番茄社区

This article is a collaboration between 番茄社区 and:

ORLANDO -- The 2017 Advances in Inflammatory Bowel Diseases (AIBD) meeting highlighted the importance of a multi-disciplinary, patient-centered approach to treating patients with inflammatory bowel disease (IBD). Experts from around the world offered novel insight on care, including data on alvimopan for postoperative ileus in the IBD population and a collaborative disease management app that improved patient care and quality of life.

番茄社区 wrapped up its coverage with a few more noteworthy studies from AIBD 2017.

Readmission after IPAA Surgery

Ileal pouch anal anastomosis (IPAA) surgery in patients with medically refractory ulcerative colitis was linked to high morbidity, according to an analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Among 1,882 patients who underwent IPAA surgery for ulcerative colitis between 2012 and 2015, one-fifth were readmitted within 30 days and one-third had a second readmission, reported H. Hande Aydinli, MD, of NYU Langone Medical Center in New York City, and colleagues.

The researchers found that the most common reasons for readmission were surgical site infection (n=88), dehydration (n=77), small bowel obstruction/ileus (n=38/18), and abdominal pain (n=28). Additionally, an American Society of Anesthesiologists (ASA) score of 4 for severe systematic disease that is a constant threat to life (OR 6.1, 95% CI 1.1-35.6, P=0.03), 3 for severe systematic disease (OR 3.0, 95% CI 1.06-8.7, P=0.03), or 2 for mild systematic disease (OR 3.1, 95% CI 1.1-8.7, P=0.03), as well age <40 years (OR 1.3, 95% CI 1.06-1.6, P=0.01), was linked to 30-day readmission.

"This study brings the possibility and consideration for national healthcare initiative in surgical management of patients with ulcerative colitis, undergoing IPAA surgery," stated the authors, concluding that future efforts to improve outcomes should focus on surgical site infection rates and postoperative dehydration ().

Oral versus IV Iron for IBD

IBD patients receiving IV iron were less frequently hospitalized and incurred lower total healthcare costs compared with patients receiving oral iron, according to German investigators.

According to an analysis of 760 German patients with IBD, all-cause hospitalization was significantly lower in the IV iron group compared with the oral iron cohort (37% vs 48%, P=0.0019), with IV group having fewer hospitalizations due to iron deficiency with or without anemia (5% vs 14%, P<0.001), reported Jürgen Stein, MD, of the Interdisciplinary Crohn Colitis Centre Rhein-Main in Frankfurt, and colleagues.

The researchers identified 29,331 patients with IBD in the German Health Risk Institute research claims database; approximately 15% had confirmed iron deficiency with or without anemia (ID/A) and more than 50% of IBD patients with ID/A had not received prescription iron replacement therapy.

After matching for age, gender, and Charlson Comorbidity Index scores, Stein's group analyzed 380 patients in both the IV and oral treatment groups to find that duration of all-cause hospitalizations was 8.5 days and 7.9 days, respectively (P=0.0016). The duration of iron deficiency-related hospitalizations was considerably shorter for patients who received IV iron (7.0 vs 9.6 days, P<0.001).

The researchers also found that while patients in the IV iron cohort had higher costs before treatment, they had lower costs for inpatient care, devices and aids, and sick leave payments compared with patients on oral treatment. This translated to higher expenditures for medication (€1,876 or about $2,200) but more inpatient setting cost savings (€1,887), they said.

Stein concluded that the "higher expenditures for pharmaceuticals were compensated by cost savings in other domains" ().

Etrolizumab for Crohn's Disease

Etrolizumab, a humanized anti-β7 monoclonal antibody, was well tolerated and resulted in endoscopic and symptom improvements in patients with moderate-to-severe Crohn's disease, researchers reported.

Analysis of data from the found that a greater proportion of patients achieved endoscopic improvement with etrolizumab 105 mg (21.0%, 90% CI 15.6-27.8) and 210 mg (17.4%. 90% CI 12.4-23.7) compared with placebo (3.4%, 90% CI 1.1-9.7) at week 14, reported William J. Sandborn, MD, of the University of California San Diego, and colleagues.

Sandborn's group randomized 300 patients, 73% of whom were refractory or intolerant to an anti-TNF, 2:2:1 to receive etrolizumab 105 mg subcutaneously every 4 weeks, etrolizumab 210 mg at weeks 0, 2, 4, 8, and 12, or placebo during a 14-week induction period.

They reported that symptomatic remission (SF≤ 3 and AP≤ 1) was observed in more patients treated with etrolizumab 105 mg and 210 mg compared with placebo at:

• Week 6: 15.0% (90% CI 10.4-21.1) for 105 mg and 25.6% (90% CI 19.7-32.6) for 201 mg vs (8.5% for placebo (90% CI 4.2-16.4)
• Week 10: 15.8% (90% CI 11.1-22.1) and 27.3% (90% CI 21.2-34.4) vs 8.5% (90% CI 4.2-16.4)
• Week 14: 20.8% (90% CI 15.4-27.5) and 24.8% (90% CI 18.9-31.8) vs 11.9% (90% CI 6.6-20.5)

Clinical Disease Activity Index remission (CDAI <150) was achieved at week 14 in 23.3% of patients on etrolizumab 105 mg, 28.9% on 210 mg, and 16.9% on placebo. Etrolizumab was also superior at improving PRO2 remission (weighted combined score ≤ 11 of liquid/very soft stool frequency and abdominal pain) compared with placebo (28.3% vs 28.9% vs 20.3%).

The researchers reported no deaths, anaphylaxis, or progressive multifocal leukoencephalopathy, and that frequency of adverse events was comparable with placebo.

Enrollment into subsequent induction cohorts and into the maintenance phase of BERGAMOT is ongoing, reported Sandborn. Etrolizumab is developed by Genentech ().