scholarly journals P461 Intolerance to 5-aminosalicylate is a risk of poor prognosis in ulcerative colitis patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S409-S410
Author(s):  
T Fujii ◽  
S Hibiya ◽  
C Maeyashiki ◽  
E Saito ◽  
K Takenaka ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cohort Study ◽  
Confidence Interval ◽  
Maintenance Therapy ◽  
Retrospective Review ◽  
Poor Prognosis ◽  
Hazard Ratio ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Significant Difference

Abstract Background 5-Aminosalicylates (5-ASA) are the key drugs in induction and maintenance therapy in ulcerative colitis (UC). Some UC patients are involved in 5-ASA intolerance after induction of oral 5-ASA compounds. There is no evidence of the prognosis including the risk of colectomy in 5-ASA intolerant UC patients. Methods The aim of this study is to establish the prognosis of 5-ASA intolerant UC patients in a multicenter cohort study. A retrospective review of a prospective multicenter database (2014–2018) of 1,574 UC patients was carried out and a total of 1,286 patients treated with oral 5-ASA compounds were enrolled. We compared the risk of colectomy and biologics induction between patients (i) tolerant to first 5-ASA compound (1079), (ii) intolerant to first 5-ASA compound but tolerant to other 5-ASA compound (107) and (iii) intolerant to 5-ASA compound and withdrawal of 5-ASA (100). Results We identified 1,286 patients with UC, of which 40 patients (3.1%) resulted in colectomy and 247 patients (19%) treated with biologics. Colectomy rate in patients (iii) intolerant to 5-ASA and withdrawal of 5-ASA were higher than (i) tolerant to first 5-ASA and (ii) intolerant to first 5-ASA but tolerant to other 5-ASA (9.0%, 2.7%, 1.9%, respectively). (iii) Patients withdrawal of 5-ASA showed higher risk of colectomy compared with (i) tolerant to first 5-ASA (Hazard ratio (HR) 4.71, 95% Confidence interval (CI): 2.04–10.8). The risk of colectomy among (ii) patients intolerant to first 5-ASA but tolerant to other 5-ASA showed no significant difference compared with (i) tolerant to first 5-ASA (HR 0.76, 95% CI: 0.43–1.35). The biologics induction rate in (iii) patients withdrawal of 5-ASA was significantly higher than (i) tolerant to first 5-ASA and (ii) intolerant to first 5-ASA but tolerant to other 5-ASA (37%, 18%, 16%, respectively). Also (iii) patients withdrawal of 5-ASA showed higher risk of induction with biologics compared with (i) tolerant to first 5-ASA (HR 2.35, 95% CI: 1.50–3.68). Those risk among (ii) patients intolerant to first 5-ASA but tolerant to other 5-ASA showed no significant difference compared with (i) tolerant to first 5-ASA (HR 0.76, 95% CI: 0.43–1.35). Conclusion Patients with UC who had 5-ASA intolerance and withdrew from 5-ASA showed poor prognosis. We should consider trying other 5-ASA compounds even if the patients had intolerance to one 5-ASA compound.

Pelvic Lymphadenectomy Improves Survival in Patients With Cervical Cancer With Low-Volume Disease in the Sentinel Node: A Retrospective Multicenter Cohort Study

2014 ◽  
Vol 24 (2) ◽  
pp. 303-311 ◽  
Author(s):  
Afra Zaal ◽  
Ronald P. Zweemer ◽  
Michal Zikán ◽  
Ladislav Dusek ◽  
Denis Querleu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cohort Study ◽  
Lymph Node ◽  
Sentinel Node ◽  
Prospective Trial ◽  
Multicenter Cohort Study ◽  
Sentinel Nodes ◽  
Multicenter Cohort ◽  
Significant Difference ◽  
Low Volume

ObjectiveIn this study, we aimed to describe the value of pelvic lymph node dissection (LND) after sentinel lymph node (SN) biopsy in early-stage cervical cancer.MethodsWe performed a retrospective multicenter cohort study in 8 gynecological oncology departments. In total, 645 women with International Federation of Gynecology and Obstetrics stage IA to IIB cervical cancer of squamous, adeno, or adenosquamous histologic type who underwent SN biopsy followed by pelvic LND were enrolled in this study. Radioisotope tracers and blue dye were used to localize the sentinel node, and pathologic ultrastaging was performed.ResultsAmong the patients with low-volume disease (micrometastases and isolated tumor cells) in the sentinel node, the overall survival was significantly better (P = 0.046) if more than 16 non-SNs were removed. No such significant difference in survival was detected in patients with negative or macrometastatic sentinel nodes.ConclusionsOur findings indicate that in patients with negative or macrometastatic disease in the sentinel nodes, an additional LND did not alter survival. Conversely, our data suggest that the survival of patients with low-volume disease is improved when more than 16 additional lymph nodes are removed. If in a prospective trial our data are confirmed, we would suggest a 2-stage operation.

Sa555 COLECTOMY-FREE DRUG SURVIVAL OF USTEKINUMAB IN ULCERATIVE COLITIS: A REAL-WORLD, MULTICENTER COHORT STUDY IN THE UNITED STATES

2021 ◽  
Vol 160 (6) ◽  
pp. S-549
Author(s):  
Rahul S. Dalal ◽  
Scott Esckilsen ◽  
Edward L. Barnes ◽  
Jordan C. Pruce ◽  
Jenna Marcus ◽  
...  
Keyword(s):  
United States ◽  
Ulcerative Colitis ◽  
Cohort Study ◽  
Real World ◽  
The United States ◽  
Free Drug ◽  
Multicenter Cohort Study ◽  
Drug Survival ◽  
Multicenter Cohort

Comparing the outcome between multifocal, multicentric, and bilateral breast cancer and the impact of guideline-adherent adjuvant treatment: A retrospective multicenter cohort study of 5,308 patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1078-1078
Author(s):  
Lukas Schwentner ◽  
Regine Wolters ◽  
Igor Novopashenny ◽  
Manfred Wischnewsky ◽  
Rolf Kreienberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Adjuvant Treatment ◽  
Bilateral Breast Cancer ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Significant Difference ◽  
Definition Of ◽  
The Impact ◽  
Worse Prognosis

1078 Background: Beside unifocal-unilateral (UU) breast cancer (BC) there are several subtypes including multifocal, multicentric and bilateral BC. This study tries to answer the following questions:(1) Does localization (multifocal/multicentric/bilateral) influence outcome concerning BC mortality? (2) Is there an impact of guideline-adherent adjuvant treatment in these BC subtypes? Methods: This German multi-center retrospective cohort study called BRENDA included 5277 patients obtained from 1992 until 2005. The definition of guideline adherence was based on the German national S3 breast cancer guideline (2004). Results: 4085 (77.4%) were UU, 698 (13.2%) multifocal, 282 (5.3%) multicentric and 212 (4.0%) bilateral BC. RFS in multifocal [p=0.003; HR=1.35 (95% CI: 1.11-1.65)], multicentric [p<0.001; HR=1.76 (95% CI: 1.31-2.34)] and bilateral [p<0.001; HR=2.28 (95% CI: 1.76-2.97)] BC was significantly lower compared to unilateral-unifocal BC. Concerning OAS we found only a borderline difference between UU and unilateral-multifocal [p=0.057; HR=1.22 (95% CI: 0.99-1.48)], but a significant difference between multicentric [p= 0.018; HR=1.42 (95% CI: 1.06-1.90)] resp. bilateral [p<0.001; HR=2.87 (95% CI: 2.21-3.74)] and UU-BC. There was a significant impact by guideline adherent adjuvant therapy [UU: p<0.001, HR=2.76,95%C.I.:2.25-3.38], [unilateral-multifocal: p=0.001, HR=2.04,95%C.I.:1.33-3.14], [unilateral-multicentric: p=0.020, HR=2.13,95%C.I.:1.13-4.01] and [bilateral: p=0.042, HR=2.10,95%C.I.:1.03-4.31]. After stratifying for 100% guideline adherent treatment and adjusting for age, tumor size, nodal status and grading there was no significant difference in RFS/OAS in patients with multifocal [p=0.282/p=0.610], multicentric [p=0.829/p=0.609] or bilateral BC [p=0.457/p=0.773] compared to patients with UU-BC. Conclusions: Patients with multicentric and bilateral BC have primarily a worse prognosis in terms of RFS and OAS. However if guideline adherent adjuvant treatment was applied it was no more possible to demonstrate significant differences in survival.

Mo1901 Long-Term Efficacy and Safety of Thiopurines in Patients With Biologic-Naïve Ulcerative Colitis: A Multicenter Cohort Study

2016 ◽  
Vol 150 (4) ◽  
pp. S811
Author(s):  
Shigeki Bamba ◽  
Minoru Matsuura ◽  
Takuji Kawamura ◽  
Tomohisa Takagi ◽  
Shinji Katsushima ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cohort Study ◽  
Efficacy And Safety ◽  
Multicenter Cohort Study ◽  
Term Efficacy ◽  
Multicenter Cohort

Optimal institution of azathioprine maintenance therapy in autoimmune hepatitis: a multicenter cohort study

2018 ◽  
Vol 68 ◽  
pp. S223-S224
Author(s):  
S. Pape ◽  
T. Gevers ◽  
I. Mustafajev ◽  
F. van den Brand ◽  
K. van Nieuwkerk ◽  
...  
Keyword(s):  
Cohort Study ◽  
Maintenance Therapy ◽  
Autoimmune Hepatitis ◽  
Hepatitis A ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

scholarly journals P261 Predictors and outcomes of ustekinumab dose escalation to every 4 or every 6 weeks in ulcerative colitis: a multicenter cohort study in the United States

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S296-S298
Author(s):  
R Dalal ◽  
S Esckilsen ◽  
E Barnes ◽  
J Pruce ◽  
J Marcus ◽  
...  
Keyword(s):  
United States ◽  
Ulcerative Colitis ◽  
Cohort Study ◽  
Adverse Events ◽  
Dose Escalation ◽  
Clinical Remission ◽  
The United States ◽  
Multicenter Cohort Study ◽  
Loss Of Response ◽  
Multicenter Cohort

Abstract Background Patients with ulcerative colitis (UC) on ustekinumab (UST) therapy may have suboptimal response to standard every 8 week (q8w) dosing. Empiric dose escalation to q4w or q6w is common, but the efficacy of these strategies are unknown in UC. We performed a multicenter cohort study to identify predictors and outcomes of UST dose escalation in UC. Methods This retrospective cohort study included adults initiating UST for UC (ICD-10-CM 51x) at three academic medical centers in the United States 1/1/2016-11/1/2021. Patients with prior colectomy were excluded. Disease activity was assessed using the 9-point Mayo score or simple clinical colitis activity index (SCCAI) in electronic health records. Independent variables included demographics, UC duration, extraintestinal manifestation, medication/substance use history, endoscopic extent/severity, reason for escalation, intravenous (IV) reinduction, dose interval, albumin, C-reactive protein, and bowel frequency. The primary outcome was steroid-free clinical remission (SCCAI/Mayo &lt;3 points) 12–16 weeks after escalation. Secondary outcomes were clinical response (reduction in SCCAI/Mayo by ≥3 points from baseline) at 12–16 weeks and time to escalation. Additional endpoints included endoscopic response, failure within 16 weeks (treatment discontinuation or colectomy), improvement in fecal calprotectin, UC hospitalisation, and adverse events. Multivariable logistic and cox regression were used to identify factors associated with remission and time to escalation, respectively. Results 108 UC patients initiated UST: 91.7% had prior anti-TNF exposure and 57.4% were taking oral steroids (Table 1). 39.6% (40/101 with data) achieved remission 12–16 weeks after induction. 42.6% (46/108) were escalated to q4w (n=33) or q6w (n=13) after median of 95 days (IQR 65–208 days) primarily for no/minimal response to induction (22/46) or loss of response (20/46) (Fig 1A). 55.0% (22/40 with data) achieved remission at 12–16 weeks, 67.5% (27/40) had response, 56.3% (9/16 with data) had endoscopic response (Table 2), and 30.0% (12/40) had treatment failure (Fig 1B). 10.0% (4/40) were hospitalised after median of 80 days and 5.0% (2/40) had adverse events (urinary tract infection and C. difficile infection). After multivariable analysis, lack of response to induction was inversely associated with remission after escalation. Bowel frequency and &gt;2 prior biologics were associated with time to escalation (Table 3). Conclusion UST dose escalation resulted in clinical remission in &gt;50% of UC patients and was more effective in those with loss of response compared to no/minimal response after induction. Prospective studies are needed to identify UC subpopulations that will benefit from various dosing strategies of UST.

Poor prognosis of Candida tropicalis among non-albicans candidemia: a retrospective multicenter cohort study, Korea

2019 ◽  
Vol 95 (2) ◽  
pp. 195-200 ◽  
Author(s):  
Jae-Hoon Ko ◽  
Dong Sik Jung ◽  
Ji Yeon Lee ◽  
Hyun Ah Kim ◽  
Seong Yeol Ryu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Candida Tropicalis ◽  
Poor Prognosis ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

scholarly journals Distribution of ischemic strokes in patients with atrial fibrillation

2019 ◽  
Vol 9 (4) ◽  
pp. 330-336
Author(s):  
Jussi Jaakkola ◽  
Päivi Hartikainen ◽  
Tuomas O. Kiviniemi ◽  
Ilpo Nuotio ◽  
Antti Palomäki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Left Hemisphere ◽  
Relative Frequency ◽  
Multicenter Cohort Study ◽  
Ischemic Lesion ◽  
Multicenter Cohort ◽  
Lesion Localization

BackgroundWe aimed to determine the relative frequency of affected cerebrovascular territories in patients with atrial fibrillation (AF) suffering an ischemic stroke.MethodsAltogether, 1,976 patients who suffered their first-ever ischemic stroke during 2003–2012 and were diagnosed with AF either before or within 30 days after the event were included in this retrospective multicenter cohort study. Strokes were classified radiographically to be located either within the anterior or the posterior cerebrovascular territory, and the effect of the CHA2DS2-VASc score, oral anticoagulant (OAC) use, and timing of AF diagnosis on lesion localization was determined.ResultsThe median age of the patients was 78.4 (interquartile range: 71.7–84.2) years, 1,137 (57.5%) of them were women, their mean CHA2DS2-VASc score was 3.5 (95% confidence interval: 3.4–3.5), 656 (33.2%) were receiving OAC drugs, and altogether, 1,450 (73%) had a previous AF diagnosis. The localization of ischemic lesions between the anterior and the posterior cerebrovascular territories was not affected by the timing of AF diagnosis (p = 0.46), use of OACs (p = 0.70), or the CHA2DS2-VASc score (p = 0.10). Within the anterior territory, altogether 774 strokes (53.2%) were located in the left hemisphere and 3 (0.2%) were bilateral. The timing of AF diagnosis (p = 0.84), use of OACs (p = 0.90), or the CHA2DS2-VASc score (p = 0.21) did not affect the location of the ischemic lesion between the hemispheres.ConclusionsThe timing of AF diagnosis, use of OAC drugs, or the CHA2DS2-VASc score did not affect the distribution of ischemic strokes. Anterior territory strokes were slightly more often located within the left hemisphere.

Treatment-Relevant Findings in Transesophageal Echocardiography After Stroke: A Prospective Multicenter Cohort Study

Stroke ◽  
2021 ◽  
Author(s):  
Götz Thomalla ◽  
Mira Upneja ◽  
Stephan Camen ◽  
Märit Jensen ◽  
Julian Schröder ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Transesophageal Echocardiography ◽  
Diagnostic Yield ◽  
Current Evidence ◽  
Cardiac Ultrasound ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Significant Difference

Background and Purpose: Cardiac ultrasound to identify sources of cardioembolism is part of the diagnostic workup of acute ischemic stroke. Recommendations on whether transesophageal echocardiography (TEE) should be performed in addition to transthoracic echocardiography (TTE) are controversial. We aimed to determine the incremental diagnostic yield of TEE in addition to TTE in patients with acute ischemic stroke with undetermined cause. Methods: In a prospective, observational, pragmatic multicenter cohort study, patients with acute ischemic stroke or transient ischemic attack with undetermined cause before cardiac ultrasound were studied by TTE and TEE. The primary outcome was the rate of treatment-relevant findings in TTE and TEE as defined by a panel of experts based on current evidence. Further outcomes included the rate of changes in the assessment of stroke cause after TEE. Results: Between July 1, 2017, and June 30, 2019, we enrolled 494 patients, of whom 492 (99.6%) received TTE and 454 (91.9%) received TEE. Mean age was 64.7 years, and 204 (41.3%) were women. TEE showed a higher rate of treatment-relevant findings than TTE (86 [18.9%] versus 64 [14.1%], P <0.001). TEE in addition to TTE resulted in 29 (6.4%) additional patients with treatment-relevant findings. Among 191 patients ≤60 years additional treatment-relevant findings by TEE were observed in 27 (14.1%) patients. Classification of stroke cause changed after TEE in 52 of 453 patients (11.5%), resulting in a significant difference in the distribution of stroke cause before and after TEE ( P <0.001). Conclusions: In patients with undetermined cause of stroke, TEE yielded a higher number of treatment-relevant findings than TTE. TEE appears especially useful in younger patients with stroke, with treatment-relevant findings in one out of seven patients ≤60 years. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03411642.

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