1
|
De Coninck E, Vanhoorne V, Boone M, Van Assche G, De Geest BG, De Beer T, Vervaet C. Prilling of API/fatty acid suspensions: Screening of additives for drug release modification. Int J Pharm 2020; 576:119022. [PMID: 31926276 DOI: 10.1016/j.ijpharm.2020.119022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/03/2020] [Accepted: 01/04/2020] [Indexed: 11/24/2022]
Abstract
Current study screened additives which could modify the drug release from prills made of an active pharmaceutical ingredient/fatty acid (API/FA) suspension, without negatively influencing the processability and/or stability of the formulation. Therefore, 11 additives (i.e. emulsifiers, pore-formers and FA-based lubricants) were added in a 20% concentration to a paracetamol/behenic acid formulation. Two additives, Kolliphor® P338 and P407 provided complete drug release in less than 1 h, as their thermoreversible gel formation resulted in a disintegration of the prills. Lower Kolliphor® P338 or P407 concentrations (2.5-10%) resulted in a complete but slower drug release in 24 h as the prills no longer disintegrated and the release mechanism was dominated by pore-formation. Prills with a robust drug release profile (i.e. independent of pH and surfactant concentration of the dissolution medium) were obtained after the addition of ≥5% Kolliphor® P338 or P407 to the FA-based formulation. Based on a 6-month stability study, it was concluded that Kolliphor® P407 was a suitable additive to modify the drug release profile of API/FA suspension-based prills when formulations were stored below 25 °C at low relative humidity.
Collapse
Affiliation(s)
- E De Coninck
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| | - V Vanhoorne
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| | - M Boone
- Centre for X-ray Tomography (UGCT), Department of Physics and Astronomy, Ghent University, Ghent, Belgium.
| | - G Van Assche
- Physical Chemistry and Polymer Science, Vrije Universiteit Brussel, Brussels, Belgium.
| | - B G De Geest
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| | - T De Beer
- Laboratory of Pharmaceutical Process Analytical Technology, Ghent University, Ghent, Belgium.
| | - C Vervaet
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| |
Collapse
|
2
|
Coenen S, Haeck M, Ferrante M, Noman M, Van Assche G, Vermeire S. Quality of care in an inflammatory bowel disease clinical trial center : a prospective study evaluating patients' satisfaction. Acta Gastroenterol Belg 2020; 83:25-31. [PMID: 32233268] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND STUDY AIMS Quality of care is a very timely topic in medicine. We designed a questionnaire to measure perceived quality of care and to explore areas of improvement. PATIENTS AND METHODS In this prospective study a questionnaire was developed and administered to all patients with inflammatory bowel disease participating in a randomized clinical trial. The questionnaire was based on validated surveys and supplemented with novel, relevant questions. Factors associated with (poor) quality of care were identified. RESULTS Between October 2016 and January 2017, all 107 patients participating in a randomized controlled trial completed the questionnaire (63% male, 76% ulcerative colitis, median age of 47 years). The median satisfaction score was 9 out of 10. Areas of improvement were that too little attention was paid to the disease impact on family and work, dietary and exercise pattern, daily activities and quality of life. Multivariate analysis showed that clinical remission [5.77 (2.03-16.39), p=0.001] was a predictor of good quality of care. CONCLUSIONS In this large IBD trial bureau, inflammatory bowel disease patients were very satisfied with the quality of care. Domains for quality improvement, such as attention to the impact of IBD on family and work, were identified.
Collapse
Affiliation(s)
- S Coenen
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - M Haeck
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - M Noman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| |
Collapse
|
3
|
De Coninck E, Vanhoorne V, Elmahdy A, Boone M, Van Assche G, Markl D, De Geest BG, De Beer T, Vervaet C. Prilling of API/fatty acid suspensions: Processability and characterisation. Int J Pharm 2019; 572:118756. [PMID: 31648017 DOI: 10.1016/j.ijpharm.2019.118756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 11/18/2022]
Abstract
Current study evaluated the processability and characteristics of prills made of an active pharmaceutical ingredient/fatty acid (API/FA) suspension instead of previously studied API/FA solutions to enlarge the application field of prilling. Metformin hydrochloride (MET) and paracetamol (PAR) were used as model APIs while both the effect of drug load (10-40%) and FA chain length (C14-C22) were evaluated. API/FA suspensions were processable on lab-scale prilling equipment without thermal degradation, nozzle obstruction or sedimentation in function of processing time. The collected prills were spherical (AR ≥ 0.898) with a smooth surface (sphericity ≥ 0.914) and a particle size of ±2.3 mm and 2.4 mm for MET and PAR prills, respectively, independent of drug load and/or FA chain length. In vitro drug release evaluation revealed a faster drug release at higher drug load, higher API water solubility and shorter FA chain length. Solid state characterisation via XRD and Raman spectroscopy showed that API and FA crystallinity was maintained after thermal processing via prilling and during storage. Evaluation of the similarity factor indicated a stable drug release (f2 > 50) from MET and PAR prills after 6 months storage at 25 °C or 40 °C.
Collapse
Affiliation(s)
- E De Coninck
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| | - V Vanhoorne
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| | - A Elmahdy
- Materials Science and Technology - DyMaLab Research Group, Department of Electromechanical Systems and Materials, Ghent University, Zwijnaarde, Belgium.
| | - M Boone
- Centre for X-ray Tomography (UGCT), Department of Physics and Astronomy, Ghent University, Ghent, Belgium.
| | - G Van Assche
- Physical Chemistry and Polymer Science, Vrije Universiteit Brussel, Brussels, Belgium.
| | - D Markl
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom; EPSRC Centre for Innovative Manufacturing in Continuous Manufacturing and Crystallisation, University of Strathclyde, Glasgow, United Kingdom.
| | - B G De Geest
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| | - T De Beer
- Laboratory of Pharmaceutical Process Analytical Technology, Ghent University, Ghent, Belgium.
| | - C Vervaet
- Laboratory of Pharmaceutical Technology, Ghent University, Ghent, Belgium.
| |
Collapse
|
4
|
Bislenghi G, Wolthuis A, Van Assche G, Vermeire S, Ferrante M, D'Hoore A. Cx601 (darvadstrocel) for the treatment of perianal fistulizing Crohn's disease. Expert Opin Biol Ther 2019; 19:607-616. [PMID: 31121104 DOI: 10.1080/14712598.2019.1623876] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/11/2022]
Abstract
Introduction: Given the well-documented difficulty to treat perianal fistulizing Crohn's disease (pCD), with 40% of patients experiencing recurrence even after reiterative surgery and advanced medical therapy, research in this field has focused on the role of mesenchymal stem cells (MSC). Areas covered: The aim of this article is to furnish an overview of the pathogenetic mechanisms, clinical applications and evidences for the use of MSC for pCD with particular focus on adipose-derived allogenic MSC including darvadstrocel. Expert Opinion: The effect of MSC on fistula healing is probably mediated by their anti-inflammatory properties more than by their ability to engraft and trans-differentiate in the healthy tissue. A holistic treatment of pCD, addressing different pathophysiological factors, may represent the key for an improvement in the healing rate. In this setting, MSC might play a role as 'augmentation' therapy in combination with more conventional treatments. Whether MSC have benefit in non-complex fistula in biological naïve patients, in complex fistula with many tracts and/or in rectovaginal fistulas, are unexplored fields that need further investigation. A central registry of pCD patients undergoing treatment with MSC should be created in order to elucidate the efficacy, safety and costs of stem cells treatment on long term follow up.
Collapse
Affiliation(s)
- G Bislenghi
- a Department of Abdominal Surgery , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| | - A Wolthuis
- a Department of Abdominal Surgery , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| | - G Van Assche
- b Department of Gastroenterology and Hepatology , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| | - S Vermeire
- b Department of Gastroenterology and Hepatology , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| | - M Ferrante
- b Department of Gastroenterology and Hepatology , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| | - A D'Hoore
- a Department of Abdominal Surgery , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| |
Collapse
|
5
|
Dreesen E, Van Stappen T, Ballet V, Peeters M, Compernolle G, Tops S, Van Steen K, Van Assche G, Ferrante M, Vermeire S, Gils A. Anti-infliximab antibody concentrations can guide treatment intensification in patients with Crohn's disease who lose clinical response. Aliment Pharmacol Ther 2018; 47:346-355. [PMID: 29226370 DOI: 10.1111/apt.14452] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The presence of antibodies towards infliximab (ATI) is associated with lower infliximab (IFX) trough concentrations and loss of response. IFX treatment intensification is effective for restoring response in most, but not all patients with Crohn's disease (CD). AIM To compare outcome, pharmacokinetics and immunogenicity of treatment intensification strategies in patients with CD who lost clinical response to IFX. METHODS A retrospective cohort study was conducted, including 103 patients with CD who lost clinical response during IFX maintenance therapy and therefore received a double dose IFX (10 mg/kg) and/or a next infusion after a shortened interval. IFX and ATI concentrations were measured in consecutive trough samples, just before (T0) and after (T+1) treatment intensification. RESULTS Clinical response (physicians' global assessment) and biological response and remission (CRP) were restored in 63%, 42% and 24% of patients (evaluated at T+1). Treatment intensification increased IFX trough concentrations from 1.2 μg/mL [0.3-3.6] at T0 to 3.6 μg/mL [0.5-10.2] at T+1 (P < .0001). Using a drug tolerant assay, ATI were detected in the T0 sample of 47% of patients. ATI negatively impacted the achieved IFX trough concentration (Spearman r -0.57, P < .0001) and the probability of clinical response (P = 0.034) at T+1. When ATI were quantifiable but <282 ng/mL eq. at T0, combined interval shortening and dose doubling was more effective for restoring therapeutic IFX trough concentrations (≥3 μg/mL at T+1) than dose doubling alone, which in turn was more effective than interval shortening alone (P < .001). CONCLUSION Antibodies towards infliximab can guide clinical decision-making on treatment intensification.
Collapse
Affiliation(s)
- E Dreesen
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - T Van Stappen
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - V Ballet
- Translational Research in GastroIntestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - M Peeters
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - G Compernolle
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - S Tops
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - K Van Steen
- GIGA-R Medical Genomics - BIO3 lab, ULg, Liège, Belgium.,Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - G Van Assche
- Translational Research in GastroIntestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - M Ferrante
- Translational Research in GastroIntestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - S Vermeire
- Translational Research in GastroIntestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Gils
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Germain A, de Buck van Overstraeten A, Wolthuis A, Ferrante M, Vermeire S, Van Assche G, D'Hoore A. Outcome of restorative proctocolectomy with an ileo-anal pouch for ulcerative colitis: effect of changes in clinical practice. Colorectal Dis 2018; 20:O30-O38. [PMID: 29091335 DOI: 10.1111/codi.13948] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/11/2017] [Indexed: 02/08/2023]
Abstract
AIM Surgery for ileal pouch-anal anastomosis (IPAA) has evolved over time, especially since the introduction of laparoscopy. The aim of this retrospective study was to report the impact of surgical evolution on outcome over a period of 25 years. METHOD All patients who had IPAA surgery for ulcerative colitis from 1990 to 2015 at the University Hospitals of Leuven were included. Patients were divided into three period arms (period A 1990-1999; period B 2000-2009; period C 2010-2015). The main outcome measure was anastomotic leakage. RESULTS A total of 335 patients (58.8% male) with a median age of 39 years (interquartile range 32-49 years) at surgery were included. Median follow-up was 5 years (interquartile range 2-10 years). Overall anastomotic leakage (grades A-C) was 14.9%. A significant decrease in leakage rate was observed over time (from 21.4% in period A to 12.1% in period B to 10.0% in period C; P = 0.04). The defunctioning ileostomy rate at the time of pouch construction decreased from 91.7% (period A) to 40.3% (period B) to 11.1% (period C) (P < 0.001). We observed an increase in the use of laparoscopy (23.9% in period A vs 72.6% in period B, vs 84.4% in period C; P = 0.001) and a shift to a modified two-stage procedure (4.1% in period A, vs 66.7% in period C; P < 0.0001). In a monocentric study with some of the data retrieved retrospectively it was not possible to account for the impact of preoperative nutritional status (weight loss, serum albumin level) or disease burden. Other outcome factors were not measured, for example sexual function and fecundity. CONCLUSION A higher rate of laparoscopic IPAA surgery, together with a shift towards modified two-stage procedures, was associated with a lower leakage rate despite a reduction in the use of defunctioning ileostomy.
Collapse
Affiliation(s)
- A Germain
- Department of Digestive Surgery, University Hospital of Nancy, Nancy, France.,Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - A Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
7
|
Colombel JF, Sandborn WJ, Reinisch W, Peyrin-Biroulet L, Panaccione R, Rutgeerts P, Hanauer SB, Ghosh S, Van Assche G, Robinson AM, Lau W, Maa JF, Huang B, Pappalardo B, Read H. Long-term safety of adalimumab in clinical trials in adult patients with Crohn's disease or ulcerative colitis. Aliment Pharmacol Ther 2018; 47:219-228. [PMID: 29159817 DOI: 10.1111/apt.14420] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 08/25/2017] [Accepted: 10/26/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adalimumab is used to treat moderate to severe Crohn's disease (CD) and ulcerative colitis (UC) when conventional therapies fail. AIM To update long-term adalimumab safety from CD and UC trials; the previous report was CD only, 3160 patients/3402 patient-years (PYs). METHODS Treatment-emergent adverse events (AEs; first dose to 70 days after last dose/December 31, 2015) in adults in phase 2/3 and 3/3b trials and open-label extensions were coded using Medical Dictionary for Regulatory Activities (MedDRA-v18.1). Rates were assessed as events/100 (E/100 PYs). RESULTS The database (16 trials; CD, N = 3606; UC, N = 1739) represented 4145 and 3397 PYs of exposure, respectively. For CD, incidences of any AEs with adalimumab were 60.8%-65.1%, depending on dose, and 71.5% with placebo; for UC, the incidences were 53.5%-54.8% and 56.1%, respectively. Rates of any AEs (CD, 605 E/100 PYs; UC, 361 E/100 PYs), serious AEs (CD, 36.1 E/100 PYs; UC, 18.9 E/100 PYs), and malignancies (CD, 1.2 E/100 PYs; UC, 1.0 E/100 PYs) were similar between current and prior analyses. Apparent rate of opportunistic infections was lowered to 0.3 and 0.2 E/100 PYs for CD and UC, respectively, by recent MedDRA changes excluding oral candidiasis and tuberculosis. Standardised incidence ratios for malignancies were similar to the general population (CD, 1.45 [95% CI, 0.90-2.22]; UC, 1.36 [95% CI, 0.84-2.07]). Demyelinating disorders were uncommon (CD, 0.1 E/100 PYs; UC, <0.1 E/100 PYs). CONCLUSIONS Patients with moderately to severely active Crohn's disease or ulcerative colitis continued to experience acceptable safety with adalimumab, without new safety signals.
Collapse
|
8
|
de Buck van Overstraeten A, Eshuis EJ, Vermeire S, Van Assche G, Ferrante M, D'Haens GR, Ponsioen CY, Belmans A, Buskens CJ, Wolthuis AM, Bemelman WA, D'Hoore A. Short- and medium-term outcomes following primary ileocaecal resection for Crohn's disease in two specialist centres. Br J Surg 2017; 104:1713-1722. [PMID: 28745410 DOI: 10.1002/bjs.10595] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite improvements in medical therapy, the majority of patients with Crohn's disease still require surgery. The aim of this study was to report safety, and clinical and surgical recurrence rates, including predictors of recurrence, after ileocaecal resection for Crohn's disease. METHODS This was a cohort analysis of consecutive patients undergoing a first ileocaecal resection for Crohn's disease between 1998 and 2013 at one of two specialist centres. Anastomotic leak rate and associated risk factors were assessed. Kaplan-Meier estimates were used to describe long-term clinical and surgical recurrence. Univariable and multivariable regression analyses were performed to identify risk factors for both endpoints. RESULTS In total, 538 patients underwent primary ileocaecal resection (40·0 per cent male; median age at surgery 31 (i.q.r. 24-42) years). Median follow-up was 6 (2-9) years. Fifteen of 507 patients (3·0 per cent) developed an anastomotic leak. An ASA fitness grade of III (odds ratio (OR) 4·34, 95 per cent c.i. 1·12 to 16·77; P = 0·033), preoperative antitumour necrosis factor therapy (OR 3·30, 1·09 to 9·99; P = 0·035) and length of resected bowel specimen (OR 1·06, 1·03 to 1·09; P < 0·001) were significant risk factors for anastomotic leak. Rates of clinical recurrence were 17·6, 45·4 and 55·0 per cent after 1, 5 and 10 years respectively. Corresponding rates of requirement for further surgery were 0·6, 6·5 and 19·1 per cent. Smoking (hazard ratio (HR) 1·67, 95 per cent c.i. 1·14 to 2·43; P = 0·008) and a positive microscopic resection margin (HR 2·16, 1·46 to 3·21; P < 0·001) were independent risk factors for clinical recurrence. Microscopic resection margin positivity was also a risk factor for further surgery (HR 2·99, 1·36 to 6·54; P = 0·006). CONCLUSION Ileocaecal resection achieved durable medium-term remission, but smoking and resection margin positivity were risk factors for recurrence.
Collapse
Affiliation(s)
| | - E J Eshuis
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - G R D'Haens
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Y Ponsioen
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - A Belmans
- KU Leuven-University of Leuven and Universiteit Hasselt, I-Biostat, Leuven, Belgium
| | - C J Buskens
- General Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Belgium
| | - W A Bemelman
- General Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Belgium
| |
Collapse
|
9
|
Diaz M, Van Assche G, Maurer F, Van Mele B. Thermophysical characterization of a reversible dynamic polymer network based on kinetics and equilibrium of an amorphous furan-maleimide Diels-Alder cycloaddition. POLYMER 2017. [DOI: 10.1016/j.polymer.2017.05.058] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Van Steenbergen S, Bian S, Vermeire S, Van Assche G, Gils A, Ferrante M. Dose de-escalation to adalimumab 40 mg every 3 weeks in patients with Crohn's disease - a nested case-control study. Aliment Pharmacol Ther 2017; 45:923-932. [PMID: 28164321 DOI: 10.1111/apt.13964] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/06/2017] [Accepted: 01/11/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data on dose de-escalation in patients with Crohn's disease (CD) are limited. AIM To evaluate outcomes of dose de-escalation from adalimumab (ADM) every other week (EOW) to every three weeks (ETW). METHODS We selected patients with CD receiving maintenance therapy with ADM 40 mg ETW with serum levels (SL) available before and after dose de-escalation. Sex- and age-matched controls continuing ADM 40 mg EOW were identified. Patient reported outcome, C-reactive protein (CRP) and serum albumin were collected. RESULTS Out of 898 patients, we identified 40 (11 male, median 37 years) who de-escalated to ADM 40 mg ETW for ADM-related adverse events (AE, n = 1), ADM SL >7 μg/mL (n = 8), or both (n = 31). Compared to controls, ADM SL dropped significantly within 4 months, without associated clinical or biochemical changes. In 53% of patients, dose de-escalation was associated with disappearance of AE (8/16 skin manifestation, 3/6 arthralgia, 5/7 frequent infectious episodes). During a median follow-up of 24 months, 65% of patients maintained clinical response, but 35% needed dose escalation back to ADM 40 mg EOW because of clinical relapse (n = 8), ADM SL <4 μg/mL (n = 2), or both (n = 4). CRP <3.5 mg/L at dose de-escalation was independently associated with dose escalation-free survival [odds ratio 6.28 (95% CI 1.83-21.59), P = 0.004]. We could not define a minimal ADM SL to consider or maintain dose de-escalation. CONCLUSIONS Overall, 65% of patients who de-escalated to adalimumab 40 mg every 3 weeks remained in clinical remission for a median of 24 months. In 53% of patients, adalimumab-related adverse events disappeared after dose de-escalation. Regardless of adalimumab SL, disease remission should be assessed objectively prior to dose de-escalation.
Collapse
Affiliation(s)
- S Van Steenbergen
- Department of General Practice, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - S Bian
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Gils
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| |
Collapse
|
11
|
Willocq B, Khelifa F, Brancart J, Van Assche G, Dubois P, Raquez JM. One-component Diels–Alder based polyurethanes: a unique way to self-heal. RSC Adv 2017. [DOI: 10.1039/c7ra09898g] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In the present work, we synthesized one-component self-healing polyurethanes based on thermo-reversible furan/maleimide Diels–Alder reactions.
Collapse
Affiliation(s)
- B. Willocq
- Laboratory of Polymeric and Composite Materials (LPCM)
- Center of Innovation and Research in Materials and Polymers (CIRMAP)
- University of Mons
- B-7000 Mons
- Belgium
| | - F. Khelifa
- Laboratory of Polymeric and Composite Materials (LPCM)
- Center of Innovation and Research in Materials and Polymers (CIRMAP)
- University of Mons
- B-7000 Mons
- Belgium
| | - J. Brancart
- Physical Chemistry and Polymer Science (FYSC)
- Vrije Universiteit Brussel
- Brussels
- Belgium
| | - G. Van Assche
- Physical Chemistry and Polymer Science (FYSC)
- Vrije Universiteit Brussel
- Brussels
- Belgium
| | - Ph. Dubois
- Laboratory of Polymeric and Composite Materials (LPCM)
- Center of Innovation and Research in Materials and Polymers (CIRMAP)
- University of Mons
- B-7000 Mons
- Belgium
| | - J.-M. Raquez
- Laboratory of Polymeric and Composite Materials (LPCM)
- Center of Innovation and Research in Materials and Polymers (CIRMAP)
- University of Mons
- B-7000 Mons
- Belgium
| |
Collapse
|
12
|
Billiet T, Cleynen I, Ballet V, Ferrante M, Van Assche G, Gils A, Vermeire S. Prognostic factors for long-term infliximab treatment in Crohn's disease patients: a 20-year single centre experience. Aliment Pharmacol Ther 2016; 44:673-83. [PMID: 27502581 DOI: 10.1111/apt.13754] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/09/2016] [Accepted: 07/15/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The long-term efficacy of infliximab in patients with Crohn's disease is suboptimal. AIM To study prognostic factors for real-life long-term effcacy of infliximab in Crohn's disease. METHODS All consecutive Crohn's disease patients treated with infliximab at a tertiary centre were retrospectively analysed. Only patients who received scheduled infliximab maintenance treatment were considered. Patient- and disease-related factors were used to identify independent predictors of infliximab failure-free survival using Cox proportional hazards regression. RESULTS Of 1031 patients with Crohn's disease, 261 were eligible for inclusion. Median time on infliximab was 2.4 [IQR 1.4-4.7] years, and 65 (24.9%) patients experienced infliximab failure. Estimated 5-year infliximab failure-free survival was 65.9% (95% CI 58.3-73.5). Multivariate Cox regression identified disease duration ≥1 year (HR 2.5 (95% CI 1.2-5.2), P = 0.02), L1 disease location [HR 2.0 (1.1-3.5), P = 0.02], prior anti-TNF use [HR 2.3 (1.1-4.8), P = 0.03], haemoglobin <13.5 g/dL [HR 2.3 (1.2-4.4), P = 0.02], not using therapeutic drug monitoring [HR 8.0 (4.1-15.6), P = 1 × 10(-9) ], and first dose optimisation within first year [HR 3.7 (2.1-6.6), P = 5 × 10(-6) ] as independent predictors of infliximab failure-free survival. Stratifying patients into risk groups resulted in estimated 3-year infliximab failure-free survival rates ranging from 95.3% (94.2-96.4) to 26.3% (8.6-44.0) depending on the number of risk factors (P = 8 × 10(-13) ). CONCLUSIONS This study identified several easy to obtain predictors of infliximab failure in patients with Crohn's disease, and these are in line with previous reports. Those with a high-risk profile for infliximab failure in whom infliximab initiation is considered, should be treated as early as possible making use of therapeutic drug monitoring.
Collapse
Affiliation(s)
- T Billiet
- Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - I Cleynen
- Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - V Ballet
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - M Ferrante
- Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - G Van Assche
- Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Gils
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Clinical and Experimental Medicine, Translational Research Center for GastroIntestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| |
Collapse
|
13
|
|
14
|
de Buck van Overstraeten A, Vermeire S, Vanbeckevoort D, Rimola J, Ferrante M, Van Assche G, Wolthuis A, D’Hoore A. Modified Side-To-Side Isoperistaltic Strictureplasty over the Ileocaecal Valve: An Alternative to Ileocaecal Resection in Extensive Terminal Ileal Crohn's Disease. J Crohns Colitis 2016; 10:437-42. [PMID: 26674959 PMCID: PMC4946765 DOI: 10.1093/ecco-jcc/jjv230] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative to ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn's disease [CD]. METHODS This type of strictureplasty was proposed to all patients with an extensive strictured [neo-] terminal ileal segment [> 20 cm]. Short- and long-term outcome data were retrieved from a prospectively maintained database. Safety and medium-term efficacy were studied, using both postoperative magnetic resonance enterography [MRE] and ileocolonoscopy at 6 months. RESULTS Between June 2009 and September 2014, 29 CD patients had a modified strictureplasty [male 9/29, median age 38 [range: 16-64] years]. The median length of strictureplasty was 50 [27-110] cm. Twelve patients underwent a total of 30 additional procedures during surgery, mainly additional short strictureplasties, but also segmental resections. The majority had a laparoscopic-assisted procedure. Median length of hospital stay was 9 [6-17] days. Two patients had an early rescue procedure to oversew a small anastomotic leak. MRE and ileocolonoscopy at follow-up showed a remarkable regression of inflammation and bowel wall thickness. Clinical recurrence, necessitating initiation or modification of medical therapy, and surgical recurrence were reported in 11 and 1 patient after a median follow-up of 21 [1-54] months, respectively. CONCLUSION A modified long Michelassi strictureplasty appears to be safe in patients with extensive stricturing Crohn's ileitis. Significant mucosal and bowel wall healing is observed and suggests that clearance of microbial stasis may play a role in this process.
Collapse
Affiliation(s)
| | - S. Vermeire
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - D. Vanbeckevoort
- University Hospitals Leuven, Department of Radiology, KU Leuven, Belgium
| | - J. Rimola
- Hospital Clinic de Barcelona, Department of Radiology, Barcelona, Spain
| | - M. Ferrante
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - G. Van Assche
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - A. Wolthuis
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| | - A. D’Hoore
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| |
Collapse
|
15
|
Van den Brande N, Van Assche G, Van Mele B. Thermal behaviour below and inside the glass transition region of a submicron P3HT layer studied by fast scanning chip calorimetry. POLYMER 2016. [DOI: 10.1016/j.polymer.2015.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
Defour M, Van den Brande N, Van Lokeren L, Van Assche G, Maes W, Vanderzande D, Van Mele B. Influence of the amorphous phase and preceding solution processing on the eutectic behaviour in the state diagram of P3HT : PC61BM determined by rapid heat–cool calorimetry. RSC Adv 2016. [DOI: 10.1039/c6ra20659j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Experimental determination of eutectic state diagrams for organic photovoltaics based on advanced calorimetry highlighting the importance of the amorphous phase.
Collapse
Affiliation(s)
- M. Defour
- Physical Chemistry and Polymer Science
- Materials and Chemistry
- Vrije Universiteit Brussel
- B-1050 Brussels
- Belgium
| | - N. Van den Brande
- Physical Chemistry and Polymer Science
- Materials and Chemistry
- Vrije Universiteit Brussel
- B-1050 Brussels
- Belgium
| | - L. Van Lokeren
- Physical Chemistry and Polymer Science
- Materials and Chemistry
- Vrije Universiteit Brussel
- B-1050 Brussels
- Belgium
| | - G. Van Assche
- Physical Chemistry and Polymer Science
- Materials and Chemistry
- Vrije Universiteit Brussel
- B-1050 Brussels
- Belgium
| | - W. Maes
- Design & Synthesis of Organic Semiconductors (DSOS)
- Institute for Materials Research (IMO-IMOMEC)
- Hasselt University
- B-3590 Diepenbeek
- Belgium
| | - D. Vanderzande
- Design & Synthesis of Organic Semiconductors (DSOS)
- Institute for Materials Research (IMO-IMOMEC)
- Hasselt University
- B-3590 Diepenbeek
- Belgium
| | - B. Van Mele
- Physical Chemistry and Polymer Science
- Materials and Chemistry
- Vrije Universiteit Brussel
- B-1050 Brussels
- Belgium
| |
Collapse
|
17
|
De Bie C, Ballet V, Hendriks N, Coenen S, Weyts E, Van Assche G, Vermeire S, Ferrante M. Smoking behaviour and knowledge of the health effects of smoking in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2015; 42:1294-302. [PMID: 26435040 DOI: 10.1111/apt.13423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/20/2015] [Accepted: 09/14/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The detrimental effect of smoking on development and progression of Crohn's disease (CD) is generally accepted. AIM To evaluate the awareness of smoking risks in a Belgian inflammatory bowel disease (IBD) population. METHODS In the out-patient clinic of a tertiary referral centre, 625 consecutive patients with CD, 238 patients with ulcerative colitis (UC) and 289 non-IBD controls, filled out a simple questionnaire. This questionnaire included data on smoking behaviour and awareness of smoking-related health effects, including effects on IBD. RESULTS At diagnosis, more CD patients were active smokers compared to UC (40% vs. 17%, P < 0.001). Remarkably, smoking cessation rates after diagnosis were similar for CD and UC (both 56%, P = 0.997). The great majority recognised a detrimental influence of smoking on general health (98-99%), lung cancer (95-97%), myocardial infarction (89-92%) and stroke (78-87%). Although CD patients more frequently acknowledged risks of smoking on their disease, only 37% were aware of a link with CD development, 30% of increased surgical rates and 27% of increased post-operative CD recurrence. Active smokers more frequently denied an increased risk of surgery and higher post-operative CD recurrence. Intriguingly, within the active smokers with CD, those not willing to quit smoking most often denied a potential bad influence of smoking. Taking into account disease duration, previous surgery, education level, working status and nicotine dependence, we were unable to define specific subgroups of patients requiring extra education. CONCLUSION Although patients with Crohn's disease were better informed on the detrimental effects of smoking, the awareness rate was still low.
Collapse
Affiliation(s)
- C De Bie
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - V Ballet
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - N Hendriks
- Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - S Coenen
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - E Weyts
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| |
Collapse
|
18
|
de Buck van Overstraeten A, Van Hoef S, Vermeire S, Ferrante M, Fieuws S, Wolthuis A, Van Assche G, D'Hoore A. Postoperative Inflammatory Response in Crohn's Patients: A Comparative Study. J Crohns Colitis 2015; 9:1127-31. [PMID: 26351389 DOI: 10.1093/ecco-jcc/jjv161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 05/05/2015] [Accepted: 08/28/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Surgery for Crohn's disease [CD] can be complicated by an enhanced inflammatory response. This retrospective study aims to compare the inflammatory response measured by C-reactive protein [CRP] in patients operated for CD with patients undergoing similar surgery for colorectal cancer [CRC]. METHODS All CD patients undergoing an ileocaecal resection between February 2001 and December 2013 were retrieved from a prospectively maintained database. The same number of patients with a CRC of the ascending colon, undergoing a laparoscopic right hemicolectomy between March 2009 and June 2014, were retrieved from a CRC database. CRP level during the first 7 postoperative days was used as primary outcome. RESULTS Totals of 112 consecutive CD patients (male 40.2%; median age: 32.3 yrs; interquartile range [IQR]: 25.2-45.1) and 112 consecutive CRC patients [male 53.6%; median age 71.6 yrs; IQR: 64.7-77.5] were included. Postoperative CRP level in the CD group was on average 27% higher compared with the CRC group [p = 0.02]. The day-specific differences in CRP values were 21% (p = 0.021, 95% confidence interval [CI]: 3% 41%), 41% [p = 0.005, 95% CI: 11%-79%], 49% [p = 0.007, 95% CI: 11%-96%], and 49% [p = 0.006, 95% CI: 12%-100%] higher for CD patients at Days 1, 4, 5, and 6 respectively. The difference in postoperative CRP level was partially due to differences in preoperative CRP level. CONCLUSION CD patients develop a higher postoperative CRP level, probably reflecting an enhanced postoperative inflammatory response, which may be triggered by a higher preoperative inflammatory state.
Collapse
Affiliation(s)
| | - S Van Hoef
- University Hospital Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| | - S Vermeire
- University Hospital Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - M Ferrante
- University Hospital Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - S Fieuws
- KU Leuven - University of Leuven & Universiteit Hasselt, I-Biostat, B-3000 Leuven, Belgium
| | - A Wolthuis
- University Hospital Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| | - G Van Assche
- University Hospital Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - A D'Hoore
- University Hospital Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| |
Collapse
|
19
|
Lobatón T, Ferrante M, Rutgeerts P, Ballet V, Van Assche G, Vermeire S. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther 2015; 42:441-51. [PMID: 26104047 DOI: 10.1111/apt.13294] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/22/2014] [Accepted: 06/02/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The general increased life expectancy is reflected in the age of patients with inflammatory bowel disease (IBD). The knowledge about efficacy and safety of anti-tumour necrosis factor (TNF) therapy in elderly is scarce and conflicting. AIM To assess the efficacy and safety of anti-TNF therapy in elderly patients taking into account eventual comorbidity. METHODS Observational and retrospective single-centred study where 66 IBD patients initiating anti-TNF treatment at age ≥65 years (cases: ≥65 anti-TNF) were compared with 112 IBD patients initiating anti-TNF <65 years (controls <65 anti-TNF) and 61 anti-TNF naïve IBD patients treated with immunosuppressants (IMS) and/or corticosteroids (CS) ≥65 years (controls ≥65 IMS/CS). Controls were matched to cases for IBD type, follow-up, disease duration and anti-TNF type. Comorbidity was assessed by using the Charlson Comorbidity Index (CCI). Both efficacy and safety of treatment were adjusted for comorbidity. RESULTS The short-term clinical response to anti-TNF at 10 weeks was significantly lower in cases: ≥65 anti-TNF (68% vs. 89%; P < 0.001), whereas at ≥6 months, differences were not significant (79.5% vs. 82.8%; P = 0.639). The risk for any severe adverse events was higher in cases: ≥65 anti-TNF than in controls <65 anti-TNF (RR = 4.7; P < 0.001) or controls ≥65 IMS/CS (RR = 3.09; P = 0.0008). Age older than 65 and CCI > 0 were independent risk factors for malignancy and mortality regardless of the medication. CONCLUSION Elderly patients treated with anti-TNF have a lower rate of short-term clinical response and a higher rate of severe adverse events than the younger patients under the same treatment.
Collapse
Affiliation(s)
- T Lobatón
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - P Rutgeerts
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - V Ballet
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| |
Collapse
|
20
|
Van den Brande N, Van Assche G, Van Mele B. Isothermal structure development in submicron P3HT layers studied by fast scanning chip calorimetry. POLYMER 2015. [DOI: 10.1016/j.polymer.2014.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
21
|
Baert F, Vande Casteele N, Tops S, Noman M, Van Assche G, Rutgeerts P, Gils A, Vermeire S, Ferrante M. Prior response to infliximab and early serum drug concentrations predict effects of adalimumab in ulcerative colitis. Aliment Pharmacol Ther 2014; 40:1324-32. [PMID: 25277873 DOI: 10.1111/apt.12968] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/02/2014] [Accepted: 09/05/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data for adalimumab in ulcerative colitis after prior use of infliximab are scarce. AIMS To study adalimumab response rates and predictors of response in ulcerative colitis, including drug concentrations. METHODS In this single centre cohort study 73 UC patients, previously exposed to infliximab, were assessed for response to adalimumab at weeks 12 and 52. Serum samples prior to week 12 were available and included in multivariate analysis to predict response. RESULTS Overall clinical response at week 12 and 52 were 75% and 52%, respectively. Adalimumab was continued without need for dose escalation throughout year 1 in 16 patients, 22 needed dose escalation and 35 discontinued treatment within 1 year. Prior response to infliximab and early serum concentrations correlated with response. Receiver operator characteristic curve analysis yielded optimal adalimumab concentrations of 4.58 μg/mL for week 12 and 7.0 μg/mL for week 52. Independent predictors for response at week 12 were primary response to infliximab [odds ratio (OR) 8.33; 95% confidence interval (CI) 1.8-33.3; P = 0.006] and an adalimumab concentration ≥4.58 μg/mL at week 4 (OR 4.85; 95% CI 1.3-18.6; P = 0.009). Positive predictors for week 52 response were primary response to infliximab (OR 5.2; 95% CI 1.14-23.8; P = 0.034) and adalimumab concentration at week 4 of ≥7 μg/mL (OR 3.56; 95% CI 1.17-10.79; P = 0.025). CONCLUSION Prior response to infliximab and high early adalimumab serum concentrations predict week 12 and year 1 responses to adalimumab in ulcerative colitis.
Collapse
Affiliation(s)
- F Baert
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
de Buck van Overstraeten A, Wolthuis AM, Vermeire S, Van Assche G, Laenen A, Ferrante M, Rutgeerts P, D'Hoore A. Long-term functional outcome after ileal pouch anal anastomosis in 191 patients with ulcerative colitis. J Crohns Colitis 2014; 8:1261-6. [PMID: 24662397 DOI: 10.1016/j.crohns.2014.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 12/12/2013] [Revised: 02/28/2014] [Accepted: 03/01/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND A long-lasting good functional outcome of the pelvic pouch and a subsequent satisfying quality of life (QoL) are mandatory. Long-term functional outcome and QoL in a single-center cohort were assessed. PATIENTS AND METHODS A questionnaire was sent to all patients with an IPAA for UC, operated between 1990 and 2010 in our department. Pouch function was assessed using the Öresland Score (OS) and the 'Pouch Functional Score' (PFS). QoL was assessed using a Visual Analogue Score (VAS). RESULTS 250 patients (42% females) with a median age at surgery of 38 years (interquartile range (IQR): 29-48 years) underwent restorative proctocolectomy. Median follow-up was 11 years (IQR: 6-17 years). Response rate was 81% (n=191). Overall pouch function was satisfactory with a median OS of 6/15 (IQR: 4-8) and a median PFS of 6/30 (IQR: 3-11). 24-hour bowel movement is limited to 8 times in 68% of patients (n=129), while 55 patients (29%) had less than 6 bowel movements. 12 patients (6.5%) were regularly incontinent for stools, while 154 patients (82%) reported a good fecal continence. Fecal incontinence during nighttime was more common (n=72, 39%). Pouch function had little impact on social activity (4/10; IQR: 2-6) and on professional activity (3/10; IQR: 1-6). 172 patients (90%) reported to experience an overall better health condition since their operation. The OS and the PFS correlated well (Pearson's correlation coefficient=0.83). Overall pouch function was stable over time. CONCLUSION Majority of patients report a good pouch function on the long-term with limited impact on QoL.
Collapse
Affiliation(s)
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology, University Hospital Gasthuisberg Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology, University Hospital Gasthuisberg Leuven, Belgium
| | - A Laenen
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, University Hospital Gasthuisberg Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology, University Hospital Gasthuisberg Leuven, Belgium
| | - P Rutgeerts
- Department of Gastroenterology, University Hospital Gasthuisberg Leuven, Belgium
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Belgium
| |
Collapse
|
23
|
Wolf D, D'Haens G, Sandborn WJ, Colombel JF, Van Assche G, Robinson AM, Lazar A, Zhou Q, Petersson J, Thakkar RB. Escalation to weekly dosing recaptures response in adalimumab-treated patients with moderately to severely active ulcerative colitis. Aliment Pharmacol Ther 2014; 40:486-97. [PMID: 25041859 DOI: 10.1111/apt.12863] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/19/2014] [Accepted: 06/14/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with moderately to severely active ulcerative colitis occasionally do not respond to or lose initial response to maintenance dosing of anti-TNF therapy. AIM To report the efficacy of escalation from every other week (EOW) to weekly adalimumab dosing in patients from the clinical trial ULTRA 2 (NCT00408629), by week 8 response (i.e. response after adalimumab induction therapy). METHODS Week 52 remission, response, and mucosal healing rates were assessed in ULTRA 2 adalimumab-randomised patients who escalated to weekly dosing. Patients were stratified by week 8 response per partial Mayo score. Kaplan-Meier and logistic regression analyses estimated time to weekly dosing and defined predictors of escalation to weekly dosing, respectively. Adverse events were reported for patients receiving open-label adalimumab. RESULTS The rate of escalation to weekly dosing was 16.3% (20/123) for week 8 responders and 38.4% (48/125) for week 8 nonresponders. Week 52 remission, response and mucosal healing rates with weekly dosing were 20%, 45%, and 45% for week 8 responders and 2.1%, 25% and 29.2% for nonresponders, respectively (NRI). The median time to weekly dosing was 288 days for week 8 nonresponders and not estimable for responders. Prior anti-TNF use was a significant predictor of escalation to weekly dosing. Treatment-emergent adverse event rates were similar for patients receiving open-label EOW or weekly adalimumab. CONCLUSIONS Escalation to weekly adalimumab dosing demonstrated clinical benefits for patients who lost response to therapy and may be beneficial for patients not initially responding to induction therapy. No new safety risks were identified with weekly dosing.
Collapse
Affiliation(s)
- D Wolf
- Atlanta Gastroenterology Associates, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Barhoum A, Ibrahim HM, Hassanein TF, Hill G, Reniers F, Dufour T, Delplancke MP, Van Assche G, Rahier H. Preparation and characterization of ultra-hydrophobic calcium carbonate nanoparticles. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1757-899x/64/1/012037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
25
|
Lobatón T, Vermeire S, Van Assche G, Rutgeerts P. Review article: anti-adhesion therapies for inflammatory bowel disease. Aliment Pharmacol Ther 2014; 39:579-94. [PMID: 24479980 DOI: 10.1111/apt.12639] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 12/31/2013] [Accepted: 01/08/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND A high proportion of patients with inflammatory bowel disease (IBD) do not achieve clinical remission with the current therapies including mesalazine (mesalamine), immunossupresants (IMS) and antibodies against tumour necrosis factor (anti-TNF). Moreover, IMS and anti-TNF involve a nonnegligible risk for infections and/or malignancies. The anti-adhesion molecules are one of the most interesting new treatments because of their gut-selectivity. AIM To review the physiopathology of the adhesion molecules and the current drugs targeting this mechanism. METHODS We performed a literature review in PubMed and in clinicaltrials.gov using the terms 'anti-adhesion molecules', 'inflammatory bowel disease', 'natalizumab', 'vedolizumab', 'AMG181', 'Etrolizumab', 'PF-00547659', 'AJM300', 'Alicaforsen' and 'CCX282-B' up to November 2013. RESULTS A total of eight drugs were found including those targeting the α4β1, α4β7 or αEβ7 integrins as well as the ICAM-1 and MAdCAM-1 addressins and the chemokine receptor 9. The rationale for these drugs is the blockade of gut-homing T lymphocytes and the ones targeting the α4β7/MAdCAM-1 interaction presented the most promising results in luminal disease. Vedolizumab, an α4β7 antibody, has completed phase 3 trials with very positive results especially for ulcerative colitis. However, many questions remain unanswered such as the effect of these therapies in perianal disease and extraintestinal manifestations. CONCLUSIONS The blockade of the α4β7/MAdCAM-1 interaction and especially vedolizumab is an effective and safe gut-specific treatment for IBD. Further studies are needed to clarify the efficacy and safety of the other anti-adhesion drugs and to define the specific indications of these therapies in the different scenarios of IBD.
Collapse
Affiliation(s)
- T Lobatón
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | |
Collapse
|
26
|
Van den Brande N, Van Lier G, Da Pieve F, Van Assche G, Van Mele B, De Proft F, Geerlings P. A time dependent DFT study of the efficiency of polymers for organic photovoltaics at the interface with PCBM. RSC Adv 2014. [DOI: 10.1039/c4ra12053a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In this work an intuitive (TD-DFT) approach was developed to explain the experimental efficiencies seen for organic photovoltaic devices.
Collapse
Affiliation(s)
- N. Van den Brande
- General Chemistry (ALGC)
- Vrije Universiteit Brussel (VUB)
- B-1050 Brussels, Belgium
- Physical Chemistry and Polymer Science (FYSC)
- Vrije Universiteit Brussel (VUB)
| | - G. Van Lier
- General Chemistry (ALGC)
- Vrije Universiteit Brussel (VUB)
- B-1050 Brussels, Belgium
| | - F. Da Pieve
- General Chemistry (ALGC)
- Vrije Universiteit Brussel (VUB)
- B-1050 Brussels, Belgium
| | - G. Van Assche
- Physical Chemistry and Polymer Science (FYSC)
- Vrije Universiteit Brussel (VUB)
- B-1050 Brussels, Belgium
| | - B. Van Mele
- Physical Chemistry and Polymer Science (FYSC)
- Vrije Universiteit Brussel (VUB)
- B-1050 Brussels, Belgium
| | - F. De Proft
- General Chemistry (ALGC)
- Vrije Universiteit Brussel (VUB)
- B-1050 Brussels, Belgium
| | - P. Geerlings
- General Chemistry (ALGC)
- Vrije Universiteit Brussel (VUB)
- B-1050 Brussels, Belgium
| |
Collapse
|
27
|
Khanna R, Sattin BD, Afif W, Benchimol EI, Bernard EJ, Bitton A, Bressler B, Fedorak RN, Ghosh S, Greenberg GR, Marshall JK, Panaccione R, Seidman EG, Silverberg MS, Steinhart AH, Sy R, Van Assche G, Walters TD, Sandborn WJ, Feagan BG. Review article: a clinician's guide for therapeutic drug monitoring of infliximab in inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38:447-59. [PMID: 23848220 DOI: 10.1111/apt.12407] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 04/29/2013] [Accepted: 06/21/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Tumour necrosis factor (TNF)-antagonists have an established role in the treatment of inflammatory bowel diseases (IBDs), however, subtherapeutic drug levels and the formation of anti-drug antibodies (ADAs) may decrease their efficacy. AIM The evidence supporting the use of therapeutic drug monitoring (TDM) based clinical algorithms for infliximab (IFX) and their role in clinical practice will be discussed. METHODS The literature was reviewed to identify relevant articles on the measurement of IFX levels and antibodies-to-infliximab. RESULTS Treatment algorithms for IBD have evolved from episodic monotherapy used in patients refractory to all other treatments, to long-term combination therapy initiated early in the disease course. Improved remission rates have been observed with this paradigm shift, nevertheless many patients ultimately lose response to therapy. Although empiric dose optimization or switching agents constitute the current standard of care for secondary failure, these interventions have not been applied in an evidence-based manner and are probably not cost-effective. Multiple TDM-based algorithms have been developed to identify patients that may benefit from measurement of IFX and ADA levels to guide adjustments to therapy. CONCLUSIONS Therapeutic drug monitoring offers a rational approach to the management of secondary failure to IFX. This concept has gained momentum based on evidence from case series, cohort studies and post-hoc analyses of randomised controlled trials.
Collapse
Affiliation(s)
- R Khanna
- Robarts Clinical Trials Inc., Robarts Research Institute, Western University, London, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kevans D, Van Assche G. Is there a therapeutic window of opportunity in early inflammatory bowel disease? Early stage inflammatory bowel disease: the actual management. MINERVA GASTROENTERO 2013; 59:299-312. [PMID: 23867949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Traditionally therapy for inflammatory bowel disease (IBD) encompassed a sequential approach with subjects treated with 5-ASA products and/or corticosteroids initially, and only where failing such treatment, moving on to immunomodulator or biologic therapy. In the rheumatologic literature the importance of the early introduction of immunosuppressive therapies for inflammatory arthropathies has been increasingly recognized, however this concept remains much debated in IBD with no clear consensus on the optimal therapeutic approach. In this review we discuss how the natural history of IBD provides a rationale for the early introduction of the most effective therapy. We outline how the experience of early immunosuppressive therapy in rheumatoid arthritis informs therapeutic decision making in IBD. We review the evolving treatment strategies in IBD and the current evidence supporting the introduction of immunosuppressive treatment soon after IBD diagnosis. Finally we discuss the importance of selecting appropriate therapeutic endpoints in IBD and review the potential risks and benefits of early immunosuppressive treatment strategies in IBD.
Collapse
Affiliation(s)
- D Kevans
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada -
| | | |
Collapse
|
29
|
Janssens V, Block C, Van Assche G, Van Mele B, Van Puyvelde P. RheoDSC Analysis of Hardening of Semi-Crystalline Polymers during Quiescent Isothermal Crystallization. INT POLYM PROC 2013. [DOI: 10.3139/217.2374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
The crystallization of semi-crystalline polymers is often analyzed by rheometry and calorimetry. By rheometry the viscosity evolution during crystallization can be followed, whereas from a calorimetric measurement, the evolution of the degree of crystallinity can be calculated. The time evolution of these material properties is valuable input for polymer processing simulation software and in order to combine the data in a reliable manner, hardening curves are used as a characterization tool. Such a hardening curve correlates the relative increase of the viscosity resulting from crystallization, to the advancing degree of crystallinity. In this study, these are extracted from simultaneous measurements on one sample using a RheoDSC device. The RheoDSC technique allows for the direct combination of the rheological and calorimetric signal without the need of combining separate stand-alone measurement results. In this study, isothermal crystallization experiments are used to discuss the benefits of this approach. This will lead to the recommendation that measuring the hardening effect in steady shear measurements at very low shear rates in a direct combined RheoDSC setup is the most reliable method to compile unambiguously a material specific hardening curve for semi-crystalline polymers.
Collapse
Affiliation(s)
- V. Janssens
- Department of Chemical Engineering, Applied Rheology and Polymer Processing, Leuven Material Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - C. Block
- Department of Materials and Chemistry, Physical Chemistry and Polymer Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - G. Van Assche
- Department of Materials and Chemistry, Physical Chemistry and Polymer Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - B. Van Mele
- Department of Materials and Chemistry, Physical Chemistry and Polymer Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - P. Van Puyvelde
- Department of Chemical Engineering, Applied Rheology and Polymer Processing, Leuven Material Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
30
|
|
31
|
Block C, Van Mele B, Van Puyvelde P, Van Assche G. Time–temperature-transformation (TTT) and temperature–conversion-transformation (TxT) cure diagrams by RheoDSC: Combined rheometry and calorimetry on an epoxy-amine thermoset. REACT FUNCT POLYM 2013. [DOI: 10.1016/j.reactfunctpolym.2012.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Sandborn WJ, Colombel JF, D'Haens G, Van Assche G, Wolf D, Kron M, Lazar A, Robinson AM, Yang M, Chao JD, Thakkar R. One-year maintenance outcomes among patients with moderately-to-severely active ulcerative colitis who responded to induction therapy with adalimumab: subgroup analyses from ULTRA 2. Aliment Pharmacol Ther 2013; 37:204-13. [PMID: 23173821 DOI: 10.1111/apt.12145] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/03/2012] [Accepted: 10/27/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with moderately-to-severely active ulcerative colitis (UC) are unlikely to continue anti-TNF therapy in the absence of early therapeutic response. AIM To assess week 52 efficacy, safety and benefit/risk balance of adalimumab treatment in patients with moderately-to-severely active UC failing conventional therapy who achieved clinical response at week 8 in the 52-week ULTRA 2 trial. METHODS Patients randomised to adalimumab (160/80 mg, week 0/2; 40 mg, every other week thereafter) in ULTRA 2 who achieved clinical response at week 8 per partial Mayo score (Mayo score without endoscopy subscore) were assessed for week 52 clinical remission, clinical response, mucosal healing, steroid-free remission and steroid discontinuation rates, overall and by prior anti-TNF use. Benefit/risk balance for the overall ITT population (regardless of week 8 responder status) was assessed using 'net efficacy adjusted for risk' (NEAR) odds ratios. Safety was assessed using adverse event rates. RESULTS Of 248 adalimumab-treated patients, 123 (49.6%) achieved clinical response at week 8. Of these, 30.9%, 49.6%, and 43.1% achieved clinical remission, clinical response, and mucosal healing, respectively, at week 52. Of the week 8 responders using corticosteroids at baseline (N = 90), 21.1% achieved steroid-free remission and 37.8% were steroid-free at week 52. NEAR odds ratios indicated a positive benefit/risk balance for achievement of week 8 and week 52 response or remission without serious adverse events or serious infections. No safety concerns were identified. CONCLUSIONS Adalimumab treatment was associated with a positive benefit/risk balance in the overall population of patients with moderately-to-severely active ulcerative colitis in ULTRA 2; early response was predictive of a positive outcome at 1 year (NCT00408629).
Collapse
Affiliation(s)
- W J Sandborn
- University of California San Diego, La Jolla, CA 92093-0956, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Bessissow T, Renard M, Hoffman I, Vermeire S, Rutgeerts P, Van Assche G. Review article: non-malignant haematological complications of anti-tumour necrosis factor alpha therapy. Aliment Pharmacol Ther 2012; 36:312-23. [PMID: 22725726 DOI: 10.1111/j.1365-2036.2012.05189.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 05/11/2012] [Accepted: 05/30/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tumour necrosis factor-alpha (TNF-α) is an important mediator of the molecular cascade leading to chronic inflammation. TNF-α inhibitors have proven their safety and efficacy in the treatment of inflammatory diseases. AIM To review the non-malignant haematological adverse events, such as thrombocytopaenia, neutropaenia, hypercoagulability, pancytopaenia and aplastic anaemia in patients receiving TNF-α inhibitors. METHODS We reviewed the literature by searching MEDLINE and EMBASE databases as well as references of all retrieved articles for the following terms: anti-tumour necrosis factor, anti-TNF, infliximab, adalimumab, certolizumab, etanercept, haematological complications, thrombocytopaenia, neutropaenia, anaemia, bone marrow and thrombosis. RESULTS Thombocytopaenia is a very rare phenomenon and was associated with no serious adverse events. However, transient neutropaenia developed in up to 16% of cases. Patients with a previous history of neutropaenia on other therapies or baseline neutrophil count <4 × 10(9) /L are at a particularly higher risk. The association between anti-TNF-α therapy and thrombosis is very nebulous due to the multitude of potential confounders. Only one case of primary eosinophilia has been reported with anti-TNF-α therapy. CONCLUSION Regular monitoring of the white blood cell count at baseline and with each infusion is recommended for patients on anti-TNF-α. Further studies to elucidate their interaction with the immune system are warranted.
Collapse
Affiliation(s)
- T Bessissow
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
34
|
Van Assche G, Ferrante M, Vermeire S, Noman M, Rans K, Van der Biest L, Penninckx F, Wolthuis A, Rutgeerts P, D'Hoore A. Octreotide for the treatment of diarrhoea in patients with ileal pouch anal anastomosis: a placebo-controlled crossover study. Colorectal Dis 2012; 14:e181-6. [PMID: 21951549 DOI: 10.1111/j.1463-1318.2011.02838.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Diarrhoea with urgency is a debilitating long-term complication of ileal pouch anal anastomosis (IPAA) after a proctocolectomy. Somatostatin analogues are used to control diarrhoea and high-output ostomies. Hence, we designed a prospective, double-blind, crossover trial to explore the efficacy and tolerability of octreotide to reduce diarrhoea in adult patients with IPAA. METHOD Patients were randomized to octreotide subcutaneously (SC), 500 μg three times daily (t.i.d.), or matching placebo SC for 7 days. Responders (a reduction in stool frequency of three or more stools per 24-h period and with a reduction in stool frequency of at least 30% after 7 days of treatment compared with baseline; the primary end-point) remained in the same group and nonresponders could cross over to the alternative treatment for 7 days. Open-label octeotide LAR 30 mg was offered to all responders on day 14. Flexible pouchoscopy with biopsies was performed at baseline in all patients and was repeated on days 7 and 14 in patients with pouchitis. RESULTS Fifteen patients (11 men, median age 52 years), all with ulcerative colitis, were randomized. Three patients were withdrawn for side effects during the blinded phase. Response was achieved by two of 12 and two of 11 patients treated with octreotide or placebo, respectively (including crossover, P = 0.9). The median stool frequency remained stable in both groups [Δoctreotide: 0 (IQR, -4 to 0), Δplacebo: -1 (IQR, -1 to 1), P = 0.45]. Octreotide had no effect on the modified pouch disease activity index (mPDAI), and pouchitis persisted in five of six subjects with pouchitis at onset. One subject received open-label octreotide LAR. CONCLUSION Octreotide has no clear beneficial effect on the stool pattern or on pouchitis severity in patients with high stool frequency after IPAA.
Collapse
Affiliation(s)
- G Van Assche
- University of Leuven Hospitals, Leuven, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Van Assche G, Baert F, Vermeire S. Commentary: BMI and the need for adalimumab dose escalation in Crohn's disease. Aliment Pharmacol Ther 2012; 35:848; discussion 849. [PMID: 22404407 DOI: 10.1111/j.1365-2036.2012.05023.x] [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] [Indexed: 12/08/2022]
Affiliation(s)
- G Van Assche
- Division of Gastroenterology, University Hospitals Leuven, Belgium.
| | | | | |
Collapse
|
36
|
Vande Casteele N, Ballet V, Van Assche G, Rutgeerts P, Vermeire S, Gils A. Early serial trough and antidrug antibody level measurements predict clinical outcome of infliximab and adalimumab treatment. Gut 2012; 61:321; author reply 322. [PMID: 21330576 DOI: 10.1136/gut.2010.236869] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
|
37
|
Vandenbergh J, Conings B, Bertho S, Kesters J, Spoltore D, Esiner S, Zhao J, Van Assche G, Wienk MM, Maes W, Lutsen L, Van Mele B, Janssen RAJ, Manca J, Vanderzande DJM. Thermal Stability of Poly[2-methoxy-5-(2′-phenylethoxy)-1,4-phenylenevinylene] (MPE-PPV):Fullerene Bulk Heterojunction Solar Cells. Macromolecules 2011. [DOI: 10.1021/ma201911a] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Vandenbergh
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
| | - B. Conings
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
| | - S. Bertho
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
| | - J. Kesters
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
| | - D. Spoltore
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
| | - S. Esiner
- Molecular Materials and Nanosystems, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - J. Zhao
- Physical Chemistry and Polymer Science, Department of Materials and Chemistry, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - G. Van Assche
- Physical Chemistry and Polymer Science, Department of Materials and Chemistry, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - M. M. Wienk
- Molecular Materials and Nanosystems, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - W. Maes
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
- Molecular Design and Synthesis, Katholieke Universiteit Leuven, Celestijnenlaan 200F, B-3001 Heverlee, Belgium
| | - L. Lutsen
- Division IMOMEC, IMEC, Universitaire Campus, Wetenschapspark 1, B-3590 Diepenbeek, Belgium
| | - B. Van Mele
- Physical Chemistry and Polymer Science, Department of Materials and Chemistry, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - R. A. J. Janssen
- Molecular Materials and Nanosystems, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - J. Manca
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
- Division IMOMEC, IMEC, Universitaire Campus, Wetenschapspark 1, B-3590 Diepenbeek, Belgium
| | - D. J. M. Vanderzande
- Institute for Materials Research (IMO), Hasselt University, Universitaire Campus, Building D, B-3590 Diepenbeek, Belgium
- Division IMOMEC, IMEC, Universitaire Campus, Wetenschapspark 1, B-3590 Diepenbeek, Belgium
| |
Collapse
|
38
|
Vande Casteele N, Breynaert C, Vermeire S, Rutgeerts PJ, Gils A, Van Assche G. Incidence of acute severe infusion reactions to infliximab depends on definition used rather than assay. Aliment Pharmacol Ther 2011; 34:401-3; author reply 404-5. [PMID: 21726254 DOI: 10.1111/j.1365-2036.2011.04726.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
39
|
Darius T, Monbaliu D, Aerts R, Coosemans W, de Roey J, Blockmans D, Hiele M, Van Assche G, Ferdinande P, Dierickx D, Ectors N, Lerut E, De Hertogh G, Benedetti E, Pirenne J. Living Related Intestinal Transplantation for Churg-Strauss Syndrome: A Case Report. Transplant Proc 2010; 42:4423-4. [DOI: 10.1016/j.transproceed.2010.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Claes IJJ, Lebeer S, Shen C, Verhoeven TLA, Dilissen E, De Hertogh G, Bullens DMA, Ceuppens JL, Van Assche G, Vermeire S, Rutgeerts P, Vanderleyden J, De Keersmaecker SCJ. Impact of lipoteichoic acid modification on the performance of the probiotic Lactobacillus rhamnosus GG in experimental colitis. Clin Exp Immunol 2010; 162:306-14. [PMID: 20731672 DOI: 10.1111/j.1365-2249.2010.04228.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
While some probiotic strains might have adjuvant effects in the therapy for inflammatory bowel diseases (IBD), these effects remain controversial and cannot be generalized. In this study, a dltD mutant of the model probiotic Lactobacillus rhamnosus GG (LGG), having a drastic modification in its lipoteichoic acid (LTA) molecules, was analysed for its effects in an experimental colitis model. Dextran sulphate sodium (DSS) was used to induce either moderate to severe or mild chronic colitis in mice. Mice received either phosphate-buffered saline (PBS), LGG wild-type or the dltD mutant via the drinking water. Macroscopic parameters, histological abnormalities, cytokine and Toll-like receptor (TLR) expression were analysed to assess disease activity. LGG wild-type did not show efficacy in the different experimental colitis set-ups. This wild-type strain even seemed to exacerbate the severity of colitic parameters in the moderate to severe colitis model compared to untreated mice. In contrast, mice treated with the dltD mutant showed an improvement of some colitic parameters compared to LGG wild-type-treated mice in both experimental models. In addition, treatment with the dltD mutant correlated with a significant down-regulation of Toll-like receptor-2 expression and of downstream proinflammatory cytokine expression in the colitic mice. These results show that molecular cell surface characteristics of probiotics are crucial when probiotics are considered for use as supporting therapy in IBD.
Collapse
Affiliation(s)
- I J J Claes
- Centre of Microbial and Plant Genetics, University Hospital, K. U. Leuven, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Thienpont C, D'Hoore A, Vermeire S, Demedts I, Bisschops R, Coremans G, Rutgeerts P, Van Assche G. Long-term outcome of endoscopic dilatation in patients with Crohn's disease is not affected by disease activity or medical therapy. Gut 2010; 59:320-4. [PMID: 19840991 DOI: 10.1136/gut.2009.180182] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic dilatation of Crohn's disease-related strictures is an alternative to surgical resection in selected patients. The influence of disease activity and concomitant medical therapy on long-term outcomes is largely unknown. AIM AND METHODS To study the long-term safety and efficacy of stricture dilatation in a single centre cohort. RESULTS Between 1995 and 2006, 237 dilatations where performed in 138 patients (mean age 50.6+/-13.4, 56% female) for a clinically obstructive stricture (<5 cm, 84% anastomotic). Immediate success of a first dilatation was 97% with a 5% serious complication rate. After a median follow-up of 5.8 years (IQR 3.0-8.4), recurrent obstructive symptoms led to a new dilatation in 46% or surgery in 24%. Niether elevated levels of C-reactive protein nor endoscopic disease activity predicted the need for new intervention. None of the concomitant therapies influenced the outcome. CONCLUSION This largest series ever reported confirms that long term efficacy of endoscopic dilatation of Crohn's disease outweighs the complication risk. Neither active disease at the time of dilatation nor medical therapy afterwards predict recurrent dilatation or surgery.
Collapse
Affiliation(s)
- C Thienpont
- Division of Gastroenterology. University Hospital Gasthuisberg, 49 Herestraat, 3000-Leuven, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Dignass A, Van Assche G, Lindsay JO, Lémann M, Söderholm J, Colombel JF, Danese S, D'Hoore A, Gassull M, Gomollón F, Hommes DW, Michetti P, O'Morain C, Oresland T, Windsor A, Stange EF, Travis SPL. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. J Crohns Colitis 2010. [PMID: 21122489 DOI: 10.1016/j.crohns.2010.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 12/13/2022]
Affiliation(s)
- A Dignass
- Department of Medicine I, Markus-Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt/Main, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Dignass A, Van Assche G, Lindsay JO, Lémann M, Söderholm J, Colombel JF, Danese S, D'Hoore A, Gassull M, Gomollón F, Hommes DW, Michetti P, O'Morain C, Oresland T, Windsor A, Stange EF, Travis SPL. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. J Crohns Colitis 2010; 4:28-62. [PMID: 21122489 DOI: 10.1016/j.crohns.2009.12.002] [Citation(s) in RCA: 997] [Impact Index Per Article: 71.2] [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] [Received: 12/04/2009] [Accepted: 12/04/2009] [Indexed: 02/08/2023]
Affiliation(s)
- A Dignass
- Department of Medicine I, Markus-Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt/Main, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The natural history of Crohn's disease is characterized by progression to complicated and disabling disease, often necessitating surgical interventions. There is either circumstantial or direct evidence to support the disease-modifying potential of several therapeutic agents. Healing of endoscopic lesions is an emerging surrogate marker of disease modification, as mucosal lesions are considered to reflect ongoing inflammation and tissue damage that lead to the formation of fistulas and fibrotic strictures, which are the main indications for surgery. In contrast to systemic steroids, both azathioprine and anti-tumor necrosis factor (TNF) agents have demonstrated the potential of mucosal healing. Prevention of hospitalization and surgery in the short and medium term has been demonstrated for the anti-TNF agents infliximab and adalimumab. The evidence supporting a role for medical therapy in the prevention of fibrotic wall thickening and in the obliteration of fistula tracks is limited and should be the focus of further prospective studies. These studies should validate predictors of complicated disease and randomized studies should be performed in high-risk groups to investigate whether early introduction of immunosuppressive agents or biologic therapies slows down disease progression and alters the natural history of the disease.
Collapse
Affiliation(s)
- G Van Assche
- Department of Gastroenterology, University Hospital Leuven, 3000 Leuven, Belgium.
| | | | | |
Collapse
|
45
|
Dignass A, Van Assche G, Lindsay JO, Lémann M, Söderholm J, Colombel JF, Danese S, D'Hoore A, Gassull M, Gomollón F, Hommes DW, Michetti P, O'Morain C, Oresland T, Windsor A, Stange EF, Travis SPL. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. J Crohns Colitis 2010. [PMID: 21122489 DOI: 10.1016/j.crohns2010.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- A Dignass
- Department of Medicine I, Markus-Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt/Main, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Arijs I, Li K, Toedter G, Quintens R, Van Lommel L, Van Steen K, Leemans P, De Hertogh G, Lemaire K, Ferrante M, Schnitzler F, Thorrez L, Ma K, Song XYR, Marano C, Van Assche G, Vermeire S, Geboes K, Schuit F, Baribaud F, Rutgeerts P. Mucosal gene signatures to predict response to infliximab in patients with ulcerative colitis. Gut 2009; 58:1612-9. [PMID: 19700435 DOI: 10.1136/gut.2009.178665] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Infliximab is an effective treatment for ulcerative colitis with over 60% of patients responding to treatment and up to 30% reaching remission. The mechanism of resistance to anti-tumour necrosis factor alpha (anti-TNFalpha) is unknown. This study used colonic mucosal gene expression to provide a predictive response signature for infliximab treatment in ulcerative colitis. METHODS Two cohorts of patients who received their first treatment with infliximab for refractory ulcerative colitis were studied. Response to infliximab was defined as endoscopic and histological healing. Total RNA from pre-treatment colonic mucosal biopsies was analysed with Affymetrix Human Genome U133 Plus 2.0 Arrays. Quantitative RT-PCR was used to confirm microarray data. RESULTS For predicting response to infliximab treatment, pre-treatment colonic mucosal expression profiles were compared for responders and non-responders. Comparative analysis identified 179 differentially expressed probe sets in cohort A and 361 in cohort B with an overlap of 74 probe sets, representing 53 known genes, between both analyses. Comparative analysis of both cohorts combined, yielded 212 differentially expressed probe sets. The top five differentially expressed genes in a combined analysis of both cohorts were osteoprotegerin, stanniocalcin-1, prostaglandin-endoperoxide synthase 2, interleukin 13 receptor alpha 2 and interleukin 11. All proteins encoded by these genes are involved in the adaptive immune response. These markers separated responders from non-responders with 95% sensitivity and 85% specificity. CONCLUSION Gene array studies of ulcerative colitis mucosal biopsies identified predictive panels of genes for (non-)response to infliximab. Further study of the pathways involved should allow a better understanding of the mechanisms of resistance to infliximab therapy in ulcerative colitis. ClinicalTrials.gov number, NCT00639821.
Collapse
Affiliation(s)
- I Arijs
- Department of Gastroenterology, University of Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Ruffolo C, Penninckx F, Van Assche G, Vermeire S, Rutgeerts P, Coremans G, D'Hoore A. Outcome of surgery for rectovaginal fistula due to Crohn's disease. Br J Surg 2009; 96:1190-5. [PMID: 19688772 DOI: 10.1002/bjs.6661] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study examined the outcome of surgery for symptomatic Crohn's rectovaginal fistula (RVF) and assessed the effect of therapy with antibody against tumour necrosis factor (TNF) on healing. METHODS Fifty-six patients with Crohn's disease underwent surgery for a RVF between January 1993 and December 2006. Outcome analysis was performed in February 2008 in relation to the surgical procedures used and the effect of anti-TNF treatment. RESULTS Four patients with a healed fistula still had a stoma at final follow-up for other reasons and were excluded from the analysis. Fistula closure was achieved in 81 per cent of the remaining 52 patients. Primary and secondary surgical success rates were 56 and 57 per cent respectively. The primary healing rate was similar in patients who received anti-TNF treatment before the first operation (12 of 18 patients) and those who did not (19 of 34). In univariable analysis, duration of Crohn's disease (P = 0.037) and previous extended colonic resection (P < 0.001) were significantly related to failure of primary surgery, but only the latter remained significant in multivariable analysis (P < 0.001). Late recurrence developed in four patients. CONCLUSION Fistula closure was achieved in most patients, but more than one operation was often required.
Collapse
Affiliation(s)
- C Ruffolo
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | | | |
Collapse
|
48
|
Ferrante M, D'Hoore A, Vermeire S, Declerck S, Noman M, Van Assche G, Hoffman I, Rutgeerts P, Penninckx F. Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis 2009; 15:1062-70. [PMID: 19161179 DOI: 10.1002/ibd.20863] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent reports suggest that the preoperative use of infliximab (IFX) increases postoperative infectious complications in patients with ulcerative colitis (UC). Therefore, we determined the impact of IFX on postoperative infectious complications. METHODS A consecutive group of 141 UC patients (41% female, median age 39.8 years) undergoing (procto)colectomy was studied. Postoperative infectious complications were compared between 22 patients who received IFX within 12 weeks prior to (procto)colectomy (IFX group) and 119 patients who did not (control group). Short-term infectious complications, consisting of anastomotic leaks, pelvic abscesses, wound infections, and nonsurgical site infections, were recorded within 30 days after primary surgery. RESULTS At primary surgery there was no significant difference in gender, disease extent, smoking behavior, body mass index, and concomitant medication (including corticosteroids) between the groups. Patients in the IFX group less often underwent restorative proctocolectomy without defunctioning ileostomy (9% versus 34%, P = 0.022), had a significantly shorter median (interquartile range, IQR) disease duration (2.7 [1.2-8.6] versus 5.9 [2.6-13.0] years, P < 0.036) and a significantly higher C-reactive protein level at primary surgery (51.7 [9.9-103.6] versus 19.1 [7.5-42.6] mg/L, P = 0.023). There was no short-term mortality. A moderate-to-high dose of corticosteroids (>or=20 mg methylprednisolone for >or=2 months, odds ratio 5.19 [95% confidence interval [CI]: 1.72-15.66], P = 0.003) and a restorative proctocolectomy without defunctioning ileostomy (odds ratio 6.45 [95% CI: 2.12-19.64], P = 0.001) were independent predictors of short-term postoperative infectious complications. CONCLUSION Corticosteroids and a restorative proctocolectomy without defunctioning ileostomy, but not IFX, are associated with an increased risk of short-term postoperative infectious complications in UC.
Collapse
Affiliation(s)
- M Ferrante
- Department of Gastroenterology, University Hospital Leuven, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Rahier JF, Ben-Horin S, Chowers Y, Conlon C, De Munter P, D'Haens G, Domènech E, Eliakim R, Eser A, Frater J, Gassull M, Giladi M, Kaser A, Lémann M, Moreels T, Moschen A, Pollok R, Reinisch W, Schunter M, Stange EF, Tilg H, Van Assche G, Viget N, Vucelic B, Walsh A, Weiss G, Yazdanpanah Y, Zabana Y, Travis SPL, Colombel JF. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009; 3:47-91. [PMID: 21172250 DOI: 10.1016/j.crohns.2009.02.010] [Citation(s) in RCA: 366] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 02/08/2023]
|
50
|
Schnitzler F, Fidder H, Ferrante M, Noman M, Arijs I, Van Assche G, Hoffman I, Van Steen K, Vermeire S, Rutgeerts P. Long-term outcome of treatment with infliximab in 614 patients with Crohn's disease: results from a single-centre cohort. Gut 2009; 58:492-500. [PMID: 18832518 DOI: 10.1136/gut.2008.155812] [Citation(s) in RCA: 419] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS This observational study assessed the long-term clinical benefit of infliximab (IFX) in 614 consecutive patients with Crohn's disease (CD) from a single centre during a median follow-up of 55 months (interquartile range (IQR) 27-83). METHODS The primary analysis looked at the proportion of patients with initial response to IFX who had sustained clinical benefit at the end of follow-up. The long-term effects of IFX on the course of CD as reflected by the rate of surgery and hospitalisations and need for corticosteroids were also analysed. RESULTS 10.9% of patients were primary non-responders to IFX. Sustained benefit was observed in 347 of the 547 patients (63.4%) receiving long-term treatment. In 68.3% of these, treatment with IFX was ongoing and in 31.7% IFX was stopped, with the patient being in remission. Seventy patients (12.8%) had to stop IFX due to side effects and 118 (21.6%) due to loss of response. Although the yearly drop-out rates of IFX in patients with episodic (10.7%) and scheduled treatment (7.1%) were similar, the need for hospitalisations and surgery decreased less in the episodic than in the scheduled group. Steroid discontinuation also occurred in a higher proportion of patients in the scheduled group than in the episodic group. CONCLUSIONS In this large real-life cohort of patients with CD, long-term treatment with IFX was very efficacious to maintain improvement during a median follow-up of almost 5 years and changed disease outcome by decreasing the rate of hospitalisations and surgery.
Collapse
Affiliation(s)
- F Schnitzler
- Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
| | | | | | | | | | | | | | | | | | | |
Collapse
|