ABSTRACT
Objective: Vitamin D has been widely studied as a mediator of the immune response, becoming evident the prevalence of hypovitaminosis D in patients with Crohn's disease. This work aims at evaluating the serum levels of vitamin D in patients suffering from Crohn's disease in a southeast region of Brazil. Methods: It is a prospective study, with statistical analysis of the values of serum vitamin D measured between April 2014 and April 2015 in patients with Crohn's disease. Individuals with mild anal complaints, without any colorectal involvement, comprised the control group. Results: One hundred and four patients whose average age was 40.6 years were evaluated, being 56 (53.8%) female and 48 (46.2%) male. The average serum vitamin D level was 21.6 ng/mL, with standard deviation 13.85. The control group was comprised by 66 individuals, whose average age was 48.9 years. With 38 (57.6%) female and 28 (42.4%) male. In this group the average serum vitamin D level was 40.9 ng/mL. Statistical significance was demonstrated with p<0.0001. Conclusion: There was high prevalence of hypovitaminosis D in patients with Chron's disease, when compared to the control group. Hypovitaminosis D was not evidenced in patients in the latter group.
Objetivo: A vitamina D tem sido amplamente estudada como mediadora da resposta imune, tornando-se evidente a prevalência de hipovitaminose D em pacientes com doença de Crohn. Este trabalho objetiva avaliar os níveis séricos de vitamina D nos pacientes com portadores de doença de Crohn em uma região do sudeste do Brasil. Métodos: Trata-se de estudo prospectivo, com análise estatística dos valores da vitamina D sérica dosados entre Abril de 2014 e Abril de 2015 em pacientes com doença de Crohn. Indivíduos com queixas anais leves, sem qualquer acometimento colorretal, compuseram o grupo controle. Resultados: Foram avaliados 104 pacientes, cuja média de idade foi de 40,6 anos, sendo 56 (53,8%) mulheres e 48 (46,2%) homens. O nível sérico de vitamina D médio foi 21,6 ng/mL, com desvio-padrão de 13,85. O grupo controle foi composto por 66 indivíduos, cuja média de idade foi 48,9 anos, com 38 (57,6%) mulheres e 28 (42,4%) homens. Neste grupo o nível sérico médio de vitamina D foi 40,9 ng/mL. Foi demonstrada significância estatística com p<0,0001. Conclusão: Houve elevada prevalência de hipovitaminose D em pacientes com doença de Crohn, quando comparados ao grupo controle. Não foi evidenciada hipovitaminose D entre os pacientes deste último grupo.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Vitamin D , Vitamin D/immunology , Biomarkers , Crohn Disease/immunology , Vitamin D/adverse effects , Vitamin D Deficiency , Crohn Disease , Crohn Disease/ethnology , Crohn Disease/metabolism , Crohn Disease/drug therapy , Statistics, Nonparametric , Immunity, CellularABSTRACT
OBJETIVO: A azatioprina (AZA) tem sido usada freqüentemente no tratamento da doença de Crohn (DC). O objetivo do presente estudo foi avaliar a freqüência, evolução e abordagem dos efeitos adversos da AZA no tratamento de pacientes com DC. MÉTODOS: Foram incluídos prospectivamente 106 pacientes portadores de DC em uso de AZA, de janeiro de 2002 a dezembro de 2006. Registraram-se dados clínicos e demográficos, com controle laboratorial mensal dos efeitos hematológicos e supervisão de reações adversas por meio de avaliação clínica. Realizou-se comparação entre os grupos com e sem efeitos adversos. RESULTADOS: Cinqüenta e seis (52,7 por cento) dos pacientes estudados apresentaram pelo menos um efeito adverso, requerendo redução transitória da dose da droga; 18 (17 por cento) necessitaram suspender definitivamente o uso de AZA, geralmente devido a reações de hipersensibilidade. Náuseas e vômitos, freqüentemente leves, ocorreram em 29 (27,4 por cento); a raça negra e aqueles com comorbidades apresentaram mais intolerância gástrica do que os brancos e aqueles sem outras doenças associadas (p=0,04). Leucopenia foi o efeito adverso mais freqüente, ocorrendo em 36 (34 por cento). O tempo de uso de AZA foi maior em pacientes com leucopenia do que nos não leucopênicos (p=0,001), enquanto a dose média de AZA foi menor naqueles com leucopenia comparados aos não leucopênicos (p=0,005). Não houve infecções graves, neoplasias ou óbitos durante o tratamento com AZA. CONCLUSÃO: A AZA mostrou ser uma droga relativamente segura no tratamento da DC, desde que seja mantida supervisão clínica e laboratorial periódica durante todo o tratamento.
OBJECTIVE: Azathioprine (AZA) is frequently used in Crohn's disease (CD) therapy. This paper aimed to evaluate the frequency, evolution and management of AZA side effects in CD patients. METHODS: One hundred and six CD patients under AZA therapy were evaluated prospectively from January 2002 to December 2006. Clinical and demographic data were recorded, together with a monthly laboratory control of hematological or other adverse reactions by means of clinical evaluation. Comparison was carried out between groups with and without side effects. RESULTS: At least one adverse reaction was found in 56 (52.7 percent) of the patients studied and required a transient drug reduction; 18 (17 percent) had to definitely stop use of AZA, often because of hypersensitivity reactions. Nausea, vomit, although slight, occurred in 29 (27.4 percent). The black race and those with co-morbidities had more gastric intolerance than Caucasians and those without other associated disease (p=0.04). Leucopoenia was the more frequent side effect observed, occurring in 36 (34 percent). The period of AZA use was longer for patients with leucopoenia than for those without (p=0.001), while the mean dose of AZA was lower for those with leucopoenia when compared to non-leucopoenics (p=0.005). No serious infections, malignancy or death was noticed as a consequence of AZA use. CONCLUSION: In this study use of AZA in therapy for Crohn's disease disclosed that the drug is satisfactorily safe as long as periodical clinical and laboratory supervision is carried out during treatment.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Azathioprine/adverse effects , Crohn Disease/drug therapy , Immunosuppressive Agents/adverse effects , Leukopenia/chemically induced , Black People , Azathioprine/administration & dosage , Brazil , Crohn Disease/blood , Crohn Disease/ethnology , Epidemiologic Methods , White People , Immunosuppressive Agents/administration & dosage , Nausea/chemically induced , Time Factors , Treatment Outcome , Vomiting/chemically induced , Young AdultABSTRACT
PURPOSE: The incidence and prevalence of Crohn's disease (CD) varies geographically and with racial/ ethnic background. The highest frequency of occurrence is in North America and Northern Europe. Incidence is highest among Caucasians, lower in blacks and Hispanics, and lowest in Asians. However in the mid-1980s and 1990s, the incidence and prevalence increased in continental Europe, the Middle East, the Pacific Rim, Africa, and Latin America. An increase in the incidence of CD has been noted in Puerto Rico, although our population differs genetically from other described CD populations. A study in our population showed lower prevalence of ASCA and no NOD2 in our CD patients. Infliximab, a TNFa antibody, is effective in refractory inflammatory CD and in fistulizing disease. Since limited data exists regarding CD in Hispanics, the fastest growing minority group in the United States, we designed this retrospective study with patients treated with infliximab at our institution. We wanted to determine if the response to infliximab in genetically admixed Hispanics differed from that previously reported. METHODS: Baseline characteristics, infusion related information and clinical response was abstracted from medical records. Clinical response was classified as complete response, partial response, and nonresponse. RESULTS: The study included 15 patients treated for refractory inflammatory disease, 9 for fistulizing disease, and 11 for both. The positive response rate was 83%(29/35) and the non response rate was 17%(6/35). Overall the patients with complete, partial, and no response were 13/35(37%), 16/35(46%), and 6/ 35(17%), respectively. No statistically significant association was found between response and disease location. Significant association was found between response and fistula type (p = 0.02). Steroid withdrawal was possible in 21/31 patients (68%). In terms of safety, 9/35 patients (26 %) suffered an adverse reaction, 4 patients required therapy discontinuation. CONCLUSION: This study suggests that infliximab has similar global response, allowance of steroid withdrawal and safety in Hispanics as in other populations. Ethnicity does not seem to influence response rate to infliximab.