Clinical Gastroenterology and Hepatology最新文献

{"title":"Tenofovir Is Associated With a Better Prognosis Than Entecavir for Hepatitis B Virus–Related Hepatocellular Carcinoma","authors":"Sung Won Chung ,&nbsp;Hyun Jun Um ,&nbsp;Won-Mook Choi,&nbsp;Jonggi Choi,&nbsp;Danbi Lee,&nbsp;Ju Hyun Shim,&nbsp;Kang Mo Kim,&nbsp;Young-Suk Lim,&nbsp;Han Chu Lee","doi":"10.1016/j.cgh.2024.07.013","DOIUrl":"10.1016/j.cgh.2024.07.013","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Whether tenofovir or entecavir has different effects on the prevention of hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) in secondary and tertiary preventive settings is still a matter of debate. This study aimed to compare the long-term prognosis of HCC between tenofovir and entecavir in patients with chronic hepatitis B.</div></div><div><h3>Methods</h3><div>Chronic hepatitis B patients diagnosed with HCC between November 2008 and December 2018 and treated with either entecavir or tenofovir at a tertiary center in Korea were included. The effect of tenofovir compared with entecavir on the prognosis of HBV-related HCC was assessed using multivariable-adjusted Cox and propensity score (PS)–matched analyses. Various predefined subgroup analyses were conducted.</div></div><div><h3>Results</h3><div>During a median follow-up period of 3.0 years, the mortality rate for entecavir-treated patients (n = 3469) was 41.2%, while tenofovir-treated patients (n = 3056) had a mortality rate of 34.6%. Overall survival (OS) was better in the tenofovir group (adjusted hazard ratio [aHR], 0.79; <em>P</em> &lt; .001), which were consistently observed in the PS-matched analysis. The magnitude of the risk difference in OS was more prominent 2 years after the diagnosis of HCC (aHR, 0.50; <em>P</em> &lt; .001) than 2 years before (aHR, 0.88; <em>P</em> = .005), and it was more pronounced in patients with earlier HCC stages. In all subgroups, except for those with shorter life expectancy, such as those with compromised liver function, tenofovir was associated with better OS compared with entecavir.</div></div><div><h3>Conclusions</h3><div>Among patients with HBV-related HCC, those treated with tenofovir had a better prognosis than those treated with entecavir, particularly among those with prolonged survival.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 300-309.e9"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline Viral Load and On-Treatment Hepatocellular Carcinoma Risk in Chronic Hepatitis B: A Multinational Cohort Study","authors":"Won-Mook Choi ,&nbsp;Terry Cheuk-Fung Yip ,&nbsp;Grace Lai-Hung Wong ,&nbsp;W. Ray Kim ,&nbsp;Leland J. Yee ,&nbsp;Craig Brooks-Rooney ,&nbsp;Tristan Curteis ,&nbsp;Laura J. Clark ,&nbsp;Zarena Jafry ,&nbsp;Chien-Hung Chen ,&nbsp;Chi-Yi Chen ,&nbsp;Yi-Hsiang Huang ,&nbsp;Young-Joo Jin ,&nbsp;Dae Won Jun ,&nbsp;Jin-Wook Kim ,&nbsp;Neung Hwa Park ,&nbsp;Cheng-Yuan Peng ,&nbsp;Hyun Phil Shin ,&nbsp;Jung Woo Shin ,&nbsp;Yao-Hsu Yang ,&nbsp;Young-Suk Lim","doi":"10.1016/j.cgh.2024.07.031","DOIUrl":"10.1016/j.cgh.2024.07.031","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Hepatocellular carcinoma (HCC) risk persists in patients with chronic hepatitis B (CHB) despite antiviral therapy. The relationship between pre-treatment baseline hepatitis B virus (HBV) viral load and HCC risk during antiviral treatment remains uncertain.</div></div><div><h3>Methods</h3><div>This multinational cohort study aimed to investigate the association between baseline HBV viral load and on-treatment HCC risk in 20,826 noncirrhotic, hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with baseline HBV DNA levels ≥2000 IU/mL (3.30 log₁₀ IU/mL) who initiated entecavir or tenofovir treatment. The primary outcome was on-treatment HCC incidence, stratified by baseline HBV viral load as a categorical variable.</div></div><div><h3>Results</h3><div>In total, 663 patients developed HCC over a median follow-up of 4.1 years, with an incidence rate of 0.81 per 100 person-years (95% confidence interval [CI], 0.75–0.87). Baseline HBV viral load was significantly associated with HCC risk in a non-linear parabolic pattern, independent of other factors. Patients with baseline viral load between 6.00 and 7.00 log₁₀ IU/mL had the highest on-treatment HCC risk (adjusted hazard ratio, 4.28; 95% CI, 2.15–8.52; <em>P</em> &lt; .0001) compared with those with baseline viral load ≥8.00 log₁₀ IU/mL, who exhibited the lowest HCC risk.</div></div><div><h3>Conclusion</h3><div>Baseline viral load showed a significant, non-linear, parabolic association with HCC risk during antiviral treatment in noncirrhotic patients with CHB. Early initiation of antiviral treatment based on HBV viral load may help prevent irreversible HCC risk accumulation in patients with CHB.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 310-320.e7"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online-Only vs Conventional Publication of Original Research Articles: A Randomized Controlled Trial","authors":"Fasiha Kanwal,&nbsp;Gina Reitenauer,&nbsp;Thoba Khumalo Petrovic,&nbsp;Nicholas J. Tomeo,&nbsp;Yan Liu,&nbsp;Aaron P. Thrift","doi":"10.1016/j.cgh.2024.10.002","DOIUrl":"10.1016/j.cgh.2024.10.002","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 359-361"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Advanced Therapies for Inflammatory Bowel Diseases: Practical Considerations and Positioning","authors":"David I. Fudman ,&nbsp;Ryan A. McConnell ,&nbsp;Christina Ha ,&nbsp;Siddharth Singh","doi":"10.1016/j.cgh.2024.06.050","DOIUrl":"10.1016/j.cgh.2024.06.050","url":null,"abstract":"<div><div>The therapeutic armamentarium for management of inflammatory bowel diseases has expanded dramatically in the last 5 years, with the introduction of several medications with different mechanisms of action. These include the oral small molecule drugs Janus kinase inhibitors (including upadacitinib, approved for Crohn’s disease and ulcerative colitis [UC], and tofacitinib, approved for UC) and sphingosphine 1-phosphate receptor modulators (ozanimod and etrasimod, both approved for UC), and biologic agents, such as selective interleukin-23 antagonists (risankizumab approved for Crohn’s disease, and mirikizumab approved for UC). The efficacy and safety of these therapies vary. In this review, we discuss practical use of these newer advanced therapies focusing on real-world effectiveness and safety data, dosing and monitoring considerations, and special situations for their use, such as pregnancy, comorbid immune-mediated disease, use in hospitalized patients with acute severe UC, and in the perioperative setting. We also propose our approach to positioning these therapies in clinical practice, relying on careful integration of the medication’s comparative effectiveness and safety in the context of an individual patient’s risk of disease- and treatment-related complications and preferences.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 3","pages":"Pages 454-468"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of Inflammatory Bowel Disease Care","authors":"Edward V. Loftus Jr MD ,&nbsp;Joana Torres MD, PhD ,&nbsp;Jason K. Hou MD, MS ,&nbsp;Charles J. Kahi MD, MS ,&nbsp;Siddharth Singh MD, MS","doi":"10.1016/j.cgh.2024.10.004","DOIUrl":"10.1016/j.cgh.2024.10.004","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 3","pages":"Pages 383-385"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of Biologics and Small Molecule in Ulcerative Colitis: A Systematic Review and Network Meta-analysis","authors":"Mohammad Shehab ,&nbsp;Fatema Alrashed ,&nbsp;Abdulwahab Alsayegh ,&nbsp;Usama Aldallal ,&nbsp;Christopher Ma ,&nbsp;Neeraj Narula ,&nbsp;Vipul Jairath ,&nbsp;Siddharth Singh ,&nbsp;Talat Bessissow","doi":"10.1016/j.cgh.2024.07.033","DOIUrl":"10.1016/j.cgh.2024.07.033","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Treatment options for moderate to severe ulcerative colitis (UC) are increasing rapidly, but the lack of comparative efficacy trials makes treatment choices a clinical challenge. This network-meta-analysis aimed to compare the relative efficacy of biologics and small molecules in achieving remission in patients with moderate to severe UC.</div></div><div><h3>Methods</h3><div>The literature was searched up to May 2024. Phase 3 placebo or active comparator randomized controlled trials were included. The primary outcome was induction and maintenance of endoscopic improvement (Mayo Endoscopic Score [MES] ≤1). Secondary outcomes were the induction and maintenance of clinical remission, endoscopic (MES = 0) and histological remission. A sub-analysis was performed based on the randomized controlled trial design and previous exposure to biologic therapy.</div></div><div><h3>Results</h3><div>We identified 36 studies that met our inclusion criteria, with 14,270 patients with UC. Upadacitinib ranked highest in inducing clinical remission (99.6%), and endoscopic improvement (99.2%), followed by risankizumab (91.4%) and (82.3%), respectively. In maintenance of endoscopic improvement, upadacitinib ranked first (98.6%) followed by filgotinib 200 mg (79.2%). Risankizumab ranked first in the induction of histological remission (89.4%), followed by guselkumab (88.3%). Upadacitinib ranked first (93.1%) in maintaining histological remission, followed by guselkumab (89.5%).</div></div><div><h3>Conclusion</h3><div>Upadacitinib appears to be superior to other therapies in achieving clinical remission, endoscopic improvement and remission, and histological remission. Furthermore, novel biologics such as risankizumab and guselkumab ranked high in achieving these outcomes. This study highlights the efficacy of small molecule drugs and novel selective interleukin-23s as alternatives to other biologics.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 250-262"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Incorporate Subcutaneous Infliximab and Vedolizumab in Your Practice","authors":"Sara N. Horst ,&nbsp;Melissa Kirkpatrick ,&nbsp;Elizabeth Scoville ,&nbsp;Anthony Buisson","doi":"10.1016/j.cgh.2024.07.042","DOIUrl":"10.1016/j.cgh.2024.07.042","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 216-219.e2"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The IBD Clinic of Tomorrow: Holistic, Patient-Centric, and Value-based Care","authors":"Benjamin Click ,&nbsp;Raymond K. Cross ,&nbsp;Miguel Regueiro ,&nbsp;Laurie Keefer","doi":"10.1016/j.cgh.2024.04.042","DOIUrl":"10.1016/j.cgh.2024.04.042","url":null,"abstract":"<div><div>There is increasing recognition of the associated bi-directional impact of inflammatory bowel disease (IBD) on patient well-being and the potential benefit of multidisciplinary teams to address these unique needs. At certain IBD centers, there has been an evolution towards patient-centric, holistic care to enhance well-being and improve health-related outcomes. Multiple models, incorporating various disciplines, care modalities, digital tools and care delivery, and resource support have arisen in IBD. Although most IBD centers of excellence are now incorporating such multidisciplinary care models, many practices still practice IBD-limited specialty care, limiting evaluations and interventions to the IBD itself and its direct consequences (eg, extraintestinal manifestations). In this piece, we seek to review the evolution of IBD care towards a patient-centric, holistic model (termed 360 IBD Care) including the role and impact of digital health tools, monitoring, and delivery in IBD, and a shift towards value-based care models with discussion of payor priorities in IBD. We also suggest potential opportunities for IBD practitioners to incorporate elements of holistic care on a local scale. Together, we hope such care models will enhance not only IBD-specific health outcomes, but also improve the general well-being of our patients with IBD today and tomorrow.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 3","pages":"Pages 419-427.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IBD Matchmaking: Rational Combination Therapy","authors":"Robert Battat ,&nbsp;John T. Chang ,&nbsp;Edward V. Loftus Jr. ,&nbsp;Bruce E. Sands","doi":"10.1016/j.cgh.2024.05.051","DOIUrl":"10.1016/j.cgh.2024.05.051","url":null,"abstract":"<div><div>A growing number of patients with Crohn’s disease and ulcerative colitis have disease that is refractory to multiple advanced therapies, have undergone multiple surgeries, and require further treatment options. For this reason, there has been increasing use of multiple simultaneous advanced targeted therapies. Although the knowledge on combined advanced targeted therapy (CATT) in inflammatory bowel disease (IBD) has been largely limited to observational data and early-phase randomized controlled trials, combination of therapies is commonplace in many other diseases. This review discusses conceptual frameworks of CATT in IBD, provides context of combined therapies in other diseases, provides current evidence for CATT in IBD, and projects future applications and positioning of CATT using existing, novel, and orthogonal mechanisms of action. CATT aims to address the need to overcome low efficacy rates and frequent loss of response of current individual therapies. Both treatment exposure and disease duration are major determinants of response to therapy. Identification of safe and effective CATT may impact positioning of this strategy to apply to a broader IBD population.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 3","pages":"Pages 469-479"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elsewhere in the AGA Journals","authors":"","doi":"10.1016/S1542-3565(24)01109-1","DOIUrl":"10.1016/S1542-3565(24)01109-1","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages A17-A18"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}