LINKED CONTENT
This article is linked to Avni‐Biron et al papers. To view these articles, visit https://doi.org/10.1111/apt.17224 and https://doi.org/10.1111/apt.17282
Summary
Background
Ustekinumab and vedolizumab are commonly used after anti‐tumour necrosis factor (TNF) failure in patients with Crohn’s disease (CD). No randomised controlled trial has compared ...these drugs.
Aims
To compare the effectiveness of ustekinumab and vedolizumab in CD patients refractory to anti‐TNF.
Methods
From PubMed, EMBASE and the Cochrane Library, through March 27, 2021, we identified studies that compared ustekinumab and vedolizumab in patients with CD refractory to anti‐TNF. The main outcomes were clinical remission and steroid‐free clinical remission at weeks 14 and 52. Secondary outcomes were biological remission and treatment persistence. We computed pooled odds ratios (OR) and 95% confidence intervals (CI) using random effects meta‐analysis.
Results
We identified 1513 reports. Among them, 38 studies were assessed for eligibility and five studies were included. All studies included were of high quality: four were retrospective and one was prospective. Among 1026 patients, 659 received ustekinumab and 367 received vedolizumab. At week 14, clinical remission (OR 1.36; 95%CI: 0.74‐2.47; I2 = 50%), steroid‐free clinical remission (OR 1.24; 95%CI: 0.79‐1.92; I2 = 52%) and biological remission (OR 0.80; 95%CI: 0.50‐1.28; I2 = 0%) rates were similar between the two treatments. At week 52, ustekinumab was associated with higher rates of clinical remission (OR 1.87; 95% CI: 1.18‐2.98; I2 = 0%), steroid‐free clinical remission (OR 1.56; 95% CI: 1.23‐1.97; I2 = 0%), biological remission (OR 1.86; 95% CI: 1.03‐3.37; I2 = 29%) and treatment persistence (OR 2.37; 95% CI: 1.56‐3.62; I2 = 0%).
Conclusion
In patients with CD refractory to anti‐TNF, ustekinumab and vedolizumab are similarly effective in induction, but as maintenance treatment, ustekinumab appears to be more effective than vedolizumab.
In patients with Crohn’s disease refractory to anti‐TNF, ustekinumab appears to be more effective than vedolizumab as maintenance treatment.
Editorial: Another brick in the CDST wall Amiot, Aurelien; Antoine, Meyer; Carbonnel, Franck
Alimentary pharmacology & therapeutics,
July 2024, Letnik:
60, Številka:
1
Journal Article
Recenzirano
Odprti dostop
LINKED CONTENT
This article is linked to Kim et al papers. To view these articles, visit https://doi.org/10.1111/apt.17989 and https://doi.org/10.1111/apt.18045.
The incidence and severity of ulcerative colitis (UC) are higher in nonsmokers than in smokers. The natural course of UC in smokers who stop smoking is not known. The aim of this study was to ...determine the impact of cessation of smoking on the course of UC among the cohort of patients regularly seen at our institution.
The severity of UC, as judged by the occurrence of flare-ups and the need for systemic steroids, immunosuppressive drugs and colectomy, was determined in 32 patients with UC who stopped smoking after the diagnosis of UC. We compared the period after cessation of smoking (7-yr mean follow-up) with the period between the onset of the disease and the cessation of smoking (9-yr mean duration). The course of UC in this group was compared with that of 32 nonsmokers and 32 continuing smokers matched for sex, age, and age at onset.
In patients who quit, cessation of smoking was followed by an increase in the rate of years with active disease (p < 0.01), years with hospitalization (p < 0.05) and years with major medical therapy (oral steroids, intravenous steroids, and azathioprine, p < 0.01). After cessation of smoking, the rate of years with immunosuppressive therapy was significantly greater in ex-smokers and nonsmokers than in continuing smokers (p < 0.01). The risk of colectomy in ex-smokers after smoking cessation was similar to that of nonsmokers and continuing smokers.
In smokers with UC who stop smoking, the severity of the disease increases after smoking cessation, with an increase in the disease activity and the need for hospital admission and major medical therapy. In addition, the need for azathioprine therapy becomes similar to that of nonsmokers.
Summary
Background
The risk of lymphoma in patients with inflammatory bowel disease (IBD) treated with anti‐TNF agents remains unclear.
Aim
To assess the comparative risk of lymphoma with anti‐TNF ...agents and/or thiopurines in IBD
Methods
We searched PubMed, EMBASE and Cochrane Library to identify studies that evaluated lymphoproliferative disorders associated with anti‐TNF agents with or without thiopurines. The risk of lymphoma was assessed through four comparator groups: combination therapy (anti‐TNF plus thiopurine), anti‐TNF monotherapy, thiopurine monotherapy and control group. Pooled incidence rate ratios (IRR) were estimated through Poisson‐normal models.
Results
Four observational studies comprising 261 689 patients were included. As compared with patients unexposed to anti‐TNF and thiopurines, those exposed to anti‐TNF monotherapy, thiopurine monotherapy or combination therapy had pooled IRR (per 1000 patient‐years) of lymphoma of 1.52 (95% CI: 1.06‐2.19; P = 0.023), 2.23 (95% CI: 1.79‐2.79; P < 0.001) and 3.71 (95% CI: 2.30‐6.00; P ≤ 0.01), respectively. The risk of lymphoma associated with combination therapy was higher than with thiopurines or anti‐TNF alone with pooled IRR of 1.70 (95% CI: 1.03‐2.81; P = 0.039) and 2.49 (95% CI: 1.39‐4.47; P = 0.002), respectively. The risk did not differ between anti‐TNF monotherapy and thiopurine monotherapy with pooled IRR of 0.72 (95% CI: 0.48‐1.07; P = 0.107). All observational studies were of high quality according to the Newcastle‐Ottawa scale.
Conclusions
There is an increased risk of lymphoma in IBD patients treated with anti‐TNF agents, either alone or when combined with thiopurines.
LINKED CONTENT
This article is linked to Chen et al papers. To view these articles, visit https://doi.org/10.1111/apt.17392 and https://doi.org/10.1111/apt.17471
Background
The WallFlex
®
and Evolution
®
stents are the most widely used duodenal stents, but no study has compared them.
Aims
We aimed to compare the efficacy and safety of WallFlex
®
and Evolution
...®
stents for malignant gastric outlet obstruction.
Methods
We included all consecutive patients who were treated for malignant gastric outlet obstruction with WallFlex
®
or Evolution
®
self-expandable metal uncovered duodenal stents between 2013 and 2020. Multivariable Cox models were performed to assess duodenal stent failure, as defined by gastric outlet obstruction necessitating another duodenal stent.
Results
We included 129 patients: 74 received a WallFlex
®
stent and 55 received an Evolution
®
stent. The non-failure rate was of 68% (95%CI 55–84) and 65% (95%CI 50–84) at 6 months and of 48% (95%CI 32–73) and 45% (95%CI 27–74) at 1 year, with the WallFlex
®
and Evolution
®
stents, respectively. The median time to duodenal stent failure was 10.5 months in the WallFlex
®
group and 9.3 months in the Evolution
®
group. The type of duodenal stent was not associated with duodenal stent failure (
p
logrank = 0.43, adjusted hazard ratio 1.55; 95%CI 0.77–3.14). The overall survival was similar between the two groups (
p
logrank = 0.92). Three patients had complications due to Evolution
®
stents; it consisted in dismantled stents that led to hemorrhage in one patient.
Conclusions
WallFlex
®
and Evolution
®
duodenal stents had similar efficacy for malignant gastric outlet obstruction. There were more adverse events with Evolution
®
stents.
