scholarly journals Effectiveness of vedolizumab dose intensification to achieve inflammatory bowel disease control in cases of suboptimal response

2019 ◽  
Vol 11 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Mark A Samaan ◽  
Siddharth Birdi ◽  
Maria Sierra Morales ◽  
Sailish Honap ◽  
Aravind Gokul Tamilarasan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Activity Index ◽  
Univariate Analysis ◽  
C Reactive Protein ◽  
Dose Intensification ◽  
Reactive Protein ◽  
Predictors Of Response ◽  
Proven Efficacy ◽  
Inflammatory Bowel

BackgroundDespite the proven efficacy of vedolizumab (VDZ) for ulcerative colitis (UC) and Crohn’s disease (CD), suboptimal response is commonly encountered. However, data regarding the effectiveness of dose intensification (by interval shortening) to achieve response are limited.ObjectivesWe evaluated the effectiveness of dose intensification at achieving response in patients with a previously suboptimal response to VDZ. Additionally, we aimed to identify predictors of response to this strategy.MethodsWe performed a retrospective cohort study of patients who underwent VDZ dose intensification for suboptimal response. Clinical disease activity was evaluated at the point of dose intensification (baseline) and at weeks 12 and 24. Response was defined as Harvey-Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI) reduction of ≥3, and remission as HBI <5 or SCCAI <3.ResultsA total of 36 patients received dose intensification to 4-weekly infusions: 18 CD, 14 UC and 4 inflammatory bowel disease-unclassified (analysed in the UC group). Median SCCAI scores fell from 6 (range 0–11) at baseline to 4 (0–6, p=0.008) at week 24, while HBI scores did not change significantly (4 (0–27) and 3 (0–8), p=0.092). Overall median C reactive protein (CRP) fell from 6 mg/L (1–23) to 2 mg/L (1–17, p=0.011). Of 20 patients with clinically active disease at baseline, 10 (50%) responded, of whom 4 (20%) achieved remission at week 24. Univariate analysis demonstrated low baseline CRP (p=0.045) and response at week 12 (0.020) were associated with week 24 response.ConclusionsOur findings demonstrate VDZ dose intensification to be effective at achieving clinical response in half of patients. Low baseline CRP and response at week 12 are potential predictors of week 24 response.

scholarly journals Predictors and Management of Loss of Response to Vedolizumab in Inflammatory Bowel Disease

2018 ◽  
Vol 24 (11) ◽  
pp. 2461-2467 ◽  
Author(s):  
Eugenia Shmidt ◽  
Gursimran Kochhar ◽  
Justin Hartke ◽  
Prianka Chilukuri ◽  
Joseph Meserve ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Bowel Disease ◽  
C Reactive Protein ◽  
Dose Intensification ◽  
Reactive Protein ◽  
Loss Of Response ◽  
Increased Risk ◽  
Tnf Antagonist ◽  
Inflammatory Bowel

Abstract Background We quantified loss of response (LOR) to vedolizumab (VDZ) in clinical practice and assessed the effectiveness of VDZ dose intensification for managing LOR. Methods Retrospective review (May 2014–December 2016) of a prospectively maintained inflammatory bowel disease (IBD) registry. Kaplan-Meier estimates were used to determine rates of LOR to VDZ . Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Success of recapturing response (>50% reduction in symptoms from baseline) and remission (complete resolution of symptoms) after dose intensification was quantified. Results Cumulative rates for VDZ LOR were 20% at 6 months and 35% at 12 months, with slightly lower rates in Crohn’s disease than in ulcerative colitis (6 months 15% vs 18% and 12 months 30% vs 39%, P = 0.03). On multivariable analysis, LOR to a tumor necrosis factor (TNF) antagonist before VDZ use was associated with an increased risk for LOR to VDZ [hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.25–2.97] in all patients. For Crohn’s disease patients specifically, higher baseline C-reactive protein concentration was associated with increased risk for LOR to VDZ (HR 1.01 per mg/dL increase, 95% CI 1.01–1.02). Shortening of VDZ infusion interval from 8 to every 4 or 6 weeks recaptured response in 49% and remission in 18% of patients. Conclusions LOR to a TNF antagonist before VDZ use and higher baseline C-reactive protein are important predictors of VDZ LOR. Treatment response can be recaptured in almost half of these patients with VDZ infusion interval shortening.

scholarly journals The Relationship between C-Reactive Protein/Albumin Ratio and Disease Activity in Patients with Inflammatory Bowel Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yi-Han Chen ◽  
Li Wang ◽  
Shu-Yi Feng ◽  
Wei-Min Cai ◽  
Xiao-Fu Chen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Inflammatory Markers ◽  
C Reactive Protein ◽  
Distribution Width ◽  
Albumin Ratio ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Inflammatory Bowel

Objectives. The aims of this study were to evaluate the C-reactive protein/albumin ratio (CRP/ALB), inflammatory markers, and parameters from the complete blood count (CBC) in patients with inflammatory bowel disease (IBD) and their associations with disease activity. Methods. A total of 876 IBD patients, composed of 275 patients with ulcerative colitis (UC) and 601 patients with Crohn’s disease (CD), were included in this retrospective study, and the serum C-reactive protein (CRP), albumin (ALB), erythrocyte sedimentation rate (ESR), and CBC parameters were measured. To explore the disease activity, the Mayo score and Crohn disease activity index were used to assess UC and CD patients, respectively. Results. The CRP/ALB ratio, CRP, ESR, platelet to lymphocyte ratio (PLR), red blood cell distribution width (RDW), and neutrophil to lymphocyte ratio (NLR) levels in active IBD patients were significantly higher than those in inactive IBD patients, whereas ALB and lymphocyte to monocyte ratio (LMR) levels were significantly decreased (P<0.001). The receiver operating characteristic analysis showed that the optimum cut-off values of the CRP/ALB ratio for active UC and CD were 0.18 and 0.43, with sensitivities of 67.8% and 75.8% and specificities of 86.7% and 92.0%, respectively. Multivariable logistic analysis revealed that after adjusting for these inflammatory markers (ESR, NLR, PLR, and LMR), the CRP/ALB ratio was a statistically significant parameter capable of differentiating the disease activity of UC and CD. Conclusions. This study indicated that the CRP/ALB ratio was closely related to the IBD disease activity. Compared with CBC parameters, the CRP/ALB ratio had a higher discriminative capacity for active IBD.

scholarly journals P314 C-Reactive protein is associated with depression and anxiety in patients with inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S311-S311
Author(s):  
T Rodriguez ◽  
J Karpin ◽  
C Traboulsi ◽  
V Rai ◽  
D Rubin
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Patient Characteristics ◽  
Adaptive Testing ◽  
Prior History ◽  
Depression And Anxiety ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Severity Scores ◽  
Inflammatory Bowel

Abstract Background Depression and anxiety are comorbidities of inflammatory bowel disease (IBD). Though previous studies have proposed a relationship between anxiety, depression and IBD, causality and directionality are unknown. We used a novel computerised adaptive testing technology to screen IBD patients for depression and anxiety and compared the screening results to recent measures of C-reactive protein (CRP). Methods Consecutive patients at our tertiary IBD clinic were asked to complete the validated CAT-MH™ survey from Adaptive Testing Technologies (Chicago, IL); we then reviewed disease and patient characteristics. CRP measures from within 6 months of survey administration were used and levels ≥5 mg/l were considered positive. Patients who are CRP non-reactive were excluded. Pearson Chi-Square test was used to assess correlation. Results 134 patients (75 women, 112 Caucasian, 84 Crohn’s disease) participated in the study, 85 of whom had no prior history of psychiatric disorders. We identified 51 patients with depression (46 mild, 3 moderate, 2 severe) and 36 subjects with anxiety (24 mild, 10 moderate, 2 severe). Of the 134 patients recruited for this study, 57 had CRP reported. Median time between CRP measurement and CAT-MH™ administration was 2 days (IQR = 70). Categorical analysis stratified patients with positive and negative CRP who are also positive for depression and/or anxiety. Compared with patients with negative CRP values, patients with positive CRP were more likely to also test positive for depression and anxiety. These results were statistically significant for depression (p = 0.008) and nearly significant for anxiety (p = 0.058) (Figure 1). Quartile analysis of the 21 patients with elevated CRP levels revealed an increasing trend of average depression and anxiety severity scores. However, this correlation was lost when CRP &gt;21 mg/l (Figure 2). Conclusion We illustrate the significant association between CRP and depression and anxiety severity scores on the CAT-MH™ survey. These findings suggest a positive relationship between inflammation and depression and anxiety in IBD patients. Physicians should consider patients with elevated CRP levels at risk for these mental health conditions.

scholarly journals Clinical Significance of C-Reactive Protein Levels in Predicting Responsiveness to Iron Therapy in Patients with Inflammatory Bowel Disease and Iron Deficiency Anemia

2014 ◽  
Vol 60 (5) ◽  
pp. 1375-1381 ◽  
Author(s):  
Tariq Iqbal ◽  
Jürgen Stein ◽  
Naveen Sharma ◽  
Stefanie Kulnigg-Dabsch ◽  
Senthil Vel ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Iron Deficiency ◽  
Clinical Significance ◽  
Iron Deficiency Anemia ◽  
Bowel Disease ◽  
Deficiency Anemia ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Inflammatory Bowel

Ultra-High C-Reactive Protein Levels in Hospitalized Inflammatory Bowel Disease Patients Are Associated with Severe Complications Beyond Disease Activity

2011 ◽  
Vol 106 ◽  
pp. S490
Author(s):  
Jana Hashash ◽  
Kofi Clarke ◽  
Leonard Baidoo ◽  
David Binion ◽  
Arthur Barrie ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Inflammatory Bowel

scholarly journals An Evaluation of the Correlation between Hepcidin Serum Levels and Disease Activity in Inflammatory Bowel Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Zehra Betül Paköz ◽  
Cem Çekiç ◽  
Mahmut Arabul ◽  
Elif Sarıtaş Yüksel ◽  
Serkan İpek ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Active Phase ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Inflammatory Bowel ◽  
The Mean

Aim. While there are many well-defined serological markers for inflammatory bowel disease (IBD), there is limited evidence that they positively affect clinical outcomes. This study aimed to evaluate the correlation between hepcidin serum levels and disease activity in IBD.Materials and Methods. Eighty-five consecutive IBD patients were enrolled in the study. Hepcidin serum levels were assessed using an enzyme-linked immunosorbent assay (ELISA) and were compared with disease activity as well as the interleukin-6 (IL-6) and C-reactive protein (CRP) levels.Results. The mean hepcidin serum levels in Crohn’s disease (CD) patients in remission and in the active phase were3837±1436and3752±1274 pg/mL, respectivelyP=0.613. The mean hepcidin serum levels in ulcerative colitis (UC) patients in remission and in the active phase were4285±8623and3727±1176 pg/mL, respectivelyP=0.241. Correlation analysis between inflammatory markers and hepcidin serum levels indicated that there was no correlation between hepcidin levels and IL-6P=0.582or CRPP=0.783.Conclusion. As an acute-phase protein, hepcidin seems to have a lower efficacy than other parameters in the detection of activation in IBD.

Correlation of C-Reactive Protein With Clinical, Endoscopic, Histologic, and Radiographic Activity in Inflammatory Bowel Disease

2005 ◽  
Vol 11 (8) ◽  
pp. 707-712 ◽  
Author(s):  
Craig A Solem ◽  
Edward V Loftus ◽  
William J Tremaine ◽  
William S Harmsen ◽  
Alan R Zinsmeister ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Inflammatory Bowel
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