scholarly journals SAT0394 CAN FECAL CALPROTECTIN PREDICT FUTURE DEVELOPMENT OF INFLAMMATORY BOWEL DISEASE IN AXIAL SPONDYLOARTHRITIS PATIENTS? – TREASURE REAL-LIFE DATA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1146-1147
Author(s):  
G. K. Yardimci ◽  
O. C. İçaçan ◽  
G. Kabadayi ◽  
B. Farisoğullari ◽  
B. Armagan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Future Development ◽  
Bowel Disease ◽  
Fecal Calprotectin ◽  
Occurrence Rate ◽  
First Year ◽  
Calprotectin Level ◽  
Inflammatory Bowel

Background:Patients with active inflammatory bowel diseases (IBD) fecal calprotectin (FC) levels are high and FC can be used for diagnosis [1].Objectives:This study aimed to investigate whether fecal calprotectin levels could predict future development of IBD in axSpA patients.Methods:This study was practiced in three centers using TReasure database and that are able to measure FC. Fecal calprotectin levels were measured in 137 axSpA patients as of September 2018 and FC level ≥200 µg/g was considered significant. All study subjects were evaluated for IBD symptoms (loose defecation, mucous diarrhea, bloody defecation, bloody diarrhea, abdominal pain, obstruction, or pseudo-obstruction) at beginning of the study and every 3 months for the first year. 25 RA patients and 24 healthy volunteers were included as a control group. Disease activity was evaluated by the ASDAS CRP, BASDAI,BASFI, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS)-pain, VAS-fatigue, and tender and swollen joint count for axSpA patients.Results:This study included 137 axSpA patients and all patients followed for 1 year. Of the 137 axSpA patients 33.6% were females and median (Q1-Q3) age was of 43 years (33-50 years), median (Q1-Q3) disease duration was 8.9 years (5.0-13.9 years). The median (Q1-Q3) fecal calprotectin level was 48 µg/g (30-122 µg/g) and FC level was ≥200 µg/g in 23/137 (16.8%) in axSpA patients. FC level was elevated in 15/24 (62.5%) RA patients and none of the healthy volunteers. Patients median (Q1-Q3) BASDAI was 2.2 (1.0-3.6) / 1.4 (0.4-2.2), median (Q1-Q3) BASFI 1.55 (0.4-3.4) / 1.5 (0.3-3.0) and median (Q1-Q3) ASDAS CRP 1.63 (1.3-2.2) / 1.5 (1.3-1.9) at baseline and first year respectively and there was no difference regarding fecal calprotectin level. In 1 year follow-up 9 (6.5%) patient had abdominal pain, 2 (1.4%) had bloody defecation, 1 (0.7%) had loose defecation and Crohn disease developed in an axSpA patient with high FC (266 µg/g) (Table 1). IBD occurrence rate was 0.73/100 patient-year for all SpA patients, and IBD occurrence rate was 4.34/100 patients year for SpA patients with ≥200 µg/g FC level.Table 1.IBD symptom inquiry and development of IBD in the first yearn (%)Loose defecation1 (0.73)Mucous diarrhea0Bloody defecation2 (1.45)Bloody diarrhea0Abdominal pain9 (6.56)Obstruction0Pseudo-obstruction0Inflammatory bowel disease1 (0.73)Conclusion:In one year follow-up, IBD occurrence rate was 0.73/100 patient-year, at a similar rate with DESIR cohort [2]. However, FC level may be a predictor for the development of IBD in SpA patients (occurrence rate 4.34/100 patients year). Further follow up duration and more patients may be needed to make conclusion in these field.References:[1]Simioni, J., et al.,Fecal Calprotectin, Gut Inflammation and Spondyloarthritis.Arch Med Res, 2019.50(1): p. 41-46.[2]Wendling, D., et al.,Effect of Gut Involvement in Patients with High Probability of Early Spondyloarthritis: Data from the DESIR Cohort.J Rheumatol, 2019.Disclosure of Interests:Gözde Kübra Yardimci: None declared, Ozan Cemal İçaçan: None declared, Gokhan Kabadayi: None declared, Bayram Farisoğullari: None declared, Berkan Armagan: None declared, Cemal Bes: None declared, Servet Akar: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

scholarly journals P533 Adalimumab 80mg every other week in inflammatory bowel disease: Treatment intensification outcomes in real life clinical practice

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S507-S509
Author(s):  
M I Calvo Moya ◽  
I Omella Usieto ◽  
I El Hajra Martinez ◽  
E Santos Perez ◽  
Y Gonzalez Lama ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clinical Practice ◽  
Bowel Disease ◽  
Smoking Habit ◽  
Real Life ◽  
Fecal Calprotectin ◽  
Treatment Intensification ◽  
Loss Of Response ◽  
Inflammatory Bowel

Abstract Background Adalimumab (ADA) intensification is recommended for inadequate or loss of response in inflammatory bowel disease (IBD) patients. A new presentation of ADA 80mg administered every other week (eow) has been approved as an alternative to ADA 40mg every week (ew). Data regarding impact of ADA 80mg eow in clinical practice is still scarce. The aim of this study was to assess long-term durability, safety and cost-effectiveness of treatment with ADA 80mg eow in patients with IBD. Methods A retrospective cohort study in a tertiary hospital that included all IBD patients under intensified maintenance therapy with ADA 80mg eow was performed. Durability was calculated considering the time from the first dose to treatment withdrawn or to the end of follow-up. Biological remission (BR) was defined as CR together with fecal calprotectin (FC) <250µg/g and C-reactive protein (CRP) <5mg/dl. Economic impact of ADA 80mg eow was estimated considering current price of both ADA 40mg and ADA 80mg pens at our centre. Results Sixty-three patients (52 CD and 11 CU) were included; median age 47 (IQR 39–59), 54% male; median duration of the disease before ADA of 11 years (IQR 6–20); 30% were active smokers. Among CD patients, 56% had ileal disease, 17% colonic and 27% ileocolonic. The inflammatory behavior was the most frequent (52%) and 31% had perianal disease. In UC, 55% had extensive colitis. 44 patients (70%) were bio-naïve and 36 (57%) received immunosuppressants at baseline. At the time of escalation, 48 patients (76%) were symptomatic. After intensification, 52 (83%) patients (CD 42 and UC 10) achieved CR and 46 (73%) BR. The changes in the levels of FC, CRP and ADA were significant (p <0.001) (Graphs 1–3). 22 patients (35%) discontinued treatment after a median of 6.5 (IQR 5–10) months due to: 11 no clinical response (50%), 4 loss of response (18%), 3 adverse events (14%) (psoriasis) and 4 endoscopic progression (18%). 44 patients (70%) remained under treatment and in CR (median follow-up 17 months, IQR 13–24) (Graph 4) and with a median ADA levels of 10.46 mg/l (IQR 7.34–15.25). Use of ADA 80 eow regimen saved 223500€ in patients who maintained treatment. In the multivariate analysis, being in CR when intensifying reduced the risk of treatment discontinuation by 87% (HR 0.13, 95%CI 0.02–0.99; p<0.001), having reached BR by 99.5% (HR 0.05, 95%CI 0.02–0.14; p <0.001) and having ADA levels ≥5 mg/l after intensification by 68% (HR 0.32, 95%CI 0.13–0.75; p = 0.02). Smoking habit was associated with treatment withdrawn (HR 1.74, 95%CI 1.02–2.96; p=0.04). Conclusion ADA intensification to 80mg eow in IBD patients is safe, effective and may reduce costs in real life clinical practice. Early intensification, even in CR, may enhance ADA treatment durability.

scholarly journals A191 TEN YEARS FOLLOW UP OF EARLY ONSET INFLAMMATORY BOWEL DISEASE PATIENTS- A SINGLE CENTER RETROSPECTIVE COHORT STUDY

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 207-209
Author(s):  
A Eindor ◽  
L Meleady ◽  
L Alam ◽  
K Gena ◽  
Z Hamilton ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Early Onset ◽  
First Year ◽  
Biologic Treatment ◽  
Disease Characteristics ◽  
Inflammatory Bowel ◽  
Disease Location ◽  
Pediatric Ibd

Abstract Background Early onset inflammatory bowel disease (EOIBD) and Very early onset inflammatory bowel disease (VEOIBD) prevalence has been increasing over the last decades. These young patients have been known to have special disease characteristics and disease location. Although it is known that only a low percentage of these patients require biologic treatment after diagnosis, there is only scarce evidence about their long- term outcome and biologic requirements. Aims To assess the ten year outcome of early onset and very early onset IBD patients. Methods We retrospectively reviewed IBD patients diagnosed under 10 years of age, between January 2005 and December 2009, from the British Columbia (BC) Pediatric IBD database. Disease characteristics and symptoms at diagnosis were documented. The disease location and severity at diagnosis were documented according to the Paris classification. Data collected retrospectively included a ten year treatment follow up period, number of hospitalizations, corticosteroid courses and surgeries. These parameters were documented at three time points: after the first year, after five years and ten years. Results 68 patients under the age of 10 were diagnosed with IBD during the study period. 2 patients failed to meet inclusion criteria and were excluded. Median age at diagnosis was 6.06 (IQR 4.5–8.6). 47.7% of patients had Crohn’s disease and 71.2% were males. 63 patients completed the 5 year follow up, and 52 the 10-year period due to lack of follow up or transfer to adult care. After the first year of follow up 0% patients in the VEOIBD group and 5% patients in the EOIBD group were treated with biologic treatment, whereas after the 10-year period 42.3% and 29.6% of patients were treated with biologic therapy respectively (p=0.282). Overall, 4 patients underwent colectomy and 2 a small bowel resection. Conclusions Although the percentage of VEIBD and EOIBD patients receiving biologic treatment after ten years is higher than after the first year, it is still lower than what is reported in the literature in older pediatric IBD patients and adults. Funding Agencies None

scholarly journals Azathioprine in the maintainance remission in inflammatory bowel disease patients: 7-year follow up

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Cassieri ◽  
A M Mastromatteo ◽  
R Pica ◽  
M Zippi ◽  
E S Corazziari ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Bowel Disease ◽  
First Year ◽  
Loss Of Response ◽  
Steroid Dependent ◽  
Treatment Data ◽  
Inflammatory Bowel ◽  
Maintenance Of Remission

Abstract Background Azathioprine (AZA) and thiopurine are widely used for induction and maintenance of remission in steroid dependent patients with inflammatory bowel disease (IBD). Methods Aim of this study has been to investigate its efficacy and safety in maintaining steroid-free remission in steroid dependent IBD patients seven year after the institution of treatment. Data from consecutive IBD outpatients referred in our Institution, between 1985-2016, were reviewed and all patients treated with AZA were included in this retrospective study. AZA was administered at the recommended dose of 2-2.5 mg/kg. Results Out of 2802 consecutive IBD outpatients visited in the index period, AZA was prescribed to 433 patients, 236 (54.5%) were affected by Crohn's disease (CD) and 197 (45.5%) by ulcerative colitis (UC). One hundred and seventy-nine patients with a follow-up < 84 months were excluded from the study. Two hundred and fifty-four patients were evaluated, 141 (55.5%) with CD and 113 (44.5%) with UC. One hundred and thirty-nine (54.7%) were male and 115 (45.3%) female (average age of 35.62 ± 14.20 SD years, range 14-74 y.). Seven year after the institution of treatment, 127 (50%) patients still were in steroid-free remission (83 CD vs 44 UC, 58.8% and 38.9%, respectively, p = 0.0024), 71 (27.9%) had a relapse requiring retreatment with steroids (29 CD vs 42 UC, 20.6% and 37.2%, respectively, p = 0.0047), 56 (22.1%) discontinued the treatment due to side effects (29 CD vs 27 UC, 20.6% and 23.9%, respectively). Loss of response from 1st to 7th year of follow-up was low, about 20%. Conclusions Seven year after the onset of treatment 50% of patients did not require further steroid courses. After the first year loss of response was low in six subsequent years. In the present series the maintenance of steroid-free remission was significantly higher in CD than in UC patients. The occurrence of side effects leading to the withdrawal of AZA treatment has been low. Key messages An important therapeutic moment of IBD is mantaining remission in steroid dipendent patients. AZA can be a viable and inexpensive alternative to treath these patients.

scholarly journals Bone Loss Prevention of Bisphosphonates in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Yan Hu ◽  
Xiaoting Chen ◽  
Xiaojing Chen ◽  
Shuang Zhang ◽  
Tianyan Jiang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bone Loss ◽  
Adverse Events ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Occurrence Rate ◽  
Mineral Density ◽  
Significant Difference ◽  
Inflammatory Bowel

Objective. The purpose of this study was to evaluate the effect of bisphosphonates in improving bone mineral density (BMD) and decreasing the occurrence rate of fractures and adverse events in patients with inflammatory bowel disease (IBD). Methods. Randomized controlled trials (RCTs) which use bisphosphonates in IBD patients were identified in PubMed, MEDLINE database, EMBASE database, Web of Knowledge, and the Cochrane Databases between 1990 and June 2016. People received bisphosphonate or placebos with a follow-up of at least one year were also considered. STATA 12.0 software was used for the meta-analysis. Results. Eleven randomized clinical trials were included in the meta-analysis. The data indicated that the percentage change in the increased BMD in the bisphosphonates groups was superior to that of the control groups at the lumbar spine and total hip. At the femoral neck, there was no significant difference between the two groups. The incidence of new fractures during follow-up showed significant reduction. The adverse event analysis revealed no significant difference between the two groups. Conclusion. Our results demonstrate that bisphosphonates therapy has an effect on bone loss in patients with IBD but show no evident efficiency at increasing the incidence of adverse events.

scholarly journals Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study

2020 ◽  
Vol 14 (7) ◽  
pp. 896-903 ◽  
Author(s):  
Antoine Martin ◽  
Maria Nachury ◽  
Laurent Peyrin-Biroulet ◽  
Yoram Bouhnik ◽  
Stephane Nancey ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Clinical Remission ◽  
First Year ◽  
Reactive Protein ◽  
Infusion Reactions ◽  
Inflammatory Bowel ◽  
Maintenance Of Remission ◽  
Risk Of Relapse

Abstract Background and Aim It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. Methods This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. Results A total of 95 patients [58 with Crohn’s disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6–25.4] months. After a median follow-up period of 11.2 [5.8–17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33–0.95], p = 0.03) and discontinuation due to patients’ elective choice (HR = 0.41, 95% CI [0.21–0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4–13.3] months, respectively, without any infusion reactions. Conclusions In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.

scholarly journals Fecal Calprotectin Use in Inflammatory Bowel Disease and Beyond: A Mini-Review

2015 ◽  
Vol 29 (3) ◽  
pp. 157-163 ◽  
Author(s):  
Bashaar Alibrahim ◽  
Mohammed I Aljasser ◽  
Baljinder Salh
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Intestinal Tract ◽  
Fecal Calprotectin ◽  
Response To Treatment ◽  
Gastrointestinal Disorders ◽  
Disease Relapse ◽  
Inflammatory Bowel ◽  
Irritable Bowel

Given the number of inflammatory disorders affecting the gastrointestinal tract directly and indirectly, coupled with the considerable overlap with functional disorders, it is evident that more useful noninvasive diagnostic tests are required to aid with diagnosis. If these tests can also have some utility for individual patient follow-up in terms of disease activity and response to treatment, as well as providing forewarning of disease relapse, it would be extremely useful information for the clinician. One recently described test that may fulfill several of these attributes is based on leakage of a mononuclear cell cytoplasmic protein, calprotectin, along the intestinal tract, which can then be quantified in feces. This has been used to distinguish patients exhibiting symptoms of irritable bowel syndrome from patients with inflammatory bowel disease, with a measure of success greater than with currently used techniques. The present article summarizes the experience with this test used in inflammatory bowel disease, as well as a variety of gastrointestinal disorders.

scholarly journals P276 Influence of vedolizumab on extraintestinal manifestations in Inflammatory Bowel Disease: a nationwide multicenter study of the GETECCU Eneida registry

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S308-S309
Author(s):  
P Pérez Galindo ◽  
J P Gisbert ◽  
M Carrillo-Palau ◽  
F Bertoletti ◽  
M González-Vivó ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
De Novo ◽  
First Year ◽  
Extraintestinal Manifestations ◽  
Associated Factor ◽  
Baseline Response ◽  
Inflammatory Bowel ◽  
Biologic Drug

Abstract Background Evidence regarding vedolizumab (VDZ) influence on extraintestinal manifestations (EIMs) in inflammatory bowel disease patients (IBD) is scarce. Our aim was to analyze the effectiveness of VDZ in pre-existing EIMs and the occurrence of de novo EIMs during VDZ therapy in IBD. Methods We performed an observational, multicenter, retrospective cohort study including patients from the Spanish ENEIDA registry promoted by GETECCU. We retrospectively identified 551 patients from 20 centers. The co-primary outcomes were to evaluate the response of EIMs to VDZ and to assess the frequency of de novo EIMs during therapy. Secondary outcomes were to analyze associated factors with EIMs response to VDZ, time from VDZ initiation to occurrence of de novo EIMs and the discontinuation rate of VDZ because of worsening/de novo EIMs. Response and worsening of IBD and EIMs were defined by clinical and laboratory criteria according to the physician’s assessment. Results The median age of the cohort was 49.7 years (IQR 38-60), 50.8% were female, 50.8% had Crohn’s disease and 90.4% had prior biologic exposure (more than 1 biologic drug in 57.9%). At baseline 133 patients (24.1%) had pre-existing EIMs of whom 21 showed more than 1 EIM; 76.7% of EIMs were articular and 31% cutaneous. Regarding 77 patients with active EIMs at baseline, response of EIMs to VDZ at 3 months was observed in 23 (29.9%), worsening in 13 (16.9%) and no change in 41 (53.2%). Response rates for active EIMs were 35.4% for peripheral arthritis (PA), 11.8% for axial arthropathy (AA), 35.7% for cutaneous EIMs and 33.3% for ocular EIMs. Response of IBD at 3 months was the only associated factor with response of EIMs to VDZ (OR=3.72; CI 95% [1.08-12.83]). Among 56 patients with inactive EIMs at baseline, worsening of EIMs was observed in 5 patients after 12 months of VDZ therapy (13.5%) (3 cases of PA and 2 of AA). During follow-up 25 patients (4.5%) developed 27 de novo EIMs (17 cases of PA, 4 of AA, 4 of erythema nodosum, 1 of pyoderma gangrenosum and 1 of episcleritis). Median time from VDZ initiation to onset of de novo EIMs was 244 days (IQR 115-693). Presence of more than 1 pre-existing EIM was the only associated factor with de novo EIM onset during first year of VDZ therapy (OR=14.5; 95% CI [3.3-62]). Worsening of pre-existing EIMs or de novo EIMs was the cause of VDZ discontinuation in 15 patients (5.8% of all patients who discontinued VDZ). Conclusion VDZ achieved clinical response of active EIMs in nearly a third of patients after 3 months of therapy, being the response of IBD to VDZ the only associated factor. Worsening of inactive EIMs or de novo EIMs during VDZ therapy was infrequent.

scholarly journals Frequency of inflammatory bowel diseases in patients with ankylosing spondylitis

2020 ◽  
Vol 2 (37) ◽  
pp. 12-15
Author(s):  
G. V. Lukina ◽  
P. I. Kulakova ◽  
A. A. Novikov ◽  
N. A. Savenkova ◽  
E. A. Alexandrova ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Bowel Disease ◽  
Fecal Calprotectin ◽  
High Disease Activity ◽  
Calprotectin Level ◽  
Inflammatory Bowel

Background. Аnkylosing spondylitis (AS) is closely associated with inflammatory bowel disease (IBD). 5–10 % of patients with SpA eventually develop inflammatory bowel disease, with Crohn's disease being more common than ulcerative colitis. Colonoscopy is usually used to diagnose inflammatory bowel disease, but this procedure is invasive. FC is clinically used to detect IBD and correlates well with clinical, endoscopic, and histological indicators of disease activity in IBD.The aim. To evaluate the incidence of inflammatory bowel disease in patients with ankylosing spondylitis.Materials and methods. In the analysis were included 40 patients with ankylosing spondylitis, among them 26 (65.0 %) men, and 14 (35.0 %) women, the average age of patients was 41.2 ± 10.5, the duration of the disease was on average 13.0 ± 8.8 years. All patients were examined with ESR, CRP, esophagogastroduodenoscopy, colonoscopy and quantitative analysis of the fecal calprotectin levels using the method of lateral immunochromatography with the BUHLMANN Quantum Blue rapid test. Standart range: 100–1,800 µg/g.Results. All patients had a high disease activity, the average BASDAI was 5.2 ± 1.7, the average ASDAS CRP 3.8 ± 1.1. 35 (87.5 %) patients had calprotectin level more than 100 µg/g, the remaining 5 (12.5 %) patients less than 100 µg/g. 12 (30.0 %) patients had the calprotectin level more than 1,800 µg/g, 23 (57.5 %) from 101 to 1800 µg/g. All patients with FC levels more than 100 µg/g showed an increase CRP level (mean 28.4 mg/l) and ESR (mean 36.3 mm/h). IBD were diagnosed in 9 (22.5 %) cases: 5 (12.5 %) patients with Crohn's disease and 4 (10 %) patients with ulcerative colitis, in the remaining (77.5 %) cases there was no intestinal pathology.Conclusion. The results showed high frequency of IBD in patients with AS. Patients with high fecal calprotectin levels (more than 100 μg/g) had high disease activity (AS). In most cases, inflammatory bowel disease were diagnosed in patients AS with fecal calprotectin levels more than 100 µg/g.

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