frequency of recurrence during the discontinuation period, regardless of whether the drug before discontinuation was a PPI or VPZ.
Collapse
Affiliation(s)
- Hironori Tanaka
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshihisa Takeuchi
- Endoscopic Centre, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Shinya Nishida
- Endoscopic Centre, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Hitosi Hongo
- Fujita Gastroenterological Hospital, Osaka, Japan
| | - Michiaki Takii
- Osaka Medical and Pharmaceutical University Mishima-Minami Hospital, Takatsuki, Japan
| | | | | | | | | | | | - Masahiro Sakaguchi
- Department of Internal Medicine, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Takashi Abe
- Hanwasumiyoshi General Hospital, Osaka, Japan
| | - Akitoshi Hakoda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Noriaki Sugawara
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Taro Iwatsubo
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shinpei Kawaguchi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kazuhiro Ota
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuichi Kojima
- Endoscopic Centre, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| |
Collapse
|
12
|
Dohi O, Ono S, Kawada K, Kitamura S, Hatta W, Hori S, Kanzaki H, Murao T, Yagi N, Sasaki F, Hashiguchi K, Oka S, Katada K, Shimoda R, Mizukami K, Suehiro M, Takeuchi T, Katsuki S, Tsuda M, Naito Y, Kawano T, Haruma K, Ishikawa H, Mori K, Kato M. Linked color imaging provides enhanced visibility with a high color difference in upper gastrointestinal neoplasms. J Gastroenterol Hepatol 2023; 38:79-86. [PMID: 36184994 DOI: 10.1111/jgh.16018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/07/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM The aim of this post-hoc analysis in a randomized, controlled, multicenter trial was to evaluate the visibility of upper gastrointestinal (UGI) neoplasms detected using linked color imaging (LCI) compared with those detected using white light imaging (WLI). METHODS The visibility of the detected UGI neoplasm images obtained using both WLI and LCI was subjectively reviewed, and the median color difference (ΔE) between each lesion and the surrounding mucosa according to the CIE L*a*b* color space was evaluated objectively. Multivariate logistic regression analysis was performed to identify factors associated with neoplasms that were missed under WLI and detected under LCI. RESULTS A total of 120 neoplasms, including 10, 32, and 78 neoplasms in the pharynx, esophagus, and stomach, respectively, were analyzed in this study. LCI enhanced the visibility 80.9% and 93.6% of neoplasms in pharynx/esophagus and stomach compared with WLI, respectively. LCI also achieved a higher ΔE of enhanced neoplasms compared with WLI in the pharynx/esophagus and stomach. The median WLI ΔE values for gastric neoplasms missed under WLI and later detected under LCI were significantly lower than those for gastric neoplasms detected under WLI (8.2 vs 9.6, respectively). Furthermore, low levels of WLI ΔE (odds ratio [OR], 7.215) and high levels of LCI ΔE (OR, 22.202) were significantly associated with gastric neoplasms missed under WLI and later detected under LCI. CONCLUSION Color differences were independently associated with missing gastric neoplasms under WLI, suggesting that LCI has an obvious advantage over WLI in enhancing neoplastic visibility.
Collapse
Affiliation(s)
- Osamu Dohi
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Takahisa Murao
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiro Katada
- Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Yosa-gun, Kyoto, Japan
| | - Ryo Shimoda
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | | | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Toshihisa Takeuchi
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Shinichi Katsuki
- Gastroenterology, Otaru Ekisaikai General Hospital, Otaru, Japan
| | - Momoko Tsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Yuji Naito
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | | | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Osaka, Japan
| | - Keita Mori
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | | |
Collapse
|
13
|
Nakajima N, Takeuchi T. [Idiopathic peptic ulcer disease]. Nihon Shokakibyo Gakkai Zasshi 2023; 120:816-826. [PMID: 37821371 DOI: 10.11405/nisshoshi.120.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Noriyuki Nakajima
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University
| | | |
Collapse
|
14
|
Nakata R, Tanaka F, Sugawara N, Kojima Y, Takeuchi T, Shiba M, Higuchi K, Fujiwara Y. Analysis of autonomic function during natural defecation in patients with irritable bowel syndrome using real-time recording with a wearable device. PLoS One 2022; 17:e0278922. [PMID: 36490298 PMCID: PMC9733845 DOI: 10.1371/journal.pone.0278922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autonomic dysfunction is a factor in irritable bowel syndrome (IBS). However, there are no reports of autonomic nervous system (ANS) activity during natural defecation in patients with IBS. We aimed to clarify the relationship between ANS activity and life events, such as defecation and abdominal symptoms, using real-time recording. METHODS Six patients with IBS and 14 healthy controls were enrolled in this prospective multicenter study. ANS activity was recorded for 24 h using a T-shirt wearable device, and life events were recorded simultaneously in real time using a smartphone application software. Low frequency/high frequency (LF/HF) and HF calculated by power spectrum analysis were defined as activity indicators of the sympathetic and parasympathetic nerves, respectively. RESULTS The means of LF/HF and HF in the period with positive symptoms were comparable between the groups; however, the sum of LF/HF, sum of ΔLF/HF, and the maximum variation in ΔLF/HF were significantly higher in the IBS group. In the IBS group, the sum of ΔLF/HF and LF/HF increased significantly from 2 min before defecation, and the sum of LF/HF remained significantly higher until 9 min after defecation. The sum of ΔLF/HF at 2 min before defecation was significantly positively correlated with the intensity of abdominal pain and diarrhea and constipation scores. In contrast, it was significantly negatively correlated with defecation satisfaction and health-related quality of life. CONCLUSIONS In patients with IBS, sympathetic nerve activity was activated 2 min before defecation, which was correlated with abdominal symptoms and lower QOL.
Collapse
Affiliation(s)
- Rieko Nakata
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazuhide Higuchi
- Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
15
|
Tanaka H, Ota K, Sugawara N, Iwatsubo T, Kawaguchi S, Mori Y, Nakajima N, Hakoda A, Kojima Y, Inoue Y, Takeuchi T, Higuchi K. Treating an Intractable Jejunocutaneous Fistula by Endoscopic Metallic Stent Placement: A Case Report of Successful Palliative Endoscopic Treatment in a Case Demonstrating Peritoneal Dissemination with Terminal Stage Gastric Cancer. Intern Med 2022; 61:3343-3347. [PMID: 35400702 PMCID: PMC9751718 DOI: 10.2169/internalmedicine.9331-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 74-year-old woman with recurrent gastric cancer underwent laparotomy for peritoneal dissemination, and the damaged jejunum formed a jejunocutaneous fistula. Because conservative treatment alone could not cure the fistula, we performed an endoscopic placement of a partially covered self-expandable metallic stent (SEMS) to cover the fistula. After the procedure, the contrast medium no longer leaked from the intestinal lumen. One month after stent placement, the cutaneous opening had closed. This case report demonstrates the potential for using partially covered SEMS to treat intractable jejunocutaneous fistula in patients with terminal-stage malignant tumors.
Collapse
Affiliation(s)
- Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Shimpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriyuki Nakajima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Minase Hospital, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| |
Collapse
|
16
|
Ota K, Mori Y, Tanaka H, Murata T, Iwatsubo T, Kawaguchi S, Kojima Y, Nakajima N, Hakoda A, Sugawara N, Takeuchi T, Higuchi K. Severe Anemia Caused by Gastric Antral Vascular Ectasia and Autoimmune Gastritis. Intern Med 2022; 61:2873-2876. [PMID: 35249927 PMCID: PMC9593141 DOI: 10.2169/internalmedicine.9225-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 80-year-old man presented to our hospital with general fatigue on exertion that had gradually worsened over 6 months. His blood test revealed severe anemia, and gastroscopy revealed findings consistent with gastric antral vascular ectasia (GAVE) and autoimmune gastritis. We diagnosed the patient with severe anemia caused by GAVE and autoimmune gastritis. The present case suggested that GAVE is triggered by autoimmune gastritis, and the mechanism is likely related to hypergastrinemia. The reporting of this rare case may help elucidate the cause of GAVE, which is currently unknown.
Collapse
Affiliation(s)
- Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Takahiro Murata
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Shimpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriyuki Nakajima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| |
Collapse
|
17
|
Maki Y, Natsume J, Ito Y, Okai Y, Bagarinao E, Yamamoto H, Ogaya S, Takeuchi T, Fukasawa T, Sawamura F, Mitsumatsu T, Maesawa S, Saito R, Takahashi Y, Kidokoro H. Involvement of the Thalamus, Hippocampus, and Brainstem in Hypsarrhythmia of West Syndrome: Simultaneous Recordings of Electroencephalography and fMRI Study. AJNR Am J Neuroradiol 2022; 43:1502-1507. [PMID: 36137665 PMCID: PMC9575537 DOI: 10.3174/ajnr.a7646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE West syndrome is a developmental and epileptic encephalopathy characterized by epileptic spasms, neurodevelopmental regression, and a specific EEG pattern called hypsarrhythmia. Our aim was to investigate the brain activities related to hypsarrhythmia at onset and focal epileptiform discharges in the remote period in children with West syndrome using simultaneous electroencephalography and fMRI recordings. MATERIALS AND METHODS Fourteen children with West syndrome underwent simultaneous electroencephalography and fMRI at the onset of West syndrome. Statistically significant blood oxygen level-dependent responses related to hypsarrhythmia were analyzed using an event-related design of 4 hemodynamic response functions with peaks at 3, 5, 7, and 9 seconds after the onset of each event. Six of 14 children had focal epileptiform discharges after treatment and underwent simultaneous electroencephalography and fMRI from 12 to 25 months of age. RESULTS At onset, positive blood oxygen level-dependent responses were seen in the brainstem (14/14 patients), thalami (13/14), basal ganglia (13/14), and hippocampi (13/14), in addition to multiple cerebral cortices. Group analysis using hemodynamic response functions with peaks at 3, 5, and 7 seconds showed positive blood oxygen level-dependent responses in the brainstem, thalamus, and hippocampus, while positive blood oxygen level-dependent responses in multiple cerebral cortices were seen using hemodynamic response functions with peaks at 5 and 7 seconds. In the remote period, 3 of 6 children had focal epileptiform discharge-related positive blood oxygen level-dependent responses in the thalamus, hippocampus, and brainstem. CONCLUSIONS Positive blood oxygen level-dependent responses with hypsarrhythmia appeared in the brainstem, thalamus, and hippocampus on earlier hemodynamic response functions than the cerebral cortices, suggesting the propagation of epileptogenic activities from the deep brain structures to the neocortices. Activation of the hippocampus, thalamus, and brainstem was still seen in half of the patients with focal epileptiform discharges after adrenocorticotropic hormone therapy.
Collapse
Affiliation(s)
- Y Maki
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - J Natsume
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Developmental Disability Medicine (J.N.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - Y Ito
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
- Department of Pediatrics (Y.I.), Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center, Okazaki, Japan
| | - Y Okai
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
- Department of Pediatric Neurology (Y.O.), Toyota Municipal Child Development Center, Toyota, Japan
| | - E Bagarinao
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - H Yamamoto
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - S Ogaya
- Department of Pediatric Neurology (S.O.), Aichi Developmental Disability Center Central Hospital, Kasugai, Japan
| | - T Takeuchi
- Department of Pediatrics (T.T.), Japanese Red Cross Nagoya First Hospital
| | - T Fukasawa
- Nagoya, Japan; and Department of Pediatrics (T.F.), Anjo Kosei Hospital, Anjo, Japan
| | - F Sawamura
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - T Mitsumatsu
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - S Maesawa
- Neurosurgery (S.M., R.S.), Nagoya University Graduate School of Medicine, Nagoya, Japan
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| | - R Saito
- Neurosurgery (S.M., R.S.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Takahashi
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
| | - H Kidokoro
- From the Departments of Pediatrics (Y.M., J.N., Y.I., Y.O., H.Y., F.S., T.M., Y.T., H.K.)
- Brain and Mind Research Center (J.N., Y.I., Y.O., E.B., H.Y., S.M., H.K.), Nagoya University, Nagoya, Japan
| |
Collapse
|
18
|
Iwatsubo T, Mori Y, Abe S, Hakoda A, Sugawara N, Ota K, Takeuchi T. Additional irrigation tube with therapeutic endoscope to aid gel immersion endoscopic submucosal dissection. Endoscopy 2022; 55:E64-E65. [PMID: 36179712 PMCID: PMC9829805 DOI: 10.1055/a-1930-6140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan,Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Shinya Abe
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan,Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan,Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| |
Collapse
|
19
|
Iwatsubo T, Takeuchi T, Hakoda A, Fujiwara Y, Nagami Y, Naito Y, Dohi O, Tatsuta T, Sawaya M, Jin X, Koike T, Sugimoto M, Murata M, Hamada K, Okada H, Kobara H, Chiyo T, Yoshida N, Tomatsuri N, Inaba T, Ishikawa S, Nagahara A, Ueyama H, Koizumi E, Iwakiri K, Mizukami K, Murakami K, Furuta T, Suzuki T, Ogasawara N, Kasugai K, Isomoto H, Kawaguchi K, Shibagaki K, Kataoka H, Shimura T, Suzuki H, Nishizawa T, Higuchi K. Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis. Gastric Cancer 2022; 25:916-926. [PMID: 35622240 DOI: 10.1007/s10120-022-01303-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The risk of bleeding after gastric endoscopic submucosal dissection (ESD) in antithrombotic agent users has increased, and its management remains a problem. Second-look endoscopy (SLE) following gastric ESD in antithrombotic agent users may be effective in preventing delayed bleeding, but this requires elucidation. Therefore, this study aimed to investigate the efficacy of SLE in reducing bleeding after gastric ESD in patients receiving antithrombotic agents. METHODS This retrospective cohort study was conducted at 19 referral hospitals in Japan. A total of 1,245 patients who were receiving antithrombotic agents underwent gastric ESD between January 2013 and July 2018. The incidence of delayed bleeding was compared between SLE and non-SLE groups using propensity score matching analysis. RESULTS Overall, 858 patients (SLE group, 657 patients; non-SLE group, 201 patients) were analyzed. After matching, 198 pairs were created. Delayed bleeding occurred in 10 patients (5.1%) in the SLE group and 16 patients (8.1%) in the non-SLE group [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.23-1.46, p = 0.310]. In the subgroup analysis, SLE reduced the incidence of delayed bleeding in patients receiving heparin bridging therapy (6.3% and 40.0%, respectively; p = 0.004). In the SLE group, prophylactic coagulation did not significantly reduce delayed bleeding compared to the no treatment group (14.6% and 8.6%, respectively; p = 0.140). CONCLUSIONS SLE was ineffective in reducing bleeding after gastric ESD in antithrombotic agent users, overall. A prospective comparative study is warranted to definitively evaluate the effectiveness of SLE in reducing bleeding in high-risk patients.
Collapse
Affiliation(s)
- Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Toshihisa Takeuchi
- Endoscopic Center, Osaka Medical and Pharmaceutical University Hospital, 2-7, Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuji Naito
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Tatsuta
- Departments of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Manabu Sawaya
- Departments of Gastroenterology and Hematology, Hirosaki National Hospital, Aomori, Japan
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kenta Hamada
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiroyuki Okada
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Taiga Chiyo
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Norimasa Yoshida
- Department of General Internal Medicine and Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan
| | - Naoya Tomatsuri
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Shigenao Ishikawa
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Eriko Koizumi
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takahiro Suzuki
- Center for Clinical Research, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University Hospital, Aichi, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University Hospital, Aichi, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Koichiro Kawaguchi
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kotaro Shibagaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Tokyo, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| |
Collapse
|
20
|
Sugawara N, Iwatsubo T, Takeuchi T. Endoscopic hemostasis of an active hypopharyngeal hemorrhage via gel immersion endoscopy. Dig Endosc 2022; 34:e141-e142. [PMID: 35880413 DOI: 10.1111/den.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/23/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| |
Collapse
|
21
|
Ota K, Kojima Y, Takeuchi T. Collaborative management with dental specialists for loose teeth in patients undergoing multiple endoscopies. Dig Endosc 2022; 34:1261. [PMID: 35778926 DOI: 10.1111/den.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/30/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Kazuhiro Ota
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yuichi Kojima
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Toshihisa Takeuchi
- Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| |
Collapse
|
22
|
Tawa H, Kakimoto K, Numa K, Kinoshita N, Kawasaki Y, Tatsumi Y, Koshiba R, Nakata S, Hirata Y, Ota K, Sakiyama N, Kojima Y, Koubayashi E, Nishikawa H, Takeuchi T, Inoue T, Fukunishi S, Miyazaki T, Nakamura S, Higuchi K. Therapeutic Drug Monitoring of Golimumab for the Prediction of Long-Term Clinical Remission in Patients with Ulcerative Colitis. Digestion 2022; 103:329-338. [PMID: 35697000 PMCID: PMC9932821 DOI: 10.1159/000524593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS A considerable number of patients with ulcerative colitis (UC) who initially respond to golimumab (GLM), an anti-TNF-α antibody, gradually lose clinical response. Therapeutic drug monitoring has been proposed to optimize serum anti-TNF-α antibody concentrations before the loss of response; however, little is known about ideal serum GLM concentrations. We aimed to evaluate whether the serum GLM trough levels (TLs) early after the initiation of induction therapy affect the long-term outcomes in UC and to identify the early GLM TLs that should be targeted for better long-term outcomes. METHODS Thirty-one patients were prospectively evaluated. The primary outcome was clinical remission at 54 weeks, and we measured the serum GLM TLs at weeks 6, 10, and 14. Receiver operating characteristic (ROC) curves were constructed to identify optimal GLM TL thresholds early after induction therapy that were associated with clinical remission at week 54. RESULTS The GLM TL at week 14, but not at weeks 6 or 10, was significantly associated with clinical remission at week 54 (median [IQR] 1.6 [1.3-1.6] μg/mL vs. 0.9 [0.6-1.3] μg/mL; p = 0.04). The area under the ROC curve for GLM TLs at week 14 was 0.78. We identified a week-14 GLM TL of 1.1 μg/mL as the target threshold for achieving clinical remission at week 54. CONCLUSION Our results demonstrate the value of early serum GLM TLs in predicting the long-term outcomes of GLM for patients with UC.
Collapse
|
23
|
Nakata S, Kakimoto K, Numa K, Kinoshita N, Kawasaki Y, Tatsumi Y, Tawa H, Koshiba R, Hirata Y, Ota K, Sakiyama N, Kojima Y, Nishikawa H, Inoue T, Takeuchi T, Fukunishi S, Miyazaki T, Nakamura S, Higuchi K. Risk Factors for Nephrotoxicity due to Tacrolimus Therapy for Ulcerative Colitis. Digestion 2022; 103:339-346. [PMID: 35705006 PMCID: PMC9932845 DOI: 10.1159/000524594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The calcineurin inhibitor tacrolimus is reportedly effective for moderate/severe ulcerative colitis (UC); however, it is also reportedly associated with nephrotoxicity. We investigated the risk factors for tacrolimus-induced nephrotoxicity and whether renal impairment adversely affected the outcomes of tacrolimus treatment in patients with UC. METHODS We conducted a retrospective study of 93 patients with UC who were administered tacrolimus leading to high trough levels (10-15 ng/mL) for 2 weeks and low trough levels (5-10 ng/mL) for 3 months. RESULTS Acute kidney injury (AKI) occurred in 44 patients (47.3%) during tacrolimus treatment. Of these patients, 34 (36.6%) developed AKI during the high trough phase and 17 (18.3%) developed AKI when the trough value exceeded the original target value of 15 ng/mL. Multivariate logistic regression analysis revealed that the male sex was significantly associated with AKI (p = 0.002, AOR = 4.38, 95% CI [1.69-11.3]). Clinical remission rate after 4, 8, 12, and 24 weeks of tacrolimus treatment in patients with AKI was lower than that in patients without AKI. Six patients (6.5%) had chronic kidney disease (CKD) after tacrolimus treatment completion, and all patients with CKD developed AKI during treatment. The median duration of treatment with no improvement in AKI was significantly longer in patients with CKD than in those without CKD (p = 0.016). CONCLUSION We revealed the risk factors for tacrolimus-induced nephrotoxicity. Renal impairment occurrence adversely affected the tacrolimus treatment outcome; therefore, it is important to carefully administer tacrolimus to prevent renal impairment.
Collapse
|
24
|
Kinoshita N, Kakimoto K, Shimizu H, Nishida K, Numa K, Kawasaki Y, Tawa H, Nakazawa K, Koshiba R, Hirata Y, Sakiyama N, Koubayashi E, Takeuchi T, Miyazaki T, Higuchi K, Nakamura S, Nishikawa H. Serum IL-13 Predicts Response to Golimumab in Bio-Naïve Ulcerative Colitis. J Clin Med 2022; 11:jcm11174952. [PMID: 36078882 PMCID: PMC9456517 DOI: 10.3390/jcm11174952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022] Open
Abstract
A certain number of patients with ulcerative colitis (UC) are refractory to anti-TNF-α antibodies; biomarkers are thus needed to predict treatment efficacy. This study aimed to evaluate whether serum biomarkers that were reported to be associated with UC or anti-TNF-α antibody could predict the response to golimumab, a human anti-TNF-α monoclonal antibody, in bio-naïve patients with UC. We prospectively enrolled 23 consecutive patients with UC who were treated with golimumab. Serum samples were collected before the first golimumab dose. Eleven molecules were measured by electrochemiluminescence (ECL) or enzyme-linked immunosorbent assay (ELISA) and their association with efficacy after 10 weeks of golimumab treatment. Among the serum biomarkers, IL-13 levels were significantly higher in the non-remission group than in the remission group (p = 0.014). IL-15 levels were significantly lower in the non-response group than in the response group (p = 0.04). For clinical remission at week 10, the IL-13 0.20 concentration of pg/mL was associated with a sensitivity and specificity of 82.4% and 83.3%, respectively. Serum IL-13 may be a biomarker to predict golimumab efficacy in biologic-naïve patients with UC, and thus may help to tailor personalized treatment strategies.
Collapse
Affiliation(s)
| | - Kazuki Kakimoto
- Correspondence: ; Tel.: +81-726-83-1221; Fax: +81-726-84-6532
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Iwatsubo T, Takeuchi T, Lee SW, Kawaguchi S, Ota K, Kojima Y, Higuchi K. Very Delayed Perforation after Esophageal Endoscopic Submucosal Dissection and Intralesional Triamcinolone Injection. Case Rep Gastroenterol 2022; 16:462-468. [PMID: 36157601 PMCID: PMC9459565 DOI: 10.1159/000526134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
We report a case of delayed perforation following esophageal endoscopic submucosal dissection (ESD). A patient with Parkinson's disease presented with two superficial carcinomatous lesions in the middle third of the esophagus. ESD was performed, and 4/5 of the esophageal circumference was resected, including the adjacent lesion area. Immediately post-ESD, triamcinolone acetonide was injected into the submucosa underlying the ulcer to prevent scarring and stenosis. Histopathological examination of the resected specimen revealed squamous cell carcinoma limited to the lamina propria with negative margins. Seventeen days post-ESD, the patient experienced sudden-onset chest pain during a meal. Computed tomography showed pneumomediastinum, which indicated a delayed perforation. We immediately performed subtotal esophagectomy. A sharply torn longitudinal perforation was present in the post-ESD ulcer. Delayed perforation after esophageal ESD is extremely rare. In this case, the perforation might have been caused by food impaction and delayed ulcer healing due to triamcinolone injection.
Collapse
Affiliation(s)
- Taro Iwatsubo
- Endoscopic Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- *Taro Iwatsubo,
| | - Toshihisa Takeuchi
- Endoscopic Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shinpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kazuhiro Ota
- Endoscopic Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuichi Kojima
- Endoscopic Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| |
Collapse
|
26
|
Morimoto T, Maekawa T, Mizuta S, Matsubayashi H, Takeuchi T, Hata Y, Ishikawa T. P-127 Identification of the optimal puncture position by image analysis may reduce oocyte degeneration in intracytoplasmic sperm injection (ICSI). Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is it possible to identify the optimal puncture position by image analysis where oocyte degeneration is reduced in ICSI procedure?
Summary answer
Visualizing the likelihood of unintentional membrane rupture (UMR) using image analysis can reduce oocyte degeneration and thereby generate more embryos available for treatment.
What is known already
It is known that the oocyte degeneration after both conventional-ICSI and Piezo-ICSI are often observed when UMR occurs during the puncturing process and the likelihood of UMR may depends on the location of the puncture site on the oolemma. Identifying the appropriate puncturing position may decrease the likelihood of membrane rupture and thus degeneration, however, there are no studies identifying the optimal puncture position during ICSI.
Study design, size, duration
We have developed the ICSI Position Detector (IPD), which can identify an area where rupture is likely to occur and visualize it on a video monitor. This study included 1,110 mature oocytes retrieved from 190 consenting patients. Matured oocytes were inseminated either by Conventional-ICSI (n = 437, average maternal age: 39.1±4.6 y.o.) or Piezo-ICSI (n = 673, average maternal age: 38.6±4.5 y.o.). ICSI was performed blindly, moving images were recorded and analyzed retrospectively during ICSI using IPD.
Participants/materials, setting, methods
Inseminated oocytes were subsequently divided into two groups according to IPD results, oocytes on which ICSI was performed at the position with a low chance of UMR (appropriate group), and with a high chance of UMR (non-appropriate group) by IPD. The rates of UMR, degeneration, fertilization (2PN), blastocyst formation, and good-quality blastocyst (Grade 3BB and above on day 5 by the Gardner scoring) were compared between the two groups of both conventional-ICSI and Piezo-ICSI.
Main results and the role of chance
The areas in which UMR is less likely to occur and more likely to occur are heterogeneously distributed. When ICSI was performed blindly, about half was from the non-appropriate position. In appropriate group of Piezo-ICSI, rates of UMR (4.3% vs. 17.4%, P < 0.001) and degeneration (1.0% vs. 5.7%, P < 0.001) were significantly lower than those of non-appropriate group, whereas rates of fertilization (88.0% vs. 78.4%, P < 0.01) and blastocyst formation (57.8% vs. 45.9%, P < 0.01) were significantly higher than those of non-appropriate group, respectively. The rate of good-quality blastocyst (28.8% vs. 24.9%) was in favor of appropriate group, but not significantly different. In appropriate group of Conventional-ICSI, rates of UMR (6.7% vs. 20.6%, P < 0.001) and degeneration (1.5% vs. 6.6%, P < 0.01) were significantly lower than those of non-appropriate group, whereas rate of fertilization (88.7% vs. 69.5, P < 0.001) was significantly higher than those of non-appropriate group, respectively. The rates of blastocyst formation (37.5% vs. 35.3%), good-quality blastocyst (21.3% vs. 18.7%) were all in favor of appropriate group, but not significantly different.
Limitations, reasons for caution
This is a single private fertility clinic study. Its reproducibility should be assessed in different laboratory conditions and the hands of different operators. Moreover, specific studies should be addressed on the effect of the other putative confounders under investigation (e.g. kind of ovulation trigger, patient demographics, culture environment, etc.).
Wider implications of the findings
This study demonstrated that the IPD is useful to identify the optimal puncture location site to prevent UMR on ICSI procedure, resulting in reducing UMR and degeneration of the oocytes and increasing culture results, thereby, generating more embryos available for transfer or cryopreservation.
Trial registration number
not applicable
Collapse
Affiliation(s)
- T Morimoto
- Reproduction Clinic Tokyo, Reproductive medicine , Tokyo, Japan
| | - T Maekawa
- Reproduction Clinic Tokyo, Reproductive medicine , Tokyo, Japan
| | - S Mizuta
- Reproduction Clinic Osaka, Reproductive medicine , Osaka, Japan
| | - H Matsubayashi
- Reproduction Clinic Tokyo, Reproductive medicine , Tokyo, Japan
| | - T Takeuchi
- Reproduction Clinic Tokyo, Reproductive medicine , Tokyo, Japan
| | - Y Hata
- University of Hyogo, Graduate School of Simulation Studies , Kobe, Japan
| | - T Ishikawa
- Reproduction Clinic Osaka, Reproductive medicine , Osaka, Japan
| |
Collapse
|
27
|
Ishikawa T, Mizuta S, Yamaguchi K, Ohara Y, Doshida M, Takeuchi T, Matsubayashi H. O-207 Incidence of Y chromosome microdeletions and microdissection testicular sperm extraction (micro TESE) in patients with Japanese azoospermic patients. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What is the frequency of azoospermia factor (AZF) microdeletions and sperm retrieval rate (SRR) by micro TESE in patients with these deletions?
Summary answer
AZFc is most frequent of Y chromosome microdeletions and a predictor of micro TESE outcome in Japanese azoospermic men.
What is known already
After Klinefelter syndrome, Y chromosome microdeletions are the second most frequent genetic cause of male infertility, with a prevalence of 2%-10% in non-obstructive azoospermia (NOA) and three spermatogenesis loci in the Y chromosome long arm (Yq11) have been classified as AZFa, AZFb, and AZFc. The classical correlation of histopathology phenotypes with these three microdeletions comprises of complete absence of germ cells (Sertoli cell-only syndrome) in patients with AZFa microdeletions, maturation arrest of meiosis in patients with AZFb microdeletions, and hypospermatogenesis in patients with AZFc microdeletions, however, individual variation in the extent of deletions has led to various spermatogenic phenotypes.
Study design, size, duration
We performed a retrospective study based on two reproduction centers in Japan and evaluated 1373 azoospermic patients in our clinics between September 2013 and December 2021. We investigated the frequency of AZF microdeletions and SRR by micro TESE in patients with these microdeletions and therefore aimed to evaluate the correlation between AZF microdeletions and micro TESE results.
Participants/materials, setting, methods
A total of 1373 azoospermic were enrolled. After the diagnosis of azoospermia, karyotype analysis and detection of Y chromosome microdeletions were performed on peripheral blood lymphocytes of these patients. Y chromosome microdeletions in AZFa, AZFb, and AZFc regions were detected using Promega Y Chromosome AZF Analysis System version 2.0 (Promega Co.). Twenty sequence-tagged sites within the AZF region of Yq11 and the sex-determining region Y gene were targeted for polymerase chain reaction (PCR) amplification.
Main results and the role of chance
One hundred and fifty-two AZF microdeletions (11.1%) were detected in the azoospermic patients. The most common deleted region was AZFc (60 cases, 4.4%). Among the patients, 17 (1.2%), 1 (0.1%), 42 (3.1%), 13 (1.0%), and 6 (0.5%) had AZFa, AZFa+b, AZFb+c, AZFb, and AZFa+b+c microdeletions, respectively. When the cases were grouped according to causes of infertility that could be detected, no Y chromosome microdeletions were detected in some groups (cases with Klinefelter Syndrome, hypogonadotropic hypogonadism, congenital absence of vas deferens, and 47, XYY karyotype). Fifty-three azoospermic men with AZFc microdeletions underwent micro TESE, and spermatozoa were detected in 88.7% (47/53) of these men. In contrast, we detected spermatozoa in only 20.4% (109/534) of the azoospermic men without AZF microdeletions. The SRR was much higher in patients with AZFc microdeletions than that of patients without AZF deletions. Although three azoospermic men with AZFb+c microdeletions had also undergone micro TESE following patient request, we did not retrieve spermatozoa.
Limitations, reasons for caution
We excluded post chemotherapy NOA showing 46, XX and AZFa+b+c deletions post bone marrow transplantation from female donor. Additionally, we did not detect AZFc partial deletion including gr/gr deletion. The cohort size of this study is not small, however, our screened population of infertile men may be biased.
Wider implications of the findings
NOA patients with AZFc microdeletions had a high percentage of successful sperm retrieval by micro TESE. Our study emphasizes that diagnosis of Y chromosome microdeletions is critical for preconception genetic counseling and provides clinically valuable prognostic information to couples considering surgical sperm retrieval.
Trial registration number
None
Collapse
Affiliation(s)
- T Ishikawa
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
| | - S Mizuta
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
| | - K Yamaguchi
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
| | - Y Ohara
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
| | - M Doshida
- Reproduction Clinic Tokyo , Reproductive medicine , Tokyo, Japan
| | - T Takeuchi
- Reproduction Clinic Tokyo , Reproductive medicine , Tokyo, Japan
| | - H Matsubayashi
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
| |
Collapse
|
28
|
Handa M, Takiuchi T, Kawaguchi S, Komukai S, Kitamura T, Miyake T, Ohara Y, Doshida M, Takeuchi T, Matsubayashi H, Ishikawa T, Kimura T. O-130 Reproductive outcomes of normal ovarian reserve patients after progestin-primed ovarian stimulation with chlormadinone acetate vs GnRH antagonist: A retrospective study with inverse-probability-of-treatment weighting. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To evaluate the effectiveness of chlormadinone acetate (CMA) for preventing premature LH surge in patients with normal ovarian reserve compared to cetrorelix.
Summary answer
In progestin-primed ovarian stimulation (PPOS) than GnRH antagonist (GnRH-ant), the incidence of premature LH surge was significantly lower, without significant difference in oocyte maturation rate.
What is known already
The GnRH-ant protocol is one of the conventional protocols which has some disadvantages including increased premature LH surge rate and cancelation rate. In recent years, the PPOS protocol has attracted attention as a new ovarian stimulation using progestin as an alternative to GnRH analog for suppressing a premature LH surge, however its efficacy is still controversial. In addition, many studies have investigated the reproductive outcomes of PPOS using medroxy-progesterone acetate or dydrogesterone; however, there are few reports of CMA, an oral progestin, which is inexpensive and widely used in Japan.
Study design, size, duration
This retrospective cohort study was performed in a reproduction center between March 2018 and October 2020 which included 977 Japanese patients with normal ovarian reserve undergoing PPOS with CMA (n = 299), or GnRH antagonist (GnRH-ant) with cetrorelix (n = 608) in their first IVF cycle at the reproduction center. In subgroup analysis, pregnancy outcomes after frozen embryo transfers (FET) between PPOS (n = 284) and GnRH-ant (n = 579) were also compared.
Participants/materials, setting, methods
The inclusion criteria were patients aged < 40 years and AMH ≧ 1.1 ng/mL, who underwent autologous oocyte retrieval in their first IVF cycle with freeze-all strategy. The primary outcome was the incidence of premature LH surge, the secondary outcomes was oocyte maturation rate. To reduce the impact of treatment bias and potential confounding factors, we conducted logistic regression models with inverse-probability-of-treatment weighting (IPTW).
Main results and the role of chance
After IPTW, baseline clinical data were well-balanced between the two groups, including age, AMH, BMI, the duration, type, and cause of infertility, antral follicle count, the history of recurrent spontaneous abortion, and previous IVF attempts. The premature LH surge rate was significantly lower with PPOS (3.1%) compared to GnRH-ant (20.1%) (odds ratio, 0.21; 95% confidence interval, 0.11–0.36). No significant differences were found in total gonadotropin dose (2400IU for PPOS vs 2400IU for GnRH-ant, p = 0.136), the number of oocyte retrieval (n = 15 vs n = 15, p = 0.484), oocyte maturation rate (78.8% vs 77.8%, p = 0.275), fertilization rate (73.0% vs 72.0%, p = 0.412), viable embryo rate per oocyte retrieval (40% vs 40%, p = 0.890), and good quality blastocyst rate (72.0% vs 69.6%, p = 0.092). However, the good quality day-3 embryo rate was significantly lower with PPOS (37.2% vs 49.1%, p < 0.05). There were no differences in the incidence of moderate-to-severe OHSS (0.3% vs 0.7%, p = 0.481). In FET cycles, the pregnancy outcomes, such as implantation rate (43.1 % vs 51.9 %, p = 0.013) and clinical pregnancy rate (46.5% vs 54.7%, p = 0.027) were significantly lower with PPOS, however, no significant differences were found in ongoing pregnancy rate (75.6% vs 80.5%, p = 0.325), and live birth rate (72.4% vs 79.5 %, p = 0.142).
Limitations, reasons for caution
This was a retrospective cohort study conducted in a single center. The participants in this study were limited to Japanese ethnicity. The results need to be validated across different centers and other ethnicities.
Wider implications of the findings
This is the first report assessing the reproductive outcomes on PPOS using CMA, widely used in Japan. The PPOS with CMA significantly suppressed the premature LH surge rate compared to GnRH-ant protocol, without decrease in oocyte maturation rate.
Trial registration number
N/A
Collapse
Affiliation(s)
- M Handa
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
| | - T Takiuchi
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
- Osaka university Graduate School of Medicine, Clinical Genomics , Osaka, Japan
| | - S Kawaguchi
- Osaka university Graduate School of Medicine, Division of Biomedical Statistics- Integrated Medicine , Osaka, Japan
| | - S Komukai
- Osaka university Graduate School of Medicine, Division of Biomedical Statistics- Integrated Medicine , Osaka, Japan
| | - T Kitamura
- Osaka university Graduate School of Medicine, Division of Environmental Medicine and Population Services- Social and Environmental Medicine , Osaka, Japan
| | - T Miyake
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
| | - Y Ohara
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
| | - M Doshida
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - T Takeuchi
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - H Matsubayashi
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - T Ishikawa
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - T Kimura
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
| |
Collapse
|
29
|
Felten R, Ye T, Schleiss C, Schwikowski B, Sibilia J, Monneaux F, Dumortier H, Jonsson R, Lessard C, Ng WF, Takeuchi T, Mariette X, Gottenberg JE. POS0097 IDENTIFICATION OF NEW CANDIDATE DRUGS FOR PRIMARY SJÖGREN’S SYNDROME USING A DRUG REPURPOSING TRANSCRIPTOMIC APPROACH. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundNo immunomodulatory drug has ever demonstrated its efficacy in primary Sjögren’s Syndrome (pSS). Drug repurposing, or drug repositioning, refers to the use in another disease of an existing drug, originally approved or evaluated in a different disease.ObjectivesThe objective of our study was to repurpose existing therapeutic drugs in pSS using a transcriptomic approach.MethodsWe generated pSS transcriptomic signatures from peripheral blood samples of patients with pSS compared to healthy controls in two cohorts (ASSESS and a Norwegian cohort) and data mined available pSS transcriptomic signatures in public databases. We compared each disease signature to transcriptomic signatures, obtained from the biological action of 2837 drugs, 2160 knock-in and 3799 knock-down genes, available in the Connectivity Map database. A median similarity score with regard to disease signatures was computed for each candidate drug/gene. Drugs and genes were selected if p<0.05 and similarity score >│80│. If this score is sufficiently high and statistically significant (>80, p<0.05), the tested drug or gene, mimics the signature of the disease. Conversely, if this score is sufficiently low and statistically significant (<-80, p<0.05), the tested drug or gene inverts the signature of the disease and might represent a potential treatment or therapeutic target of interest (Figure 1).Figure 1.Methods of drug-repurposing transcriptomic analysis (adapted from Toro-Dominguez et al, Arthritis Res Ther 2017;19:54)Results1091 peripheral blood transcriptomes were analyzed from 6 independent studies (906 patients with pSS and 185 healthy controls). Our analysis identified 11 transcriptomic drug signatures significantly associated with pSS signature. We identified 72 transcriptomic knock-in (11) or knock-down (61) gene signatures significantly associated with that of pSS, including 21 with a negative similarity score (Table 1).Table 1.Knock-down and knock-in genes significantly associated with the pSS transcriptomic signaturesType ofexperimentSimilarity scoreGenesNumber of genesKnock-in+IFNG, DUSP28, IFNB1, LYN, BCL2L2, TNFRSF1A, CD40, BCL10, NLK, ZNF39810-SLC52A2111Knock-down+SLC25A14, GOLIM4, DTYMK, DCXR, RRM2, IMPA1, CLTB, F12, CAB39, ID1, ISOC1, UBAP1, HIGD2A, UFD1L, SOD2, BTG1, PRKCI, HIST2H2BE, NISCH, TEAD4, MTX2, TYK2, GTF2B, NDUFS7, NNT, ACADSB, GSTP1, HOMER2, SORBS3, PCK2, PHB2, PDXK, TES, TM9SF2, TBX2, HOXA6, KIF2C, MED1, NR2F6, CD14, BECN141-TM9SF3, E2F3, PRMT3, KD, PKN2, SUCLA2, CD44, GRN, SP3, ATP5S, MYCBP2, TRAF7, POLA2, ADRB2, PSMG1, PPP2R3C, PMAIP1, ETFA, ANKRD37, SPECC1L2061Type I and II interferons were highly ranked (similarity score >99), and their overexpression mimicked the disease signature. CD40 appeared also as a very relevant target (similarity score = 98.8). Three drugs had a significant negative similarity score: ampicillin (-88.69, p=0.0019), amylocaine (-88.28, p=0.0026), and droxinostat (-85.42, p=0.0027). Droxinostat is a HDAC inhibitor. HDAC activity has been shown to be an essential element of the coactivation system for IFN-induced gene regulation and the IFN-induced innate immune response.ConclusionThis first drug repositioning transcriptomic approach in Sjögren’s syndrome confirms the interest of targeting interferons and identifies histone deacetylases as potential therapeutic targets.AcknowledgementsInvestigators of the ASSESS cohort: Emmanuelle Dernis, Valerie Devauchelle-Pensec, Philippe Dieude, Jean-Jacques Dubost, Anne-Laure Fauchais, Vincent Goeb, Eric Hachulla, Pierre Yves Hatron, Claire Larroche, Véronique Le Guern, Jacques Morel, Aleth Perdriger, Carinne Salliot, Stephanie Rist, Alain Saraux, Jean Sibilia, Olivier Vittecoq, Gaétane Nocturne, Philippe Ravaud, Raphaèle SerorCentre de Ressources Biologiques de l’Hôpital Bichat: Sarah TubianaJohan G. Brun for contributing to the Norwegian cohort.Funding SourcesThis work was supported by the Innovative Medicines Initiative 2 Joint Undertaking (IMI 2 JU) (NECESSITY grant 806975). The Joint Undertaking received support from the European Union’s Horizon 2020 Research and Innovation Program and from the European Federation of Pharmaceutical Industries and Associations. This work was also supported by R01 AR065953 Beth the NIH, United States. The contents are the sole responsibility of the authors and do not necessarily the official views of the NIH.JEG received an unrestricted grant from Bristol-Myer-Squibbs to do the transcriptomic analysis of the ASSESS and Norwegian cohorts. JEG received a grant from Geneviève Garnier (Association Française du Syndrome de Gougerot-Sjögren et des syndromes secs).The ASSESS cohort is promoted by the French Society of Rheumatology and received two research grants from the French Society of Rheumatology.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Disclosure of InterestsRenaud FELTEN: None declared, Tao Ye: None declared, Cédric Schleiss: None declared, Benno Schwikowski: None declared, Jean Sibilia: None declared, Fanny Monneaux: None declared, Hélène Dumortier: None declared, Roland Jonsson: None declared, Christopher Lessard: None declared, Wan Fai Ng: None declared, Tsutomu Takeuchi: None declared, Xavier Mariette: None declared, Jacques-Eric Gottenberg Grant/research support from: JEG received an unrestricted grant from Bristol-Myer-Squibbs to do the transcriptomic analysis of the ASSESS and Norwegian cohorts.
Collapse
|
30
|
Murata O, Suzuki K, Takeuchi T. AB0545 THYMUS VARIANTS ON IMAGING IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME AND POLYMYOSITIS/DERMATOMYOSITIS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe thymus, a primary lymphoid organ, plays a crucial role in immune system homeostasis [1,2]. Although several studies of an association between radiographic thymus variants and serological features in systemic autoimmune diseases such as systemic scleroderma, have been reported [3-6], information in patients with other systemic autoimmune disease, especially in primary Sjögren’s syndrome (pSS) or polymyositis/dermatomyositis (PM/DM) patients, is quite limited.ObjectivesWe investigated the association between radiographic thymus variants and clinical and immunological features in patients with pSS and PM/DM, and clarified its significance.MethodsPatients with pSS and PM/DM were randomly selected from all patients who had visited our department and underwent chest CT scan between April 2009 and March 2019. Patients with thymoma or thymic cyst and those aged less than 30 years were excluded. Thymic enlargement and thymus attenuation score in axial images of CT scans were quantitatively interpreted. We defined thymic enlargement as a thickness of more than 13 mm and graded the score by a four-point scale (score 0-3) according to previous studies [7, 8]. Association with radiographic thymus variants and clinical and immunological features was statistically analyzed.Results72 pSS and 47 PM/DM patients were enrolled. 90% and 63.8% were women and mean age was 62.7 ± 12.2 and 56.2 ± 13.7 years in pSS and PM/DM patients, respectively. Thymic enlargement was found in 16 (22.2%) and 14 (29.8%) patients with pSS and PM/DM, respectively. Thymus attenuation (score ≥ 2) was found in 11 (15.3%) and 9 (19.1%) patients with pSS and PM/DM, respectively. These findings were more frequent than in non-connective tissue diseases patients (9.1% and 9.1%, respectively). In pSS patients, radiographic thymus variants, both thymic enlargement and the thymus attenuation score, were significantly positively associated with body weight (P < 0.0073 and 0.037, respectively). Although there was no significant difference between immunological features such as titres of serum RF, the ratio of RF-positivity, SS-A antibody-positivity or SS-B antibody-positivity, and radiographic thymus variants, titres of serum RF tended to be positively associated with thymic enlargement (P = 0.057). In PM/DM patients, thymic enlargement was significantly positively associated with titres of serum RF (P = 0.046), and the thymus attenuation score was significantly positively associated with titres of serum IgG (P = 0.042) and significantly negatively associated with age (P = 0.033). There was no significant difference between the ratio of myositis specific antibody-positivity and radiographic thymus variants.ConclusionRadiographic thymus variants were frequently observed in pSS and PM/DM patients, and particularly, in case of PM/DM, may reflect an abnormal immune response involved in the pathogenesis.References[1]Gorozny JJ, et al. Trends Immunol 2001;22:251-255,[2]Seddon B, et al. Immunol Today 2000;21:94-99,[3]Truffault F, et al. Clin Rev Allergy Immunol 2017; 52:108-124,[4]Berrih-Aknin S, et al. J Autoimmun 2014;52:90-110,[5]Colaci M, et al. Rheumatology 2014;53:732-36,[6]Murata O, et al. Rheumatology 2021;60:5595-5600,[7]Ackman JB, et al. Radiology 2013;268:245-53,[8]Naidich DP, et al. Philadelphia: Lippincott-Raven 1999:57-73.AcknowledgementsI have no acknowledgements to declare.Disclosure of InterestsNone declared
Collapse
|
31
|
Tamai H, Ikeda K, Miyamoto T, Taguchi H, Kuo CF, Shin K, Hirata S, Okano Y, Sato S, Yasuoka H, Choi IA, Park SH, Weng MY, Kuwana M, Lee YJ, Ishii T, Kim J, Kameda H, Kojima T, Baek HJ, Hsu PN, Huang CM, Cheng TT, Sung WY, Taninaga T, Mori M, Miyagishi H, Sato Y, Takeuchi T, Kaneko Y. OP0062 EFFICACY AND SAFETY OF ADALIMUMAB WITH LOW AND HIGH DOSE-METHOTREXATE IN PATIENTS WITH RHEUMATOID ARTHRITIS WITH INADEQUATE RESPONSE TO METHOTREXATE: THE RANDOMISED CONTROLLED MIRACLE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that causes not only joint pain but also bone destruction resulting in impairment of quality of life. Tumor necrosis factor inhibitors have improved prognosis of patients with rheumatoid arthritis dramatically, especially in combination with methotrexate, however, the optimal dose of the concomitant methotrexate is unclear.ObjectivesTo evaluate the efficacy and safety of adalimumab in combination with reduced dose of methotrexate in patients with early RA with inadequate response to methotrexate.MethodsThe MIRACLE study was a multinational, randomized, open-label study in patients with RA with inadequate response to methotrexate conducted in Asia. It compared low dose and high dose methotrexate upon starting adalimumab. Methotrexate-naive patients with RA with a disease duration of less than two years started methotrexate at 6 to 8 mg/week and increased it to the maximum tolerable dose by week 12. Patients who have not achieved remission according to simplified disease activity index (SDAI) despite methotrexate ≥ 10 mg/week at week 24 were randomised to the maximum tolerable dose of methotrexate group (10 to 25 mg/week) or the reduced dose group (6 to 8 mg/week) and started to receive subcutaneous adalimumab 40 mg every other week. The primary endpoint was non-inferiority in the achievement of SDAI remission at week 48 in the reduced dose group compared with the maximum tolerable dose group with a non-inferiority margin of -15% based on two-sided 90% confidence interval. (NCT03505008)ResultsA total of 300 patients were enrolled in the study. Among them, 291 started methotrexate and were included in the analysis. The mean age was 57.7±15.2 years, female was 74.6%, and the mean disease duration from the diagnosis of RA was 21.1±56.2 days. Anti-CCP antibody was positive in 211 (73.0%) and the mean SDAI at study enrollment was 26.5±12.4. At week 24, with the mean dose of methotrexate of 12.6±2.9 mg/week, 108 patients (37.1%) achieved remission according to SDAI and continued MTX monotherapy. 134 patients (46.0%) were randomised and started adalimumab with 68 patients in the maximum tolerable dose group and 66 patients in the reduced dose group. At week 48, the remission achievement rates were 38.4 % and 44.8 %, respectively, with the adjusted risk difference of the reduced dose group to the maximum tolerable dose group of 6.4% (-7.0% to 19.8%, 90% CI), which met the criterion for noninferiority. No significant difference was found in health assessment questionnaire disability index ≤0.5 (59.1% vs 62.0%, respectively, p=0.72) and in radiological remission rates (Δmodified total Sharp score ≤0.5, 66.3% vs 62.0 %, respectively, p=0.59). Adverse drug reactions tended to be more frequent in the maximum tolerable dose group than in the reduced dose group (22.1% vs 9.1%, respectively, p=0.06).ConclusionThe MIRACLE randomised study demonstrated that, in patients with inadequate response to methotrexate, the efficacy of adalimumab with reduced dose of concomitant methotrexate was not inferior to that with maximum tolerable dose of methotrexate with better safety profile.Disclosure of InterestsHiroya Tamai Speakers bureau: Eisai, Grant/research support from: Eisai, Kei Ikeda Speakers bureau: AbbVie, Eisai, Eli Lilly, Novartis, Gilead, Asahi-Kasei, Grant/research support from: Mitsubishi-Tanabe, Toshiaki Miyamoto: None declared, Hiroaki Taguchi: None declared, Chang-Fu Kuo: None declared, Kichul Shin: None declared, Shintaro Hirata Speakers bureau: AbbVie, Asahi-Kasei, Astellas, Ayumi, Bristol Myers Squibb, Celgene, Chugai, Eisai, Eli Lilly, Gilead, Glaxo SmithKline, Janssen, Kyorin, Novartis, Pfizer, Sanofi, Tanabe-Mitsubishi, UCB, Paid instructor for: AbbVie, Mitsubishi-Tanabe, Consultant of: AbbVie, Astellas, Bristol Myers Squibb, Eisai, Gilead, Ily Lilly, Grant/research support from: AbbVie, Asahi-Kasei, Eisai, Otsuka, Sanofi, Shionogi, Chugai, Pfizer, Tanabe-Mitsubishi, Eli Lilly, UCB, yutaka okano: None declared, Shinji Sato Speakers bureau: AbbVie, Eisai, Grant/research support from: AbbVie, Eisai, Hidekata Yasuoka Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas, Daiichi-Sankyo, Eisai, Kissei, Takeda, Mitsubishi-Tanabe, Chugai, Novartis, Eli Lilly, Pfizer, Janssen, Sanofi, Teijin, Boehringer-Ingelheim, Bayer, Glaxo Smith Kline, Paid instructor for: AbbVie, Consultant of: AbbVie, Asahi Kasei, Grant/research support from: Mitsubishi-Tanabe, Takeda, Daiichi-Sankyo, Chugai, Bristol-Myers, MSD, Astellas, In Ah Choi Speakers bureau: Abbvie, Eisai, Sung-Hwan Park: None declared, Meng-Yu Weng Paid instructor for: Novartis, Eli Lilly, ChuGai, Abbvie, Consultant of: Abbvie, Masataka Kuwana Speakers bureau: Astellas, Asahi Kasei Pharma, Boehringer-Ingelheim, Chugai, Eisai, Janssen, Mochida, Nippon Shinyaku, Ono Pharmaceuticals, Pfizer, Mitsubishi-Tanabe, Consultant of: Boehringer-Ingelheim, Kissei, Mochida, Grant/research support from: AbbVie, Asahi Kasei Pharma, Boehringer-Ingelheim, Chugai, Eisai, MBL, Nippon Shinyaku, Ono Pharmaceuticals, Mitsubishi-Tanabe, Yun Jong Lee Grant/research support from: Yuhan, Tomonori Ishii Speakers bureau: Chugai, Mitsubishi-Tanabe, Glaxo Smith Kline, Pfizer, Eli Lilly, Janssen, AbbVie, Eisai, Astellas, Jinhyun Kim: None declared, Hideto Kameda Speakers bureau: AbbVie, Pfizer, Consultant of: AbbVie, Grant/research support from: AbbVie, Eisai, Toshihisa Kojima Speakers bureau: AbbVie, Pfizer, Eisai, Grant/research support from: AbbVie, Han Joo Baek: None declared, Ping-Ning Hsu: None declared, Chun-Ming Huang Paid instructor for: Abbvie, Pfizer, Tien-Tsai Cheng Paid instructor for: Abbvie, Grant/research support from: Abbvie, Wan-Yu Sung: None declared, Takehiro Taninaga Shareholder of: Eisai.co.,Ltd., Employee of: Eisai.co.,Ltd., Masahiko Mori Shareholder of: Eisai.co.,Ltd., Employee of: Eisai.co.,Ltd., Hideaki Miyagishi Shareholder of: Eisai.co.,Ltd., Employee of: Eisai.co.,Ltd., Yasunori Sato Speakers bureau: Eisai Co., Ltd. Kowa Company, Ltd., Consultant of: MOCHIDA PHARMACEUTICAL CO., LTD, Tsutomu Takeuchi Speakers bureau: Astellas, AbbVie, Ayumi, Bristol Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Glaxo Smith Kline, Janssen, Mitsubishi-Tanabe, Nippon-kayaku, Novartis, Pfizer, Sanofi, UCB, Grant/research support from: Asahi Kasei, AbbVie, Ayumi, Boehringer-Ingelheim, Chugai, Eisai, Eli Lilly, Mitsubishi-Tanabe, Sanofi, UCB, Yuko Kaneko Speakers bureau: Asahi Kasei, Astellas, Ayumi, Bristol Myers Squibb, Chugai, Eisai, Elli Lilly, Mitsubishi-Tanabe, Novartis, UCB, Grant/research support from: AbbVie, Chugai, Eisai, Mitsubishi-Tanabe, UCB.
Collapse
|
32
|
Shimojima Y, Kishida D, Ichikawa T, Kida T, Yajima N, Omura S, Nakagomi D, Abe Y, Masatoshi K, Takizawa N, Nomura A, Kukida Y, Kondo N, Yasuhiko Y, Yanagida T, Endo K, Hirata S, Kawahata K, Matsui K, Takeuchi T, Ichinose K, Kato M, Yanai R, Matsuo Y, Yamasaki A, Nishioka R, Takata T, Moriyama M, Takatani A, Ito T, Miyawaki Y, Ito-Ihara T, Kawaguchi T, Kawahito Y, Sekijima Y. POS0822 HYPERTROPHIC PACHYMENINGITIS IN ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS: A MULTICENTER SURVEY IN JAPAN. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHypertrophic pachymeningitis (HP), characterized by an inflammatory disorder indicating intracranial or spinal thickening of dura mater, is found to develop as a neurological involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Meanwhile, the previous studies focusing on HP in AAV have been reported as a single-institution study, and the analyses were performed in a small number of patients because HP is a rare neurological disorder. Therefore, neither etiological nor clinical characteristics of HP in AAV have been adequately elucidated.ObjectivesThis study clarified the characteristics of HP in AAV by analyzing the information of multicenter study in Japan (Japan collaborative registry of ANCA-associated vasculitis: J-CANVAS).MethodsWe analyzed the clinical information from 541 Asian patients with AAV enrolled in J-CANVAS. Of them, newly diagnosed and relapsed AAV were included in 448 and 93, respectively. The epidemiological and clinical findings were compared between patients with and without HP. Clinical manifestations related to AAV were evaluated based on the Birmingham Vasculitis Activity Score version 3. To elucidate independent factors in HP development, logistic regression analyses were additionally performed.ResultsOf the total 541 patients (mean age: 71±14 years, M:F = 1:1.2), HP was demonstrated in 28 (5.17%), including 17 (3.79%) in newly diagnosed AAV and 11 (11.8%) in relapsed AAV. The classification of granulomatosis with polyangiitis (GPA) was significantly higher in patients with HP than those without HP (50% vs. 21%, p = 0.0007). In newly diagnosed AAV, patients with HP significantly had higher GPA classification and higher positivity for PR3-ANCA than those without HP (53% vs. 17%, p = 0.001; 29% vs. 9%, p = 0.015, respectively). Conversely, positivity for MPO-ANCA was significantly higher in patients with HP than those without HP in relapsed AAV (91% vs. 55%, p = 0.025), despite not significantly different in the classification of AAV. Headache and cranial neuropathies were significant neurological symptoms in patients with HP compared to those without HP (82% vs. 6.6%, p < 0.0001; 32% vs. 2.9%, p < 0.0001, respectively). Besides, ear, nose and throat (ENT) and mucous membranes/eyes were significantly higher involvements in patients with HP than in those without HP (54% vs. 26%, p = 0.003; 29% vs. 9%, p = 0.003, respectively). Moreover, higher complications of “conjunctive hearing loss” and “sudden visual loss”, which are included in the categories of ENT and mucous membranes/eyes involvement, respectively, were significantly indicated in patients with HP than those without HP (39% vs. 7.2%, p < 0.0001; 21% vs. 1.2%, p < 0.0001, respectively). Multivariable logistic regression analysis identified that ENT (odds ratio [OR] 1.28, 95% confident interval [CI] 1.09 to 1.49, p = 0.002) and mucous membranes/eyes involvement (OR 1.37, CI 1.14 to 1.65, p = 0.0006), as well as conjunctive hearing loss (OR 4.52, CI 1.56 to 13.05, p = 0.005) and sudden visual loss (OR 1.84, CI 1.12 to 3.00, p = 0.015), were independent related factors in patients with HP.ConclusionGPA could be significantly classified in patients with HP. Notably, patients with HP significantly showed higher positivity for PR3-ANCA than those without HP in newly diagnosed AAV. Furthermore, sudden visual loss and conjunctive hearing loss might be implicated in HP development.Disclosure of InterestsNone declared
Collapse
|
33
|
Buch MH, Takeuchi T, Rajendran V, Gottenberg JE, Pechonkina A, Tan Y, Gong Q, Van Beneden K, Caporali R. AB0394 CLINICAL OUTCOMES UP TO WEEK 48 OF ONGOING FILGOTINIB (FIL) RHEUMATOID ARTHRITIS (RA) LONG-TERM EXTENSION (LTE) TRIAL OF BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUG (bDMARD) INADEQUATE RESPONDERS (IR) INITIALLY ON FIL OR PLACEBO IN A PHASE 3 PARENT STUDY (PS). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe preferential Janus kinase-1 inhibitor FIL is approved for treatment of moderate to severe active RA in Europe and Japan.ObjectivesEfficacy and safety of FIL were assessed in patients (pts) with IR to bDMARDs in a LTE trial (NCT03025308) enrolled from a Phase 3 PS (NCT02873936).1MethodsbDMARD-IR pts received FIL 200 mg (FIL200), FIL 100 mg (FIL100), or placebo (PBO), all with stable conventional synthetic (cs)DMARDs up to 24 weeks (W). At W14 of the PS, pts with IR to FIL or PBO (<20% improvement in swollen [66] and tender [68] joint counts) switched to standard of care (SOC; investigator’s choice of treatment). Pts completing the PS on FIL, PBO, or SOC could enter the LTE. PS FIL pts were maintained, blinded, on their FIL dose; PS PBO and PS SOC pts were rerandomized, blinded, to FIL200 or FIL100. Efficacy data to LTE W48 and safety data to data cutoff (June 1, 2020) are reported.ResultsThe PS included 147, 153, and 148 pts on FIL200, FIL100, and PBO. Pts continuing on LTE FIL200 and FIL100 at data cutoff: 80/121 (66%) and 76/110 (69%) from PS FIL200 and FIL100; 35/47 (75%) and 32/46 (70%) from PS PBO, and 13/23 (57%) and 13/22 (59%) from PS SOC. LTE baseline (BL) characteristics were similar in FIL200 and FIL100 pts. During LTE, PS FIL ACR20/50/70 response rates decreased modestly by W48 (Figure 1). Among PS PBO pts, response rates were lower at LTE BL, reaching similar levels to PS FIL pts by W48; rates increased to W48 in PS SOC pts on either FIL dose but not to levels of other groups. Percentages of pts attaining DAS28(CRP) ≤3.2, DAS28(CRP) <2.6, CDAI ≤10, and CDAI ≤2.8 were maintained up to W48 for FIL/FIL pts. PBO/FIL and SOC/FIL pts showed similar patterns to ACR responses (Figure 1). Exposure-adjusted incidence rates (EAIRs)/100 pt-years of exposure for treatment-emergent adverse events (TEAE), serious AEs, and serious infection were higher in SOC/FIL pts vs FIL/FIL or PBO/FIL pts, but samples were small and confidence intervals overlapped. There were 5 deaths (Table 1).Table 1.EAIRs of TEAEs in LTE, as of June 1, 2020EAIR (95% CI)FIL200+csD → FIL200+csD n=121PYE 228.4PBO+csD → FIL200+csD n=47PYE 98.1SOC+csD → FIL200+csD n=23PYE 42.1FIL100+csD → FIL100+csD n=110PYE 223.3PBO+csD → FIL100+csD n=46PYE 91.1SOC+csD → FIL100+csD n=22PYE 38.2TEAE46.9 (38.8, 56.6)38.7 (28.2, 53.2)52.2 (34.4, 79.3)40.3 (32.8, 49.5)40.6 (29.4, 56.1)49.8 (31.8, 78.0)TEAE Grade ≥310.5 (7.0, 15.7)10.2 (5.5, 18.9)19.0 (9.5, 38.0)10.3 (6.8, 15.5)13.2 (7.5, 23.2)18.3 (8.7, 38.5)TE serious AE12.3 (8.5, 17.8)12.2 (6.9, 21.5)21.4 (11.1, 41.1)8.1 (5.1, 12.8)13.2 (7.5, 23.2)21.0 (10.5, 41.9)Death1.3 (0.4, 4.1)1.0 (0, 5.7)0 (0, 8.8)0.4 (0.1, 3.2)0 (0, 4.0)0 (0, 9.7)TE infections34.2 (27.4, 42.6)22.4 (14.8, 34.1)35.6 (21.5, 59.1)22.4 (17.0, 29.5)26.3 (17.7, 39.3)39.3 (23.7, 65.2)TE serious infections3.5 (1.8, 7.0)2.0 (0.5, 8.2)7.1 (2.3, 22.1)0.9 (0.2, 3.6)2.2 (0.5, 8.8)7.9 (2.5, 24.4)Opportunistic infections0 (0, 1.6)0 (0, 3.8)0 (0, 8.8)0 (0, 1.7)0 (0, 4.0)0 (0, 9.7)TE herpes zoster2.2 (0.7, 5.1)1.0 (0.1, 7.2)0 (0, 8.8)0 (0, 1.7)2.2 (0.5, 8.8)2.6 (0.1, 14.6)TE MACE (adjudicated)1.3 (0.4, 4.1)1.0 (0.1, 7.2)0 (0, 8.8)0.9 (0.2, 3.6)1.1 (0.2, 7.8)0 (0, 9.7)TE DVT/PE (adjudicated)0.9 (0.2, 3.5)0 (0, 3.8)2.4 (0.1, 13.2)0.4 (0.1, 3.2)0 (0, 4.0)0 (0, 9.7)Malignancies (excluding NMSC)1.3 (0.4, 4.1)3.1 (1.0, 9.5)4.7 (0.6, 17.2)1.8 (0.7, 4.8)3.3 (1.1, 10.2)0 (0, 9.7)NMSC0 (0, 1.6)0 (0, 3.8)4.7 (0.6, 17.2)0 (0, 1.7)0 (0, 4.0)0 (0, 9.7)DVT, deep vein thrombosis; MACE, major adverse cardiovascular event; NMSC, nonmelanoma skin cancer; PE, pulmonary embolism; TE, treatment-emergentConclusionEfficacy was mostly maintained in PS FIL pts up to W48. Response among PS PBO and SOC pts increased from BL to W48, but response in PS SOC pts continued to be lower than in other groups; these pts may represent a refractory population. FIL safety was largely consistent between PS and LTE.References[1]Genovese MC et al. JAMA 2019;322:315–25.AcknowledgementsThis study was funded by Gilead Sciences, Inc., Foster City, CA. Medical writing support was provided by Claudine Bitel, PhD, of AlphaScientia, LLC, San Francisco, CA; and funded by Gilead Sciences, Inc., Foster City, CA.Disclosure of InterestsMaya H Buch Speakers bureau: AbbVie, Consultant of: AbbVie, Galapagos, Gilead, and Pfizer, Grant/research support from: Gilead and Pfizer, Tsutomu Takeuchi Speakers bureau: AbbVie, AYUMI, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Dainippon Sumitomo, Eisai, Eli Lilly Japan, Gilead Sciences, Mitsubishi-Tanabe, Novartis, Pfizer Japan, and Sanofi, Consultant of: Astellas, Chugai, and Eli Lilly Japan, Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Mitsubishi-Tanabe, Shionogi, Takeda, and UCB Japan, Vijay Rajendran Shareholder of: Galapagos, Employee of: Galapagos, Jacques-Eric Gottenberg Speakers bureau: AbbVie, Eli Lilly and Co., Galapagos, Gilead Sciences, Inc., Roche, Sanofi Genzyme, and UCB, Consultant of: Bristol Myers Squibb, Sanofi Genzyme, and UCB, Grant/research support from: Bristol Myers Squibb and Pfizer, Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., YingMeei Tan Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Qi Gong Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Katrien Van Beneden Shareholder of: Galapagos, Employee of: Galapagos, Roberto Caporali Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, and UCB, Consultant of: AbbVie, Amgen, BMS, Celltrion, Galapagos, Janssen, Lilly, Fresenius-Kabi, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB
Collapse
|
34
|
Kajio N, Suzuki K, Matsumoto K, Iijima H, Nakamura S, Ishizawa Y, Inamo J, Takeshita M, Yoshimoto K, Kaneko Y, Takeuchi T. POS0530 MOLECULAR SIGNATURE IN SUSTAINED CLINICAL REMISSION INDUCED BY TOCILIZUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundClinical remission is a clinical goal in the treatment of rheumatoid arthritis (RA). Sustained, biologics-free and true remission is an unachieved goal of the “treat-to-target” approach in most patients, and the determinants for achievement are still unclear. In our recent prospective study using multiomics analysis, we proposed that a molecular signature in peripheral whole blood can be a predictor for subsequent disease activity or activities of daily living.1 We also showed that tocilizumab (TCZ) induced deep clinical remission associated with gene expression in peripheral CD4+ T cells.2ObjectivesTo consolidate and expand our hypothesis, we investigated the significance of molecular signatures in sustained remission in a larger scale cohort.MethodsTo build and validate the diagnostic model, we collected 73 peripheral blood samples from 30 patients with active RA, 30 patients in clinical remission induced by TCZ and 13 healthy controls. We then collected another 23 samples at a point before TCZ was halted due to sustained clinical remission. In total, 96 samples were analyzed by a multiomics platform, which included RNA sequencing and comprehensive proteomics.ResultsWe first developed an optimized partial least-squares regression (PLSR) model using data from 5,436 genes and 255 proteins extracted in our previous model.1 The odds ratio in the model clearly reflected the clinical state with high fidelity (Figure 1). In that study, TCZ induced nearly half of the patients with clinical remission into molecular remission, with an odds ratio of less than zero. To clarify the characteristics of the molecular signature at sustained clinical remission under TCZ continuation, 23 samples were applied to the model. The odds ratio was largely the same as that for clinical remission. Next, we investigated the association with disease flare after cessation of TCZ. At some points before cessation, the median odds ratio in patients who experienced disease flare after stopping TCZ tended to be higher than that in patients with sustained remission after stopping TCZ in the transcriptomics model but not in the proteomics model. Thirty-five differentially expressed genes were identified between the two groups under the conditions of a >1.5-fold change and P-value<0.05.Figure 1.Odds ratio in the partial least-squares regression model using transcriptomics (A) and proteomics (B) data from rheumatoid arthritis and healthy control groupsConclusionOur larger scale study validated the idea in our previous study that TCZ induces molecular remission. A certain substantial gap associated with prognosis after quitting TCZ may exist as a molecular signature of sustained clinical remission induced by TCZ. These multiomics data sets enable us to understand sustained clinical remission at a molecular level.References[1]Nat Commun. 9(1):2775, 2018, 2) Sci Rep.11(1):16691, 2021Graphs:AcknowledgementsWe acknowledge funding by Chugai Pharmaceutical Co., Ltd.Disclosure of InterestsNobuhiko Kajio: None declared, Katsuya Suzuki Speakers bureau: AbbVie, AsahiKasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Gilead, Janssen, Mitsubishi Tanabe, Pfizer, Sanofi, Viatris, Consultant of: AbbVie, Asahi Kasei, Janssen, Pfizer, Grant/research support from: Chugai, Daiichi-Sankyo, Eli Lilly, Mitsubishi Tanabe, Ono, Takeda, Kotaro Matsumoto: None declared, Hiroshi Iijima: None declared, Seiji Nakamura: None declared, Yohei Ishizawa: None declared, Jun Inamo: None declared, Masaru Takeshita: None declared, Keiko Yoshimoto: None declared, Yuko Kaneko Speakers bureau: Chugai, Consultant of: Chugai, Grant/research support from: Chugai, Tsutomu Takeuchi Speakers bureau: Chugai, Consultant of: Chugai, Grant/research support from: Chugai.
Collapse
|
35
|
Hiramoto K, Saito S, Hanaoka H, Suzuki K, Kikuchi J, Fukui H, Takano R, Miyoshi F, Seki N, Sugahara K, Kaneko Y, Takeuchi T. POS0459 APTAMER-BASED PROTEOMIC SCREENING IN IDENTIFICATION OF PATHOGENIC SIGNAL PATHWAY AND URINARY BIOMARKERS ASSOCIATED WITH HISTOLOGICAL FINDINGS IN LUPUS NEPHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe current gold standard for the diagnosis and classification, assessment of the severity of lupus nephritis (LN) is a renal biopsy. On the other hand, since the procedure is highly invasive, there is a pressing need to identify biomarkers for predicting the presence and its histological severity of LN. In addition, the background pathogenesis of each histological findings is not clearly understood.ObjectivesThe purpose of this study was to elucidate the urine biomarkers for predicting the presence and the severity of histological findings of LN, and to search the pathogenic signal pathway.MethodsUrine samples from 24 biopsy-proven active LN patients were initially screened for the levels of 1305 distinct human proteins using an aptamer-based-targeted proteomic assay. We developed histological scoring system based on ISN/RPS lesion definitions and classification, NIH activity and chronicity score. Two experienced evaluators assessed the histological scores. Cluster analysis and pathway analysis were performed.ResultsA total of 24 LN patients were included: 20 (83%) had a proliferative histological class (III or IV +/-V), 4 (17%) pure membranous (V). Through cluster analysis, several histological subgroups were extracted according to correlation with each histological finding, and proteins which corelated with each histological scores were analyzed. We focused on two subgroups: one in which including active glomerular histological findings (endocapillary hypercellularity, karyorrhexis, neutrophil infiltration, subendothelial deposits) and the other in which including interstitial histological findings (interstitial inflammation, interstitial fibrosis, tubular atrophy). Histological scores in the former group showed strong positive correlation with protein group which contained 59 proteins (Group A), including CCL21, CXCL10, VCAM1. Histological scores in the latter group corelated with another protein group which contained 85 proteins (Group B), including MCP-1, CCL11. Ingenuity Pathway Analysis showed 16 pathways (PDGF Signaling, Granulocyte Adhesion and Diapedesis, etc) were upregulated in Group A and 11 pathways (IL-17 signaling, Fibrosis signaling pathway, etc) upregulated in Group B. Among group A and group B urine proteins, those showed strong correlation between respective histological findings were validated with ELISA assays.ConclusionAn aptamer-based-targeted proteomic assay screening by combining with renal histological scoring system suggested several urine proteins can predict the severity and the presence of major renal histological findings, and suggested to be related with the pathogenesis in patients with LN.Disclosure of InterestsKazuoto Hiramoto: None declared, Shuntaro Saito: None declared, Hironari Hanaoka: None declared, Katsuya Suzuki: None declared, Jun Kikuchi: None declared, Hiroyuki Fukui: None declared, Ryo Takano Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Fumihiko Miyoshi Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Noriyasu Seki Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Kunio Sugahara Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Yuko Kaneko: None declared, Tsutomu Takeuchi: None declared.
Collapse
|
36
|
Caporali R, Aletaha D, Sanmartí R, Takeuchi T, Mo D, Haladyj E, Zaremba-Pechmann L, Taylor PC. POS0701 LONG-TERM EFFICACY OF BARICITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS WHO HAVE HAD INADEQUATE RESPONSE TO csDMARDs: RESULTS FROM RA-BEYOND UP TO 7 YEARS OF TREATMENT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBaricitinib (BARI), an oral selective Janus kinase 1/2 inhibitor, has demonstrated efficacy in patients (pts) with rheumatoid arthritis (RA) for up to 3 years (yrs) in a long-term extension (LTE) study RA-BEYOND.1ObjectivesDisclose efficacy of BARI in csDMARD-IR pts in the completed LTE study (up to 7 yrs).MethodsIn RA-BUILD, csDMARD-IR pts were randomized 1:1:1 to BARI 4 mg, 2 mg, or placebo (PBO). Completers to week (wk) 24 could enter the LTE and received BARI 4 or 2 mg. In RA-BEAM, MTX-IR pts were randomized 1:1:1 to BARI 4 mg, adalimumab (ADA) 40 mg, or PBO. Completers to wk 52 received BARI 4 mg in the LTE. Pts with no response could be rescued after wk 16 in both studies. Data were analysed by treatment assigned at baseline in originating studies as observed up to time of stepdown (if applicable), study discontinuation or completion, whichever occurred earlier. Efficacy response rates (RR) were assessed as proportions of pts with observed data up to yr 7 (wk 364) for low-disease activity (LDA) (SDAI ≤ 11, DAS28-hsCRP ≤ 3.2, CDAI ≤ 10), remission (REM) (SDAI ≤ 3.3, DAS28-hsCRP < 2.6, CDAI ≤ 2.8, Boolean), and physical function (HAQ-DI ≤ 0.5). No formal statistical comparisons were conducted.ResultsApproximately 56%/25% of pts in BARI 4 mg, 80%/31% in BARI 2 mg, and 60%/25% in PBO from RA-BUILD remained active at yr 3/7; 59%/17% of pts in ADA, 54%/16% in BARI 4 mg, and 67%/14% in PBO from RA-BEAM remained active at year 3/7. SDAI and CDAI had comparable RR for LDA and REM (Table 1). DAS-28CRP LDA RR were similar to SDAI and CDAI, while REM RR were about twice those of SDAI and CDAI (Table 1). HAQ-DI ≤ 0.5 RR was achieved by 25-30% of BARI-treated pts from both trials and maintained to the end of LTE.Table 1.Efficacy outcomes in RA-BEYONDTimeaN/n (%)LDAREMHAQ-DI ≤0.5SDAICDAIDAS-28 CRPSDAICDAIDAS-28 CRPBooleanRA-BEYOND entryBARI 2 mg (BUILD)197/109197/103200/108197/38 (19.3)197/35 (17.8)200/72 (36.0)200/29 (14.5)200/50 (25.0)(55.3)(52.3)(54.0)BARI 4 mg (BUILD)188/113191/116189/112188/33191/35 (18.3)189/75 (39.7)189/26 (13.8)193/44 (22.8)(60.1)(60.7)(59.3)(17.6)BARI 4 mg (BEAM)412/288414/290412/280412/112414/108412/199412/78 (18.9)414/133 (27.3)(69.9)(70.0)(68.0)(27.2)(26.1)(48.3)Yr 3BARI 2 mg (BUILD)156/120158/116156/112156/41 (26.3)158/44 (27.8)156/81 (51.9)156/34 (21.8)159/38 (23.9)(76.9)(73.4)(71.8)BARI 4 mg (BUILD)107/76107/76107/74107/24107/26 (24.3)107/56 (52.3)107/17 (15.9)108/26 (24.1)(71.0)(71.0)(69.2)(22.4)BARI 4 mg (BEAM)222/166224/166222/164222/72224/71 (31.7)222/119222/48224/54 (24.1)(74.8)(74.1)(73.9)(32.4)(53.6)(21.6)Yr 7BARI 2 mg (BUILD)61/5061/4961/5161/17 (27.9)61/18 (29.5)61/40 (65.6)61/12 (19.7)62/16 (25.8)(82.0)(80.3)(83.6)BARI 4 mg (BUILD)45/3748/3745/3445/13 (28.9)48/16 (33.3)45/25 (55.6)45/8 (17.8)48/14 (29.2)(82.2)(77.1)(75.6)BARI 4 mg (BEAM)60/5364/5760/53 (88.3)60/18 (30.0)64/22 (34.4)60/38 (63.3)60/13 (21.7)64/14 (21.9)(88.3)(89.1)N: Number of pts with observed data; n: Number of pts with response. aTime from randomization in originating studies. Entry to RA-BEYOND=wk 24 and wk 52; Yr 3=wk 156 and wk 160; and Yr 7=wk 360 and wk 364 of RA-BUILD and RA-BEAM, respectively.ConclusionIn observed data, BARI demonstrated maintained efficacy in treatment and maintenance of physical function of a csDMARDs-IR RA pt population up to 7 yrs.References[1]Smolen JS, et al. Rheumatology (Oxford). 2021; 60(5):2256-66.Disclosure of InterestsRoberto Caporali Speakers bureau: Abbvie, Amgen, BMS, Celltrion, Eli Lilly and Company, Galapagos, Pfizer, Fresenius-Kabi, MSD, UCB, Roche,Janssen, Novartis, Sandoz, Consultant of: Abbvie, Amgen, BMS, Celltrion, Eli Lilly and Company, Galapagos, Pfizer, MSD, UCB, Janssen, Novartis, Sandoz, Daniel Aletaha Speakers bureau: Abbvie, Amgen, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: Abbvie, Amgen, Eli Lilly and Company, Novartis, Roche, SoBi, Sanofi, Raimón Sanmartí Speakers bureau: Eli Lilly and Company, Grant/research support from: Eli Lilly and Company, Tsutomu Takeuchi Speakers bureau: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co, Ltd. Daiichi Sankyo Co., Ltd. Eisai Co., Ltd. Eli Lilly Japan K.K.; Gilead Sciences, Inc. Janssen Pharmaceutical K.K.; Mitsubishi-Tanabe Pharma Co.; Novartis Pharma Co.; Pfizer Japan Inc.; Sanofi K.K.; UCB Japan Co., Ltd., Consultant of: AbbVie Japan GK, Astellas Pharma, Inc.; Chugai Pharmaceutical Co, Ltd.; Eli Lilly Japan K.K.; Eisai Co., Ltd.; Gilead Sciences, Inc.; Janssen Pharmaceutical K.K.; Mitsubishi-Tanabe Pharma Corp., Pfizer Japan Inc., Grant/research support from: AbbVie Japan GK, Asahikasei Pharma Corp., Chugai Pharmaceutical Co, Ltd., DNA Chip Research Inc.; Eisai Co., Ltd., Eli Lilly Japan K.K.; Mitsubishi-Tanabe Pharma Corp., UCB Japan Co., Ltd., Daojun Mo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ewa Haladyj Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Liliana Zaremba-Pechmann: None declared, Peter C. Taylor Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Inc, Roche, and Sanofi, Grant/research support from: Celgene, and Galapagos
Collapse
|
37
|
Kawamori K, Oguro N, Kida T, Omura S, Nakagomi D, Masatoshi K, Takizawa N, Nomura A, Yuji K, Kondo N, Yasuhiko Y, Yanagida T, Endo K, Hirata S, Kawahata K, Matsui K, Takeuchi T, Ichinose K, Kato M, Yanai R, Matsuo Y, Shimojima Y, Nishioka R, Yamasaki A, Takata T, Ito T, Moriyama M, Takatani A, Miyawaki Y, Kawahito Y, Ito-Ihara T, Kawaguchi T, Yajima N. AB0625 Association between Cytomegalovirus Reactivation and Renal Prognosis during Remission Induction Therapy for ANCA-Associated Vasculitis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCytomegalovirus (CMV) has been associated with atherosclerosis in patients with chronic renal failure, and may cause secondary nephrotic syndrome. Therefore, we hypothesized that the reactivation of CMV by immunosuppressive therapy in patients with vasculitis may affect renal function.ObjectivesThe purpose of this study was to investigate relationships between CMV infection and renal function during ANCA-associated vasculitis remission induction therapy.MethodsThis retrospective cohort study enrolled microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis patients at 25 sites in Japan who had a first or severe relapse between January 2017 and June 2020. Of these, patients with MPA or GPA who had a positive renal lesion score on BVAS (version 3) at baseline, or vasculitis findings on renal biopsy, CMV assayed by 48 weeks of treatment, were included. Patients were divided into two groups based on the presence or absence of a positive CMV antigen test during the remission induction phase (0–48 weeks of treatment). Outcomes were the rate of change in estimated glomerular filtration rate (eGFR) at 48 weeks after initiation of treatment in both groups, as determined by (eGFR at 48 weeks - eGFR at the initiation of treatment)/eGFR at the initiation of treatment; where lower values were associated with worse renal function. General linear models adjusted for age, gender, presence of diabetes or chronic kidney disease, and the use of rituximab or cyclophosphamide were generated.ResultsA total of 387 patients had CMV antigen measured during ANCA-associated vasculitis treatment, of which 164 had renal involvement and eGFR measured at 48 weeks. Seventy-seven (47.0%) were male and the median age was 75 years (range 69–80 years). CMV reactivation was observed in 44 patients (26.8%). The beta coefficient of multiple regression analysis with CMV positive as 1 and negative as 0 was 0.08 (95% confidence interval -0.13 to 0.29) (p = 0.47). The rate of change in eGFR was higher in the CMV positive group, but not statistically significantly.ConclusionContrary to our hypothesis, renal prognoses tended to be better when CMV reactivation was observed. The patients in the CMV reactivation group may have been treated more aggressively, and some patients with a poor prognosis who were not followed up for 48 weeks dropped out. Further research investigating the adjustment of treatment methods is required.Disclosure of InterestsNone declared
Collapse
|
38
|
Winthrop K, Tanaka Y, Takeuchi T, Kivitz A, Genovese MC, Pechonkina A, Matzkies F, Bartok B, Chen K, Jiang D, Tiamiyu I, Besuyen R, Strengholt S, Burmester GR, Gottenberg JE. POS0235 INTEGRATED SAFETY ANALYSIS UPDATE FOR FILGOTINIB (FIL) IN PATIENTS (PTS) WITH MODERATELY TO SEVERELY ACTIVE RHEUMATOID ARTHRITIS (RA) RECEIVING TREATMENT OVER A MEDIAN OF 2.2 YEARS (Y). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe preferential Janus kinase-1 inhibitor FIL significantly improved signs and symptoms of RA in Phase 2 and 3 trials.1–5 FIL is approved for treatment of moderate to severe active RA in Europe and Japan. Integrated safety analysis of FIL with patient data through 2019 was presented at the 2020 ACR virtual meeting.6ObjectivesTo report updated, as-treated data from the FIL integrated safety analysis with increased study drug exposure.MethodsData were integrated from 2 Phase 2 (NCT01668641, NCT01894516), 3 Phase 3 (NCT02889796, NCT02873936, NCT02886728), and 2 long-term extension (LTE) (NCT02065700, NCT03025308) trials. Phase 2 and 3 LTE data were through Nov 2020 and Jan 2021, respectively. The as-treated analysis set included all available data for pts receiving ≥1 dose FIL 200 (FIL200) or 100 mg (FIL100), including those rerandomized to FIL for LTE. Exposure-adjusted incidence rates (EAIR)/100 patient-y exposure (PYE) of treatment-emergent adverse events (TEAEs; onset after first dose and no later than 30 days after last dose or new drug first dose date −1 day) and TEAEs of special interest (AESIs) are presented.Results3691 pts received FIL200 or FIL100 for 8085.1 PYE (median 2.2, maximum 6.8 y). In the as-treated set, 61% of FIL200 and 45% of FIL100 pts received FIL for ≥2 y, 19% and 5% for ≥3 y, and 11% and 0.5% for ≥4.5 y, respectively. EAIR for TEAEs was higher with FIL100 than FIL200; EAIRs for deaths were 0.5 and 0.3 for FIL200 and FIL100 (Figure 1). Incidences of infections and serious infections were numerically greater for FIL100 vs FIL200, while EAIRs for other AESIs were comparable between doses (Table 1). EAIRs for AESIs tended to decrease since the previous update, except for venous thromboembolism (total FIL 0.1 to 0.2) and malignancies excluding NMSC (total FIL 0.5 to 0.6).Table 1.TEAEs of special interest, as-treated setTEAE, n (%) and EAIR per 100 PYE (95% CI)FIL 200 mgn=2267PYE=5302.5FIL 100 mgn=1647PYE=2782.6Total FILN=3691PYE=8085.1Infectious AEs1206 (53.2)747 (45.4)1927 (52.2)EAIR21.1 (19.7, 22.5)30.2 (26.8, 34.0)21.0 (19.9, 22.3)Serious infectious AEs80 (3.5)57 (3.5)137 (3.7)EAIR1.5 (1.1, 1.9)2.7 (1.9, 3.9)1.6 (1.3, 2.0)Opportunistic infections5 (0.2)4 (0.2)9 (0.2)EAIR0.1 (0, 0.2)*0.1 (0.1, 0.4)*0.1 (0.1, 0.2)*Active tuberculosis03 (0.2)3 (<0.1)EAIR00.1 (0, 0.3)*0 (0, 0.1)*Herpes zoster84 (3.7)30 (1.8)114 (3.1)EAIR1.6 (1.2, 2.0)1.1 (0.8, 1.5)*1.4 (1.1, 1.7)Major adverse cardiovascular eventsa19 (0.8)14 (0.9)33 (0.9)EAIR0.3 (0.2, 0.5)0.5 (0.3, 0.8)*0.4 (0.2, 0.6)Venous thromboembolismb11 (0.5)4 (0.2)15 (0.4)EAIR0.2 (0.1, 0.4)*0.1 (0.1, 0.4)*0.2 (0.1, 0.3)*Atrial systemic thrombotic eventsa1 (<0.1)1 (<0.1)2 (<0.1)EAIR0 (0, 0.1)0 (0, 0.3)0 (0, 0.1)Malignancy excluding NMSC32 (1.4)17 (1.0)49 (1.3)EAIR0.6 (0.4, 0.9)0.6 (0.4, 1.0)*0.6 (0.4, 0.8)NMSC15 (0.7)5 (0.3)20 (0.5)EAIR0.3 (0.2, 0.5)*0.2 (0.1, 0.4)*0.2 (0.2, 0.4)*Gastrointestinal perforations3 (0.1)1 (<0.1)4 (0.1)EAIR0.1 (0, 0.2)*0 (0, 0.3)*0 (0, 0.1)**Except when any study had 0 event within the treatment, the Poisson model was not adjusted by study. PYE was defined as (last dose date − first dose date + 1)/365.25.aPositively adjudicated.bAdjudicated as deep vein thrombosis or pulmonary embolism.NMSC, nonmelanoma skin cancerConclusionWith 1 additional year of exposure since the 2020 report, FIL continues to be well tolerated with no new safety concerns emerging. EAIRs of TEAEs, including deaths, and AESIs remained stable or decreased since the 2020 report, except for slight increases in rates of NMSC and malignancies excluding NMSC. In the context of demonstrated efficacy, both FIL doses had an acceptable risk/benefit profile.References[1]Westhovens R et al. Ann Rheum Dis 2017;76:998–1008.[2]Kavanaugh A et al. Ann Rheum Dis 2017;76:1009–19.[3]Combe B et al. Ann Rheum Dis 2021;80:848–58.[4]Genovese MC et al. JAMA 2019;322:315–25.[5]Westhovens R et al. Ann Rheum Dis 2021;80:727–38.[6]Winthrop K et al. Arthritis Rheumatol 2020;72(suppl 10); abstract 0229.AcknowledgementsFunding for DARWIN 1 and 2 was provided by Galapagos NV, and funding for DARWIN 3, FINCH 1, 2, 3, and 4 was provided by Gilead Sciences, Inc., Foster City, CA. Funding for this analysis was provided by Gilead Sciences, Inc. The sponsors participated in the planning, execution, and interpretation of the research. Medical writing support was provided by Gregory Bezkorovainy, MA, of AlphaScientia, LLC, San Francisco, CA; and funded by Gilead Sciences, Inc., Foster City, CA.Disclosure of InterestsKevin Winthrop Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly and Co., Galapagos NV, Gilead Sciences, Inc., GlaxoSmithKline, Pfizer, Roche, Regeneron, Sanofi, and UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, and Pfizer, Yoshiya Tanaka Speakers bureau: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol Myers Squibb, Eisai, Chugai, AbbVie, Astellas, Pfizer, Sanofi, Asahi-Kasei, GSK, Mitsubishi-Tanabe, Gilead Sciences, Inc., and Janssen, Consultant of: AbbVie, Ayumi, Daiichi-Sankyo, Eli Lilly, GSK, Taisho, and Sanofi, Grant/research support from: AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda, Tsutomu Takeuchi Speakers bureau: AbbVie, AYUMI, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Dainippon Sumitomo, Eisai, Eli Lilly Japan, Gilead Sciences, Inc., Mitsubishi-Tanabe, Novartis, Pfizer Japan, and Sanofi, Consultant of: Astellas, Chugai, and Eli Lilly Japan, Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Mitsubishi-Tanabe, Shionogi, Takeda, and UCB Japan, Alan Kivitz Shareholder of: Amgen, Gilead Sciences, Inc., GlaxoSmithKline, Pfizer, and Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, and Sanofi, Paid instructor for: Celgene, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, and Sanofi, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Genzyme, Gilead Sciences, Inc., Janssen, Novartis, Pfizer, Regeneron, Sanofi, and SUN Pharma Advanced Research, Mark C. Genovese Shareholder of: Gilead Sciences, Inc., Consultant of: AbbVie, Amgen, Beigene, Eli Lilly and Co., Genentech, Inc., Gilead Sciences, Inc., Sanofi Genzyme, RPharm, and SetPoint, Employee of: Gilead Sciences, Inc., Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Franziska Matzkies Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Beatrix Bartok Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Kun Chen Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Deyuan Jiang Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Iyabode Tiamiyu Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Robin Besuyen Shareholder of: Galapagos BV, Employee of: Galapagos BV, Sander Strengholt Shareholder of: Galapagos BV, Employee of: Galapagos BV, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly and Co., Galapagos, Gilead Sciences, Inc., and Pfizer, Consultant of: AbbVie, Eli Lilly and Co., Galapagos, Gilead Sciences, Inc., and Pfizer, Jacques-Eric Gottenberg Speakers bureau: AbbVie, Eli Lilly and Co., Galapagos BV, Gilead Sciences, Inc., Roche, Sanofi Genzyme, and UCB, Consultant of: Bristol Myers Squibb, Sanofi Genzyme, and UCB, Grant/research support from: Bristol Myers Squibb and Pfizer
Collapse
|
39
|
Nishioka R, Mizushima I, Kida T, Omura S, Nakagomi D, Masatoshi K, Takizawa N, Nomura A, Yuji K, Kondo N, Yasuhiko Y, Yanagida T, Endo K, Hirata S, Kawahata K, Matsui K, Takeuchi T, Ichinose K, Kato M, Yanai R, Matsuo Y, Shimojima Y, Yamasaki A, Takata T, Ito T, Moriyama M, Takatani A, Miyawaki Y, Ito-Ihara T, Kawaguchi T, Yajima N, Kawahito Y, Kawano M. POS0247 GLUCOCORTICOID TAPERING STRATEGY FOR ANCA-ASSOCIATED VASCULITIS: ADDRESSING THE GAP BETWEEN RECOMMENDATIONS AND REAL-WORLD PRACTICE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAntineutrophil cytoplasmic antibody -associated vasculitis (AAV) is usually treated with combination of high-dose glucocorticoid (GC) and immunosuppressive agents, followed by tapering GC dose. Although the European League Against Rheumatism (EULAR) has specific recommendations for tapering the GC dose, clinicians often taper it slower than recommended due to concerns of potential disease relapse. However, such slower taper may prolong GC exposure for the patients, increasing the risk of adverse events, particularly infection.ObjectivesThe aims of our study were (1) to clarify GC dose tapering in the treatment of AAV in a real-world setting, in contrast to the EULAR recommendation of 2015 and (2) to compare the incidence of AAV relapse and severe infection between patients underdoing EULAR-recommended tapering and those undergoing slower tapering than the recommendation.MethodsIn this multicenter (25 sites in Japan), observational, retrospective study of AAV, 541 patients who had initial or severe relapse were enrolled between January 2017 and June 2020. Of these, 349 patients with microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) who entered in GC tapering phase after successful induction treatment were included. These patients were then grouped on the pace of GC tapering, defined as the GC dose at 12 weeks after treatment initiation: (1) EULAR group: 7.5-10 mg/day of GC, according to the EULAR recommendation of 2015, and (2) SLOWER group: >10 mg/day of GC. Their baseline characteristics and clinical outcomes were compared. Primary outcome was defined as relapse-free days from treatment initiation, whereas secondary outcome included the incidence of infectious events requiring hospitalization within 48 weeks from treatment initiation. Multivariable analysis was performed to assess the relationship between tapering pace and clinical outcomes.ResultsThere were 44 patients (12.6%) in the EULAR group and 290 (83.2%) in the SLOWER group. Regarding baseline characteristics, compared with the EULAR group, the SLOWER group had significantly higher serum C-reactive protein level (EULAR, 5.89 ± 6.89 mg/dL vs SLOWER, 7.56 ± 6.01 mg/dL; p = 0.03), as well as a trend toward higher Birmingham Vasculitis Activity Score (version 3) (EULAR, 11.80 ± 7.01 SLOWER, 13.93 ± 7.06; p = 0.08) We did not observe any significant differences in the frequency of relapses between the two groups (EULAR, 8/44, 18.2% vs SLOWER, 55/290, 19.0%; p = 0.63). Multivariable Cox proportional hazard analysis revealed no relationship GC dose at 12 weeks from treatment initiation and incidence of relapse. However, upon logistic regression analysis, the SLOWER group was found to have significant higher risk of a severe infectious event within 48 weeks from treatment initiation (p = 0.046; hazard ratio, 1.27; 95% confidence interval, 1.004 – 1.601).ConclusionOur finding indicates that clinicians tended to taper GC slower for patients with higher disease activity. However, slower GC taper was not found to reduce the frequency of relapse. In addition, slower GC taper was found to increase the risk of a severe infection. Hence, clinicians should pay attention not only relapsing but also late GC taper resulting in the risk of serious infection, especially in patients with higher disease activity of AAV.References[1]Eur J Clin Invest 2015;45 (3): 346–368.[2]Rheumatology (Oxford). 2021 Dec 24;61(1):205-212.[3]Arthritis Res Ther. 2021 Mar 20;23(1):90.[4]Scand J Rheumatol. 2022 Jan 20;1-13.[5]J Rheumatol. 2018 Apr;45(4):521-528.[6]Rheumatol Adv Pract. 2021 Mar 9;5(3):rkab018.[7]Ann Rheum Dis. 2016 Sep;75(9):1583-94.Figure 1.AcknowledgementsWe would like to thank Editage (www.editage.com) for English language editing.Disclosure of InterestsNone declared
Collapse
|
40
|
Golder V, Kandane-Rathnayake R, Louthrenoo W, Chen YH, Cho J, Lateef A, Hamijoyo L, Luo SF, Jan Wu YJ, Navarra S, Zamora L, LI Z, An Y, Sockalingam S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Basnayake B, Chan M, Kikuchi J, Takeuchi T, Bae SC, O’neill S, Goldblatt F, Oon S, Gibson K, Ng K, Law A, Tugnet N, Kumar S, Tee C, Tee M, Tanaka Y, Lau CS, Nikpour M, Hoi A, Morand EF. OP0142 COMPARISON OF ATTAINMENT AND PROTECTIVE EFFECTS OF THE LUPUS LOW DISEASE ACTIVITY STATE IN PATIENTS WITH NEWLY DIAGNOSED VERSUS ESTABLISHED SLE - A MULTICENTRE PROSPECTIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundLupus low disease activity state (LLDAS) attainment has been reported to be associated with reduced damage accrual, flare, and mortality, as well as improved quality of life, in cohorts of SLE patients with established disease. Whether these associations are present in recent-onset disease is less well known.ObjectivesTo evaluate the associations of LLDAS attainment with outcomes in patients with recent onset SLE.MethodsData from a 13-country longitudinal SLE cohort (ACR/SLICC criteria) were collected prospectively between 2013 and 2020 using standard templates. Organ damage and flare were captured using SLICC Damage Index and SELENA-SLEDAI Flare Index, respectively. LLDAS was defined as Golder et al., 2019 [1]. An inception cohort was defined based on duration since SLE diagnosis<1 year at enrolment. Patient characteristics between inception and non-inception cohorts were compared using Wilcoxon rank-sum (continuous variables) or Pearson’s Chi-squared tests (categorical variables). Survival analyses were performed to examine the association between LLDAS attainment and damage accrual and flare.ResultsThe study cohort included 4,106 patients of whom 680 (16%) were recruited within 1 year of SLE diagnosis (inception cohort). Compared to the non-inception cohort, inception cohort patients were significantly younger, had higher disease activity (SLEDAI-2K and physician global assessment), used more glucocorticoids and immunosuppressants but had less organ damage at enrolment and only 88 (13.6%) patients accrued damage during a median 2.2 years follow-up (Table 1).Table 1.Non-inception cohortInception cohortp-valuen=3426n=680Age at enrolment (years), median [IQR]40 [31, 51]33 [25, 44]<0.001Age at diagnosis (years), median [IQR]28 [21, 38]33 [25, 43]<0.001SLE duration at enrolment (years), median [IQR]10 [5, 16]1 [0, 1]<0.001Study duration (years), median [IQR]2.5 [1.0, 5.4]2.2 [0.9, 3.7]<0.001Females, n (%)3155 (92.1%)623 (91.6%)0.68Asian ethnicity, n (%)3037 (89.1%)595 (88.1%)0.49Prednisolone (PNL) use - ever, n (%)2865 (83.6%)620 (91.2%)<0.001Time adjusted mean (TAM)-PNL, median [IQR]5.0 [2.2, 8.6]6.2 [3.2, 10.3]<0.001Cumulative PNL (g), median [IQR]3.4 [0.5, 9.7]3.8 [1.1, 8.5]0.26Anti-Malarial use - ever, n (%)2669 (77.9%)569 (83.7%)<0.001Immunosupressant use -ever, n (%)2367 (69.1%)521 (76.6%)<0.001AMS (TAM-SLEDAI-2K), median [IQR]2.8 [1.2, 4.6]3.1 [1.6, 5.0]0.002TAM-PGA, median [IQR]0.4 [0.2, 0.7]0.4 [0.3, 0.8]<0.001Mild/moderate/severe flare ever, n (%)1789 (52.2%)391 (57.5%)0.012Organ damage accrual, n (%)629 (20.8%)88 (13.6%)<0.001LLDAS at baseline, n (%)1730 (50.5%)195 (28.7%)<0.001LLDAS-ever (at least once), n (%)2637 (78.2%)492 (73.9%)0.014≥50% time in LLDAS (LLDAS-5), n (%)1612 (50.6%)256 (41.1%)<0.001Significantly fewer inception cohort patients were in LLDAS at enrolment than the non-inception cohort (29% vs. 51%, p<0.001). However, 74% of inception and 78% of non-inception cohort patients achieved LLDAS at least once during follow-up. Limiting analysis only to patients not in LLDAS at enrolment, time to first LLDAS attainment was assessed: inception cohort patients were 60% more likely to attain their first LLDAS (HR = 1.60 (95%CI: 1.40, 1.82), p<0.001) than non-inception cohort patients. LLDAS attainment was significantly protective against flare in the inception (HR, 95% CI) and non-inception (HR, 95% CI) cohorts. Trends towards protection against damage accrual in association with LLDAS in the inception cohort were not significant.ConclusionLLDAS attainment is protective from flare in recent onset SLE. Significant protection from damage accrual was not observed, due to low rates of damage accrual in the first years after SLE diagnosis.References[1]Golder, V., et al., Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. The Lancet Rheumatology, 2019. 1(2): p. e95-e102.AcknowledgementsWe thank all patients participating in the Asia Pacific Lupus Collaboration (APLC) cohort, and all data collectors for their ongoing support for APLC research activities.The APLC has received unrestricted project grants from AstraZeneca, BMS, Eli Lily, Janssen, Merck Serono, and UCB to support data collection contributing to this work.Disclosure of InterestsVera Golder: None declared, Rangi Kandane-Rathnayake: None declared, Worawit Louthrenoo: None declared, Yi-Hsing Chen Speakers bureau: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Lilly, GSK, Astra& Zeneca, Sanofi, MSD, Guigai, Astellas, Inova Diagnostics, UCB, Agnitio Science Technology, United Biopharma, Thermo Fisher, Consultant of: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Lilly, GSK, Astra and Zeneca, Sanofi, Guigai, Astellas, Inova Diagnostics, UCB, Agnitio Science Technology, United Biopharma, Thermo Fisher, Gilead, Grant/research support from: Yes. Clinical trials and/or research grants from Pfizer, Norvatis, BMS, Abbevie, Johnson & Johnson, Roche,Sanofi, Guigai, Roche, Boehringer Ingelheim, UCB, MSD, Astra-Zeneca,Astellas, Gilead, Jiacai Cho: None declared, Aisha Lateef: None declared, Laniyati Hamijoyo Speakers bureau: Pfizer, Novartis, Abbot, Shue Fen Luo: None declared, Yeong-Jian Jan Wu Speakers bureau: Pfizer, Lilly, Novartis, Abbvie, Sandra Navarra Speakers bureau: Pfizer, Johnson & Johnson, Novartis, Astellas, Grant/research support from: Astellas, Johnson & Johnson, Leonid Zamora: None declared, Zhanguo Li Speakers bureau: Eli, Lilly, Novartis, GSK, AbbVie, Paid instructor for: Pfizer, Roche, Johnson, Consultant of: Lilly, Pfizer, Grant/research support from: Pfizer, Yuan An: None declared, Sargunan Sockalingam Speakers bureau: Yes. Pfizer, Roche, Novartis, Grant/research support from: Roche and Novartis, Yasuhiro Katsumata Speakers bureau: Chugai Pharmaceutical Co., Ltd., Glaxo-Smithkline K.K., and Sanofi K.K., Masayoshi Harigai Speakers bureau: MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc.,Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd, Consultant of: MH is a consultant for AbbVie, Boehringer-ingelheim, Bristol Myers Squibb Co., Kissei Pharmaceutical Co.,Ltd. and Teijin Pharma., Grant/research support from: MH has received research grants from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc.,Eisai Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., Sekiui Medical, Shionogi & Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Yanjie Hao: None declared, Zhuoli Zhang Speakers bureau: Norvatis, GSK, Pfizer, BMDB Basnayake: None declared, Madelynn Chan Speakers bureau: AbbVie, Novartis, Consultant of: Advisory Board member for Pfizer, Eli-Lilly, Jun Kikuchi: None declared, Tsutomu Takeuchi Speakers bureau: AbbVie AYUMI Pharmaceutical Corp. Bristol-Myers Squibb Chugai Pharmaceutical Co, Ltd. Daiichi Sankyo Co., Ltd. Eisai Co., Ltd. Eli Lilly Japan, Gilead Sciences, Inc. Mitsubishi-Tanabe Pharma Corp. Pfizer Japan Inc. Sanofi K.K., Consultant of: Astellas Pharma, Inc. Chugai Pharmaceutical Co, Ltd. Eli Lilly Japan, Mitsubishi-Tanabe Pharma Corp., Grant/research support from: AbbVie Asahikasei Pharma Corp. Chugai Pharmaceutical Co, Ltd. Mitsubishi-Tanabe Pharma Corp. Sanofi K.K, Sang-Cheol Bae: None declared, Sean O’Neill Paid instructor for: Advisory board member for GSK, Fiona Goldblatt: None declared, Shereen Oon: None declared, Kathryn Gibson Speakers bureau: UCB, Consultant of: Novartis – co-chair for NSW and steering committee member for ARISE meeting Feb 2021Janssen Pharmaceuticals – advisory board, Grant/research support from: Novartis, Employee of: Eli Lilly, Kristine Ng Speakers bureau: speaker fees and advisory board (Abbvie, Novartis, Janssen), Annie Law: None declared, Nicola Tugnet: None declared, Sunil Kumar: None declared, Cherica Tee: None declared, Michael Tee: None declared, Yoshiya Tanaka Speakers bureau: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen, Grant/research support from: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen, C.S. Lau Shareholder of: Pfizer, Sanofi and Janssen, Mandana Nikpour Speakers bureau: Actelion, GSK, Janssen, Pfizer, UCB, Paid instructor for: UCB, Consultant of: Actelion, Boehringer Ingelheim, Certa Therapeutics, Eli Lilly, GSK, Janssen, Pfizer, UCB, Grant/research support from: Actelion, Astra Zeneca, BMS, GSK, Janssen, UCB, Alberta Hoi Consultant of: AH is on the advisory board for Abbvie and GSK, Grant/research support from: AH has received research support from AstraZeneca, GSK, BMS, Janssen, and Merck Serono, Eric F. Morand Speakers bureau: AstraZeneca, Paid instructor for: Eli Lilly, Consultant of: AstraZeneca, Amgen, Biogen, BristolMyersSquibb, Eli Lilly, EMD Serono, Genentech, Janssen, Grant/research support from: AstraZeneca, BristolMyersSquibb, Eli Lilly, EMD Serono, Janssen
Collapse
|
41
|
Caporali R, Aletaha D, Sanmartí R, Takeuchi T, Mo D, Haladyj E, Zaremba-Pechmann L, Taylor PC. POS0682 LONG-TERM EFFICACY OF BARICITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS WITH INADEQUATE RESPONSE TO bDMARDs: RESULTS FROM RA-BEYOND FOLLOWING 6.9 YEARS OF TREATMENT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundBaricitinib (BARI), an oral selective Janus kinase 1/2 inhibitor, is approved for treatment of adults with moderately-to-severely active rheumatoid arthritis (RA). BARI demonstrated efficacy in patients (pts) with RA who have inadequate response to biologic disease-modifying antirheumatic drugs (bDMARD-IR) in a 24-week (wk) phase 3 study, RA-BEACON.1 BARI efficacy was evaluated up to 3 years (yrs) of treatment in a long-term extension (LTE) study, RA-BEYOND.2ObjectivesDisclose long-term efficacy of BARI 4 mg and 2 mg in bDMARD-IR pts in the completed study RA-BEYOND.MethodsIn RA-BEACON, pts were randomized 1:1:1 to BARI 4 mg, 2 mg, or PBO; pts with no response could be rescued after wk 16. Completers to wk 24 could enter with BARI 4 or 2mg RA-BEYOND for up to 360 wks (6.9 yrs). LTE data were analysed by treatment assigned at baseline in RA-BEACON as observed up to time of stepdown (if applicable), study discontinuation, or study completion, whichever occurred earlier. Efficacy response rates (RR) were assessed as proportions of pts with observed data up to wk 360 for low-disease activity (LDA) (SDAI ≤ 11, DAS28-hsCRP ≤ 3.2, CDAI ≤ 10), remission (REM) (SDAI ≤ 3.3, DAS28-hsCRP < 2.6, CDAI ≤ 2.8, Boolean), and physical functioning (HAQ-DI ≤ 0.5). No formal statistical comparisons were conducted.Results156, 152, and 140 pts entered the LTE (4 mg, 2 mg, and PBO, respectively). Pts in BARI 4 and 2 mg arms had higher LDA and REM RR vs PBO at LTE entry (wk 24) (Table 1). PBO-treated pts achieved comparable RR to pts in the BARI 4 mg arm by wk 48 (24 wks after switch to BARI 4 mg) and up to wk 360. Of pts enrolled to RA-BEYOND, approx. 50% in BARI 4 mg, 65% in 2 mg and 61% in PBO remained active at wk 156; 17%, 26% and 26% at wk 360, respectively. SDAI LDA RR were 47%/70% and 61%/74% for pts treated with BARI 4 mg and 2 mg, at wk 156 (yr 3)/ 360 (yr 6.9), respectively; SDAI REM RR were 15%/26% and 26%/26% for BARI 4 mg and 2 mg, at wk 156/360, respectively (Table 1). SDAI and CDAI had comparable RR. DAS-28CRP LDA RR were similar to SDAI and CDAI, while REM RR were about twice those of SDAI and CDAI. HAQ-DI ≤ 0.5 RR was 15%/26% (BARI 4 mg), 21%/15% (BARI 2mg), and 9%/3% (PBO) at 3/6.9 yrs.Table 1.Efficacy outcomes in RA-BEYONDTimeaN/n (%)LDAREMSDAICDAIDAS-28 CRPSDAICDAIDAS-28 CRPBooleanHAQ-DI ≤0.5Wk 24PBOb135/31 (23.0)138/32 (23.2)135/31 (23.0)135/6 (4.4)138/8 (5.8)135/14 (10.4)135/3139/6 (4.3)(2.2)BARI 2 mg148/42 (28.4)152/43 (28.3)148/38 (25.7)148/10 (6.8)152/10 (6.6)148/22 (14.9)148/9152/17 (11.2)(6.1)BARI 4 mg150/57 (38.0)156/60 (38.5)150/60 (40.0)150/14 (9.3)156/17 (10.9)150/37 (24.7)150/11 (7.3)156/17 (10.9)Wk 48PBO128/59 (46.1)129/58 (45.0)128/58 (45.3)128/14 (10.9)129/15 (11.6)128/31 (24.2)128/5130/6 (4.6)(3.9)BARI 2 mg139/54 (38.8)140/56 (40.0)139/53 (38.1)139/13 (9.4)140/14 (10.0)139/30 (21.6)139/11 (7.9)140/16 (11.4)BARI 4 mg147/70 (47.6)149/71 (47.7)147/68 (46.3)147/22 (15.0)149/19 (12.8)147/49 (33.3)147/14 (9.5)149/19 (12.8)Wk 156PBO84/47 (56.0)85/47 (55.3)84/45 (53.6)84/15 (17.9)85/14 (16.5)84/33 (39.3)84/985/8 (9.4)(10.7)BARI 2 mg98/60 (61.2)99/60 (60.6)98/58 (59.2)98/25 (25.5)99/27 (27.3)98/43 (43.9)98/13 (13.3)99/21 (21.2)BARI 4 mg76/36 (47.4)78/35 (44.9)76/37 (48.7)76/11 (14.5)78/13 (16.7)76/25 (32.9)76/978/12 (15.4)(11.8)Wk 360PBO33/26 (78.8)35/25 (71.4)34/27 (79.4)33/8 (24.2)35/9 (25.7)34/17 (50.0)34/636/1 (2.8)(17.6)BARI 2 mg38/28 (73.7)38/28 (73.7)38/27 (71.1)38/10 (26.3)38/8 (21.1)38/20 (52.6)38/539/6 (15.4)(13.2)BARI 4 mg27/19 (70.4)27/20 (74.1)27/20 (74.1)27/7 (25.9)27/7 (25.9)27/15 (55.6)27/427/7 (25.9)(14.8)N: Number of pts with observed data; n: Number of pts with response. aNumber of wks from randomisation. bTreatment groups as assigned at randomisation.ConclusionIn observed data, BARI maintained efficacy and normative physical function bDMARD-IR population up to 6.9 yrs (360 wks).References[1]Genovese MC et al. N Engl J Med. 2016; 374:1243-52[2]Wells AF et al. Rheumatol Ther. 2021; 8:987–1001Disclosure of InterestsRoberto Caporali Speakers bureau: Abbvie, Amgen, BMS, Celltrion, Eli Lilly and Company, Galapagos, Pfizer, Fresenius-Kabi, MSD, UCB, Roche,Janssen, Novartis, Sandoz, Consultant of: Abbvie, Amgen, BMS, Celltrion, Eli Lilly and Company, Galapagos, Pfizer, MSD, UCB, Janssen, Novartis, Sandoz, Daniel Aletaha Speakers bureau: Abbvie, Amgen, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: Abbvie, Amgen, Eli Lilly and Company, Novartis, Roche, SoBi, Sanofi, Raimón Sanmartí Speakers bureau: Eli Lilly and Company, Grant/research support from: Eli Lilly and Company, Tsutomu Takeuchi Speakers bureau: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co, Ltd. Daiichi Sankyo Co., Ltd. Eisai Co., Ltd. Eli Lilly Japan K.K.; Gilead Sciences, Inc. Janssen Pharmaceutical K.K.; Mitsubishi-Tanabe Pharma Co.; Novartis Pharma Co.; Pfizer Japan Inc.; Sanofi K.K.; UCB Japan Co., Ltd., Consultant of: AbbVie Japan GK, Astellas Pharma, Inc.; Chugai Pharmaceutical Co, Ltd.; Eli Lilly Japan K.K.; Eisai Co., Ltd.; Gilead Sciences, Inc.; Janssen Pharmaceutical K.K.; Mitsubishi-Tanabe Pharma Corp., Pfizer Japan Inc., Grant/research support from: AbbVie Japan GK, Asahikasei Pharma Corp., Chugai Pharmaceutical Co, Ltd., DNA Chip Research Inc.; Eisai Co., Ltd., Eli Lilly Japan K.K.; Mitsubishi-Tanabe Pharma Corp., UCB Japan Co., Ltd., Daojun Mo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ewa Haladyj Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Liliana Zaremba-Pechmann: None declared, Peter C. Taylor Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Inc, Roche, and Sanofi, Grant/research support from: Celgene and Galapagos
Collapse
|
42
|
Tanaka Y, Atsumi T, Aletaha D, Landewé RBM, Bartok B, Pechonkina A, Yin Z, Han L, Emoto K, Kano S, Rajendran V, Takeuchi T. POS0664 RADIOGRAPHIC CHANGE IN PATIENTS WITH RHEUMATOID ARTHRITIS AND ESTIMATED BASELINE YEARLY PROGRESSION ≥5 OR <5: POST HOC ANALYSIS OF TWO PHASE 3 TRIALS OF FILGOTINIB. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn some patients (pts) with rheumatoid arthritis (RA), especially those with joint damage early in the disease, first-line methotrexate (MTX) treatment may not suffice to prevent further rapid radiographic progression (RRP).1 In FINCH 1 (NCT02889796), filgotinib 200 mg (FIL200) and 100 mg (FIL100) reduced change in modified total Sharp score (mTSS) vs placebo (PBO) in pts with RA and inadequate response to MTX (MTX-IR).2 In FINCH 3 (NCT02886728), FIL200 and FIL100 reduced change in mTSS vs MTX monotherapy (MTX mono) in MTX-naïve pts.3ObjectivesTo evaluate, via post hoc analysis of 2 trials, filgotinib’s effects on radiographic progression vs MTX mono in pts with estimated baseline (BL) yearly progression ≥5 or <5 mTSS units/year.MethodsThe double-blind 52-week (W) FINCH 1 study randomised MTX-IR pts with moderate–severe active RA to FIL200 or FIL100, subcutaneous adalimumab (ADA) 40 mg, or PBO; at W24, PBO pts were rerandomised blinded to FIL200 or FIL100; all took stable background MTX.2 In FINCH 3, MTX-naïve pts were randomised, blinded, to FIL200 + MTX, FIL100 + MTX, FIL200 alone, or MTX mono for up to W52.3 This analysis examined subgroups by estimated BL yearly progression (BL mTSS/duration in years of RA diagnosis), based on ≥5 or <5 mTSS units/year,4 a threshold commonly used to define RRP. We assessed effects of filgotinib vs ADA or PBO in mTSS change from BL (CFB) at W24/W52 (using a mixed model for repeated measures) and percentages with no W24 progression (mTSS change ≤0, ≤0.5, ≤smallest detectable change [SDC], using Fisher’s exact test).ResultsAt BL, 558/1755 MTX-IR and 787/1249 MTX-naïve pts had BL estimated yearly progression ≥5. Median mTSS in pts with BL yearly progression ≥5 and <5 was 53.25 vs 5.00 respectively in the MTX-IR trial and 6.00 vs 2.50 in the MTX-naïve trial. At W24, the mTSS CFB in pts with BL yearly progression ≥5 and <5 was 0.84 and 0.22 in MTX-IR pts taking PBO + MTX, and 0.67 and 0.25 in MTX-naïve pts taking MTX mono. At W52, in pts with BL yearly progression ≥5, FIL200 + MTX reduced mTSS change vs PBO + MTX in the MTX-IR trial and vs MTX mono in the MTX-naïve trial (Figure 1). At W24, among pts with estimated BL yearly progression ≥5, FIL200 + MTX increased odds of no progression (≤0.5 or ≤0) vs PBO + MTX in MTX-IR pts and vs MTX mono in MTX-naïve pts (Table 1).Table 1.Ratio of no radiographic progression at W24FINCH 1: MTX-IRFIL200 + MTXFIL100 + MTXADA + MTXPBO + MTXBL yearly progression≥5(n = 138)<5(n = 267)≥5(n = 139)<5(n = 265)≥5(n = 91)<5(n = 180)≥5(n = 101)<5(n = 250)% with no progression (≤0.5)87.797.088.592.587.993.976.291.6OR2.22*2.97*2.40*1.12††††% with no progression (≤0)80.491.881.388.380.289.467.386.4OR2.00*1.752.11*1.19††††% with no progression (≤SDC [1.36])91.398.192.196.692.395.681.294.0OR2.43*3.35*2.70*1.82††††FINCH 3: MTX-naïveFIL200 + MTXFIL100 + MTXFIL200 monoMTXBL yearly progression≥5<5≥5<5≥5<5≥5<5(n = 221)(n = 134)(n = 121)(n = 63)(n = 115)(n = 58)(n = 224)(n = 132)% with no progression (≤0.5)86.994.083.593.789.689.778.687.9OR1.81*2.171.382.032.34*1.20††% with no progression (≤0)78.783.672.784.180.087.967.980.3OR1.75*1.251.261.31.89*1.79††% with no progression (≤SDC [1.53])93.797.891.796.895.796.689.395.5OR1.772.081.331.452.641.33††MTX-IR ORs are FIL vs PBO + MTX; MTX-naïve are FIL vs MTX. *Nominal P<.05. †Not applicable.ADA, adalimumab; FIL, filgotinib; IR, inadequate response; mTSS, modified total Sharp score; MTX, methotrexate; OR, odds ratio; SDC, smallest detectable change; W, week.ConclusionThese data suggest filgotinib’s inhibition of radiographic progression was numerically greater than MTX monotherapy in RA pts with high estimated BL yearly progression. In those with a more moderate estimated rate of progression, filgotinib suppressed progression comparably to ADA and/or MTX.References[1]Smolen J et al. Ann Rheum Dis 2018;77:1566–1572.[2]Combe B et al. Ann Rheum Dis 2021;80:848–858.[3]Westhovens R et al. Ann Rheum Dis 2021;80:727–738.[4]Vastesaeger N et al. Rheumatology. 2009;48:1114–1121.AcknowledgementsThis study was funded by Gilead Sciences, Inc., Foster City, CA. Medical writing support was provided by Rob Coover, MPH, of AlphaScientia, LLC, San Francisco, CA; and funded by Gilead Sciences, Inc., Foster City, CA. Funding for this analysis was provided by Gilead Sciences, Inc. The sponsors participated in the planning, execution, and interpretation of the research.Disclosure of InterestsYoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, Behringer-Ingelheim, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi-Tanabe, and YL Biologics, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer-Ingelheim, Chugai, Corrona, Daiichi Sankyo, Eisai, Kowa, Mitsubishi-Tanabe, and Takeda, Tatsuya Atsumi Paid instructor for: Gilead Sciences, Inc.; Mitsubishi Tanabe; Chugai; Astellas Pharma; Takeda; Pfizer; AbbVie: Eisai; Daiichi Sankyo; Bristol-Myers Squibb; UCB Japan Co. Ltd.; Eli Lilly Japan K.K., Otsuka Pharmaceutical Co., Ltd.; and Alexion Inc., Grant/research support from: Gilead Sciences, Inc.; Mitsubishi Tanabe; Chugai; Astellas Pharma; Takeda; Pfizer; AbbVie: Eisai; Daiichi Sankyo; Bristol-Myers Squibb; UCB Japan Co. Ltd.; Eli Lilly Japan K.K., Otsuka Pharmaceutical Co., Ltd.; and Alexion Inc., Daniel Aletaha Speakers bureau: AbbVie; Amgen; Celgene; Eli Lilly; Medac; Merck; Novartis; Pfizer; Roche; Sandoz; and Sanofi/Genzyme; Bristol-Myers Squibb, Merck Sharp & Dohme, and UCB, Consultant of: Janssen; AbbVie; Amgen; Celgene; Eli Lilly; Medac; Merck; Novartis; Pfizer; Roche; Sandoz; and Sanofi/Genzyme, Grant/research support from: AbbVie, Merck Sharp & Dohme, Novartis, and Roche, Robert B.M. Landewé Paid instructor for: AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos NV, Novartis, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Galapagos NV, Novartis, Pfizer, and UCB, Beatrix Bartok Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc, Alena Pechonkina Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Zhaoyu Yin Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Ling Han Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Kahaku Emoto Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences K.K., Shungo Kano Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences K.K., Vijay Rajendran Employee of: Galapagos BV, Tsutomu Takeuchi Speakers bureau: AbbVie, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Dainippon Sumitomo Eisai, Eli Lilly Japan, Mitsubishi-Tanabe, Novartis, Pfizer Japan, Sanofi, and Gilead Sciences, Inc., Consultant of: Astellas, Chugai, and Eli Lilly Japan, Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Mitsubishi-Tanabe, Shionogi, Takeda, and UCB Japan
Collapse
|
43
|
Asaishi K, Matsui M, Nishikawa H, Goto M, Asai A, Ushiro K, Ogura T, Takeuchi T, Nakamura S, Kakimoto K, Miyazaki T, Fukunishi S, Ohama H, Yokohama K, Yasuoka H, Higuchi K. Grip Strength in Patients with Gastrointestinal Diseases. J Clin Med 2022; 11:jcm11082079. [PMID: 35456173 PMCID: PMC9025528 DOI: 10.3390/jcm11082079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
We sought to elucidate factors contributing to the grip strength (GS) decline in patients with gastrointestinal diseases (Ga-Ds, n = 602, 379 males, median age = 72 years). The GS decline in males and females was defined as <28 kg and <18 kg, respectively, following the current Asian guidelines. The median GS (male) was 28.8 kg, and GS decline (male) was found in 169 patients (44.6%). The median GS (female) was 17.5 kg, and GS decline (female) was found in 122 patients (54.7%). Advanced cancer was identified in 145 patients (24.1%). In terms of the univariate analysis of parameters of the GS decline, age (p < 0.0001), gender (p = 0.0181), body mass index (BMI, p = 0.0002), ECOG-PS (p < 0.0001), SARC-F score (p < 0.0001), hemoglobin value (p < 0.0001), total lymphocyte count (p < 0.0001), serum albumin value (p < 0.0001), C reactive protein (CRP) value (p < 0.0001), and estimated glomerular filtration rate were statistically significant. In terms of the multivariate analysis, age (p < 0.0001), BMI (p = 0.0223), hemoglobin value (p = 0.0186), serum albumin value (p = 0.0284), the SARC-F score (p = 0.0003), and CRP value (p < 0.0001) were independent parameters. In conclusion, the GS decline in patients with Ga-Ds is closely associated with not only the primary factor (i.e., aging) but also secondary factors such as inflammatory factors and nutritional factors.
Collapse
Affiliation(s)
- Ken Asaishi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Masahiro Matsui
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Hiroki Nishikawa
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
- The Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
- Correspondence: ; Tel.: +81-726-83-1221
| | - Masahiro Goto
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Akira Asai
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Kosuke Ushiro
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Takeshi Ogura
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Toshihisa Takeuchi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Shiro Nakamura
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Kazuki Kakimoto
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Takako Miyazaki
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
- The Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
| | - Shinya Fukunishi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
- The Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
| | - Hideko Ohama
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Keisuke Yokohama
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Hidetaka Yasuoka
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Kazuhide Higuchi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (K.A.); (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| |
Collapse
|
44
|
Henmi Y, Hirata Y, Koubayashi E, Hara A, Naka Y, Kakimoto K, Nouda S, Kawakami K, Takeuchi T, Higuchi K. Endoscopic diagnosis of Whipple disease in a patient without gastrointestinal symptoms: A case report. DEN Open 2022; 2:e37. [PMID: 35310739 PMCID: PMC8828164 DOI: 10.1002/deo2.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022]
Abstract
Whipple's disease is a systemic chronic bacterial infection caused by Tropheryma whipplei, a gram‐positive bacillus. T. whipplei infection in the small intestine often causes malabsorption and is often accompanied by gastrointestinal symptoms such as diarrhea and abdominal pain. In this report, we describe our experience with a case of Whipple's disease in which the affected patient did not have the typical gastrointestinal symptoms. The patient was an 80‐year‐old male who presented with complaints of weight loss and lower leg edema due to malabsorption and shortness of breath during exertion. A blood test revealed a decreased albumin level and an elevated C‐reactive protein level. Endoscopic images revealed diffuse white villi, the presence of which extended from the duodenum to the upper jejunum. We made a diagnosis of Whipple's disease based on pathological findings associated with the duodenum, electron microscopic findings, and findings of polymerase chain reaction (PCR) tests (performed using mucosal tissue). Clinical symptoms and endoscopic findings improved with antibiotics. Real‐time PCR tests were performed for a quantitative evaluation of the effect of treatment. Endoscopy is useful for diagnosing Whipple's disease when there is an absence of gastrointestinal symptoms, and hypoalbuminemia of unknown etiology is observed.
Collapse
Affiliation(s)
- Yujiro Henmi
- Moriguchi Keijinkai Hospital Osaka Japan
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Yuki Hirata
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Eiko Koubayashi
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | | | - Yutaka Naka
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Kazuki Kakimoto
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Sadaharu Nouda
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
- Midorigaoka Hospital Osaka Japan
| | - Ken Kawakami
- Moriguchi Keijinkai Hospital Osaka Japan
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| |
Collapse
|
45
|
Ota K, Kawaguchi S, Iwatsubo T, Nishida S, Tanaka H, Mori Y, Nakajima N, Hakoda A, Sugawara N, Kojima Y, Takeuchi T, Sakaguchi M, Higuchi K. Tannin-phytobezoars with Gastric Outlet Obstruction Treated by Dissolution with Administration and Endoscopic Injection of Coca-Cola ®, Endoscopic Crushing, and Removal (with Video). Intern Med 2022; 61:335-338. [PMID: 34334573 PMCID: PMC8866791 DOI: 10.2169/internalmedicine.8090-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 77-year-old man complained of postmeal vomiting and sustained general fatigue. An abdominal computed tomography scan showed massive gastric expansion and fluid storage. Gastroscopy revealed four gastric bezoars that were considered to have caused pyloric ring obstruction. The patient was asked to drink 500 mL per day of Coca-Cola® for 4 days. On the fourth day, we performed endoscopic crushing and removal by injecting Coca-Cola®, cutting the softened bezoar with endoscopic snares, and collecting the pieces with endoscopic nets. We herein report (with a video presentation) a rare case of tannin-phytobezoars endoscopically removed with the administration and injection of Coca-Cola®.
Collapse
Affiliation(s)
- Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Shimpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Shinya Nishida
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriyuki Nakajima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | | | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| |
Collapse
|
46
|
Haruma K, Kato M, Kawada K, Murao T, Ono S, Suehiro M, Hori S, Sasaki F, Koike T, Kitamura S, Dohi O, Kanzaki H, Yagi N, Hashiguchi K, Oka S, Katada K, Shimoda R, Mizukami K, Takeuchi T, Katsuki S, Tsuda M, Naito Y, Kawano T, Mori K, Ishikawa H. Diagnostic ability of linked color imaging in ultraslim endoscopy to identify neoplastic lesions in the upper gastrointestinal tract. Endosc Int Open 2022; 10:E88-E95. [PMID: 35047338 PMCID: PMC8759938 DOI: 10.1055/a-1723-2635] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background and study aims Linked color imaging (LCI) is a new image-enhancing technique that facilitates the differentiation of slight differences in mucosal color tone. We performed an exploratory analysis to evaluate the diagnostic capability of LCI in ultraslim endoscopy, using data from patients examined in the LCI-Further Improving Neoplasm Detection in upper gastrointestinal (LCI-FIND) trial, a large-scale, multicenter, randomized controlled trial that demonstrated the capability of LCI for detecting neoplastic lesions in the upper gastrointestinal tract. Patients and methods Data from the LCI-FIND prospective trial were used. In the LCI-FIND trial, 1502 patients with a history of gastrointestinal cancer were randomly assigned to two groups based on examination methods: white light imaging (WLI) followed by LCI (WLI group) and LCI followed by WLI (LCI group). The present exploratory analysis investigated the outcomes of patients who underwent ultraslim and standard endoscopies. Results Ultraslim endoscopes were used in 223 patients and standard endoscopes in 1279 patients. The primary endpoint of the LCI-FIND trial was the percentage of patients diagnosed with a neoplastic lesion using WLI or LCI. The corresponding percentage tended to be higher with LCI than with WLI among patients who underwent ultraslim endoscopy and among those who underwent standard endoscopy; the crude risk ratio was 2.21 [95 % confidence interval (CI): 1.06-4.67], and the adjusted odds ratio was 2.46 (95 % CI: 1.07-5.63). Conclusions Our exploratory analysis of data from the LCI-FIND trial showed that LCI is useful in identifying neoplastic lesions, when used in ultraslim endoscopy.
Collapse
Affiliation(s)
- Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hokkaido, Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahisa Murao
- Division of Gastroenterology Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Hokkaido, Japan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | | | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiro Katada
- Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Shimoda
- Internal Medicine and Gastrointestinal Endoscopy, Saga University, Saga, Japan
| | | | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | - Momoko Tsuda
- Division of Endoscopy, Hokkaido University Hospital, Hokkaido, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Keita Mori
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Osaka, Japan
| |
Collapse
|
47
|
Hakoda A, Takeuchi T, Kojima Y, Fujiwara Y, Nagami Y, Naito Y, Fukuda S, Koike T, Sugimoto M, Hamada K, Kobara H, Yoshida N, Inaba T, Nagahara A, Koizumi E, Murakami K, Furuta T, Ogasawara N, Isomoto H, Shibagaki K, Kataoka H, Suzuki H, Higuchi K. Risk factors and prediction of bleeding after gastric endoscopic submucosal dissection in patients on antithrombotic therapy: newly developed bleeding prediction application software, SAMURAI model. J Clin Biochem Nutr 2022; 70:189-196. [PMID: 35400818 PMCID: PMC8921730 DOI: 10.3164/jcbn.21-136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022] Open
Abstract
Bleeding after gastric endoscopic submucosal dissection (ESD) remains problematic, especially in patients receiving antithrombotic therapy. Therefore, this study aimed to identify the risk factors. In this retrospective study, patients (n = 1,207) who underwent gastric ESD while receiving antithrombotic therapy were enrolled at Osaka Medical and Pharmaceutical University Hospital and 18 other referral hospitals in Japan. Risks of post-ESD bleeding were calculated using multivariable logistic regression. The dataset was divided into a derivation cohort and a validation cohort. We created a prediction model using the derivation cohort. The accuracy of the model was evaluated using the validation cohort. Post-ESD bleeding occurred in 142 (11.8%) participants. Multivariable analysis yielded an odds ratio of 2.33 for aspirin, 4.90 for P2Y12 receptor antagonist, 1.79 for cilostazol, 0.95 for other antithrombotic agents, 6.53 for warfarin, 5.65 for dabigatran, 7.84 for apixaban, 10.45 for edoxaban, 6.02 for rivaroxaban, and 1.46 for heparin bridging. The created prediction model was called safe ESD management using the risk analysis of post-bleeding in patients with antithrombotic therapy (SAMURAI). This model had good predictability, with a C-statistic of 0.77. In conclusion, use of the SAMURAI model will allow proactive management of post-ESD bleeding risk in patients receiving antithrombotic therapy.
Collapse
Affiliation(s)
- Akitoshi Hakoda
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital
| | - Toshihisa Takeuchi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital
| | - Yuichi Kojima
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine
| | - Yuji Naito
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | | | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital
| | - Kenta Hamada
- Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine
| | - Hideki Kobara
- Department of Gastroenterology, Kagawa University Faculty of Medicine
| | - Norimasa Yoshida
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine
| | - Eriko Koizumi
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine
| | | | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
| | - Kotaro Shibagaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Keio University School of Medicine
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University Hospital
| |
Collapse
|
48
|
Yokota Y, Iwatsubo T, Takeuchi T, Hakoda A, Nakagawa Y, Kawabata K, Inoue Y, Miyamoto H, Ikeo K, Kojima Y, Miyazaki J, Abe T, Higuchi K. Effects of a novel endoscopic reporting system with voice recognition on the endoscopic procedure time and report preparation time: propensity score matching analysis. J Gastroenterol 2022; 57:1-9. [PMID: 34694471 DOI: 10.1007/s00535-021-01835-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND With the increase in endoscopic procedures, endoscopists are spending more time creating reports. Although medical reports have largely become electronic, most of the current reporting systems require manual operation. This study aimed to evaluate the efficacy of a novel endoscopic reporting system that uses voice recognition (VR) technology. METHODS We retrospectively reviewed consecutive patients who underwent esophagogastroduodenoscopy between September 2019 and March 2020 at a general hospital in Japan. The novel reporting system, used during endoscopic procedures, is equipped with VR and provides automatic responses by playing back recognized words. Differences in total time spent on the endoscopic procedure and report preparation between the manual entry (ME) and VR groups were evaluated using a propensity score matching method. RESULTS We enrolled 356 patients: 226 and 130 patients in the ME and VR groups, respectively. Propensity score matching created 101 matched pairs. After matching, the median report preparation time (311 vs. 383 s, P = 0.009) and median total time (765 vs. 842 s, P = 0.053) in the VR group were shorter than those in the ME group. The VR system independently shortened the total and report preparation times by 156 s (95% confidence interval, - 274 to - 37 s; P = 0.009) and 118 s (95% confidence interval, - 220 to - 15 s; P = 0.023), respectively, on multiple linear regression analysis. CONCLUSIONS The VR system could save the report preparation time and the total time. This novel system may improve the efficiency of endoscopy-related tasks.
Collapse
Affiliation(s)
- Yuta Yokota
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Taro Iwatsubo
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Toshihisa Takeuchi
- Endoscopic Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
| | - Akitoshi Hakoda
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yasuki Nakagawa
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Kazumi Kawabata
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Yuma Inoue
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Hayato Miyamoto
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Koichi Ikeo
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Yuichi Kojima
- Endoscopic Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Junichi Miyazaki
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Takashi Abe
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| |
Collapse
|
49
|
Ota K, Takeuchi T, Masuda D, Sanomura M, Kojima K, Nakanishi Y, Hoshimoto M, Higashino T, Imoto A, Okada T, Nouda S, Miyazaki H, Ozaki H, Fukuda KH, Kuramoto T, Sugawara N, Onishi T, Takahashi Y, Tsujimoto H, Yokoya Y, Kawabata K, Nishida S, Hakoda A, Iwatsubo T, Kawaguchi S, Kojima Y, Higuchi K. Risk factors for postoperative bleeding and early death in percutaneous endoscopic gastrostomy: A multicenter retrospective study. J Gastroenterol Hepatol 2022; 37:97-103. [PMID: 34478183 DOI: 10.1111/jgh.15680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/30/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIM Comprehensive reports on the risk factors for bleeding and early death after percutaneous endoscopic gastrostomy (PEG) are limited. In this multicenter study, we retrospectively investigated the risk factors for bleeding and early death after PEG. METHODS Patients (n = 1234) who underwent PEG between 2015 and 2020 at Osaka Medical and Pharmaceutical University and its affiliated hospitals (11 institutions in total) were evaluated for postoperative bleeding and early death (within 60 days) after PEG according to patient characteristics, construction method, medical history, medications, preoperative hematological findings, and perioperative adverse events. Multivariate logistic regression was performed to identify independent predictors of bleeding and early death after PEG. RESULTS The risk factors for bleeding after PEG were PEG tube insertion using the modified introducer method (odds ratio [OR], 4.37; P = 0.0003), low platelet count (OR, 0.99; P = 0.014), antiplatelet therapy (OR, 2.11; P = 0.036), and heparinization (OR, 4.50; P = 0.007). Risk factors for early death were low body mass index (BMI) (OR, 0.89; P = 0.015), low serum albumin levels (OR, 0.50; P = 0.035), and comorbidity of active cancer (OR, 4.03; P < 0.0001). There was no significant association between bleeding and early death after PEG. CONCLUSIONS We identified several risk factors for bleeding and early death after PEG. Risk factors for bleeding were PEG tube insertion using the modified introducer method, low platelet count, antiplatelet therapy, and heparinization. Risk factors for early death were low BMI, low serum albumin levels, and comorbidity of active cancer.
Collapse
Affiliation(s)
- Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Daisuke Masuda
- Department of Gastroenterology, Osaka Kaisei Hospital, Osaka, Osaka, Japan
| | - Makoto Sanomura
- Department of Gastroenterology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan
| | - Keishi Kojima
- Department of Internal Medicine, Sousei Hospital, Kadoma, Osaka, Japan
| | - Yoshihiko Nakanishi
- Department of Gastroenterology, Hirakata City Hospital, Hirakata, Osaka, Japan
| | | | - Takeshi Higashino
- Department of Gastroenterology, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Akira Imoto
- Department of Internal Medicine, Aoyama Hospital, Fujiidera, Osaka, Japan
| | - Toshihiko Okada
- Department of Gastroenterology and Hepatology, Katsuragi Hospital, Kishiwada, Osaka, Japan
| | - Sadaharu Nouda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Department of Gastroenterology, Midorigaoka Hospital, Takatsuki, Osaka, Japan
| | - Hirota Miyazaki
- Department of Gastroenterology, Hanwasumiyoshi General Hospital, Osaka, Osaka, Japan
| | - Haruhiko Ozaki
- Department of Gastroenterology, Osaka Kaisei Hospital, Osaka, Osaka, Japan
| | | | - Takanori Kuramoto
- Department of Internal Medicine, Sousei Hospital, Kadoma, Osaka, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Department of Gastroenterology, Hirakata City Hospital, Hirakata, Osaka, Japan
| | - Toshikazu Onishi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Department of Gastroenterology, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Yoshiaki Takahashi
- Department of Gastroenterology, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Hiroyuki Tsujimoto
- Department of Internal Medicine, Aoyama Hospital, Fujiidera, Osaka, Japan
| | - Yuta Yokoya
- Department of Gastroenterology and Hepatology, Katsuragi Hospital, Kishiwada, Osaka, Japan
| | - Kazumi Kawabata
- Department of Gastroenterology, Hanwasumiyoshi General Hospital, Osaka, Osaka, Japan
| | - Shinya Nishida
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shimpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| |
Collapse
|
50
|
Matsui M, Nishikawa H, Goto M, Asai A, Ushiro K, Ogura T, Takeuchi T, Nakamura S, Kakimoto K, Miyazaki T, Fukunishi S, Ohama H, Yokohama K, Yasuoka H, Higuchi K. Prognostic Impact of the SARC-F Score in Gastrointestinal Advanced Cancers. Cancers (Basel) 2021; 14:cancers14010010. [PMID: 35008175 PMCID: PMC8749778 DOI: 10.3390/cancers14010010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary There have been few reports with regard to the relevance between the SARC-F score and the prognosis in patients with gastrointestinal advanced cancers, and we aimed to elucidate these issues (n = 421, median age = 73 years). During the follow-up period, 145 patients (34.4%) died. The 1-year cumulative overall survival rate in patients with SARC-F ≥ 4 (recommended cutoff point, n = 103) and SARC-F < 4 (n = 318) was 33.9% and 61.6% (p < 0.0001). In the multivariate analysis for the overall survival, total lymphocyte count ≥ 1081/μL (p = 0.0014), the SARC-F score ≥ 4 (p = 0.0096), Glasgow prognostic score 1 (p = 0.0147) and 2 (p < 0.0001), ECOG-PS 2 (p < 0.0001), and 3 (p < 0.0001) and 4 (p < 0.0001) were independent predictors. In the receiver operating characteristic curve analysis on the prognostic value of the SARC-F score, the sensitivity/specificity was 0.59/0.70, and the best cutoff point of the SARC-F score was two. The SARC-F score appears to be useful in patients with gastrointestinal advanced malignancies. Abstract We sought to elucidate the prognostic impact of the SARC-F score among patients with gastrointestinal advanced malignancies (n = 421). A SARC-F score ≥ 4 was judged to have a strong suspicion for sarcopenia. In patients with ECOG-PS 4 (n = 43), 3 (n = 61), and 0–2 (n = 317), 42 (97.7%), 53 (86.9%) and 8 (2.5%) had the SARC-F score ≥ 4. During the follow-up period, 145 patients (34.4%) died. All deaths were cancer-related. The 1-year cumulative overall survival (OS) rate in patients with SARC-F ≥ 4 (n = 103) and SARC-F < 4 (n = 318) was 33.9% and 61.6% (p < 0.0001). In the multivariate analysis for the OS, total lymphocyte count ≥ 1081/μL (p = 0.0014), the SARC-F score ≥ 4 (p = 0.0096), Glasgow prognostic score (GPS) 1 (p = 0.0147, GPS 0 as a standard), GPS 2 (p < 0.0001, GPS 0 as a standard), ECOG-PS 2 (p < 0.0001, ECOG-PS 0 as a standard), ECOG-PS 3 (p < 0.0001, ECOG-PS 0 as a standard), and ECOG-PS 4 (p < 0.0001, ECOG-PS 0 as a standard) were independent predictors. In the receiver operating characteristic curve analysis on the prognostic value of the SARC-F score, the sensitivity/specificity was 0.59/0.70, and best cutoff point of the SARC-F score was two. In conclusion, the SARC-F score is useful in patients with gastrointestinal advanced malignancies.
Collapse
Affiliation(s)
- Masahiro Matsui
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Hiroki Nishikawa
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
- The Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
- Correspondence: ; Tel.: +81-726-831-221
| | - Masahiro Goto
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Akira Asai
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Kosuke Ushiro
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Takeshi Ogura
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Toshihisa Takeuchi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Shiro Nakamura
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Kazuki Kakimoto
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Takako Miyazaki
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
- The Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
| | - Shinya Fukunishi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
- The Premier Departmental Research of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
| | - Hideko Ohama
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Keisuke Yokohama
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Hidetaka Yasuoka
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| | - Kazuhide Higuchi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.M.); (M.G.); (A.A.); (K.U.); (T.O.); (T.T.); (S.N.); (K.K.); (T.M.); (S.F.); (H.O.); (K.Y.); (H.Y.); (K.H.)
| |
Collapse
|