Real-world effectiveness and safety of vedolizumab induction therapy for ulcerative colitis: A prospective nationwide Polish observational study

BACKGROUND

Vedolizumab is recommended as a first-line biological treatment, along with other biological drugs, in ulcerative colitis (UC) patients in whom conventional therapy failed and as a second-line biological treatment following a failure of a tumor necrosis factor alpha (TNF-α) antagonist.

OBJECTIVES

We aimed to assess the real-world effectiveness and safety of vedolizumab induction therapy in UC patients treated in the scope of the National Drug Program (NDP) in Poland.

MATERIAL AND METHODS

The endpoints were the proportions of patients who reached clinical response, clinical remission and mucosal healing at week 14. Partial Mayo scores, Mayo subscores and C-reactive protein (CRP) levels were also evaluated.

RESULTS

Our study population consisted of 100 patients (55 biologic-naïve and 45 biologic-exposed). The median total Mayo score at baseline was 10 (interquartile range (IQR): 9-11), and 52 patients (52%) had extensive colitis. The clinical response at week 14 was achieved in 83 (83%) and clinical remission in 24 (24%) cases. Mucosal healing was observed in 56 (62%) patients at week 14. In patients with prior failure of biologic treatment (n = 25), 17 (68%) responded to vedolizumab treatment. A decrease in the median CRP level (from 3.7 mg/L to 2.6 mg/L) and the median total Mayo score (from 10 to 4) was observed. No new safety concerns were recorded and no patients discontinued the treatment due to adverse events (AEs).

CONCLUSIONS

Vedolizumab was effective and safe as induction therapy for UC in a Polish real-world population including patients with severely active UC and a low number of patients with prior biological treatment failures.

Real-world outcomes of 54-week vedolizumab therapy and response durability after treatment discontinuation in ulcerative colitis: results from a multicenter prospective POLONEZ study

Background

Vedolizumab is a gut-selective anti-lymphocyte trafficking agent used to treat ulcerative colitis (UC) and Crohn's disease.

Objectives

We aimed to evaluate the effectiveness, safety, and durability of the therapeutic effect of vedolizumab after treatment discontinuation in a real-world cohort of patients with UC treated in Poland.

Design

This was a multicenter, prospective study involving patients with moderate to severely active UC from 12 centers in Poland who qualified for reimbursed treatment with vedolizumab between February and November 2019.

Methods

The primary endpoints were clinical response (⩾2-point improvement from baseline on partial Mayo score) and clinical remission (partial Mayo score 0-1), including steroid-free remission, at week 54. Other outcomes included response durability at 26 weeks after treatment discontinuation, identification of predictors of response and remission, and safety assessment.

Results

In all, 100 patients with UC were enrolled (55 biologic naïve and 45 biologic exposed). At baseline, 68% of patients were on corticosteroids and 45% on immunomodulators. Clinical response was observed in 62% of patients, clinical remission in 50%, and steroid-free remission in 42.6% at week 54. Within 26 weeks after treatment discontinuation, 37% of patients who maintained response by week 54 relapsed. The decreased number of liquid stools and rectal bleeding and endoscopic response at week 14 were predictive factors for response at week 54. Time from diagnosis ranging 2-5 years, decreased stool frequency, and non-concomitant use of corticosteroids at baseline and at week 14 were predictive factors for remission at week 54. Partial Mayo score < 3 with no subscale score > 1 at week 54 was a predictive factor for durable response after treatment discontinuation. The rate of serious adverse events related to treatment was 3.63 per 100 patient-years.

Conclusion

Vedolizumab is effective and safe in UC treatment in Polish patients. However, the relapse rate after the treatment cessation was high.

Registration

ENCePP (EUPAS34119).

Mechanism of Bonding Reactive Dyes with Copolymer (chloromethyl)oxirane-1H-imidazole cationised Cellulose

Introducing the cellulose chain cationic groups in the modification process completely changes the charge on the cotton surface from negative to partially or totally positive. That allows the electrostatic attraction and simultaneous exhaustion and fixation of reactive dyes. This reaction can be carried out without salt and alkali at room temperature. Similarly, the reaction between reactive dye and an alone copolymer ([IME]⁺Cl⁻) with TLC chromatography was confirmed. The analysis with the use of particle optimisation with MM+ molecular mechanics and quantum-chemical calculations PM3 by the method of all valence orbitals confirmed the experimental results of the high activity of the nucleophile formed on the hydroxyl group in the chain of a modifier. It was found and experimentally confirmed that the reactive dyes during the dyeing process of the cotton cationised with copolymer (chloromethyl)oxirane -1H-imidazole ([IME]⁺Cl⁻) create covalent bonds due to a reaction with the hydroxyl group located in the modification agent instead of with the hydroxyl group in the glucopiranose ring. Although the dyeing takes place in very mild conditions, a high degree of setting is achieved, comparable to conventional methods.

Characteristics of patients with moderate-to-severe ulcerative colitis treated with vedolizumab: results from a Polish multicenter, prospective, observational real-life study (the POLONEZ study)

BACKGROUND

Vedolizumab, a humanized antibody targeting the α₄β₇ integrin, was proven to be effective in the treatment of moderate-to-severe ulcerative colitis (UC) in randomized clinical trials. The aim of the POLONEZ study is to determine the demographic and clinical characteristics of the patients with UC treated with vedolizumab within the scope of the National Drug Program in Poland and to assess the real-world effectiveness and safety of vedolizumab in the study population. Here we report the demographic and clinical characteristics of these patients.

METHODS

This prospective study included adult patients eligible for UC treatment with vedolizumab who were recruited from 12 centers in Poland between February and November 2019. Collected data included sex, age, disease duration, presence of extraintestinal manifestations or comorbidities, status of previous biologic treatment, and current concomitant treatment. Disease extent was determined according to the Montreal classification, and disease activity was measured with the Mayo Score.

RESULTS

A total of 100 (55 biologic-naïve and 45 biologic-exposed) patients were enrolled in the study (51% female, median age 35 years). Among biologic-exposed patients (mostly infliximab-treated), 57% had failed to respond to the therapy. The disease duration was significantly shorter in biologic-naïve (median 5 years) than in biologic-exposed (8 years, p = 0.004) or biofailure patients (7 years, p = 0.04). In the overall population the median Total Mayo Score was 10. Disease extent and activity were similar between the subgroups.

CONCLUSIONS

Our study indicates that patients treated with vedolizumab in Poland receive the drug relatively early after UC diagnosis, but their disease is advanced. More than half of the patients had not been treated with biologic drugs before initiating vedolizumab. The study was registered in ENCePP database (EUPAS34119).

LAY SUMMARY

Characteristics of patients treated for ulcerative colitis with vedolizumab in Poland Treatment of moderate-to-severe ulcerative colitis (UC) with the integrin antagonist vedolizumab became available within the Polish National Drug Program (NDP) in 2018. In this study, for the first time, we provide detailed demographic and clinical characteristics of 100 patients (median age 35 years, 51% female) treated with vedolizumab in Poland, of whom 55 were biologic-naïve and 45 biologic-exposed. The median duration of disease was 6 years. The disease duration was shorter in biologic-naïve than in biologic-exposed patients. Most patients were affected by extensive colitis (52%) or left-sided colitis (42%). Median disease activity was 10 according to the Total Mayo Score. Sixty-eight patients received concomitant systemic corticosteroids and 45 patients received immunomodulators. Our findings indicate that Polish patients receiving vedolizumab have a high disease activity and are treated relatively early after UC diagnosis. This might be due to the criteria for inclusion of a patient in the NDP.

Reply to the 'Comment on "Investigation on the structure and thermoelectric properties of CuxTe binary compounds"' by A. H. Barajas-Aguilar, A. M. Garay-Tapia, and S. J. Jiménez-Sandoval, Dalton Trans., 2020, 49, DOI: 10.1039/C9DT03607E

In a communication to Dalton Transaction and in a paper in Journal of Physics: Condensed Matter, Aarón H. Barajas-Aguilar et al. have raised comments on our paper published earlier in Dalton Transactions.

The influence of steroidal and triterpenoid saponins on monolayer models of the outer leaflets of human erythrocytes, E. coli and S. cerevisiae cell membranes

The present paper discusses the use of monolayers of lipid mixtures mimicking the composition of biological membranes of bacteria, erythrocyte and yeast in the context of the anti-bacterial, hemolytic and anti-fungal activity of saponins. Saponins are plant-produced glycosidic biosurfactants with either steroidal or triterpenoidal aglycone. In the present study we used digitonin as a representative steroidal saponin (extracted from Digitalis purpurea) and a mixture of triterpenoid saponins from Quillaja saponaria Molina. The effect of saponins was studied first on monolayers consisting of single lipids characteristic for the given type of biological membrane, and then - on model mixed lipid monolayers. Finally, the monolayers were formed from total lipid extracts of natural cell membranes (E. coli and S. cerevisiae) to verify the results obtained in the simplified models. The effect of saponins on monolayers was studied by a combination of surface pressure relaxation, infrared reflection - absorption spectroscopy (IRRAS) and fluorescence microscopy. In line with expectations, sterols (cholesterol and ergosterol) play a major role in the saponin-lipid interactions in monolayers, which may explain especially the hemolytic and antifungal properties of saponins. In contrast, bacterial membranes are devoid of sterols, although the presence of similar compounds may be responsible for their affinity to saponins. Nevertheless, the effect of saponins on bacterial models is less pronounced than for the erythrocyte or fungal ones.

Investigation on the structure and thermoelectric properties of CuxTe binary compounds

The thermal conductivity of Cu2Te is around 4 W m−1 K−1 at 300 K with low Cp values.

Transition-metal-free [3 + 3] annulation of indol-2-ylmethyl carbanions to nitroarenes. A novel synthesis of indolo[3,2-b]quinolines (quindolines)

Indol-2-ylmethyl carbanions stabilized by alkoxycarbonyl, cyano or benzenesulfonyl groups react with nitroarenes to form σ^H-adducts, which in the presence of base (triethylamine or DBU) and trimethylchlorosilane transform into indolo[3,2-b]quinoline derivatives in moderate to good yields.

Electronic and thermoelectric properties of Zn and Se double substituted tetrahedrite

The influence of Zn and Se double substitution on the electronic and thermoelectric properties of tetrahedrite is investigated in this study.

Synthesis of [1]Benzothieno[2,3-b]quinolines via Transition-Metal-Free [3+3] Annulation of Nitroarenes and Benzo[b]thiophen-3-ylacetonitrile or 3-(Phenylsulfonylmethyl)benzo[b]thiophene Carbanions

Benzo[b]thiophen-3-ylacetonitriles or 3-(phenylsulfonylmethyl)benzo[b]thiophenes react with nitrobenzene derivatives in the presence of potassium tert-butoxide and chlorotrimethylsilane to form, in good yields, 11-cyano- or 11-(phenylsulfonyl)[1]benzothieno[2,3-b]quinolines, respectively.

Disordering Effects of Digitonin on Phospholipid Monolayers

Digitonin, a steroidal saponin obtained from the foxglove plant (Digitalis purpurea), displays a wide spectrum of biological properties and is often used as a model in mechanistic investigations of the biological activity of saponins. In the present study, Langmuir monolayers of zwitterionic (DPPC, DMPE, POPC, POPE, DSPC, DSPE, and DPPE) and ionic (DPPS and DPPG) phospholipids were employed in order to better understand the effect of digitonin on the lipid organization. For this purpose, a combination of surface pressure relaxation, infrared reflection absorption spectroscopy (IRRAS), and fluorescence microscopy measurements was used. The observed increase in surface pressure (Π) suggests that digitonin can adsorb at the air/water interface, both bare and covered with the uncompressed phospholipid monolayers. However, the detailed analysis of IRRAS and fluorescence microscopy data shows that digitonin interacts with the lipid monolayers in a very selective way, and both the headgroup and the lipid tails affect this interaction. Nevertheless, it should be noted that in no case did digitonin cause any disruptive effects on the monolayers. The DPPE and DPPS monolayers get disordered by penetration with digitonin, despite an increase in surface pressure, leading to an unprecedented LC-LE transition. Interestingly, saponin could be easily squeezed out of these monolayers by mechanical compression.

Transition-metal-free synthesis of 3-(1-pyrrolidinyl)quinolines and 3-(1-pyrrolidinyl)quinoline 1-oxides via a one-pot reaction of 3-(1-pyrrolidinyl)crotonates with nitrobenzenes

A carbanion of tert-butyl 3-(1-pyrrolidinyl)crotonate adds to nitrobenzenes to form σ^H-adducts, which in the presence of pivaloyl chloride and triethylamine are converted into 3-(1-pyrrolidinyl)quinolines or 3-(1-pyrrolidinyl)quinoline 1-oxides depending on the nitrobenzene structure. This is the first methodology in which a quinoline ring is constructed from a substrate bearing a pyrrolidinyl ring. Starting from optically pure enamines, the method allows synthesis of the corresponding chiral products without racemisation.

General synthesis of 2,1-benzisoxazoles (anthranils) from nitroarenes and benzylic C-H acids in aprotic media promoted by combination of strong bases and silylating agents

Carbanions of phenylacetonitriles, benzyl sulfones, and dialkyl benzylphosphonates add nitroarenes at the ortho-position to the nitro group to form \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sigma ^\mathrm{H}$$\end{document}σH-adducts that, upon treatment with trialkylchlorosilane and additional base (t-BuOK or DBU), transform into 3-aryl-2,1-benzisoxazoles in moderate-to-good yields.

Simple synthesis 11-substituted norcryptotackieine derivatives

11-Substituted indolo[2,3-b]quinolines were obtained in reactions ofN-protected indol-3-yl-acetonitrile, -acetate, and -methylsulfone with nitrobenzene derivatives in presence of base and trialkylchlorosilanes.

Simple synthesis of pyrrolo[3,2-e]indole-1-carbonitriles

Alkylation of 5-nitroindol-4-ylacetonitriles with ethyl chloroacetate, α-halomethyl ketones, and chloroacetonitrile followed by a treatment of the products with chlorotrimethylsilane in the presence of DBU gives 1-cyanopyrrolo[3,2-e]indoles substituted in position 2 with electron-withdrawing groups.

Neutron reflectivity study of alkylated azacrown ether at the air-liquid and the liquid-liquid interfaces

We report the neutron reflectometry study of partially deuterated di-hexadecyl-diaza-18-crown-6 ether (d-ACE-16) at the air-water and the oil-water interfaces. At the air-water interface, the thickness of the monolayer is smaller than that for a fully stretched d-ACE-16 molecule, suggesting a tilt of the alkyl chains with respect to the normal. At the oil-water interface, the same molecules were found to form a more diffuse layer distribution stretching across both sides of the interface. On the oil side, the molecules are densely packed within a thickness of 17 A, the hydrophilic part of the molecule with the azacrown ether ring being immersed in the adjacent aqueous side of the interface. The latter consists of a thick 38 A layer comprising staggered, loosely adsorbed d-ACE-16 molecules. With increasing spread amount, the adsorbed layer density increases at the oil side until saturation at ca. 2.25 x 10(-6) mol m(-2), above which the layer collapses.

[Endosonography of the rectum and other imaging methods in the diagnosis of bowel inflammatory diseases]

This paper presents the usefulness of rectal endosonography in the diagnostics of the rectal wall and anorectal lesions in patients with inflammatory bowel diseases, mainly with Crohn's disease. Value of endosonography, computed tomography and magnetic resonance imaging were compared.

Emerging diseases of Africa and the Middle East

The term "emerging diseases" has been used recently to refer to different scenarios, all of which indicate changes in the dynamics of disease in the population. Of the OIE List A diseases, major changes have been experienced with rinderpest, peste des petit ruminants (PPR), contagious bovine pleuropneumonia (CBPP), foot-and-mouth disease, African swine fever, lumpy skin disease, and Rift Valley fever. Rinderpest represents a success story of the 1990s, thanks to the programs of the Pan African Rinderpest Campaign (PARC). The situation has changed from that of the 1980s when rinderpest was widespread throughout most of Tropical Africa and the Middle East. PPR is a disease that has become of increasing importance throughout Tropical Africa and the Middle East. CBPP, which had previously been reduced to sporadic incidence within endemic areas, invaded new areas, causing heavy mortality. African swine fever has extended to West Africa and to Madagascar, in both regions resulting in heavy losses. Climatic changes in both East and West Africa were associated with an upsurge of Rift Valley fever. Deficiencies in national veterinary services have contributed to failures in early detection and response; in many regions investigation and diagnosis services have deteriorated. The continuing structural adjustment program for national veterinary services will need to take into account their transformation from providers of services (e.g., vaccinations, medicines) to inspection and quality assurance services. Surveillance, early warning, and disease emergency preparedness will need to be pursued more vigorously in Africa and the Middle East as vital components of national veterinary services.