268 research outputs found
Impact of therapies on bowel damage in Crohn’s disease
No full textCrohn's disease (CD) is a chronic inflammatory bowel disease that usually progresses to bowel damage, defined as strictures, fistulas and abscesses. These complications require intestinal resection and lead to further irreversible structural damage. Cross-sectional imaging, such as magnetic resonance imaging, computed tomography and ultrasound, are accurate in assessing intestinal damage at a definite time point and the progression of damage over time. Recently, an imaging-based index, the Lémann Index, has been proposed and developed in order to quantify bowel damage in CD patients; emerging data confirm that this Index can measure the structural damage with good sensitivity to change. One challenge remains to understand whether existing or future treatments might be able to stop bowel-damage progression or even reverse intestinal damage, improving the prognosis and changing the natural history of CD. We reviewed the current data available in the literature focused on the measure of structural damage in CD patients, mainly focusing on the impact on therapies in reversing bowel damage. We also explored some further perspectives on measuring and targeting intestinal damage in clinical research and in clinical practice as an ultimate therapeutic target
Review article: infliximab for Crohn's disease treatment - shifting therapeutic strategies after 10 years of clinical experience
No full textP>Background Crohn's disease is a progressive condition, with most patients developing a penetrating or stricturing complication over time. A decade ago, treatment goals consisted of immediate symptomatic control. The introduction of anti-tumour necrosis factor (anti-TNF) therapies, however, has changed the way patients with Crohn's disease are treated. Over 10 years of clinical data and experience have demonstrated these therapies to be highly effective in Crohn's disease. Aim To provide clinicians guidance on optimising treatment with anti-TNF therapies in Crohn's disease by introducing an evidence- and personal opinion-based treatment algorithm using infliximab initial anti-TNF therapy. Methods Scientific literature was reviewed using MEDLINE to evaluate data on clinical trials with infliximab in luminal and fistulising Crohn's disease. Results The data from several landmark infliximab trials have changed clinical practice and led to a readjustment of treatment goals in Crohn's disease, allowing patients to achieve more than just symptomatic relief including sustained steroid-free remission. Infliximab induces complete mucosal healing and reduces the rates of hospitalisation and surgery. Based on disease-related risk factors, a treatment algorithm for infliximab is delineated in favour of a rapid step-up approach in patients at high risk for a disabling course of disease. Conclusion Adopting the suggested treatment algorithm for infliximab into clinical routine is aimed to optimise outcomes for patients with Crohn's disease
Personalizing psychological treatment along the IBD journey: From diagnosis to surgery
No full textPersonalized medicine is becoming a widespread effort to provide the right treatment to the right patient at the right time. However, it lacks of consideration for nonmedical factors, such as patient preferences and psychosocial factors, that should not be avoided. The present study summarizes the psychosocial difficulties experienced by patients with inflammatory bowel disease (IBD) during different phases of the disease in order to identify methods to assess psychosocial risk factors and personalize treatment strategies. To reach this goal, the quantitative literature is matched with the patients' perspective, offering a broad overview of psychosocial risk factors that IBD patients experience. Quantitative results offer strong evidences for specific psychosocial risk factors in IBD and for weak results of psychosocial interventions, but show a lack of individually tailored researches, instruments and interventions, increasing the distance between the research findings and clinical practice. At the same time, qualitative findings show important, though veiled information uncovered by the quantitative research (e.g., identity recovery, fight for control, sexual concerns), which may be used as a starting point for further explorations. The present study suggests a need to adopt individualized therapeutic approach and deliver psychological therapies while taking into account patients' experiences and preferences
sj-docx-1-tag-10.1177_17562848231177153 – Supplemental material for Iron deficiency anemia impacts disease progression and healthcare resource consumption in patients with inflammatory bowel disease: a real-world evidence study
No full textSupplemental material, sj-docx-1-tag-10.1177_17562848231177153 for Iron deficiency anemia impacts disease progression and healthcare resource consumption in patients with inflammatory bowel disease: a real-world evidence study by Gionata Fiorino, Jean-Frederic Colombel, Kostas Katsanos, Fermín Mearin, Jürgen Stein, Margherita Andretta, Stefania Antonacci, Loredana Arenare, Rita Citraro, Stefania Dell’Orco, Luca Degli Esposti, Antonio Ramirez de Arellano Serna, Neige Morin and Ioannis E. Koutroubakis in Therapeutic Advances in Gastroenterology</p
The use of biosimilars in immune-mediated disease: A joint Italian Society of Rheumatology (SIR), Italian Society of Dermatology (SIDeMaST), and Italian Group of Inflammatory Bowel Disease (IG-IBD) position paper
No full textBiological agents are widely used in rheumatology, dermatology and inflammatory bowel disease. Evidence about their efficacy and safety has been strengthened for all those therapeutic indications over the last decade. Biosimilar agents are monoclonal antibodies similar to previously approved biologics. In the European Union, they have been approved for all the indications in the management of immune-mediated inflammatory diseases (IMIDs), although data only in rheumatoid arthritis and ankylosing spondylitis are currently available. Direct evidence on efficacy, safety, and immunogenicity of biosimilars is mandatory in psoriasis, psoriatic arthritis, and inflammatory bowel disease, as well as in children. Based on the current evidence in the literature, we present the joint official position of the Italian Societies of Rheumatology, Dermatology and Inflammatory Bowel Disease on the use of biosimilars in IMID
IL-23 Blockade for Crohn s disease: next generation of anti-cytokine therapy
No full textAdaptive immunity in intestinal inflammation may play a key role in the pathogenesis of Crohn's disease. In particular, interleukin (IL)-23 may be a key mediator in chronic intestinal inflammation by inducing the differentiation of naïve CD4 + T cells into Th17, with the production of several pro-inflammatory cytokines. Furthermore, IL-23 induces interferon-γ (IFN- γ) production from activated T cells, a critical cytokine in innate and adaptive immunity against infections. Areas covered: We aim to review the available data from literature regarding the role of IL-23, with a more specific focus on the recent progresses in the therapeutic modulation of this cytokine. Expert commentary: Increased knowledge regarding the role of IL-23 has allowed for the development of effective therapeutic progresses by blocking the IL-23 mediated pathways. Primary or secondary loss of response to anti-TNF therapies in Crohn's disease patients during the first year is widely described in literature: the development of new drugs, with alternative mechanisms of action, is thus a key point to consider for the optimal management of these subjects. Drugs blocking the IL-12/23 pathway showed a good efficacy and safety profile in immune-mediated diseases Further studies are necessary regarding the role of the single blockade of IL-23
Improving quality of care in endoscopy of inflammatory bowel disease: can we do better?
No full textEndoscopy plays a key role in the management of inflammatory bowel disease (IBD). There is an increased need for quality assurance programs that evaluate the quality, safety and patient experiences of endoscopy, by assessing procedural and clinical outcomes
Clinical course of COVID-19 in 41 patients with immune-mediated inflammatory diseases: Experience from humanitas center, Milan
No full textIBD Flare in the COVID-19 Pandemic: Therapy Discontinuation Is to Blame
No full textLay Summary This prospective case-control study investigated the impact of severe acute respiratory syndrome coronavirus 2 infection on inflammatory bowel disease course and looked for risk factors associated with flares. In the severe acute respiratory syndrome coronavirus 2 pandemic era, inflammatory bowel disease course is not influenced by infection, while therapy discontinuation is a risk factor for disease flare
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