AudioAbstracts

Guest: Shail M. Govani, MD, MSc

Incidence and Predictors of Success of Adalimumab Dose Escalation and De-escalation in Ulcerative Colitis: a Real-World Belgian Cohort Study.

Saartje Van de Vondel, MD, Filip Baert, MD, PhD, Christine Reenaers, MD, PhD, Stijn Vanden Branden, MD, Leila Amininejad, MD, Pieter Dewint, MD, PhD, Wouter Van Moerkercke, MD, Jean-François Rahier, MD, PhD, Pieter Hindryckx, MD, PhD, Peter Bossuyt, MD, Marc Ferrante, MD, PhD, and Belgian IBD Research and Development (BIRD)

BACKGROUND:

Adalimumab (ADM) has been shown efficacious in ulcerative colitis (UC). In randomized controlled trials, dose escalation from 40 mg ADM every other week to 40 mg every week was required in 20%–25% of patients within 1 year. Real-life data suggest higher escalation rates. Attempts for dose de-escalation have not been studied yet. We assessed the need for, outcome of, and predictors of dose escalation and de-escalation in a large retrospective cohort of UC patients treated with ADM.

METHODS:

We included 231 consecutive patients from 10 Belgian centers initiating ADM treatment for active UC before September 1, 2015 (follow-up ≥1 year in each patient). We performed detailed chart review to identify variables associated with short-term clinical benefit (based on physician global assessment and absence of rectal bleeding at week 10), success …

Guest: Ruchi Gupta, MD, MPH

Despite the increasing prevalence of food allergies in children nationwide, accurate and comprehensive statistics regarding its impacts didn’t exist, which is exactly why The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States study was conducted. Here to walk us through its findings is Dr. Ruchi Gupta, Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine and lead author of the study.

Guest: Ruchi Gupta, MD, MPH

Despite the increasing prevalence of food allergies in children nationwide, accurate and comprehensive statistics regarding its impacts didn’t exist, which is exactly why The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States study was conducted. Here to walk us through its findings is Dr. Ruchi Gupta, Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine and lead author of the study.

This episode of Audio Abstracts reviews two studies conducted in Finland that investigated the link between premenopausal use of hormonal intrauterine treatment for menorrhagia and breast cancer incidence rates.

The first study, Cancer Risk in Women Using the Levonorgestrel-Releasing Intrauterine System in Finland, examined the incidence rates of several common cancers among intrauterine treatment users. The authors found that the risk of breast cancer increased within this patient population, while all other cancer risk profiles decreased.

As a follow-up to this study, a second publication titled Levonorgestrel-Releasing Intrauterine System and the Risk of Breast Cancer: A Nationwide Cohort Study, reported that patients using this IUD were at an increased risk of lobular and ductal breast cancers, specifically.

Comparing SurePath, ThinPrep, and conventional cytology as primary test method: SurePath is associated with increased CIN II+ detection rates. Rozemeijer K, Penning C, Siebers AG, Naber SK, Matthijsse SM, van Ballegooijen M, van Kemenade FJ, de Kok IM. Cancer Causes Control. 2016 Jan;27(1):15-25.doi: 10.1007/s10552-015-0678-1. Epub 2015 Oct 12. Background Information: In the previous audio abstract summarizing the results from these researchers from the Erasmus Medical Center in the Netherlands, the BMJ 2017 article described the use of LBC in the Dutch screening program and the impact on interval cervical cancers). In this second installation, we will be reviewing a previous publication from the same group, where the effectiveness of LBC will be described in terms of detecting cytological abnormalities and corresponding detection of cervical intraepithelial lesions within cervical biopsy specimens. Objective: To compare the relative effectiveness of liquid-based cytology, in terms of atypical cytology classification and corresponding biopsy-confirmed cervical lesions, in relation to manually read conventional Pap smears, within the Dutch cervical cancer screening program Design: Retrospective, population based cohort study Setting Population: Nationwide network and registry of histology and cytology in the Netherlands PALGA database between January 2000 and March 2011. Population included 3,118,685 conventional smear results; 1,313,731 SurePath ...

Infliximab Trough Levels at Induction to Predict Treatment Failure During Maintenance.

Liefferinckx C1, Minsart C, Toubeau JF, Cremer A, Amininejad L, Quertinmont E, Devière J, Gils A, van Gossum A, Franchimont D. BACKGROUND:

Infliximab (IFX) is indicated for the treatment of inflammatory bowel diseases (IBD). Nevertheless, loss of response (LOR) to IFX is reported in up to 10% to 30% of patients within the first year of treatment. Our objective was to evaluate the impact of the pharmacokinetics of IFX at induction on treatment failure.

METHODS:

This is a longitudinal cohort study on 269 patients with IBD treated with IFX in a single center. A total of 2331 blood samples were prospectively collected from 2007 until March 2015 with a retrospective analysis of clinical data. IFX trough levels (TLs) were measured by enzyme-linked immunosorbent assay. Antibodies to IFX were measured by drug-sensitive bridging assay.

RESULTS:

During follow-up, patients were defined according to treatment outcome. At week 6, median IFX TL in patients requiring a switch to another treatment due to LOR (LOR switched group) (2.32 μg/mL [0.12-19.93 μg/mL]) was lower than in patients with long-term response (long-term responders) (8.66 μg/mL [0.12-12.09 μg/mL], P = …

Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study.

Vavricka SR1, Gubler M, Gantenbein C, Spoerri M, Froehlich F, Seibold F, Protic M, Michetti P, Straumann A, Fournier N, Juillerat P, Biedermann L, Zeitz J, Misselwitz B, Scharl M, Heinrich H, Manser CN, Safroneeva E, Raja Ali RA, Rogler G, Schoepfer AM, Greuter T; Swiss IBD Cohort Study Group. BACKGROUND:

Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution.

METHODS:

Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation.

RESULTS:

Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). …

Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure

Assa A1, Bronsky J, Kolho KL, Zarubova K, de Meij T, Ledder O, Sladek M, van Biervliet S, Strisciuglio C, Shamir R.

BACKGROUND:

The outcome of patients with Crohn's disease who failed anti-tumor necrosis factor alpha (anti-TNFα) therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNFα agent postoperatively.

METHODS:

Pediatric patients with Crohn's disease who underwent intestinal resection and were treated with anti-TNFα agents postoperatively were assessed retrospectively. Patients were stratified to those with preoperative anti-TNFα pharmacodynamic failure and those with no preoperative anti-TNFα treatment.

RESULTS:

A total of 53 children were included, 18 with pharmacodynamic failure and 35 controls. Median age at intestinal resection was 14.8 years with 23 (43%) girls. The median time from intestinal resection to anti-TNFα initiation was 8 months (interquartile range 4-14 months). At the time of postoperative anti-TNFα initiation, there were no differences in clinical, laboratory, and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNFα treatment after 12 months and at the …

Anti-VEGF Comparative Effectiveness Trial for Diabetic Macular Edema: Additional Post-Hoc Analyses Lee M. Jampol, MD, Adam R. Glassman, MS, Neil M. Bressler, MD, John A. Wells, MD, Allison R. Ayala MS JAMA Ophthalmol. 2016;134(12):1429-1434. doi:10.1001/jamaophthalmol.2016.3698 Abstract Importance: Post-hoc analyses from DRCR.net randomized trial comparing aflibercept, bevacizumab, and ranibizumab for diabetic macular edema (DME) might influence interpretation of study results. Objective: To provide additional post-hoc clinically relevant outcomes comparing three anti-VEGF agents for DME Design, Setting, Participants: Post-hoc analysis from a 2-year randomized clinical trial of 660 participants comparing three anti-VEGF treatments in eyes with center-involved DME causing vision impairment. Exposure: Random allocation to intravitreous aflibercept (2.0-mg), bevacizumab (1.25-mg) or ranibizumab (0.3-mg) administered up to monthly based on a structured retreatment regimen. Focal/grid laser was added after 6 months for persistent DME. Main Outcome Measures: Change in visual acuity area under the curve; change in central subfield thickness (CST) within subgroups based on whether an eye received laser treatment for DME during the study Results: For eyes with initial visual acuity (VA) 20/50 or worse, VA improvement was greater with aflibercept than the other agents at one year, but superior only to bevacizumab at the two year visit. VA remained largely ...

Cervical cancer incidence after normal cytological sample in routine screening using SurePath, ThinPrep, and conventional cytology: population based study Kirsten Rozemeijer, Steffie K Naber, Corine Penning, Lucy I H Overbeek, Caspar W N Looman, Inge M C M de Kok, Suzette M Matthijsse, Matejka Rebolj, Folkert J van Kemenade, and Marjolein van Ballegooijen BMJ 2017;356:j504 Abstract: Objective: To compare the cumulative incidence of cervical cancer diagnosed within 72 months after a normal screening sample between conventional cytology and liquid based cytology tests SurePath and ThinPrep. Design: Retrospective population based cohort study. Setting: Nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA), January 2000 to March 2013. Population: Women with 5 924 474 normal screening samples (23 833 123 person years). Exposure: Use of SurePath or ThinPrep versus conventional cytology as screening test. Main outcome measurement: 72 month cumulative incidence of invasive cervical cancer after a normal screening sample for each screening test. Cox regression analyses assessed the hazard ratios, adjusted for calendar time, age, screening history, and socioeconomic status and including laboratories as random effects. Results: The 72 month cumulative cancer incidence was 58.5 (95% confidence interval 54.6 to 62.7) per 100 000 normal conventional cytology samples, ...