Therapeutic Advances in Gastroenterology最新文献

{"title":"New genetic biomarkers predicting 5-aminosalicylate-induced adverse events in patients with inflammatory bowel diseases.","authors":"Jihye Park, I Seul Park, Ji Hyung Kim, Jung Hyun Ji, Soo Jung Park, Jae Jun Park, Tae Il Kim, Seung Won Kim, Jae Hee Cheon","doi":"10.1177/17562848241227029","DOIUrl":"10.1177/17562848241227029","url":null,"abstract":"<p><strong>Background: </strong>Notably, 5-aminosalicylates (5-ASA) are vital in treating inflammatory bowel diseases (IBD). The adverse events of 5-ASA rarely occur but they could be fatal.</p><p><strong>Objectives: </strong>We aimed to discover new genetic biomarkers predicting 5-ASA-induced adverse events in patients with IBD.</p><p><strong>Design: </strong>This was a retrospective observational study.</p><p><strong>Methods: </strong>We performed a genome-wide association study on patients with IBD in South Korea. We defined subset 1 as 39 all adverse events and 272 controls; subset 2 as 20 severe adverse events and 291 controls (mild adverse events and control); subset 3 as 20 severe adverse events and 272 controls; and subset 4 as 19 mild adverse events and 272 controls. Logistic regression analysis was performed and commonly found associated genes were determined as candidate single-nucleotide polymorphisms predicting 5-ASA adverse events.</p><p><strong>Results: </strong>Patients with Crohn's disease (CD) were significantly negatively associated with the development of adverse events compared to patients with ulcerative colitis (UC) (5.3% <i>versus</i> 22.9%). However, sex and age at diagnosis were unassociated with the adverse events of 5-ASA. rs13898676 [odds ratio (OR), 20.33; 95% confidence interval (CI), 5.69-72.67; <i>p</i> = 3.57 × e^-6], rs12681590 (OR, 7.35; 95% CI, 2.85-19.00; <i>p</i> = 3.78 × e^-5), rs10967320 (OR, 4.51; 95% CI, 2.18-9.31; <i>p</i> = 4.72 × e^-5), and rs78726924 (OR, 3.54; 95% CI, 1.69-7.40; <i>p</i> = 7.96 × e^-5) were genetic biomarkers predicting 5-ASA-induced severe adverse events in patients with IBD.</p><p><strong>Conclusion: </strong>The adverse events of 5-ASA were more common in patients with UC than those with CD in our study. We found that novel rs13898676 nearby <i>WSB2</i> was the most significant genetic locus contributing to 5-ASA's adverse event risk.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10822078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between psoriasis, psoriasis severity, and inflammatory bowel disease: a population-based analysis.","authors":"Uria Shani, Niv Ben-Shabat, Roula Qassem, Adi Lahat, Mahmud Omar, Einat Savin, Arad Dotan, Yonatan Shneor Patt, Lior Fisher, Galia Zacay, Howard Amital, Abdulla Watad, Kassem Sharif","doi":"10.1177/17562848241227037","DOIUrl":"10.1177/17562848241227037","url":null,"abstract":"<p><strong>Background: </strong>The skin-gut axis, characterized by bidirectional communication between the skin and gut, plays a crucial role in the pathogenesis of psoriasis and inflammatory bowel diseases (IBD).</p><p><strong>Objectives: </strong>We aimed to explore the association between psoriasis and IBD and identify predictors associated with IBD development among patients with psoriasis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>A retrospective study which utilized an electronic database from the Meuhedet Health Maintenance Organization (MHMO) in Israel. Psoriasis was categorized as severe if any systemic agent or phototherapy was administered. Univariate and multivariate logistic regressions were used to identify specific predictors for IBD, with adjustments made for potential confounders. The study received approval from the Ethical Committee of the MHMO.</p><p><strong>Results: </strong>In total, 61,003 adult patients who were diagnosed with psoriasis between 2000 and 2022 were included. Among them, 1495/61,003 patients (2.4%) were diagnosed with IBD, as compared to 3834/244,012 patients (1.6%) in the non-psoriasis group [adjusted odds ratio (OR): 1.47; 95% confidence interval (CI): 1.37-1.56; <i>p</i> < 0.001]. Increased age (OR: 1.01; 95% CI: 1.01-1.02; <i>p</i> < 0.001), male gender (OR: 1.22; 95% CI: 1.03-1.45; <i>p</i> = 0.024), and Jewish ethnicity (OR: 2.5; 95% CI: 1.2-4.1; <i>p</i> < 0.001) were identified as significant risk factors for IBD. Spondyloarthropathies, including psoriatic arthritis (OR: 2.27; 95% CI: 1.86-2.77; <i>p</i> < 0.001) and ankylosing spondylitis (OR: 2.82; 95% CI: 1.5-5.32; <i>p</i> < 0.05), were associated with a higher prevalence of IBD. Furthermore, severe psoriasis was significantly associated with a higher likelihood of IBD, compared to mild psoriasis (OR: 16.03; 95% CI: 11.02-23.34; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>A significant association between psoriasis and IBD was demonstrated, including its subtypes: Crohn's disease and ulcerative colitis. Moreover, such association may depend on psoriasis severity as determined by the treatment used. This association warrants further investigation and implies a potential need for closer monitoring of patients with severe psoriasis.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10822082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of double-balloon endoscopy and an endoscopic scoring system to assess endoscopic remission in isolated small bowel Crohn's disease after treatment with infliximab.","authors":"Wei Han, Jing Hu, Juan Wu, Peipei Zhang, Qiuyuan Liu, Naizhong Hu, Qiao Mei","doi":"10.1177/17562848231224842","DOIUrl":"10.1177/17562848231224842","url":null,"abstract":"<p><strong>Background: </strong>It is unclear how clinical and endoscopic factors affect the attainment of endoscopic remission (ER) in patients with small bowel Crohn's disease (SB-CD) who are infliximab-naïve.</p><p><strong>Objectives: </strong>We aimed to identify the effect of different factors on attaining ER using double-balloon endoscopy (DBE) evaluation.</p><p><strong>Design: </strong>A single-center retrospective observational study was conducted from 1 January 2018 to 30 November 2022. Among 262 patients who were screened for isolated SB-CD by baseline DBE, 108 patients were assessed for effectiveness during maintenance infliximab therapy by a second DBE evaluation.</p><p><strong>Methods: </strong>DBE findings before and after infliximab therapy were compared. ER was defined as a simple endoscopic score for CD (SES-CD) below 3, and segmental ER as SES-CD activity of 0. Multivariate regression with calculations of odds ratios (OR) was used to determine the impact of different factors on attaining ER.</p><p><strong>Results: </strong>In all, 41 patients (38.0%) achieved ER. An elevated C-reactive protein at week 6 was independently associated with a decreased probability of ER [OR: 0.86, 95% confidence interval (CI) = 0.75-0.98, <i>p</i> = 0.03]. Segmental ER of the terminal ileum, rather than the proximal ileum, was associated with a higher rate of ER (60.9% <i>versus</i> 38.2%, <i>p</i> = 0.01). High baseline SES-CD (⩾16) was unrelated to overall ER. For patients with disease in the terminal ileum, those with moderate/severe disease were less likely to attain segmental ER than those with mild disease [adjusted odds ratios (aOR): 0.27, 95% CI: 0.09-0.83, <i>p</i> = 0.02]. A large ulcer in the terminal ileum was associated with a lower rate of segmental ER (aOR: 0.18, 95% CI: 0.06-0.56, <i>p</i> = 0.01).</p><p><strong>Conclusion: </strong>For infliximab-naïve patients with SB-CD, the overall severity of the endoscopic score was unrelated to attainment of ER. Patients were less likely to attain segmental ER if they had greater endoscopic inflammation or larger ulcers in the terminal ileum.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena.","authors":"Mengqi Li, Sha Chen, Shuxiang Li, Tingting Lv, Buer Li, Shan Shan, Min Li, Na Zeng, Qianyi Wang, Yuanyuan Kong, Hong Ma, Xinyan Zhao, Xiaojuan Ou, Hong You, Weijia Duan, Jidong Jia","doi":"10.1177/17562848231224840","DOIUrl":"10.1177/17562848231224840","url":null,"abstract":"<p><strong>Background: </strong>Mildly elevated levels of transaminase and/or immunoglobulin G (IgG) are common in patients with primary biliary cholangitis (PBC). It is still unclear whether adding immunosuppressive therapy to ursodeoxycholic acid (UDCA) benefits those patients who are not fulfilling the diagnostic criteria of PBC with autoimmune hepatitis (AIH) features.</p><p><strong>Objectives: </strong>To assess the efficacy of adding immunosuppressive therapy to UDCA for patients with PBC and autoimmune phenomena but not fulfilling the diagnostic criteria of PBC with AIH features.</p><p><strong>Design: </strong>This is a retrospective-prospective cohort study in a tertiary medical center.</p><p><strong>Methods: </strong>Patients with PBC and autoimmune phenomena were defined by the elevation of IgG and/or transaminase but did not fulfill the diagnostic criteria of PBC with AIH features. We grouped these patients based on with and without add-on immunosuppressive therapy and balanced their baseline characteristics using inverse probability treatment weighting (IPTW).</p><p><strong>Results: </strong>A total of 652 patients with PBC and autoimmune phenomena were included, with a median follow-up of 4.08 years. After IPTW, the pseudo sample size in the add-on therapy and monotherapy groups was 558 and 655, respectively. After 1 year of observation, patients in the add-on therapy group had a higher biochemical response rate (normalization of transaminase and IgG levels) (49% <i>versus</i> 17%, <i>p</i> < 0.001). Furthermore, add-on therapy improved the transplant-free survival in the subgroup of patients with PBC and transaminase ⩾3 × upper limit of normal (ULN) or IgG ⩾1.3 × ULN (<i>p</i> = 0.033).</p><p><strong>Conclusion: </strong>Add-on immunosuppressive therapy may improve the normalization rates of transaminase and IgG levels in all patients with PBC and mildly elevated transaminase and IgG levels and the long-term outcomes in the subgroup of the patients with transaminase ⩾3 × ULN or IgG ⩾1.3 × ULN.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echoendoscopic ultrasound pancreatic adenocarcinoma diagnosis and theranostic approach: should <i>KRAS</i> mutation research be recommended in everyday practice?","authors":"Dominique Béchade, Lola-Jade Palmieri, Benjamin Bonhomme, Simon Pernot, Jeanne Léna, Marianne Fonck, Sophie Pesqué, Gautier Boillet, Antoine Italiano, Gilles Roseau","doi":"10.1177/17562848231224943","DOIUrl":"10.1177/17562848231224943","url":null,"abstract":"<p><strong>Background: </strong>The impact of <i>KRAS</i> mutation testing on pancreatic ductal adenocarcinoma (PDAC) samples by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for reducing the need to repeat EUS-FNA has been demonstrated. Such testing however is not part of standard practice for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB).</p><p><strong>Objectives: </strong>We aim to analyse the proportion of non-contributive samples by EUS-FNB and to evaluate the impact of <i>KRAS</i> mutation testing on the diagnosis, theranostics and survival.</p><p><strong>Design: </strong>In this retrospective study, the impact on diagnosis and survival of <i>KRAS</i> testing for contributive and non-contributive samples by EUS-FNB was analysed.</p><p><strong>Methods: </strong>The EUS-FNB samples, combined with <i>KRAS</i> testing using the Idylla^® technique on liquid-based cytology from patients with PDAC between February 2019 and May 2023, were retrospectively reviewed. The cytology results were classified according to the guidelines of the World Health Organization System for Reporting Pancreaticobiliary Cytopathology (WHOSRPC).</p><p><strong>Results: </strong>A total of 85 EUS-FNB specimens were reviewed. In all, 25 EUS-FNB samples did not lead to a formal diagnosis of PDAC according to the WHOSRPC (30.2%). Out of these 25, 11 (44%) could have been considered positive for a PDAC diagnosis thanks to the <i>KRAS</i> mutation test without carrying out further diagnosis procedures. The sensitivity of <i>KRAS</i> mutation testing using the Idylla technique was 98.6%. According to the available data, survival rates were not statistically different depending on the type of mutation.</p><p><strong>Conclusion: </strong><i>KRAS</i> mutation testing on liquid-based cytology using the Idylla or equivalent technique, combined with the PDAC EUS-FNB sample, should become a standard for diagnosis to avoid delaying treatment by doing another biopsy. Furthermore, knowledge of the <i>KRAS</i> status from treatment initiation could be used to isolate mutations requiring targeted treatments or inclusion in clinical research trials, especially for wild-type <i>KRAS</i> PDAC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment persistence and switching patterns of ABP 501 in European patients with inflammatory bowel disease.","authors":"Ran Jin, Silvia Kruppert, Florian Scholz, Isabelle Bardoulat, Khalil Karzazi, Greg Kricorian, James L O'Kelly, Walter Reinisch","doi":"10.1177/17562848231222332","DOIUrl":"10.1177/17562848231222332","url":null,"abstract":"<p><strong>Background: </strong>Approval of the adalimumab (ADA) biosimilar ABP 501 for inflammatory bowel disease (IBD) indications was based on the principle of extrapolation, without indication-specific clinical trial data.</p><p><strong>Objectives: </strong>To evaluate the real-world treatment patterns of ABP 501 in patients with IBD.</p><p><strong>Design: </strong>Retrospective analysis of pharmacy claims data from Germany and France.</p><p><strong>Methods: </strong>Continuously insured adult IBD patients who initiated ABP 501 between October 2018 and March 2020 were included. Treatment persistence, adherence, and post-ABP 501 switching patterns were evaluated for two mutually exclusive groups: ADA-naïve patients (i.e. no baseline use of ADA products) and ADA-experienced patients (i.e. previously treated with ADA products).</p><p><strong>Results: </strong>A total of 3362 German patients and 733 French patients were included, with 54.4% and 65.3% being ADA-naïve patients, respectively. Median persistence (95% CI) on ABP 501 was 10.9 months (9.8-11.6) in ADA-naïve patients and 14.2 months (12.7-15.2) in ADA-experienced patients in Germany; for the French cohort, ADA-naïve and -experienced patients had median persistence of 12.8 months (10.2-14.7) and 11.5 months (8.8-14.4), respectively. During the first 12 months of ABP 501 initiation, 53.7% of German patients and 51.0% of French patients were adherent to the therapy. About 20% of patients in both countries switched from ABP 501 to another targeted therapy. In the German cohort, ADA-naïve patients most frequently switched to non-tumor necrosis factor inhibitor biologics, but ADA-experienced patients most commonly switched to reference product (RP); in the French cohort, patients most often switched to RP regardless of prior exposure to ADA products.</p><p><strong>Conclusion: </strong>About 50% of patients persisted on and were adherent to ABP 501 therapy during the first 12 months after treatment initiation in two large European countries. Post-ABP 501, switching patterns varied between countries, indicating diversified treatment practices warranting further research on reason(s) for switching and potential overall treatment outcomes.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10787526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139467224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between hiatal hernia and Barrett's esophagus: an updated meta-analysis with trial sequential analysis.","authors":"Shaoze Ma, Zhenhua Tong, Yong He, Yiyan Zhang, Xiaozhong Guo, Xingshun Qi","doi":"10.1177/17562848231219234","DOIUrl":"10.1177/17562848231219234","url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma. It is critical to recognize the risk factors associated with BE.</p><p><strong>Objectives: </strong>The present meta-analysis aims to systematically estimate the association of hiatal hernia with the risk of BE.</p><p><strong>Design: </strong>A meta-analysis with trial sequential analysis.</p><p><strong>Data sources and methods: </strong>The PubMed, EMBASE, and Cochrane Library databases were searched. The pooled odds ratios (ORs) and adjusted ORs (aORs) with their 95% confidence intervals (CIs) were calculated for the combined estimation of unadjusted data and data adjusted for confounders, respectively. Heterogeneity was quantified using the Cochrane <i>Q</i> test and <i>I</i>² statistics. Subgroup, meta-regression, and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity.</p><p><strong>Results: </strong>Forty-seven studies with 131,517 participants were included. Based on the unadjusted data from 47 studies, hiatal hernia was significantly associated with an increased risk of any length BE (OR = 3.91, 95% CI = 3.31-4.62, <i>p</i> < 0.001). The heterogeneity was significant (<i>I</i>² = 77%; <i>p</i> < 0.001) and the definition of controls (<i>p</i> = 0.014) might be a potential contributor to heterogeneity. Based on the adjusted data from 14 studies, this positive association remained (aOR = 3.26, 95% CI = 2.44-4.35, <i>p</i> < 0.001). The heterogeneity was also significant (<i>I</i>² = 65%; <i>p</i> < 0.001). Meta-analysis of seven studies demonstrated that hiatal hernia was significantly associated with an increased risk of long-segment BE (LSBE) (OR = 10.01, 95% CI = 4.16-24.06, <i>p</i> < 0.001). The heterogeneity was significant (<i>I</i>² = 78%; <i>p</i> < 0.001). Meta-analysis of seven studies also demonstrated that hiatal hernia was significantly associated with an increased risk of short-segment BE (OR = 2.76, 95% CI = 2.05-3.71, <i>p</i> < 0.001). The heterogeneity was not significant (<i>I</i>² = 30%; <i>p</i> = 0.201).</p><p><strong>Conclusion: </strong>Hiatal hernia should be a significant risk factor for BE, especially LSBE.</p><p><strong>Registration: </strong>PROSPERO registration number CRD42022367376.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in patients with ulcerative colitis treated with two consecutive anti-TNF agents: data from the ENEIDA registry.","authors":"Margalida Calafat, Paola Torres, Joan Tosca-Cuquerella, Rubén Sánchez-Aldehuelo, Montserrat Rivero, Marisa Iborra, María González-Vivo, Isabel Vera, Luisa de Castro, Luis Bujanda, Manuel Barreiro-de Acosta, Carlos González-Muñoza, Xavier Calvet, José Manuel Benítez, Mónica Llorente-Barrio, Gerard Surís, Fiorella Cañete, Lara Arias-García, David Monfort, Andrés Castaño-García, Francisco Javier Garcia-Alonso, José M Huguet, Ignacio Marín-Jímenez, Rufo Lorente, Albert Martín-Cardona, Juan Ángel Ferrer, Patricia Camo, Javier P Gisbert, Ramón Pajares, Fernando Gomollón, Jesús Castro-Poceiro, Jair Morales-Alvarado, Jordina Llaó, Andrés Rodríguez, Cristina Rodríguez, Pablo Pérez-Galindo, Mercè Navarro, Nuria Jiménez-García, Marta Carrillo-Palau, Isabel Blázquez-Gómez, Eva Sesé, Pedro Almela, Patricia Ramírez de la Piscina, Carlos Taxonera, Iago Rodríguez-Lago, Lidia Cabrinety, Milagros Vela, Miguel Mínguez, Francisco Mesonero, María José García, Mariam Aguas, Lucía Márquez, Marisol Silva Porto, Juan R Pineda, Koldo García-Etxebarría, Federico Bertoletti, Eduard Brunet, Míriam Mañosa, Eugeni Domènech","doi":"10.1177/17562848231221713","DOIUrl":"10.1177/17562848231221713","url":null,"abstract":"<p><strong>Background: </strong>Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC) but little is known when it is used as the second anti-TNF.</p><p><strong>Objectives: </strong>To compare the clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially).</p><p><strong>Results: </strong>Overall, 473 UC patients were included (330 IVi and 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4% in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission.</p><p><strong>Conclusion: </strong>The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of cyclosporin induction and ustekinumab maintenance combination therapy in patients with steroid-refractory acute severe ulcerative colitis.","authors":"Francesco Vitali, Timo Rath, Entcho Klenske, Anna-Lena Vögele, Ingo Ganzleben, Sebastian Zundler, Deike Strobel, Carol Geppert, Arndt Hartmann, Markus F Neurath, Raja Atreya","doi":"10.1177/17562848231218555","DOIUrl":"10.1177/17562848231218555","url":null,"abstract":"<p><strong>Background: </strong>Effective management of patients with acute severe ulcerative colitis (ASUC) is a major challenge and there remains a paucity of available maintenance treatment options after efficacious cyclosporin induction therapy.</p><p><strong>Objectives: </strong>We investigated the long-term effectiveness and safety of cyclosporin and ustekinumab combination therapy in patients with steroid refractory ASUC.</p><p><strong>Design: </strong>Monocentric, prospective study.</p><p><strong>Methods: </strong>We included patients with steroid refractory ASUC with multiple failed prior advanced therapies, who were treated with cyclosporin and ustekinumab combination therapy.</p><p><strong>Results: </strong>Among the 11 included patients, 10 had prior failure to infliximab and 8 failed at least three previous biological therapies. The mean baseline Mayo and Lichtiger scores were 10.9 (9-12) and 13.3 (11-14), respectively. Ustekinumab was initiated 3.2 weeks (1-8) after initiation of cyclosporin treatment and combination therapy was continued for a mean of 11.5 (4-20) weeks. Clinical response was achieved in six patients at week 16 and clinical steroid-free clinical remission in five patients at week 48. Endoscopic remission was achieved in five patients at week 16 and together with histological remission in five patients at week 52. Intestinal ultrasound demonstrated mean bowel wall thickening in the sigmoid colon of 5.5 mm at baseline and 3.5 mm at week 52, respectively. Two patients had to undergo colectomy (mean 4.5 months, range 3-6) and three stopped ustekinumab therapy due to ineffectiveness. Overall, combination therapy was well tolerated.</p><p><strong>Conclusion: </strong>Combination of cyclosporin and ustekinumab therapy allowed nearly half of ASUC patients to reach clinical and endoscopic remission after 52 weeks, warranting further studies.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in endoscopic management of small-bowel polyps in Peutz-Jeghers syndrome and familial adenomatous polyposis.","authors":"Yohei Funayama, Satoshi Shinozaki, Tomonori Yano, Hironori Yamamoto","doi":"10.1177/17562848231218561","DOIUrl":"10.1177/17562848231218561","url":null,"abstract":"<p><p>Before the development of double-balloon enteroscopy (DBE), the standard management of small-bowel polyposis was surgical resection. This is an invasive procedure that could lead to short bowel syndrome. In the 21st century, several new enteroscopy techniques were distributed worldwide, including DBE, single-balloon enteroscopy, spiral enteroscopy, and motorized spiral enteroscopy. These devices enable the diagnoses and endoscopic interventions in the entire small bowel, even in patients with a history of laparotomy. In patients with Peutz-Jeghers syndrome (PJS), endoscopic ischemic polypectomy with clips or a detachable snare is the preferred method for managing pedunculated polyps because it is less likely to cause adverse events than conventional polypectomy. Although polyps in patients with PJS always recur, repeat endoscopic resection can reduce the total number and mean size of polyps in the long-term clinical course. Endoscopic reduction of small-bowel intussusception caused by PJS polyps can be successfully performed using DBE without surgery. A transparent hood is useful for securing a visual field during the treatment of small-bowel polyps, and minimal water exchange method is recommended to facilitate deep insertion. Familial adenomatous polyposis (FAP) is a genetic disorder that increases the risk of developing colorectal cancer. Because jejunal and ileal polyps in patients with FAP have the potential to develop into cancer <i>via</i> the adenoma-carcinoma sequence, periodical surveillance, and endoscopic resection are needed for them, not only polyps in the duodenum. In cases of multiple small-bowel polyps in patients with FAP, cold snare polypectomy without retrieval is an acceptable treatment option for polyps that are 10 mm or smaller in size. Additional good pieces of evidence are necessary to confirm these findings because this narrative review mostly includes retrospective observational studies from single center, case reports, and expert reviews.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}