A Comparison of Short- and Long-Term Therapeutic Outcomes of Infliximab- versus Tacrolimus-Based Strategies for Steroid-Refractory Ulcerative Colitis

Background/Aims. Antitumor necrosis factor antibodies and calcineurin inhibitors have shown good therapeutic efficacy for steroid-refractory ulcerative colitis (UC). Although some studies have compared the efficacy of infliximab (IFX) and cyclosporin A, there are no published studies comparing IFX and tacrolimus (Tac). This study aimed to compare therapeutic efficacies between IFX- and Tac-based strategies for steroid-refractory UC.Methods. Between July 2009 and August 2013, 95 patients with steroid-refractory UC received either IFX(n=48)or Tac(n=47)in our hospital. In the IFX group, the patients continued to receive maintenance treatment with IFX. In the Tac group, patients discontinued Tac treatment up to 3 months and subsequently received thiopurine. We retrospectively compared the therapeutic outcomes between the groups.Results. There was no significant difference in the colectomy-free rate, clinical remission rate, and clinical response rate at 2 months between the groups. However, relapse-free survival was significantly higher in the IFX group than in the Tac group (p<0.001; log-rank test). The proportions of serious adverse events did not differ between the groups.Conclusion.The findings of our study showed that IFX and Tac have similar short-term therapeutic efficacy for steroid-refractory UC. Maintenance treatment with IFX, however, yields better long-term outcomes than Tac-thiopurine bridging treatment.

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Long-term Outcomes in Steroid-refractory Ulcerative Colitis Treated with Tacrolimus Alone or in Combination with Purine Analogues

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjv175 ◽

2015 ◽

Vol 10 (1) ◽

pp. 31-37 ◽

Cited By ~ 13

Author(s):

K. J. Schmidt ◽

N. Müller ◽

A. Dignass ◽

D. C. Baumgart ◽

H. Lehnert ◽

...

Keyword(s):

Ulcerative Colitis ◽

Long Term Outcomes ◽

Purine Analogues ◽

Steroid Refractory

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124Impact of intimal tracking for recanalization of CTO lesions on long-term clinical outcomes

European Heart Journal ◽

10.1093/eurheartj/ehz747.0040 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Kano ◽

K Nasu ◽

M Habara ◽

T Shimura ◽

M Yamamoto ◽

...

Keyword(s):

Clinical Outcomes ◽

Cox Regression ◽

Target Lesion ◽

Hazard Ratio ◽

Rank Test ◽

Total Occlusion ◽

Significant Difference ◽

The Impact

Abstract Background For recanalization of coronary chronic total occlusion (CTO) lesions, subintimal guidewire tracking in both antegrade and retrograde approaches are commonly used. Purpose This study aimed to assess the impact of subintimal tracking on long-term clinical outcomes after recanalization of CTO lesions. Methods Between January 2009 and December 2016, 474 CTO lesions (434patients) were successfully recanalized in our center. After guidewire crossing in a CTO lesion, those lesions were divided into intimal tracking group (84.6%, n=401) and subintimal tracking group (15.4%, n=73) according to intravascular ultrasound (IVUS) findings. Long-term clinical outcomes including death, target lesion revascularization (TLR), target vessel revascularization (TVR) were compared between the two groups. In addition, the rate of re-occlusion after successful revascularization was also evaluated. Results The median follow-up period was 4.7 years (interquartile range, 2.8–6.1). There was no significant difference of the rate of cardiac death between the two groups (intimal tracking vs. subintimal tracking: 7.0% vs. 4.1%; hazard ratio, 0.61; 95% confidence interval [CI], 0.19 to 2.00; p=0.41), TLR (14.3% vs. 16.2%; hazard ratio, 1.34; 95% CI, 0.71 to 2.53; p=0.37), and TVR (17.5% vs. 20.3%; hazard ratio, 1.27; 95% CI, 0.72 to 2.23; p=0.42). However, the rate of re-occlusion was significantly higher in the subintimal tracking group than intimal tracking group at 3-years re-occlusion (4.2% vs. 14.5%; log-rank test, p=0.002, Figure). In the multivariate COX regression, subintimal guidewire tracking was an independent predictor of re-occlusion after CTO recanalization (HR: 5.40; 95% CI: 2.11–13.80; p<0.001). Figure 1 Conclusions Subintimal guidewire tracking for recanalization of coronary CTO was associated with significantly higher incidence of target lesion re-occlusion during long-term follow-up period.

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Review of normal gastrointestinal tract, ulcerative colitis, proctitis and rectal medication adherence

British Journal of Nursing ◽

10.12968/bjon.2020.29.14.805 ◽

2020 ◽

Vol 29 (14) ◽

pp. 805-811

Author(s):

Pineshwari Naeck-Boolauky ◽

Jitka Adio ◽

Jennie Burch

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Gastrointestinal Tract ◽

Side Effects ◽

Rectal Mucosa ◽

Gi Tract ◽

Therapeutic Outcomes ◽

Rectal Medication ◽

Inflammatory Bowel

The gastrointestinal (GI) tract has a number of functions—ingestion, digestion, absorption and elimination. When the GI tract is working normally, it is efficient. However, this can change when disease, such as inflammatory bowel disease (IBD) occurs. IBD is a long-term relapsing and remitting autoimmune disease; it incorporates ulcerative colitis (UC). In UC, part or all the mucosa lining the rectum and colon becomes inflamed and ulcerated. UC that affects the rectum only is called proctitis. Effective treatment is essential. It is better to target the rectal mucosa directly in proctitis, using topical rectal medications in enemas or suppositories, as these have fewer side-effects and resolve symptoms more quickly than systemic drugs. However, patients may not feel clear about aspects of their IBD care and can find it difficult to initiate and comply with treatment and maintenance regimens. Nurses need to educate and support them to achieve optimal therapeutic outcomes in both the immediate and long terms.

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Thiopurine Treatment in Ulcerative Colitis: A Critical Review of the Evidence for Current Clinical Practice

Inflammatory Bowel Diseases ◽

10.1093/ibd/izx025 ◽

2017 ◽

Vol 24 (1) ◽

pp. 67-77 ◽

Cited By ~ 1

Author(s):

Sara van Gennep ◽

Nanne K de Boer ◽

Geert R D’Haens ◽

Mark Löwenberg

Keyword(s):

Ulcerative Colitis ◽

Clinical Practice ◽

Critical Review ◽

Maintenance Treatment ◽

Randomized Trials ◽

Current Clinical Practice ◽

Sufficient Power ◽

Significant Difference ◽

Endoscopic Remission ◽

Remission Rates

Abstract Background Due to toxicity problems and controversial evidence, thiopurine use in ulcerative colitis (UC) has faced a lot of criticism. We present a critical review of the literature on efficacy of thiopurines in UC. Methods Studies evaluating therapeutic efficacy of thiopurine remission induction and/or maintenance treatment in UC were identified using the Cochrane Library, MEDLINE, and EMBASE. Results Out of 5 randomized trials on thiopurine induction treatment, 3 demonstrated a significant effect of thiopurine treatment vs mesalamine or placebo in steroid-dependent UC patients: (1) lower endoscopic activity scores, (2) higher clinical remission rates, and (3) more patients who discontinued steroids. Two found no significant difference in clinical and endoscopic remission of azathioprine compared with sulfasalazine or placebo in patients with active UC. Out of 7 randomized trials on thiopurine maintenance treatment, 4 demonstrated significant higher clinical and endoscopic remission rates in thiopurine-treated patients compared with placebo or mesalamine. Three found no significant difference in clinical and endoscopic remission of thiopurine maintenance treatment compared with sulfasalazine or placebo. Conclusions All studies that investigated thiopurine treatment in UC had shortcomings, such as lack of sufficient power, no use of blinding, allowed concomitant treatment with steroids, and no endoscopy to confirm active disease at study entry or to evaluate therapeutic efficacy. Hence, current clinical practice of thiopurine treatment in UC is based on minimal and controversial evidence. This underscores the need for clinical studies with sufficient power and objective end points in order to determine efficacy of thiopurines in UC. 10.1093/ibd/izx025_video1 izx025.video1 5732762967001

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086 Clinical, investigational and treatment factors do not determine prognosis of patients with inflammatory neuropathies

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.74 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A27.3-A28

Author(s):

Mahima Kapoor ◽

Aisling Carr ◽

Michael P Lunn ◽

Mary M Reilly

Keyword(s):

Upper Limb ◽

Remission Rate ◽

Ivig Treatment ◽

Retrospective Data ◽

Significant Difference ◽

Recent Treatment ◽

Successful Group ◽

Inflammatory Neuropathies ◽

Measure Disease Activity

IntroductionIdentifying patients who need long-term immunoglobulin (IVIg) treatment in patient with inflammatory neuropathies is essential as recent treatment trials show a remission rate of up to 40%.AimsCompare retrospective data on clinical, investigational and treatment factors in patients who have ceased IVIg with patients who have failed a cessation trial.Methods15 patients who successfully suspended IVIg infusions were compared with 15 in whom decreasing or stopping IVIg was unsuccessful.Results30 patients (12 with CIDP and 3 with MMN in both groups) were diagnosed 39.5 months from onset of symptoms in the successful group vs. 40.7 months in the unsuccessful group (p=0.953). There was a significant difference in the summed upper limb sensory amplitudes on electrophysiology prior to starting IVIg between the patients with CIDP (17.4 mV vs. 9.8mV p=0.007). There was no difference in the average doses between the groups. A successful cessation trial was attempted at a mean of 60.5 months post starting treatment, compared with 60 months in the unsuccessful patients.ConclusionThere is a need for objective biomarker to measure disease activity because other than one neurophysiology marker, other factors did not help predict a successful cessation trial of IVIg.

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Sleeve lobectomy an affidable lung sparing procedure

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17159 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17159-17159

Author(s):

G. Cavallesco ◽

P. Maniscalco ◽

F. Quarantotto ◽

F. Acerbis ◽

M. Santini ◽

...

Keyword(s):

Main Bronchus ◽

Rank Test ◽

Sleeve Lobectomy ◽

Term Survival ◽

Average Hospital ◽

Long Term Survival ◽

Kaplan Meier ◽

Significant Difference ◽

Similar Survival

17159 Background: Sleeve Lobectomy (Sl) is generally considered a surgical alternative of choice to Pneumonectomy (Pn) for the treatment of central NSCLC. The aim of this study is to value if the Sl could be really a Lung saving procedure that warrants right survivals, according to stage of disease, with acceptable perioperative risks. Methods: In 165 patients (67 Sl and 98 Pn) operated from 1995 to 2003 for NSCLC of main bronchus we have analyzed the hospital stay, morbidity and mortality within 30 days, long term survival. In 39 Sl and 46 Pn we compared spyrometric volume’s changes at a distance of 6–24 months from operation. Sl was performed where it was technically possible. Long term survivals had been separated and comparated according to pathologic stadium (TNM 1997) and lymphonodal involvement: all these data were estimated by Kaplan-Meier method and log rank test. All statistical data underwent SPSS elaboration and significant assumption for p < 0.05. Results: In our population of study we didn’t check any statistically significant’s differences comparing age, sex or preoperative Fev1. Complications occurred in 28% of cases where Sl was performed and in 36.7% after Pn with a mortality rate of 2.9% vs 5.1%. Average hospital staying was longer in patients underwent to Pneumonectomy. Long term survival (5 years) in Sl group is 36% and 24% in Pn group with a statistically significant difference P = 0.016, but this difference is not evident from the comparison between the two group’s survivals based on pathological stadium or lymphonodal involvement. Spyrometric values showed a global Fev1 reduction of 245 ml (−10%) after Sl procedure and 884ml (36.3%) after Pn with a significant difference of p = 0.0042. Conclusions: In this study Sl got similar survival results if not better, with those obtained after Pn. Moreover, Sl showed to be a lung sparing procedure with an acceptable operative risk. These data confirmed that SL is the gold standard surgical procedure in the treatment of central tumors where if technically possible. [Table: see text] No significant financial relationships to disclose.

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Long-term cardiopulmonary mortality after radiation for locally advanced esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.99 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 99-99 ◽

Cited By ~ 1

Author(s):

Abigail Berman Milby ◽

Andrzej Pawel Wojcieszynski ◽

Smith Apisarnthanarax ◽

James M. Metz ◽

John Peter Plastaras

Keyword(s):

Esophageal Cancer ◽

Esophageal Carcinoma ◽

Background Radiation ◽

Univariate Analysis ◽

Locally Advanced ◽

Rank Test ◽

Trimodality Therapy ◽

Significant Difference

99 Background: Radiation (RT) is considered an integral component of trimodality therapy for locally-advanced esophageal carcinoma to improve locoregional control and potentially survival. However, the long-term risk of cardiopulmonary mortality (CPM) is not well-understood in this population. Methods: Patients age 20-85 with esophageal carcinoma with T3, T4 or node positive (N+) disease who underwent esophagectomy were identified within 17 Surveillance, Epidemiology, and End Results registries from 1988-2006. Patients with metastatic disease or <6 mo follow up were excluded. CPM was calculated for patients receiving vs not receiving RT and compared by the Kaplan-Meier method. The log-rank test was used for univariate associations and Cox proportional hazards model was used for multivariate analysis (MVA). Results: A total of 4,079 patients met the defined selection criteria of whom 2,408 were treated with RT, and 1,671 were not. Median age was 62.2 yrs (22-84) and follow-up was 22 mos (6-248). There was no significant difference in CPM in patients who received RT versus those who did not (p=0.8). At 10 yr, the majority of deaths were from esophageal cancer (73 with vs 78% without RT) compared to CPM (13.7 with vs 11.6% without RT). On univariate analysis ( table ), age <60, diagnosis era, and histology were significant independent predictors of CPM. On MVA, age <60 (HR 0.36) and diagnosis era (0.63 for 1994-2000 and 0.55 for 2000-2006) remained statistically significant for CPM. Conclusions: RT for esophageal cancer is not associated with an increased long-term risk of CPM in the overall population. Older age and earlier diagnosis era predict for CPM. Although survival in esophageal cancer is dominated by cancer deaths, advances in RT are still needed to prevent excess treatment-related mortality. [Table: see text]

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