COMBINATION OF ADVANCED THERAPIES IN PATIENTS WITH COMPLEX INFLAMMATORY BOWEL DISEASE
Digestive and Liver Disease
; 54:S113, 2022.
Article
in English
| EMBASE | ID: covidwho-1996805
ABSTRACT
Background and aim:
Dual Targeted Therapy (DTT) is a novel therapeutic strategy proposed for the management of patients with complex inflammatory bowel disease (IBD). Our aim was to evaluate the safety and effectiveness of this approach in a real-life setting Materials andmethods:
In this single centre retrospective cohort study, we collected data on IBD patients receiving DTT from 2017 to 2022. Baseline characteristics, clinical activity of intestinal and extraintestinal disease, C-reactive protein (CRP) levels, endoscopic assessment and adverse events (AEs) were recorded. Clinical remission, CRP normalization, endoscopic remission and occurrence of AEs were investigated at baseline and during follow upResults:
Sixteen patients were identified;indications for DTT were uncontrolled IBD (11 patients), uncontrolled extraintestinal manifestations (EIMs) (6 patients 4 spondyloarthritis, 2 psoriatic disease). Patients received vedolizumab (VDZ, 14, 87.5%), ustekinumab (UST, 8, 50%), anti-TNFα (7, 43.8%), sekukinumab (2, 12.5%), tofacitinib (1, 6.3%). The most common combinations were VDZ+UST (6 patients, 37.5%) and adalimumab+VDZ (3, 18.8%). At baseline, 15/16 (93.8%) and 4/6 (66.6%) patients had active intestinal and EI symptoms, respectively;14 (87.5%) patients had positive CRP and 5 (31.3%) were receiving oral steroids. Median follow-up duration on DTT was 15 months (IQR 11-22). Clinical intestinal remission was reported by 6/16 (37.5%) and 3/11 (27.3%) patients at 6 and 12 months, respectively. Clinical remission of EIMs was reported by 3/7 (42.9%) at 6 and 5/7 (71.4%) patients at 12 months, respectively. CRP normalization was observed in 3/16 (18.8%) and 6/11 (54.5%) patients at 6 and 12 months, respectively. 80% of patients on steroid therapy at baseline discontinued them within 6 months. Endoscopic assessments were available for 8 patients, with endoscopic remission in 2, endoscopic improvement in 3 and no improvement in 3. Four patients (25%) experienced an AE (1 COVID-19 and reactivation of perianal disease;1 mild pneumonitis and reactivation of perianal disease;1 drug-induced pneumonitis;1 arthralgia and COVID-19). Finally, 1 patient underwent colectomy due to uncontrolled disease. Three patients discontinued DTT 2 because of treatment failure, 1 because of an AE (drug-induced pneumonitis)Conclusions:
DTT can be considered a reasonably safe and effective treatment in complex IBD patients, either with uncontrolled intestinal inflammation or with concomitant EIMs, when other therapeutic options have failed
C reactive protein; endogenous compound; steroid; tofacitinib; tumor necrosis factor antibody; ustekinumab; vedolizumab; adult; adverse drug reaction; arthralgia; clinical article; clinical assessment; cohort analysis; colectomy; conference abstract; controlled study; coronavirus disease 2019; drug combination; drug safety; drug therapy; enteropathy; female; follow up; human; inflammation; inflammatory bowel disease; lack of drug effect; male; molecularly targeted therapy; pneumonia; psoriasis; remission; retrospective study; side effect; spondylarthritis; steroid therapy; surgery; treatment failure
Full text:
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Digestive and Liver Disease
Year:
2022
Document Type:
Article
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