Summary
Background
The optimal choice of biological agents after failure of anti‐tumour‐necrosis‐factor‐(TNF)α agent in Crohn’s disease (CD) is yet to be defined.
Aims
To assess the effectiveness and ...safety of ustekinumab compared to vedolizumab as second‐line treatment in CD patients who failed anti‐TNFα therapy.
Methods
Retrospective analysis of clinical response and remission at 14 and 52 weeks to ustekinumab by physician global assessment (PGA). A propensity score‐matched analysis with a cohort treated with vedolizumab was performed.
Results
Of 282 patients (mean age 40 ± 15, F:M ratio 1.7:1) treated with ustekinumab, clinical response or remission was reached by 200/282 patients (70.9%) at 14 weeks, and 162/259 patients (62.5%) at 52 weeks. Overall, 74 adverse events occurred, of which 26 were labelled as serious (8.3 per 100 person‐year). After exclusion of patients without prior anti‐TNFα exposure and patients previously exposed to vedolizumab or ustekinumab, we analysed 275/282 patients (97.5%) on ustekinumab and 118/135 patients (87.4%) on vedolizumab. Propensity score analysis revealed that at 14 weeks, patients treated with ustekinumab were 38% (95% CI 25%‐50%; P < 0.001) more likely to achieve clinical remission, while at 52 weeks, the difference of 9% (95% CI −15% to 33%; P = 0.462) was not significant.
Conclusions
Ustekinumab was effective and well tolerated in this real‐world cohort. While ustekinumab proved more effective at 14‐weeks, we found no statistically significant differences at 52 weeks compared to vedolizumab.
Ustekinumab was effective and well tolerated in a real‐world cohort, with no new safety signals. According to our propensity score‐matched analysis, vedolizumab should be first considered in older patients or with multimorbidity, while ustekinumab may be preferred in younger patients with psoriasis and for achieving remission more rapidly.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
LINKED CONTENTThis article is linked to Tandon et al and Tandon and Huang papers. To view these articles, visit https://doi.org/10.1111/apt.15587 and https://doi.org/10.1111/apt.15655.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
LINKED CONTENT
This article is linked to Rosiou et al papers. To view these articles, visit https://doi.org/10.1111/apt.17039 and https://doi.org/10.1111/apt.17137
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
LINKED CONTENT
This article is linked to Kumar et al papers. To view these articles, visit https://doi.org/10.1111/apt.16839 and https://doi.org/10.1111/apt.16918
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Introduction:
Inflammatory Bowel Disease (IBD) affects many women of childbearing age, and rates of voluntary childlessness (VC) exceed those of the general population by far. The factors surrounding ...VC remain incompletely understood.
Methods:
Female members of the patient organisation Crohn’s and Colitis UK aged 18–45 years were invited to complete an online questionnaire collecting data on demographics, disease characteristics, Crohn’s and Colitis pregnancy-specific disease-related knowledge (CCPKnow), and childlessness status.
Results:
A total of 1324 women (mean age 33 years) completed the survey: 776 (59%) were diagnosed with Crohn’s disease (CD), 496 (38%) with ulcerative colitis (UC) and 4% with inflammatory bowel disease–unclassified (IBD-U); 40% had children (14% pre-diagnosis (I); 26% post-diagnosis (II)), 36% planned to have children at some stage (III), 7% reported fertility problems (IV), and 17% were classified as voluntarily childless (VC). VC was associated with poorer CCPKnow scores 5.98 vs. 7.47 in (III); p < 0.001, older age 35 years old vs. 28 years old in (II); p < 0.001, unemployment (9.7% VC; p < 0.001), being single (34.5% VC; p < 0.001) not seeking medical advice (p < 0.001), and diagnosis of CD (19.3% vs. 13.9% UC; p = 0.015). Women with VC had more hospital admissions mean 2.85 vs. 2.17 (III); p = 0.03 and surgical interventions mean 1.27 vs. 0.65 (III); p < 0.001
Conclusion:
The aetiology of VC in women with IBD is multifactorial. Women’s choice regarding children appears related to disease burden. VC is also associated with poor knowledge (CCPKnow), and women may stay childless unnecessarily. Patient education programmes could help to reduce the rate of VC in women with IBD, through correcting misconceptions and alleviating patient concerns.
Interactions within a population shape the spread of infectious diseases but contact patterns between individuals are difficult to access. We hypothesised that key properties of these patterns can be ...inferred from multiple infection data in longitudinal follow-ups. We developed a simulator for epidemics with multiple infections on networks and analysed the resulting individual infection time series by introducing similarity metrics between hosts based on their multiple infection histories. We find that, depending on infection multiplicity and network sampling, multiple infection summary statistics can recover network properties such as degree distribution. Furthermore, we show that by mining simulation outputs for multiple infection patterns, one can detect immunological interference between pathogens (i.e. the fact that past infections in a host condition future probability of infection). The combination of individual-based simulations and analysis of multiple infection histories opens promising perspectives to infer and validate transmission networks and immunological interference for infectious diseases from longitudinal cohort data.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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This article is linked to Sedano et al papers. To view these articles, visit https://doi.org/10.1111/apt.16328 and https://doi.org/10.1111/apt.16366
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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