scholarly journals Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Gut ◽  
2019 ◽  
Vol 69 (5) ◽  
pp. 852-858 ◽  
Author(s):  
Julien Kirchgesner ◽  
Nynne Nyboe Andersen ◽  
Fabrice Carrat ◽  
Tine Jess ◽  
Laurent Beaugerie
Keyword(s):  
Incidence Rates ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Cox Proportional Hazard Models ◽  
Inflammatory Bowel ◽  
Artery Disease ◽  
The Impact ◽  
Necrosis Factor

ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

scholarly journals P261 Systematic review with meta-analysis: The impact of concomitant immune-mediated diseases on the disease course of inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S280-S281
Author(s):  
M Attauabi ◽  
M Zhao ◽  
F Bendtsen ◽  
J Burisch
Keyword(s):  
Biologic Therapy ◽  
Meta Analysis ◽  
Multidisciplinary Care ◽  
Disease Course ◽  
Immune Mediated ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Meta Analyses ◽  
The Impact

Abstract Background Several studies have shown an association between inflammatory bowel diseases [IBD] and immune-mediated diseases [IMIDs], but data on the impact of co-occurring IMIDs on IBD course are inconsistent. The aim of this study was to investigate the impact of co-occurring IMIDs on IBD phenotype and disease course. Methods PubMed and EMBASE were searched from database inception through December 2018 and updated in October 2019 for studies reporting prevalences or odds, risks or hazard ratios of IBD-related disease outcomes in patients with and without co-existing IMIDs. Meta-analyses were performed to estimate summary prevalences and risks of the outcomes which included disease extension, IBD-related surgery and hospitalisation, malignancy, mortality and need of medication (biologic therapy, steroids and immunomodulators). IMIDs were stratified into primary sclerosing cholangitis [PSC] and ‘IMIDs other than PSC’. Results A total of 93 studies comprising 14,307 IBD patients with IMIDs and 3,409,914 IBD patients without IMIDs were included in the study. Summary risks and prevalences with 95% confidence intervals for each outcome are presented in figures 1 and 2, respectively. The following results are all significant (p < 0.05). Compared with patients without co-occurring IMIDs, patients with ulcerative colitis [UC] and co-occurring IMIDs other than PSC more frequently received immunomodulators and steroids, and patients with Crohn’s disease [CD] and concomitant IMIDs other than PSC more often received biologic therapy. UC patients with co-existing IMIDs other than PSC more often underwent IBD-related surgery, while patients with CD and PSC received fewer surgeries. In addition, UC patients with co-occurring PSC were at increased risk for having extensive colitis, pancolitis, and malignancies. Patients with UC and PSC had a higher mortality rate, but no difference was found among patients with IMIDs other than PSC. PSC did not influence hospitalisation rates among IBD patients. Conclusion This meta-analysis found that IBD patients with co-existing IMIDs have a different disease course than patients without concomitant IMIDs. This study emphasises the importance of multidisciplinary care of IBD and that physicians caring for IBD patients need to be aware of IMIDs as a prognostic factor.

Association Between Inflammatory Bowel Disease and Dementia: A Retrospective Cohort Study

2021 ◽  
pp. 1-8
Author(s):  
Rebecca Zingel ◽  
Jens Bohlken ◽  
Karel Kostev
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Cumulative Incidence ◽  
Critical Role ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
General Practices ◽  
Incidence Of Dementia

Background: The critical role of inflammatory processes in the pathogenesis of dementia has recently been established. Objective: The aim of this study was to investigate the association between inflammatory bowel disease (IBD) and dementia risk in patients followed in general practices in Germany. Methods: This study included patients aged over 60 with an initial diagnosis of IBD (Crohn’s Disease (CD), ulcerative colitis (UC)) who were followed in 1,159 German general practices between January 1995 and December 2014. IBD patients were matched to healthy patients using propensity scores based on age, gender, index year, insurance type and comorbidities. Kaplan-Meier curves were used to study the development of dementia in patients with or without IBD within up to 15 years of the index date. Cox proportional hazard regression models were used to estimate the relationship between IBD and dementia. Results: The study included 3,850 patients with and 3,850 patients without IBD and revealed a higher cumulative incidence of dementia in IBD patients than in non-IBD patients after the follow-up period. The cumulative incidence of dementia differed within IBD subtypes; it was significantly higher in UC patients than in CD patients. Cox proportional hazard models showed that IBD is associated with a 1.22-fold increase in the risk (95% CI: 1,07–1,39) of developing dementia. UC patients had a 1.25-fold higher risk of developing dementia (95% CI: 1.07–1.46). CD is not significantly associated with an increased risk of dementia (HR: 1.17, 95% CI: 0.93–1.47). Conclusion: A positive association between IBD and dementia was found in patients followed in general practices in Germany.

Expanding Research on the School-to-Prison Pipeline: Examining the Relationships between Suspension, Expulsion, and Recidivism among Justice-Involved Youth

2021 ◽  
pp. 001112872199933
Author(s):  
Abigail Novak ◽  
Abigail Fagan
Keyword(s):  
Juvenile Justice ◽  
Hazard Models ◽  
Educational Systems ◽  
Proportional Hazard ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Using Data ◽  
Pathways To Desistance

Limited research has examined the associations between different forms of school exclusion and offending, and variation in these associations according to age of first exclusionary event, among justice-involved youth. Using data from the Pathways to Desistance Study, the current study examined the associations between suspension, expulsion, and recidivism and the association between age at first suspension/expulsion and recidivism. According to Cox proportional hazard models, both expulsion and frequency of suspension increased risk of recidivism; age at first suspension was not associated with recidivism, and youth who were first expelled in childhood were significantly less likely to recidivate than youth first expelled in adolescence. Results suggest juvenile justice and educational systems should provide collaborative services to better support justice-involved youth.

scholarly journals DOP43 Impact of Inflammatory Bowel Diseases on the phenotype and severity of psoriasis and spondyloarthropathies

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S081-S081
Author(s):  
M Attauabi ◽  
M Damsgaard Wewer ◽  
F Bendtsen ◽  
J B Seidelin ◽  
J Burisch
Keyword(s):  
Systematic Review ◽  
Inflammatory Bowel Diseases ◽  
Meta Analysis ◽  
Disease Phenotype ◽  
Model Quality ◽  
High Quality ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background It is unclear whether inflammatory bowel diseases (IBD) affect the phenotype and severity of co-occurring axial spondyloarthropathies (axSpA) and psoriasis. Therefore, we aimed to investigate the characteristics of axSpA and psoriasis in relation to co-occurring IBD. Methods The systematic review and meta-analysis were conducted according to Cochrane’s recommendations. PubMed and EMBASE were searched from database inception till January 2020 for studies reporting disease phenotype and severity of axSpA and psoriasis in association with co-occurrence of IBD. Meta-analyses were performed using a random-effects model. Quality of the studies was assessed by the Newcastle-Ottawa Scale (NOS). Results The electronic search yielded 12,220 studies which were narrowed down to 152 after screening based on study titles and abstracts. Of these, a full-text review identified 20 eligible studies, including twelve and eight studies describing characteristics of axSpA and psoriasis, respectively, in relation to IBD. AxSpA was identified among a total of 321 and 8,660 patients with and without a co-occurring IBD, respectively, and the studies’ mean NOS score was 6.8, including seven and five studies of moderate and high quality, respectively. The meta-analysis demonstrated that presence of co-occurring IBD was associated with an increased risk of dactylitis (risk ratio (RR)=2.06 (95%CI 1.24–3.42), I2=0%), but not enthesitis (RR=0.93 (95%CI 0.48–1.81), I2=86%). Furthermore, IBD was associated with a significantly lower Bath Ankylosing Spondylitis Radiology Index (mean difference (meandiff) -2.28 (95%CI -3.26-(-1.30)), p<0.01, I2=0%), better Schober’s test results (meandiff 0.80 (95%CI 0.64–1.49), p<0.01, I2=0%), and a lower finger to floor distance (meandiff -6.36 (95%CI -10.36-(-2.36)), p<0.01, I2=0%). The phenotype of psoriasis was assessed among 680 and 222,279 patients with and without a co-occurring IBD. The mean NOS score was 7.4, including two studies of moderate methodological quality, while the remaining six studies were of high quality. The presence of IBD was associated with a significantly less frequent presentation of psoriasis in the nails (RR=0.14 (95%CI 0.05–0.42), I2=0%) but not psoriatic arthritis (RR=0.94 (95%CI 0.27–3.31), I2=75%). Finally, the presence of IBD was associated with a milder phenotype of psoriasis (RR=1.41 (95%CI 1.02–1.96), p=0.04, I2=70%). Conclusion This is the first systematic review with meta-analysis investigating the impact of IBD on the disease phenotype and severity of psoriasis and axSpA. Our data suggest that IBD modifies psoriasis and axSpA to be milder and emphasizes the importance of a multidisciplinary approach to patients with psoriasis or axSpA and co-occurring IBD.

scholarly journals P506 The Impact of Anxiety in Patients With Inflammatory Bowel Diseases Treated With Biologics during COVID Lockdown. A Comparative Study between Hospitalized and non-hospitalized patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S487-S488
Author(s):  
L Bertani ◽  
B Barberio ◽  
F Zanzi ◽  
D Maniero ◽  
L Ceccarelli ◽  
...  
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Depression Scale ◽  
Stressful Events ◽  
Psychological Status ◽  
Fisher Exact Test ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Impact ◽  
At Home

Abstract Background The first wave of COVID-19 pandemic management implied to remain at home in order to reduce the spread of the infection. Several patients with inflammatory bowel diseases (IBD) treated with biologics had to go to the hospital to perform intravenous (i.v.) therapies, whereas patients treated with subcutaneous (s.c.) ones could remain at home. Since immumodulatory therapies as well as the access to high-risk places like hopitals have been associated to an increased risk of infections, we have investigated whether patients hospitalized or treated at home showed similar levels of anxiety related to the pandemic situation. Methods We conducted a survey including consecutive IBD patients treated with biologics at three Italian referral centers referring to the first lockdown period. We included consecutive adult patients in clinical and biochemical remission treated with biologics, administered i.v. or s.c. Patients experiencing a disease flare during these months were excluded from the study, in order to avoid potential biases related to disease activity. Patients underwent the normally scheduled clinical visits, performed at home by using phone or video calls for patients treated with s.c. drugs and only in specific cases (i.e. suspected COVID symptoms) for patients treated with i.v. ones. We administered to all patients the Hospital Anxiety and Depression Scale (HADS) questionnaire and other 11 questions, specifically related to COVID and its implications. Group differences in continuous and nominal variables were tested by Kruskal–Wallis test and Fisher exact test, respectively. Results A total of 189 IBD patients were recruited, 112 (59.3%) treated with i.v. drugs and 77 (40.7%) with s.c. ones. The two groups of patients had similar scores in the 14 single items of the HADS questionnaire (p>0.10 for all). The total HADS score obtained by the sum of all items was also almost identical between groups (37.1 ± 2.8 vs 37.2 ± 2.8; p=0.98). In patients treated with i.v. drugs receiving a televisit (n=17), the rates of satisfaction about telemedicine (58.8%) and the lack of in-person care (33.3%) were significantly lower compared with those treated with s.c. drugs (94.8% and 92.2%, respectively; both p<0.0005). Conclusion Our results suggest that there is no need to convert patients from i.v. to s.c. therapy, since the risk of infection as well as of disease relapse due to stressful events are similar in both groups. Moreover, the hospitalization for drug administration does not affect the the psychological status of the patients. Interestingly, patients used to coming to the hospital have more need for in-person contact than patients used to be treated at home, suggesting that the choice of telemedicine should be personalized.

The role of immunotherapy on the survival of pancreatic cancer patients.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 714-714
Author(s):  
Saber Ali Amin ◽  
Michael Baine ◽  
Jane L. Meza ◽  
Chi Lin
Keyword(s):  
Pancreatic Cancer ◽  
Multivariable Analysis ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Surgery Group ◽  
Age Of Diagnosis ◽  
Cox Proportional Hazard Models ◽  
Definitive Surgery ◽  
The Impact

714 Background: Immunotherapy has revolutionized the treatment landscape of many malignancies, but its therapeutic role in pancreatic cancer (PC) remains unclear. The objective of this study is to investigate the impact of immunotherapy on the overall survival of PC patients stratified by definitive surgery of the pancreas using the National Cancer Database (NCDB). Methods: Patients with pancreatic adenocarcinoma were identified from NCDB. Cox proportional hazard models were employed to assess the impact of immunotherapy on survival after being stratified by surgery and adjusted for age of diagnosis, race, sex, place of living, income, education, treatment facility type, insurance status, year of diagnosis, and treatment types such as chemotherapy and radiation therapy. Results: Of 252,280 patients who were analyzed, 214,632 (85.08%) had definitive surgery, and 37,638 (14.92%) did not get definitive surgery of the pancreas. In the surgery group, 351 (0.93%) received immunotherapy and 37,287 (99.07%) did not while in the no surgery group, 838 (0.39%) received immunotherapy and 213,804 (99.61%) did not. In the multivariable analysis, patients who received immunotherapy had significantly improved OS both in the no surgery group (HR: 0.886, CI: 0.655-0.714; P < 0.0001) and in the surgery group (HR: 0.846, CI: 0.738-0.971; P < 0.0001) compared to patients who did not receive immunotherapy. Treatment with chemotherapy plus immunotherapy was associated with significantly improved OS (HR: 0.871, CI: 0.784-0.967; P < 0.009) compared to chemotherapy without immunotherapy in the no surgery group, while it was not significant in the surgery group. Chemoradiation plus immunotherapy was associated with significantly improved OS (HR: 0.787, CI: 0.684-0.906; P < 0.0009) in the no surgery group and (HR: 0.799, CI: 0.681-0.938) in the surgery group compared to chemoradiation alone. Conclusions: In this study, the addition of immunotherapy to chemoradiation therapy was associated with significantly improved OS in PC patients with or without definitive surgery. The study warrants further future clinical trials of immunotherapy in PC.

scholarly journals The Influence of Early Menopause on Cardiovascular Risk in Women with Rheumatoid Arthritis

2014 ◽  
Vol 41 (7) ◽  
pp. 1270-1275 ◽  
Author(s):  
Emily C. Pfeifer ◽  
Cynthia S. Crowson ◽  
Shreyasee Amin ◽  
Sherine E. Gabriel ◽  
Eric L. Matteson
Keyword(s):  
Rheumatoid Arthritis ◽  
Hormone Replacement ◽  
Population Based ◽  
Proportional Hazard ◽  
Inception Cohort ◽  
Early Menopause ◽  
American College Of Rheumatology ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Objective.Early menopause is associated with an increased risk for developing rheumatoid arthritis (RA). The risk for cardiovascular disease (CVD) in women increases following menopause. Because RA is associated with an increased risk of CVD, this study was undertaken to determine whether early menopause affects the risk of developing CVD in women with RA.Methods.A population-based inception cohort of 600 women with RA who fulfilled 1987 American College of Rheumatology criteria for RA between 1955 and 2007 and were age ≥ 45 years at diagnosis was assembled and followed. Age at menopause and duration of hormone replacement therapy, along with occurrence of CVD, was ascertained by review of medical records. Cox proportional hazard models compared women who underwent early menopause (natural or artificial menopause at age ≤ 45 yrs) to those within the cohort who did not undergo early menopause.Results.Of 600 women, 79 experienced early menopause. Women who underwent early menopause were at significantly higher risk for developing CVD when compared to women who did not (HR 1.56; 95% CI 1.08–2.26).Conclusion.The risk of CVD in women with RA was higher in those who experienced early menopause, and like other known risk factors should increase clinician concern for development of CVD in these patients.

scholarly journals Non-O Blood Group is Associated With a Higher Risk of Dyslipidaemia Amongst French Women

2020 ◽  
Author(s):  
Conor MacDonald ◽  
Anne-Laure Madika ◽  
Gianluca Severi ◽  
Agnes Fournier ◽  
Marie-Christine Boutron-Ruault
Keyword(s):  
Cardiovascular Disease ◽  
Blood Group ◽  
Blood Groups ◽  
Proportional Hazard ◽  
Abo Blood Groups ◽  
Cross Sectional ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Incident Cases

Abstract IntroductionThe non-O blood groups have previously been associated with higher risk of cardiovascular disease in prospective cohort studies. While cross-sectional studies have identified higher serum cholesterol amongst A-group individuals, there is no evidence from prospective studies whether this translates into a higher risk of dyslipidaemia that requires treatment. This study aimed to prospectively determine potential associations between ABO blood groups and risk of incident dyslipidaemia requiring treatment.MethodsWe assessed associations between blood ABO group and dyslipidaemia in women participating in the E3N cohort. We included women who did not have cardiovascular disease at baseline. We used logistic regression to determine associations between ABO group and prevalent dyslipidaemia at baseline. Cox proportional hazard models were used to determine if blood ABO group was associated with an increased risk of incident dyslipidaemia, controlling for potential confounding.ResultsAt baseline, 55,512 women were included, and 10,058 incident cases of dyslipidaemia were identified at a rate of 17.6/1,000 PY. Of these participants, 24,510 reported being of the O-group, and 31,002 of non-O. Non-O blood groups were associated with prevalent dyslipidaemia (OR = 1.17 [1.13: 1.21]). The non-O blood groups were associated with an increased risk of dyslipidaemia (HR non-O = 1.14 [1.10: 1.19]), specifically the A group (HRA = 1.18 [1.13: 1.23]). Interactions with smoking were considered possible (p-interaction = 0.06), with AB smokers showing the highest risk of dyslipidaemia (HRAB smokers = 1.54 [1.12: 2.11]).ConclusionNon-O blood group, specifically the A group were associated with a moderately increased risk of dyslipidaemia.

scholarly journals Concerns and attitudes of patients with inflammatory bowel diseases during the COVID-19 pandemic

2020 ◽  
Author(s):  
Matina-Lydia Chatzinikolaou ◽  
Eirini Zacharopoulou ◽  
Georgios Kokkotis ◽  
Maria Palatianou ◽  
Stamatina Vogli ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Relevant Information ◽  
Sources Of Information ◽  
Sense Of Security ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Negative Effect ◽  
Inflammatory Bowel ◽  
Coronavirus Infection ◽  
The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has changed inflammatory bowel disease (IBD) care. The use of telemedicine was quickly adopted, however the impact of COVID-19 on IBD patients’ feelings and sense of security for their health has not been extensively evaluated.Aims: Our aim was to assess patients’ views and concerns regarding their IBD condition, compliance with treatment and preventive measures, accessibility to health services and sources of information they used during the coronavirus pandemic.Methods: A questionnaire-based survey of patients with IBD (n=237) was conducted at a University and an NHS GI Units.Results: Greek patients with IBD expressed high levels of fear of coronavirus infection, with more than 50% being afraid of dying as a result of COVID-19. Seven out of ten participants felt that their IBD medications increased risk of infection and this fear was significantly higher in patients on immunosuppression. Only 2% of patients discontinued treatment on their own, all of whom were receiving immunosuppression. More than 90% of participants reported staying home and washing their hands. Three quarters of patients had access to a doctor when needed and almost 50% used the electronic paperless prescription system. Participants were satisfied with the information they received regarding COVID-19. The main sources of information were media, internet and social networks, with only one third seeking guidance from their gastroenterologist. Conclusions: The COVID-19 pandemic had a profound, negative effect on IBD patients’ lives. COVID-19-related fears need to be actively addressed, particularly in IBD patients on immunosuppression, and relevant information should be continuously provided.

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