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Abstract
Over 50% of patients with sarcoidosis will require anti-inflammatory therapy at some point in their disease course. Indications for therapy are to improve health-related quality of life, prevent or arrest organ dysfunction (or organ failure) or avoid death. Recently published treatment guidelines recommended a stepwise approach to therapy however there are some patients for whom up front combination or more intense therapy maybe reasonable. The last decade has seen an explosion of studies and trials evaluating novel therapeutic agents and treatment strategies. Currently available anti-inflammatory therapies and several novel therapies are discussed here.
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Affiliation(s)
- Ogugua Ndili Obi
- Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
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2
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Kardes E, Sözeri B, Demir F, Sezgin Akcay BI. Risk Factors for Ocular Complications and Visual Loss in Patients with Juvenile Idiopathic Arthritis-associated Uveitis at a Turkish Tertiary Ophthalmology and Pediatric Rheumatology Referral Center. Ocul Immunol Inflamm 2023; 31:1984-1991. [PMID: 36170554 DOI: 10.1080/09273948.2022.2123833] [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] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate the rates of ocular complications and visual loss and their risk factors in patients with juvenile idiopathic arthritis (JIA) -associated uveitis. METHODS Medical records of 51 patients were reviewed. RESULTS The incidence of visual loss to the 20/50 or worse was found to be 0026/ eye-year (EY) in the present study. Cataract and ocular hypertension occurred during the follow-up period and were significantly associated with visual acuity loss to 20/50 or worse (p = .008, HR 11.932, 95% CI 1.915-74.355; p = .03, HR 7.323, 95% CI 1.216-44.110, respectively). Anti-TNF therapy was initiated in 88.2% of our cases and 93.3% of them achieved uveitis inactivity. CONCLUSION The risk of vision loss is higher in patients with JIA-associated uveitis who had complications at presentation. We attribute the lower complication rates and better visual outcomes in our study to the early and frequent use of biologic agents.
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Affiliation(s)
- Esra Kardes
- FEBO, University of Health Sciences, Umraniye Training and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey
| | - Betül Sözeri
- Ümraniye Training and Research Hospital, Pediatric Rheumatology Clinic, University of Health Sciences, Istanbul, Turkey
| | - Ferhat Demir
- Ümraniye Training and Research Hospital, Pediatric Rheumatology Clinic, University of Health Sciences, Istanbul, Turkey
| | - Betül Ilkay Sezgin Akcay
- FEBO, FICO University of Health Sciences, Ümraniye Training and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey
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3
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Ohm M, van Straalen JW, Zijlstra M, de Joode-Smink G, Jasmijn Sellies A, Swart JF, Vastert SJ, van Montfrans JM, Bartels M, van Royen-Kerkhof A, Wildenbeest JG, Lindemans CA, Wolters V, Wennink RAW, de Boer JH, Knol MJ, Heijstek MW, Sanders EAM, Verduyn-Lunel FM, Berbers GAM, Wulffraat NM, Jansen MHA. Meningococcal ACWY conjugate vaccine immunogenicity and safety in adolescents with juvenile idiopathic arthritis and inflammatory bowel disease: A prospective observational cohort study. Vaccine 2023:S0264-410X(23)00480-2. [PMID: 37198018 DOI: 10.1016/j.vaccine.2023.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Immunogenicity to meningococcal serogroup ACWY (MenACWY) conjugate vaccine has not been studied in immunocompromised minors with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). We determined immunogenicity of a MenACWY-TT vaccine in JIA and IBD patients at adolescent age and compared results to data from aged-matched healthy controls (HCs). METHODS We performed a prospective observational cohort study in JIA and IBD patients (14-18 years old), who received a MenACWY vaccination during a nationwide catch-up campaign (2018-2019) in the Netherlands. Primary aim was to compare MenACWY polysaccharide-specific serum IgG geometric mean concentrations (GMCs) in patients with HCs and secondary between patients with or without anti-TNF therapy. GMCs were determined before and 3-6, 12, and 24 months postvaccination and compared with data from HCs at baseline and 12 months postvaccination. Serum bactericidal antibody (SBA) titers were determined in a subset of patients at 12 months postvaccination. RESULTS We included 226 JIA and IBD patients (66 % and 34 % respectively). GMCs were lower for MenA and MenW (GMC ratio 0·24 [0·17-0·34] and 0·16 [0·10-0·26] respectively, p < 0·01) in patients compared to HCs at 12 months postvaccination. Anti-TNF users had lower MenACWY GMCs postvaccination compared with those without anti-TNF (p < 0·01). The proportion protected (SBA ≥ 8) for MenW was reduced in anti-TNF users (76 % versus 92 % in non-anti-TNF and 100 % in HCs, p < 0.01). CONCLUSION The MenACWY conjugate vaccine was immunogenic in the vast majority of JIA and IBD patients at adolescent age, but seroprotection was lower in patients using anti-TNF agents. Therefore, an extra booster MenACWY vaccination should be considered.
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Affiliation(s)
- Milou Ohm
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marieke Zijlstra
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gerrie de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anne Jasmijn Sellies
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joris M van Montfrans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marije Bartels
- Department of Pediatric Hematology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Annet van Royen-Kerkhof
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Caroline A Lindemans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Victorien Wolters
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roos A W Wennink
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marloes W Heijstek
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frans M Verduyn-Lunel
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Park J, Cheon JH. Updates on conventional therapies for inflammatory bowel diseases: 5-aminosalicylates, corticosteroids, immunomodulators, and anti-TNF-α. Korean J Intern Med 2022; 37:895-905. [PMID: 35882566 PMCID: PMC9449200 DOI: 10.3904/kjim.2022.132] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/13/2022] [Indexed: 12/03/2022] Open
Abstract
The incidence and prevalence of inflammatory bowel diseases (IBDs) are rapidly increasing worldwide. IBDs are considered an emerging problem not only in Western countries but also in developing counties. The relapses and complications of active IBD mandate various medications. Nevertheless, hospitalization, emergency room visits, or surgery may be required, resulting in a socioeconomic burden. Great advances have been made in the development of new therapeutic options for IBD to achieve induction and maintenance remission. Nevertheless, conventional therapy is still the mainstay in the treatment of IBD. This review article provides an update on recent advances in conventional therapies, including 5-aminosalicylates, corticosteroids, immunomodulators, and anti-tumor necrosis factor-α agents to treat IBD.
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Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
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5
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Farisogullari B, Cuceoglu MK, Oral H, Yardimci GK, Bilginer Y, Ozen S, Karadag O. Biologics for immunoglobulin A vasculitis: targeting vasculitis or comorbid disease? Intern Emerg Med 2022; 17:1599-1608. [PMID: 35347546 DOI: 10.1007/s11739-022-02968-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 11/05/2022]
Abstract
In this study, we aimed to evaluate the clinical features and treatments, including the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in a large cohort of pediatric and adult immunoglobulin A vasculitis (IgAV). Since data on the use of bDMARDs in IgAV are very limited, we collated the reasons for use of bDMARDs during the disease course. Patients who were enrolled in the Hacettepe University Vasculitis Research Centre (HUVAC) registry were included. In this prospective database dating from 2014, there were 436 IgAV patients classified as IgAV according to Ankara 2008 and/or American College of Rheumatology 1990 criteria. 88 adults and 330 pediatric IgAV patients were included as the main study group. Concomitant spondyloarthritis (SpA) was observed only in adult patients (10% vs 0% in children, p < 0.001). IgAV relapse was more common in adults than in children (p: 0.017). Adult patients were mostly treated with corticosteroid (p < 0.001) and conventional synthetic disease-modifying anti-rheumatic drug treatment (< 0.001), while more than half of the pediatric patients were followed up without immunosuppressive treatment. Ten (11%) adult patients used biologics. Among them, two patients used rituximab due to IgAV disease activity, three used infliximab due to SpA, three used etanercept due to SpA (one patient had a pediatric onset enthesitis-related arthritis), and two used anakinra due to recurrent familial Mediterranean fever attacks. This is the first study evaluating the use of all bDMARDs for any reason in the IgAV cohorts in the literature. None of the pediatric patients used biologics. Our data suggest biologics are mainly used for comorbid inflammatory diseases over refractory vasculitis in adult IgAV.
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Affiliation(s)
- Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Hakan Oral
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gozde Kubra Yardimci
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey.
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Dai C, Huang YH. Risk of Infections with Anti-TNF Agents in Patients with Crohn's Disease After Elective Surgery. Dig Dis Sci 2022; 67:1421-1422. [PMID: 33939139 DOI: 10.1007/s10620-021-06976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Cong Dai
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, No. 92 of Beier Road, Heping District, Shenyang City, 110001, Liaoning Province, China.
| | - Yu-Hong Huang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, No. 92 of Beier Road, Heping District, Shenyang City, 110001, Liaoning Province, China
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Abstract
Inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis are associated with adverse pregnancy outcomes. Active maternal disease during pregnancy is associated with additional negative outcomes. Anti-TNF agents are effective treatments for inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis. These agents cross the placenta starting in the second trimester, with levels detected for several months after birth. This has led to safety concerns, with continued therapy during pregnancy for both the mother and the infant. This review covers retrospective and prospective data published from various cohorts of pregnant women exposed to anti-TNF agents during pregnancy. It highlights the safety of anti-TNF drugs in pregnancy, breast-feeding, and during the first year of life of the infant.
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Affiliation(s)
- Kara M De Felice
- Department of Gastroenterology, Louisiana State University, Department of Gastroenterology, New Orleans, La.
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn
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Patwardhan A, Spencer CH. Biologics in refractory idiopathic inflammatory myositis (IIM): What experience in juvenile vs adult myositis tells us about the use of biologics in pediatric IIM. Mod Rheumatol 2021; 31:933-948. [PMID: 33499694 DOI: 10.1080/14397595.2021.1881027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Juvenile dermatomyositis (JDM) is an extremely heterogeneous orphan disease with limited amount of dedicated research on the subject matter. Recent research suggests that JDM may not just be the classic antibody driven complements mediated microangiopathy as was thought to be in the past. The etiopathogenesis of JDM also involves inappropriate stimulation of innate immune system followed by dysregulation of the adaptive immune response through dendritic cells. Many variable immune factors such as genetics, major histocompatibility complex expressions, immunohistochemical variabilities, and diversity in specific and associated autoantibodies may make individual IIM and JDM cases unique. The diversity in IIM and JDM also explains individual variability in response to specific therapies. Classifying and matching the right patients to the right treatment is crucial to the successful treatment of these patients with better outcomes. Sub-type specific biologic therapy may be the best current treatment that can match the patient to the best treatment options. A PubMed search was performed to find all the available cases of refractory myositis patients treated with biologics up to July 2020. Using this search this article reviews all the current biologic treatment options and experiences for both adults and children in the context of recent basic science to assist pediatric rheumatologists in choosing the optimal biologic therapy for a child with recalcitrant JDM.
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Affiliation(s)
| | - Charles H Spencer
- University of Mississippi Medical Center, Batson Children's Hospital, Jackson, MS, USA
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Wendling D. Local sacroiliac injections in the treatment of spondyloarthritis. What is the evidence? Joint Bone Spine 2019; 87:209-213. [PMID: 31216488 DOI: 10.1016/j.jbspin.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022]
Abstract
Local sacroiliac injections represent an available treatment option in spondyloarthritis (SpA). There is no synthetic data about efficacy of this procedure in SpA. The aim of this review is to analyze the available data of the literature of local sacroiliac injections in SpA. METHODS A Pubmed search of papers published after 1990 was performed. RESULTS Pubmed search retained 15 publications in spondyloarthritis, 12 with corticosteroids (total of 468 injections in 268 patients), including 2 small-sized controlled studies, and 3 with TNF blockers (24 patients in open studies). With steroids, the two controlled studies (with a total number of 30 patients only) demonstrated significant results over placebo. In open studies, good response was reported in more than 80% of the cases, with a mean duration of improvement over 8 months. Reduction of sacroiliac inflammation on MRI was also found in several studies after injection. There is no consensus about the technique of injection or the type of steroid injected. No particular safety concern was reported. Many limitations have to be considered in the interpretation of these results. CONCLUSION This kind of procedure should be kept in the therapeutic armament in the current setting of costly targeted systemic treatments of spondyloarthritis. However, definition of a clear position in the treatment strategy needs further well-conducted studies.
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Affiliation(s)
- Daniel Wendling
- Department of Rheumatology, University Teaching Hospital, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4266, EPILAB, Université Bourgogne Franche-Comté, 25030 Besançon, France.
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10
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Shan J, Zhang J. Impact of obesity on the efficacy of different biologic agents in inflammatory diseases: A systematic review and meta-analysis. Joint Bone Spine 2018; 86:173-183. [PMID: 29635017 DOI: 10.1016/j.jbspin.2018.03.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/13/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Obesity is a worldwide epidemic and a growing body of evidence suggests that it may affect the body's response to biologic agents. We investigated the influence of obesity on the efficacy of different biologic agents used to treat inflammatory diseases. METHODS Medline, EMBASE and the Cochrane Database were searched using relevant MeSH and keyword terms for obesity and bDMARDs. Articles were selected if they reported a clinical response in obese subjects relative to other BMI categories. Response and remission outcomes were assessed using meta-analysis and all other reported outcomes were summarized. RESULTS Among the 3850 records retrieved, 24 articles met the inclusion criteria, including 10 on rheumatoid arthritis (RA), 4 on axial spondyloarthritis (axSpA), 4 on Crohn's disease (CD), 4 on psoriasis (Ps) and 2 on psoriasic arthritis (PsA). Four biological disease-modifying anti-rheumatic drugs (bDMARDs) - anti-TNF agents, T cell co-stimulation inhibitor (abatacept), IL-6 inhibitor (tocilizumab), and B-cell depletion therapy (rituximab) - were involved. The meta-analysis showed that the odds to reach a good response or achieve remission were lower in obese (BMI>30kg/m2) than non-obese (BMI≤30kg/m2) patients who were treated with anti-TNF agents (good responder % in RA: OR 0.34, 95% CI 0.18-0.64; remission% in RA: OR 0.36, 95% CI 0.21-0.59; BASDAI50% in axSpA: OR 0.41, 95% CI 0.21-0.83), but no significant difference between obese and non-obese was found in patients treated with abatacept (good responder % in RA: OR 0.75, 95% CI 0.42-1.36; remission% in RA: OR 0.84, 95% CI 0.65-1.09) and tocilizumab (good responder % in RA: OR 1.08, 95% CI 0.44-2.63; remission% in RA: OR 0.91, 95% CI 0.50-1.66). CONCLUSION Obesity hampered the effect of anti-TNF agents, but not those of abatacept and tocilizumab, suggesting that a personalized treatment strategy should be considered for obese patients with inflammatory diseases.
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Affiliation(s)
- Juan Shan
- Chengdu medical college, No. 783 XinDu Road, Chengdu, 610500 Sichuan Province, PR China.
| | - Jiabi Zhang
- West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province, PR China
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11
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Andrade P, Lopes S, Gaspar R, Nunes A, Magina S, Macedo G. Anti-Tumor Necrosis Factor-α-Induced Dermatological Complications in a Large Cohort of Inflammatory Bowel Disease Patients. Dig Dis Sci 2018; 63:746-54. [PMID: 29349693 DOI: 10.1007/s10620-018-4921-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS The broader use of anti-tumor necrosis factor (TNF) agents in inflammatory bowel disease (IBD) has been associated with a high rate of adverse reactions. Dermatological complications are among the most common adverse events. We assessed the incidence, risk factors, management, and outcome of anti-TNF-induced dermatological complications in a large cohort of IBD patients. METHODS This was an observational retrospective study at a single tertiary referral center. All consecutive adult IBD patients treated with anti-TNF agents between 2005 and 2015 were identified. Patients who developed at least one dermatological complication while on anti-TNF therapy were included. RESULTS From the 732 patients treated with anti-TNF agents, 211 (29%) developed at least one dermatological complication: 52% women (mean age of 42 ± 13 years), 85% with Crohn's disease, 67% were under infliximab. Median follow-up time under anti-TNF therapy was 53 (27-77) months. Dermatological complications recorded were: infections (13.5%), psoriasiform lesions (5.3%), injection/infusion reactions (3.8%), skin cancer (0.5%), and miscellaneous (5.6%). Overall, female gender (OR = 1.658, p = 0.029), smoking (OR = 2.021, p = 0.003), and treatment with an infliximab dose of 10 mg/kg (OR = 2.012, p = 0.007) were independent risk factors for dermatological complications in multivariable analysis. Female gender (OR = 3.63, p = 0.017), smoking (OR = 2.846, p = 0.041), and treatment with adalimumab (OR = 8.894, p < 0.001) were independently associated with development of psoriasiform lesions. Three (3%) patients with infectious complications and 12 (31%) patients with psoriasiform lesions discontinued anti-TNF therapy definitively. CONCLUSIONS Dermatological manifestations occurred in almost one-third of our population. Infections were the most common complication, but anti-TNF-induced psoriasiform lesions were the most common cause for anti-TNF therapy definitive discontinuation.
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12
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Abstract
PURPOSE OF REVIEW The goal of this paper is to review the major adverse cutaneous reactions that have been reported to the most commonly used biologics. RECENT FINDINGS Anti-TNF agents and immune checkpoint inhibitors have significant, immune-mediated cutaneous manifestations that can necessitate discontinuation. Anti-TNF agents, IL-6 inhibitors, and IL-12/23 inhibitors can paradoxically cause psoriasis flares or unmask previously undiagnosed psoriasis. IL-17 inhibitors are unique in increasing risk for Candida infections. Benign injection site reactions, non-specific rash, cellulitis, and hypersensitivity reactions are relatively common adverse events. A wide variety of cutaneous reactions caused by biologics have been reported, ranging from benign injection site reactions to life-threatening cutaneous reactions necessitating discontinuation of the implicated biologic agent.
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Affiliation(s)
- Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Amy S Levin
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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13
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Pham HV, Hasan I, Udaltsova N, Pham K, Abramson O, Armstrong MA, Postlethwaite D, Li D. Rates and Predictors of Vaccinations Among Inflammatory Bowel Disease Patients Receiving Anti-Tumor Necrosis Factor Agents. Dig Dis Sci 2018; 63:209-17. [PMID: 28836068 DOI: 10.1007/s10620-017-4716-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/07/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND As an important quality measure, the rates of recommended immunizations among immunocompromised inflammatory bowel disease (IBD) patients in community practice have not been well studied. AIMS This study sought to investigate the rates and predictors of recommended immunizations and screening tests among IBD patients receiving anti-tumor necrosis factor (TNF) therapy in a large integrated healthcare organization. METHODS We conducted a retrospective cohort study of 1401 IBD patients on anti-TNF therapy between 2010 and 2013 within the Kaiser Permanente Northern California healthcare system. The rates of vaccinations and screening tests were quantified, and the associated predictors were investigated. RESULTS Vaccination rates for influenza and pneumococcus were 43.5 and 24.1%, respectively. The majority of patients (73.7%) received hepatitis B screening and/or vaccine. Patients receiving infliximab had higher rates of pneumococcal vaccine (P = 0.002), hepatitis B screening (P < 0.001), and tuberculin skin test (P < 0.001) compared with patients receiving adalimumab. Older patient age (≥50 years) was associated with higher likelihood of having HBsAg test (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-2.0, P = 0.002), influenza vaccine (OR 2.6 [2.1-3.4], P < 0.001), and pneumococcal vaccine (OR 4.0 [3.0-5.3], P < 0.001). In contrast, older providers (≥50 years) were associated with significantly lower likelihood of their patients' having hepatitis A and B screening tests, and pneumococcal vaccination. CONCLUSIONS The rates of immunizations for IBD patients receiving anti-TNF treatment were lower than recommended. Structured reminders for vaccinations and education for both patients and providers (older physicians in particular) may prove beneficial in improving immunization rates among immunocompromised IBD patients.
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14
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Abstract
INTRODUCTION Although anti-tumour necrosis factor (TNF) agents have caused a paradigm shift in the management of moderate-to-severe Crohn's, they are sometimes associated with diminished or absent response in a considerable proportion of patients. Hence agents targeting pathways other than TNF are needed. Ustekinumab is a monoclonal antibody directed against the p40 subunit of IL-12 and 23. AREAS COVERED This manuscript summarises the available evidence on the efficacy and safety of Ustekinumab in Crohn's disease through data available from randomised controlled trials and compassionate use programs across the world. EXPERT OPINION Current literature strongly supports the fact that ustekinumab is clinically efficacious and reasonably safe for induction and maintenance of remission in moderate-to-severe Crohn's disease.
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Affiliation(s)
- E G Simon
- a Department of Gastroenterology , Christian Medical College , Vellore , India.,b NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - S Samuel
- b NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - S Ghosh
- c Department of Medicine and IBD Clinic , University of Calgary , Calgary , Canada
| | - G W Moran
- b NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
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15
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Tocci G, Goletti D, Marino V, Matucci A, Milano GM, Cantini F, Scarpa R. Cardiovascular outcomes and tumour necrosis factor antagonists in chronic inflammatory rheumatic disease: a focus on rheumatoid arthritis. Expert Opin Drug Saf 2017; 15:55-61. [PMID: 27924645 DOI: 10.1080/14740338.2016.1218469] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Many chronic rheumatic diseases have an inflammatory etiology, leading to accelerated atherosclerosis and increased occurrence of vascular diseases. In rheumatoid arthritis (RA), a reduction in cardiovascular (CV) events has been reported under treatments reducing systemic inflammation. Areas covered: Given the central role of tumour necrosis factor alpha (TNFα) in chronic inflammatory conditions and in atherosclerosis, it has been suggested that TNFα-antagonists may reduce CV risk and mortality. Although there are no randomized controlled or head-to-head trials investigating the effect of specific anti-TNF-agents on CV outcomes, observational cohort studies, national registry data, and meta-analyses in RA have reported improved CV outcomes with anti-TNF therapy. Expert opinion: It is unclear whether this is due to reduced systemic inflammation or a specific anti-TNF effect at the atherosclerotic plaque level. Observed CV benefits appear to correlate with anti-TNF response. Conversely, although inconsistently, anti-TNF agents have also been linked with increased incidence/worsening of heart failure. Additional CV adverse events with anti-TNFs include vasculitis and venous thromboembolic events. We provide an overview of the likely effects of anti-TNF therapy on CV risk and adverse events, and evaluated differences in CV outcomes among different anti-TNF-agents.
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Affiliation(s)
- Giuliano Tocci
- a Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , University of Rome Sapienza , Sant'Andrea Hospital, Rome , Italy.,b IRCCS Neuromed , Pozzilli , Italy
| | - Delia Goletti
- c Translational Research Unit, Department of Epidemiology and Preclinical Research , National Institute for Infectious Diseases , Rome , Italy
| | | | - Andrea Matucci
- e Immunoallergology Unit , Department of Biomedicine, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Giuseppe Maria Milano
- f Department of Pediatric Hematology, Oncology and Transplant Unit , IRCCS Ospedale Pediatrico Bambino Gesù , Rome , Italy
| | - Fabrizio Cantini
- g Division of Rheumatology , Misericordia e Dolce Hospital , Prato , Italy
| | - Raffaele Scarpa
- h Rheumatology Research Unit, Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
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16
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Hammami A, Slama AB, Jaziri H, Ameur WB, Mansour IB, Brahem A, Ajmi S, Jemni H, Ksiaa M, Jmaa A. Unusual case of duodenobiliary fistula complicating Crohn's disease successfully treated with Adalimumab. Arab J Gastroenterol 2016; 17:188-190. [PMID: 27939339 DOI: 10.1016/j.ajg.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/10/2016] [Accepted: 11/27/2016] [Indexed: 12/16/2022]
Abstract
Crohn's disease (CD) is characterized by transmural inflammation of the gastrointestinal tract, which predisposes to the formation of fistula. Duodenal involvement occurs in less than 5% of cases and often leads to clinically relevant strictures. However, fistula formation in the duodenum is exceptional. Herein, we report an unusual case of duodenobiliary fistula due to CD occurring in a 65-year-old patient who was successfully treated by anti-tumor necrosis factor (TNF) agents. This case report highlights the efficacy of anti-TNF alpha agents in the treatment of a bilioenteric fistula because it increases the probability of clinical remission and mucosal healing and therefore reduces the need for surgical treatment which may be associated morbidity.
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Affiliation(s)
- Aya Hammami
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia.
| | - Aida Ben Slama
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
| | - Hanen Jaziri
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
| | - Wafa Ben Ameur
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
| | - Imed Ben Mansour
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
| | - Ahlem Brahem
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
| | - Salem Ajmi
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
| | - Hela Jemni
- Department of Radiology, University Hospital of Sahloul, Tunisia
| | - Mehdi Ksiaa
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
| | - Ali Jmaa
- Department of Gastroenterology, University Hospital of Sahloul, Tunisia
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17
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Shwaartz C, Fields AC, Sobrero M, Cohen BD, Divino CM. Effect of Anti-TNF Agents on Postoperative Outcomes in Inflammatory Bowel Disease Patients: a Single Institution Experience. J Gastrointest Surg 2016; 20:1636-42. [PMID: 27405310 DOI: 10.1007/s11605-016-3194-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 05/02/2016] [Accepted: 06/15/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anti-tumor necrosis factor (TNF) agents have been an integral part in the treatment of inflammatory bowel disease. However, a subset of inflammatory bowel disease patients ultimately requires surgery and up to 30 % of them have undergone treatment with anti-TNF agents. Studies assessing the effect of anti-TNF agents on postoperative outcomes have been inconsistent. The aim of this study is to assess postoperative morbidity in inflammatory bowel disease patients who underwent surgery with anti-TNF therapy prior to surgery. METHODS This is a retrospective review of 282 patients with inflammatory bowel disease undergoing intestinal surgery between 2013 and 2015 at the Mount Sinai Hospital. Patients were divided into two groups based on treatment with anti-TNF agents (infliximab, adalimumab, certolizumab) within 8 weeks of surgery. Thirty-day postoperative outcomes were recorded. Univariate and multivariate statistical analyses were carried out. RESULTS Seventy-three patients were treated with anti-TNF therapy within 8 weeks of surgery while 209 patients did not have exposure. Thirty-day anastomotic leak, intra-abdominal abscess, wound infection, extra-abdominal infection, readmission, and mortality rates were not significantly different between the two groups. CONCLUSIONS The use of anti-TNF medications in inflammatory bowel disease patients within 2 months of intestinal surgery is not associated with an increased risk of 30-day postoperative complications.
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Affiliation(s)
- Chaya Shwaartz
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Adam C Fields
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Maximiliano Sobrero
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Brian D Cohen
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Celia M Divino
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA.
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Qazi T, Shah B, El-Dib M, Farraye FA. The Tolerability and Efficacy of Rapid Infliximab Infusions in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2016; 61:589-96. [PMID: 26441281 DOI: 10.1007/s10620-015-3893-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/18/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Few studies have assessed the loss of efficacy or patient and caregiver satisfaction with rapid infliximab infusions. The aim of this study is to assess the tolerability, loss of efficacy and to describe the impact on resource utilization and patient satisfaction in rapid infliximab infusions. METHODS Subjects with inflammatory bowel disease receiving rapid infliximab infusions were included in the study. Subjects received maintenance infusions from June 2011 to June 2013. Incidence of adverse reactions and the total number of rapid infliximab infusions were recorded. Efficacy was compared to published studies evaluating the long-term efficacy of infliximab infusions. Patient satisfaction was addressed through a survey following the implementation of the rapid infusion protocol. RESULTS Seventy-five subjects with IBD were included in the study. Five hundred and twenty-two rapid infliximab infusions were provided to patients. There were no acute or delayed infusion reactions. Ten subjects (13 %) required either a dose escalation or interval adjustment between infliximab infusions. A majority of patients reported increased satisfaction with 1-h infliximab infusions, and 97 % of surveyed patients opted to continue rapid infusions. The rapid infliximab infusion protocol increased infusion unit efficiency by increasing capacity by 15 %. Cost savings in the elimination of nursing time translated to approximately $108,150 savings at our institution. CONCLUSIONS Rapid infliximab infusions do not appear to increase the risk of loss of response compared to historical studies of long-term infliximab efficiency. A rapid infliximab infusion protocol improved efficiency in our infusion unit and increased patient and nursing satisfaction.
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Affiliation(s)
- Taha Qazi
- Department of Internal Medicine, Boston University School of Medicine, 72 East Concord Street, Evans 124, Boston, MA, 02118, USA.
| | - Bhavesh Shah
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
| | - Mohammed El-Dib
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
| | - Francis A Farraye
- Section of Gastroenterology, Boston University School of Medicine, Boston, MA, USA
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Abstract
PURPOSE The inflammatory bowel diseases (IBD) are chronic immune-mediated inflammatory diseases of the gut that occur in genetically predisposed individuals exposed to environmental triggers. Several immunosuppressive agents have been successfully used for induction and maintenance treatment in inflammatory bowel disease. These include steroids, thiopurines, methotrexate, anti-tumor necrosis factor (anti-TNF) alpha agents, anti-alpha 4 integrins, and anti-IL-12/23 agent to name a few. There are also limited data on novel approaches including thalidomide and stem cell transplant. In spite of the significant successes associated with these agents, numerous malignancies have been associated with their use. Lymphomas including hepatosplenic T cell lymphomas, non-melanoma skin cancers and, more recently, melanoma have been described, specifically with anti-TNF. METHODS We reviewed the available published literature on melanoma in IBD, melanoma associated with anti-TNF, and the data on other treatment options in patients with IBD. In addition, we also reviewed the limited data on the gut specific integrin-vedolizumab. This may provide an additional option in the management of the subset of patients with IBD and melanoma. RESULTS Options for treatment of IBD should be based on the stage of melanoma, control of IBD, and patient preferences. It should involve shared decision-making and close interdisciplinary follow-up between the IBD physician and the dermatologist, preferably with expertise in the management of melanoma. CONCLUSIONS Treatment choices in patients with IBD and melanoma are challenging. There is very limited data providing guidance in this subset of patients. As such, treatment and follow-up should be individualized, extensively discussed with patients and their families as appropriate, and done in conjunction with a close follow-up by gastroenterologist and dermatologist.
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Affiliation(s)
- Jungmin Lee
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, 15212, USA
| | - Kofi Clarke
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, 15212, USA. .,Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, 15212, USA.
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20
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Meijs S, Gardenbroek TJ, Sprangers MAG, Bemelman WA, Buskens CJ, D'Haens GRAM, Löwenberg M. Health-related quality of life and disability in patients with ulcerative colitis and proctocolectomy with ileoanal pouch versus treatment with anti-TNF agents. J Crohns Colitis 2014; 8:686-92. [PMID: 24418659 DOI: 10.1016/j.crohns.2013.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 10/10/2013] [Revised: 12/04/2013] [Accepted: 12/16/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS We compared health-related quality of life (HRQL) and disability in ulcerative colitis (UC) patients in remission with anti-tumor necrosis factor agents (TNF) or after restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA). METHODS Two patient cohorts were studied. The first group consisted of patients in remission after RPC with IPAA (surgery group). The second group consisted of patients in remission with infliximab or adalimumab (medical group). For inclusion in the surgery group the pouch had to be functional for ≥1year and patients were excluded in case of postoperative complications. In the medical group, patients had to be on maintenance therapy with anti-TNF agents for ≥1year and in clinical remission. HRQL and disability outcomes were assessed using SF-36, COREFO, WPAI:UC and EORTC questionnaires. RESULTS 60 patients were included, 30 patients in both groups. 58 out of 60 patients (97%) returned the completed questionnaires: 29 patients in the surgery group (median age 42 years [22-67]; 48% female) and 29 patients in the medical group (median age 45 years [19-68]; 65% female). Patient characteristics were comparable between the two groups. There were no significant differences in SF-36, WPAI:UC and EORTC questionnaires between both groups, except for the medication and stool frequency scale (COREFO questionnaire) that was significantly higher in the surgery vs. the medical group (p=0.004 and p<0.001, respectively). CONCLUSION HRQL and disability were not different among the medical and surgical group, except for stool frequency and anti-diarrhea medication use that was significantly higher in surgically treated patients.
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Affiliation(s)
- Simone Meijs
- Academic Medical Centre, Department of Gastroenterology & Hepatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tjibbe J Gardenbroek
- Academic Medical Centre, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mirjam A G Sprangers
- Academic Medical Centre, Department of Medical Psychology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Willem A Bemelman
- Academic Medical Centre, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Christianne J Buskens
- Academic Medical Centre, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Academic Medical Centre, Department of Gastroenterology & Hepatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mark Löwenberg
- Academic Medical Centre, Department of Gastroenterology & Hepatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Spiliopoulou I, Foka A, Bounas A, Marangos MN. Mycobacterium kansasii cutaneous infection in a patient with sarcoidosis treated with anti-TNF agents. Acta Clin Belg 2014; 69:229-31. [PMID: 24773076 DOI: 10.1179/0001551214z.00000000052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We describe a Mycobacterium kansasii cutaneous infection that was diagnosed in a 52-year-old female patient with sarcoidosis receiving anti-TNF agents. The diagnosis was based on the positive culture of the foot ulcerative tissue. The isolation and identification of bacterium was based on phenotypic and molecular methods. Therapy and follow-up of the patient is discussed.
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