scholarly journals TNF inhibitors in Crohn’s disease and the effect on surgery rates

2021 ◽  
Author(s):  
M Eberhardson ◽  
P Myrelid ◽  
J K Söderling ◽  
A Ekbom ◽  
Å H Everhov ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Tnf Inhibitors ◽  
Surgery Rates

scholarly journals Endoscopic stricturotomy and ileo-colonic resection in patients with primary Crohn’s disease-related distal ileum strictures

2020 ◽  
Vol 8 (4) ◽  
pp. 312-318
Author(s):  
Nan Lan ◽  
Tracy L Hull ◽  
Bo Shen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Distal Ileum ◽  
Colonic Resection ◽  
Free Survival ◽  
Anastomotic Strictures ◽  
Procedural Complications ◽  
Inflammatory Bowel ◽  
Surgery Rates

Abstract Background Stricture is a common presentation of Crohn’s disease with the site of prevalence being the distal ileum. This study aimed to compare the efficacy and safety of patients with primary distal ileum stricture treated with endoscopic stricturotomy (ESt) vs ileo-colonic resection (ICR). Methods All consecutive patients with primary distal ileum stricture that were treated with ESt and/or ICR were extracted from the interventional inflammatory bowel disease (i-IBD) unit from 2001 to 2016. All patients with a stricture >5 cm or those with anastomotic strictures were excluded from the study. The primary outcomes were surgery-free survival and post-procedural complications. Results A total of 13 patients receiving ESt and 32 patients receiving ICR were included in this study. Although the length of the stricture is comparable between the two groups (2.4 ± 0.9 vs 3.0 ± 1.1 cm, P = 0.17), patients who received surgery had a more complicated obstruction presented by the high pre-stenosis proximal dilation rate (67.7% vs 9.1%, P = 0.001). All patients in both groups achieved immediate technical success after treatment. The median follow-up durations were 1.8 and 1.5 years in the ESt and ICR groups, respectively. The subsequent surgery rates were similar between the two groups (15.4% vs 18.8%, P = 0.79) and the overall surgery-free survival was also comparable between the two groups (P = 0.98). Post-procedural adverse events were seen in 2/29 ESt procedures (6.9% per procedure) and 8/32 (25.0%) patients receiving ICR (P = 0.05). Conclusions ESt achieved comparable stricture-related surgery-free survival as ICR, while ESt had a numerically lower post-operative complication rate.

Tumor necrosis factor inhibitors and acute leukemia in two cases.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18010-e18010
Author(s):  
Mehmet Ozen ◽  
Onur Keskin ◽  
Orhan Kucuksahin ◽  
Ufuk Ilgen ◽  
Pervin Topcuoglu ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Tumor Necrosis Factor ◽  
Crohn's Disease ◽  
Acute Leukemia ◽  
Natural Killer ◽  
Solid Tumors ◽  
Tumor Necrosis ◽  
Tnf Inhibitors ◽  
Killer Activity ◽  
Necrosis Factor

e18010 Background: Inhibitors of tumor necrosis factor alpha (anti-TNF agents) are commonly used in Crohn’s disease and rheumatoid arthritis. Relationship between TNF inhibitors and development of malignancy, e.g., lymphoma and solid tumors, is defined recently. However, a few authors reported leukemia. Crohn’s disease and also azothioprine may also be associated with leukemia. Here, we are presenting two acute myeloid leukemia (AML) cases using azothioprine and anti-TNF inhibitors for Crohn’s disease. Methods: Observational case report. Results: Case 1: A 56-year-old male patient with active Crohn’s disease for 4 years was refractory to first line mesalazine, corticosteroid and azothioprine treatment. So, anti-TNF monoclonal antibody (moAb) (Adalimumab) had been given. After second dose of adalimumab treatment AML (AML-M2 as FAB) developed. Case 2: A 38-year-old male had been diagnosed with ankylosing spondylitis for 7 years and Crohn’s disease for 2 years. He had been treated with salazopyrin and indomethacin. Anti-TNF etanercept (50 mg/wk) was started 30 months ago due to severe active pulmonary disease. After 1 year, he developed active Crohn’s disease. So, the treatment changed to infliximab. Also, mesalazine and azothioprine were added to treatment. On the 18th month of the infliximab t(15;17) positive acute promyelocytic leukemia were developed in the patient. Conclusions: Blocking TNF with anti TNF agents may cause blocking apoptosis and inhibit natural killer activity. So, antitumoral activity of natural killer cells is blocked by these agents. TNF alpha gene mutation has been associated with CLL, lymphoma, myelodysplastic syndrome and secondary AML. Azothioprine may also increase leukemia, lymphoma and solid tumors risk at patient on anti TNF treatment. Following the diagnosis of Crohn’s disease without immunomodulator treatment a case had developed acute leukemia in the literature. In our patients, anti-TNF, azothioprine and inflammatory bowel disease may be cause acute leukemia cumulatively. Physicians should be careful and regularly check the patients using anti-TNF agents in considering of malignancy development. In conclusion, the pathogenesis of leukemia development after TNF blockage should be clarified.

Tu1726 – The Impact of Early Disease Control with Vedolizumab on Surgery Rates Among Patients with Crohn's Disease: A Post Hoc Analysis of the Gemini Trials

2019 ◽  
Vol 156 (6) ◽  
pp. S-1100
Author(s):  
Parambir S. Dulai ◽  
Laurent Peyrin-Biroulet ◽  
Kristen Hahn ◽  
Natasha Khalife ◽  
Dirk Lindner ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Control ◽  
Early Disease ◽  
Post Hoc Analysis ◽  
Surgery Rates ◽  
Post Hoc ◽  
The Impact

scholarly journals Clinical Practice of Adalimumab and Infliximab Biosimilar Treatment in Adult Patients With Crohn’s Disease

2020 ◽  
Vol 27 (1) ◽  
pp. 106-122
Author(s):  
Walter Reinisch ◽  
Krisztina Gecse ◽  
Jonas Halfvarson ◽  
Peter M Irving ◽  
Jørgen Jahnsen ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Symptomatic Relief ◽  
Certolizumab Pegol ◽  
Tnf Inhibitors ◽  
Treatment Algorithms ◽  
Monitoring Tools ◽  
Clinical Scenarios ◽  
Endoscopic Remission ◽  
Evidence Based Guidelines

Abstract The introduction of tumor necrosis factor (TNF) inhibitors has significantly changed the treatment landscape in Crohn’s disease (CD). The overall therapeutic achievements with TNF inhibitors such as infliximab, adalimumab, and certolizumab pegol paved the way to push the boundaries of treatment goals beyond symptomatic relief and toward cessation of objective signs of inflammation, including endoscopic remission. Even though these agents are widely used for the treatment of moderate to severe CD, heterogeneity still exists in translating evidence-based guidelines on the use of anti-TNF agents into actual treatment algorithms in CD. This might be due to several reasons including disparities in health expenditure policies; lack of harmonization between countries; and variations in assessment of disease severity, use of disease monitoring tools, or application of treatment targets by physicians. With the advent of biosimilars, patent-free versions of reference biologics are now available to minimize health inequalities in drug availability. In this context, this article aims to provide practical clinical guidance for the use of infliximab and adalimumab biosimilars in patients with moderate to severe CD by outlining different clinical scenarios that patients may encounter during their treatment journey.

scholarly journals DOP070 Endoscopic response to induction therapy with TNF inhibitors is the best predictor of long term mucosal healing in Crohn's disease

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S67-S68
Author(s):  
I. Alfaro ◽  
M. Masamunt ◽  
N. Planell ◽  
A. Lόpez-García ◽  
J. Castro ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Induction Therapy ◽  
Mucosal Healing ◽  
Tnf Inhibitors

scholarly journals New Onset, Aggravation and Recurrence of Crohn's Disease upon Treatment with Three Different Tumor Necrosis Factor Inhibitors

2015 ◽  
Vol 9 (1) ◽  
pp. 106-112 ◽  
Author(s):  
Jonas Zeitz ◽  
Susann Enderlin ◽  
Luc Biedermann ◽  
Matthias Turina ◽  
Sebastian Leibl ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Tumor Necrosis Factor ◽  
Crohn's Disease ◽  
Tumor Necrosis ◽  
Tnf Inhibitors ◽  
Etanercept Treatment ◽  
Abdominal Symptoms ◽  
Long Term Treatment ◽  
Tnf Inhibition ◽  
Necrosis Factor

Tumor necrosis factor (TNF) is a major cytokine in the pathogenesis of inflammatory bowel disease (IBD), and TNF inhibition is a cornerstone of contemporary IBD therapy. However, paradoxical induction of IBD has recently been reported upon treatment of rheumatologic disorders with TNF inhibitors. In previous cases, induction of IBD was associated with one single drug and IBD was successfully managed by switching TNF inhibitors. We report the case of a patient with juvenile rheumatoid arthritis under long-term treatment with etanercept. After switching TNF inhibition to adalimumab, symptoms of Crohn's disease (CD) occurred and the diagnosis of CD was established by endoscopy. Further treatment with adalimumab and subsequently infliximab aggravated the abdominal symptoms, necessitating ileocecal resection, after which symptoms resolved for several months. Etanercept treatment due to recurrent rheumatologic symptoms was followed by recurrent CD symptoms and findings, which resolved upon discontinuation of etanercept. This case suggests that induction, aggravation and recurrence of IBD can be rare class effects of TNF inhibition.

scholarly journals Probability of Stoma in Incident Patients With Crohn’s Disease in Sweden 2003-2019: A Population-based Study

2021 ◽  
Author(s):  
Åsa H Everhov ◽  
Thordis Disa Kalman ◽  
Jonas Söderling ◽  
Caroline Nordenvall ◽  
Jonas Halfvarson ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Cumulative Incidence ◽  
Disease Diagnosis ◽  
Population Based ◽  
Population Based Study ◽  
Stoma Formation ◽  
Elderly Onset ◽  
Surgery Rates

Abstract Background Surgery rates in patients with Crohn’s disease have decreased during the last few decades, and use of antitumor necrosis agents (anti-TNF) has increased. Whether these changes correlate with a decreased probability of stoma is unknown. The objective of this study was to investigate the incidence of stoma in patients with Crohn’s disease over time. Methods Through linkage of national registers, we identified patients who were diagnosed with Crohn’s disease in 2003–2014 and were followed through 2019. We compared formation and closure of stomas over the calendar periods of diagnosis (2003–2006, 2007–2010, and 2011–2014). Results In a nationwide cohort of 18,815 incident patients with a minimum 5 years of follow-up, 652 (3.5%) underwent formation of a stoma. This was mostly performed in conjunction with ileocolic resection (39%). The 5-year cumulative incidence of stoma formation was 2.5%, with no differences between calendar periods (P = .61). Less than half of the patients (44%) had their stoma reversed. Stomas were more common in elderly-onset compared with pediatric-onset disease: 5-year cumulative incidence 3.6% vs 1.3%. Ileostomies were most common (64%), and 24.5% of the patients who underwent stoma surgery had perianal disease at end of follow-up. Within 5 years of diagnosis, 0.8% of the incident patients had a permanent stoma, and 0.05% had undergone proctectomy. The time from diagnosis to start of anti-TNF treatment decreased over calendar periods (P < .001). Conclusions Despite increasing use of anti-TNF and a low rate of proctectomy, the cumulative incidence of stoma formation within 5 years of Crohn’s disease diagnosis has not decreased from 2003 to 2019.

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