scholarly journals De-escalation of IBD Therapy: When, Who, and How?

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Akbar K Waljee ◽  
Natapat Chaisidhivej ◽  
Sameer D Saini ◽  
Peter D R Higgins
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Biologic Therapy ◽  
Successful Therapy ◽  
Disease Exacerbation ◽  
Inflammatory Bowel ◽  
Practical Guidance ◽  
Biologic Medication ◽  
Risk Of Relapse

Abstract When patients with inflammatory bowel disease reach clinical remission with biologic therapy, a question that often comes up is, “when can I stop my biologic medication?” This is a question fraught with challenges for both physicians and patients. For physicians, there are valid concerns that stepping down from a successful therapy will lead to relapse and disease exacerbation, and that stepping down could lead to anti-biologic antibodies. For patients, the question is often driven by concerns about long-term side effects and costs of biologics. This review provides an overview of the rationale for, and risks of, withdrawal of IBD therapy. Selected studies have shown how to identify subsets of patients in whom de-escalation can be performed with low risk of relapse. Practical guidance on when and how to de-escalate IBD therapy is provided.

Comparison of Oral Prednisolone, Budesonide and Probiotics in the Treatment of Canine Inflammatory Bowel Disease

2021 ◽  
Author(s):  
M. Sandhya Bhavani ◽  
S. Kavitha ◽  
B. Gowri ◽  
Abid Ali Bhat
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Bowel Disease ◽  
Activity Index ◽  
Disease Activity Index ◽  
Oral Prednisolone ◽  
Published Data ◽  
Inflammatory Bowel ◽  
Faecal Score

Background: Inflammatory bowel disease (IBD) is the common cause of chronic gastrointestinal signs in dogs. The treatment possesses numerous difficulties due to the idiopathic nature of the disease. Conventional steroid therapy usually produces side effects on long term usage. Thus, there is a need for alternative therapies. When compared to human medicine, there is no published data on the use of budesonide and probiotic in the treatment of canine IBD in India. The present study was proposed to compare oral prednisolone, budesonide and probiotics in the management of canine inflammatory bowel disease. Methods: Thirty dogs with idiopathic IBD were selected and randomly grouped. They were subjected to therapy involving prednisolone, budesonide or probiotics. Clinical assessment was performed by calculation of the post treatment Clinical Inflammatory Bowel Disease Activity Index (CIBDAI) score, faecal score and endoscopy. Biochemical analysis of alkaline phosphatase and alanine transaminase were done to record side effects of steroid administration. Result: It was observed from the present study that both prednisolone and budesonide are equally effective in the management of IBD in dogs. Probiotics were found to be less effective when compared to prednisolone and budesonide in the treatment of IBD.

scholarly journals Safety of Biologic Therapy in Liver Transplant Recipients: Case Closed?

2019 ◽  
Vol 26 (6) ◽  
pp. 960-960
Author(s):  
Brian C Davis
Keyword(s):  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Biologic Therapy ◽  
Transplant Recipients ◽  
Long Term Outcomes ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel ◽  
Liver Transplant Recipients

Patients with inflammatory bowel disease who undergo liver transplantation may be considered for biologic therapy, but providers should closely monitor for infections such as cholangitis and Clostridioides difficile infection. Further research in prospective registries with long-term outcomes is needed.

Review of normal gastrointestinal tract, ulcerative colitis, proctitis and rectal medication adherence

2020 ◽  
Vol 29 (14) ◽  
pp. 805-811
Author(s):  
Pineshwari Naeck-Boolauky ◽  
Jitka Adio ◽  
Jennie Burch
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Gastrointestinal Tract ◽  
Side Effects ◽  
Rectal Mucosa ◽  
Gi Tract ◽  
Therapeutic Outcomes ◽  
Rectal Medication ◽  
Inflammatory Bowel

The gastrointestinal (GI) tract has a number of functions—ingestion, digestion, absorption and elimination. When the GI tract is working normally, it is efficient. However, this can change when disease, such as inflammatory bowel disease (IBD) occurs. IBD is a long-term relapsing and remitting autoimmune disease; it incorporates ulcerative colitis (UC). In UC, part or all the mucosa lining the rectum and colon becomes inflamed and ulcerated. UC that affects the rectum only is called proctitis. Effective treatment is essential. It is better to target the rectal mucosa directly in proctitis, using topical rectal medications in enemas or suppositories, as these have fewer side-effects and resolve symptoms more quickly than systemic drugs. However, patients may not feel clear about aspects of their IBD care and can find it difficult to initiate and comply with treatment and maintenance regimens. Nurses need to educate and support them to achieve optimal therapeutic outcomes in both the immediate and long terms.

scholarly journals P709 Is azathioprine safe as long-term treatment in paediatric patients with inflammatory bowel disease?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S573-S573
Author(s):  
M A Martínez Ibeas ◽  
I Bacelo Ruano ◽  
S Rodríguez Manchón ◽  
M Velasco Rodríguez-Belvís ◽  
J F Viada Bris ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Adverse Effects ◽  
Term Treatment ◽  
Tpmt Activity ◽  
Duration Of Treatment ◽  
Median Dosage ◽  
Long Term Treatment ◽  
Inflammatory Bowel

Abstract Background The toxicity of azathioprine (AZA) includes myelosuppression, infections, pancreatitis, photosensitivity, and hepatotoxicity. The aim of this study was to describe the adverse effects profile of azathioprine as long-term treatment in paediatric inflammatory bowel disease (IBD). Methods An observational, descriptive and retrospective study was performed in the paediatric IBD Unit of a tertiary care hospital from September 2008 to December 2018. It was included patients under 18 diagnosed with IBD who were treated with AZA during their follow-up. We recorded epidemiological data, thiopurine methyltransferase (TPMT) enzyme activity, AZA side effects, and the dosage the patients were receiving when these effects took place. Bone marrow suppression (BMS) was defined as leukopenia, thrombocytopenia and/or anaemia. Acute pancreatitis (AP) induced by azathioprine was considered when two of these criteria (Atlanta 2012) were met: lipase increase (> 3 times normal value), congruent signs and symptoms and/or echographic findings, without other possible aetiology and with complete recovery after AZA withdrawal. Results We included 52 patients, being 31 men (59.6%). They were diagnosed with Crohn′s disease (CD) (73%), ulcerative colitis (UC) (21%) and IBD-unclassified (6%). The median TPMT activity was 17 U/ml (14.2–19.2). Up to 63.5% developed adverse effects by AZA with a median time from the beginning of treatment of 11.4 months (2.6–26.4) and a median dosage of 2 mg/kg/day (1.7–2.3). The most frequent side effect was BMS (52%). These patients had a median TPMT activity of 16.9 U/ml (14.2–18.9), the median duration of treatment was 14 months (3.9–27.7), and the median dosage was 2 mg/kg/d (1.8–2.5). BMS was more frequent in patients with UC (p 0.04) and longer treatment (p 0.08). No differences were found according to age, sex or TPMT activity. Up to 11.5% developed AP, the median duration of treatment until its appearance was 1.5 months (0.7–43.3) and the median dosage was 2 mg/kg/d (1.5–2.5). No differences were found related to age, sex, diagnosis or dosage. Other side effects were: 3 flu-like symptoms, 3 opportunistic infections, 2 hypertransaminasemia, and 1 patient with elevated pancreatic enzymes and hyperbilirubinemia. AZA was discontinued in 14 patients (43.8%): in 6 due to AP, in 4 due to severe lymphopenia, in 2 because of Epstein-Barr virus infection, in 1 due to flu-like symptoms and in 1 with several adverse effects. Conclusion More than half of the patients treated with AZA presented side effects, mainly BMS, although most of them were mild and temporary, and the withdrawal of the drug was not necessary. It seems that TPMT activity is not useful to predict BMS, but this adverse effect could be related to a longer treatment.

scholarly journals P123 Sarcopenia is a predictor for severe disease course in paediatric inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S197-S198 ◽  
Author(s):  
L Atlan ◽  
L T Pratt ◽  
S Cohen ◽  
S Shiran ◽  
A Yerushalmy-feler
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Muscle Mass ◽  
Bowel Disease ◽  
Biologic Therapy ◽  
Disease Outcome ◽  
Disease Course ◽  
Lower Quartile ◽  
Disease Exacerbation ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) is a chronic immune-mediated disease with high impact on nutritional status. Sarcopenia was related to higher risk of intestinal resection and rescue therapy in adult IBD patients; however, data in paediatric population is missing. The aim of this study was to evaluate muscle mass as a predictor of disease outcome in paediatric IBD. Methods All paediatric IBD patients that underwent a magnetic resonance enterography (MRE) study for disease assessment at the Tel Aviv Sourasky Medical Center in 2008–2019 were retrospectively included. Muscle mass was assessed by measuring the area of the psoas muscle at the upper level of L3 on MRE by a freehand region of interest (ROI). Psoas index was defined as the average psoas area divided by body surface area, and then was divided into quartiles. Disease location and radiological signs of IBD were documented. Clinical data including disease activity and course, medications, exacerbations and laboratory results were documented. Results We included 101 patients, 69 (68.3%) Crohn’s disease patients and 32 (31.7%) ulcerative colitis patients. The mean age was 13.05 ± 3.48 years at diagnosis and 15.03 ± 3.27 years at MRE. The psoas index was significantly lower in patients with presence of fatty proliferation (p = 0.021), comb sign (p = 0.001) and extensive disease in MRE (p = 0.012) and in radiologic evidence of disease complications such as abscess or fistula (p = 0.027). In a univariate analysis, patients with psoas index in the lower quartile had significantly higher risk of need for biologic therapy during follow-up (HR = 35.1, p < 0.001; Figure 1) and higher risk of disease exacerbation (HR = 25.1, p < 0.001; Figure 2) compared with patients with psoas index in the upper quartile. In a multivariate analysis adjusted for age, gender, disease type, haemoglobin, C-reactive protein, albumin, disease activity and interval from diagnosis to MRE, patients with psoas index in the lower quartile had significantly higher risk of need for biologic therapy (HR = 12.1, p = 0.046) and of disease exacerbation (HR = 9, p = 0.047) compared with patients with psoas index in the upper quartile. Conclusion Sarcopenia correlates with the radiological severity of IBD and was found to be an independent predictor for severe clinical disease course. Muscle mass in MRE studies may be used as a possible marker for disease outcome in paediatric IBD.

scholarly journals P634 Long term risk of relapse after anti-TNF discontinuation based on mucosal healing in inflammatory bowel disease

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S404-S404
Author(s):  
J.M. García Ortíz ◽  
M. Sáenz Gallo ◽  
C. Trigo Salado ◽  
M.D. De La Cruz Ramirez ◽  
J.L. Marquez Galan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Mucosal Healing ◽  
Inflammatory Bowel ◽  
Risk Of Relapse

scholarly journals P314 TNF gene activation used as criterion to discontinue biologic therapy – A patient series introducing the NovaPrime TNF kit

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S340-S341
Author(s):  
R Goll ◽  
J Kay-Martin ◽  
A Viola ◽  
E Paulssen ◽  
Ø K Moe ◽  
...  
Keyword(s):  
Gene Expression ◽  
Inflammatory Bowel Disease ◽  
Biologic Therapy ◽  
Biologic Drugs ◽  
Endoscopic Remission ◽  
Inflammatory Bowel ◽  
Tnf Gene ◽  
Normal Controls ◽  
Active Disease

Abstract Background Severe inflammatory bowel disease can be successfully treated with biologic drugs such as anti-TNF. However, there is no consensus on if and how to stop treatment. Our group has earlier shown that normalization of TNF gene expression may be a beneficial prognostic factor when attempting to discontinue biologic therapy. We here present data from a series of patients in endoscopic remission and with normalized TNF gene expression. Methods Severe inflammatory bowel disease can be successfully treated with biologic drugs such as anti-TNF. However, there is no consensus on if and how to stop treatment. Our group has earlier shown that normalization of TNF gene expression may be a beneficial prognostic factor when attempting to discontinue biologic therapy. We here present data from a series of patients in endoscopic remission and with normalized TNF gene expression. A total of 91 patients were recruited at hospitals in Norway and Italy: 55 patients (32 UC, 23 CD) in remission (picked by normalization of TNF using our in-house TNF qPCR), and for comparison: 14 patients with active disease, and 22 normal controls. Mucosal samples taken prior to drug discontinuation from all patients were re-measured for TNF mRNA by the NovaPrime TNF kit. Results A clear difference could be seen between normal controls and patients with active disease, showing highly elevated TNF mRNA values in the active disease group. The patients in remission had values resembling the normal controls with values generally below a cut-off of 9060 copies/µg total RNA by the NovaPrime TNF kit. The patients in remission were followed for up to 5 years noting two endpoints: relapse triggering any adjustment of medication, and relapse triggering restart of biologics. Median survival time before adjusting medication was 12 months for ulcerative colitis and 17 months for Crohn’s disease. Median time to restart of biologics was 21 months (2 – 40) overall, and after 3 years 43% still were not in need of biologic therapy. Conclusion We conclude that the NovaPrime TNF kit yields consistent readings comparable to our in-house assay, and that this industrial standard kit enables any PCR lab to perform TNF gene expression in samples from intestinal mucosa. A considerable proportion of patients with normalized TNF gene expression can maintain long term remission without biologic therapy, relieving health care costs and potential side effects of long-term therapy.

scholarly journals Anti-Tnf Side Effects in the Treatment of Chronic Inflammatory Bowel Disease

2021 ◽  
Vol 2 (1) ◽  
pp. 1-5
Author(s):  
Elhidaoui I ◽  
◽  
Oubaha S ◽  
Benjouad K ◽  
◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Bowel Disease ◽  
Chronic Inflammatory Bowel Disease ◽  
Cardiac Complications ◽  
Cutaneous Lesions ◽  
Specific Patient ◽  
Short And Long Term ◽  
Inflammatory Bowel

IBD is a common, serious and disabling chronic digestive disease, Their different manifestations, whether digestive and extra-digestive, require a multi-professional care adapted to each specific patient. Anti-TNFs are now an essential therapeutic weapon in the management of inflammatory bowel disease (IBD). Their effectiveness in both the short and long term has been demonstrated in various studies. However short and long term anti-tnf results vary from patient to patient which can be explained in many cases by the significant number of discontinued treatment in patients that experience side effects. The purpose of our work is to study the different side effects occurring in patients under biotherapy, the management of these side effects and their prevention. We prospectively analyzed since four years the medical records of 54 IBD patients who received anti-TNF treatment. An exhaustive pre-therapeutic assessment was performed systematically in all patients. A clinical and biological control was carried out systematically before each therapeutic administration to search for undesirable reactions. Side effects were classified into several categories including immediate hypersensitivity reactions, dermatological complications, infectious, neurological, haematological, neoplasic and cardiac complications. During this period, 54 patients were treated with biotherapies, representing 24.2% of all IBD patients. We observed 29 side effects, an incidence of 46% including two severe effects 3.5%, occurring on average after one month of treatment. The hematological undesirable effects were the most frequent appeared in 14 patients (26%), severe infection specifically tuberculosis appeared in 2 patients (3.6%), allergic effects were severe in only one case (anaphylactic shock), finally the secondary cutaneous lesions of Anti-TNF were observed in a single patient (extensive psoriasis). Severe adverse reactions led to permanent discontinuation of Anti-TNF in 24.1% of cases. The use of anti-TNF treatment is likely to generate numerous undesirable effects, hence the advantage of respecting the recommendations relating to the assessment before any treatment with biotherapy and of making regular clinical follow-up during treatment with a meticulous clinical examination as well as biological monitoring in order to prevent the occurrence of these complications, and to manage them correctly once they appear.

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