Heparins in ulcerative colitis: proposed mechanisms of action and potential reasons for inconsistent clinical outcomes

2015 ◽  
Vol 8 (6) ◽  
pp. 795-811 ◽  
Author(s):  
Qi Ying Lean ◽  
Nuri Gueven ◽  
Rajaraman D Eri ◽  
Rajesh Bhatia ◽  
Sukhwinder Singh Sohal ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Outcomes ◽  
Mechanisms Of Action

PGI7 Correlation between Clinical Outcomes and HTA Decisions in Ulcerative Colitis

2021 ◽  
Vol 24 ◽  
pp. S95
Author(s):  
P. Manchanda ◽  
K. Mark ◽  
J. Rubinstein
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Outcomes

scholarly journals Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000662
Author(s):  
Sen Yagi ◽  
Shinya Furukawa ◽  
Kana Shiraishi ◽  
Yu Hashimoto ◽  
Kazuhiro Tange ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Serum Albumin ◽  
Clinical Outcomes ◽  
Clinical Remission ◽  
Acute Inflammation ◽  
Japanese Patients ◽  
Cross Sectional Study ◽  
Mucosal Healing ◽  
High Serum ◽  
Cross Sectional

ObjectiveSerum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal healing (MH) has been indicated as the therapeutic goal for UC, the association between serum albumin and MH remains unclear. We evaluated this issue in patients with UC overall and explored whether duration of UC affected this association.DesignThis cross-sectional study recruited consecutive patients with UC. Study subjects consisted of 273 Japanese patients with UC. Serum albumin was divided into tertiles based on its distribution in all study subjects. One endoscopy specialist was responsible for measuring partial MH and MH, which were defined as a Mayo endoscopic subscore of 0–1 and 0, respectively. The association between serum albumin and clinical outcomes was assessed by multivariate logistic regression.ResultsRates of clinical remission, partial MH and MH were 57.9%, 63% and 26%, respectively. Only high serum albumin (>4.4 mg/dL) was significantly positively associated with MH (OR 2.29 (95% CI: 1.03 to 5.29), p for trend=0.043). In patients with short UC duration (<7 years) only, high serum albumin was significantly positively associated with MH and clinical remission. In patients with long UC duration (≥7 years), in contrast, no association between serum albumin and clinical outcomes was found.ConclusionIn Japanese patients with UC, serum albumin was significantly positively associated with MH. In patients with short UC duration, serum albumin might be a useful complementary marker for MH.

scholarly journals Stopping 5-aminosalicylates in patients with ulcerative colitis starting biologic therapy does not increase the risk of adverse clinical outcomes: analysis of two nationwide population-based cohorts

Gut ◽  
2018 ◽  
Vol 68 (6) ◽  
pp. 977-984 ◽  
Author(s):  
Ryan C Ungaro ◽  
Berkeley N Limketkai ◽  
Camilla Bjørn Jensen ◽  
Kristine Højgaard Allin ◽  
Manasi Agrawal ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
The United States ◽  
Health Claims ◽  
Sensitivity Analyses ◽  
Clinical Event ◽  
Clinical Events ◽  
Increased Risk ◽  
National Databases

ObjectiveThe benefit of continuing 5-aminosalicylate (5-ASA) in patients with ulcerative colitis (UC) who initiate anti-tumour necrosis factor-alpha (anti-TNF) biologics is unknown. We aimed to compare clinical outcomes in patients with UC already on 5-ASA who started anti-TNF and then either stopped or continued 5-ASA.DesignOur primary outcome was any adverse clinical event defined as a composite of new corticosteroid use, UC-related hospitalisation or surgery. We used two national databases: the United States (US) Truven MarketScan health claims database and the Danish health registers. Patients with UC who started anti-TNF after having been on oral 5-ASA for at least 90 days were included. Patients were classified as stopping 5-ASA if therapy was discontinued within 90 days of starting anti-TNF. We performed multivariable Cox regression models controlling for demographics, clinical factors and healthcare utilisation. Adjusted HRs (aHR) with 95% CI are reported comparing stopping 5-ASA with continuing 5-ASA.ResultsA total of 3589 patients with UC were included (2890 US and 699 Denmark). Stopping 5-ASA after initiating anti-TNF was not associated with an increased risk of adverse clinical events in the U.S. cohort (aHR 1.04; 95% CI 0.90 to 1.21, p=0.57) nor in the Danish cohort (aHR 1.09; 95% CI 0.80 to 1.49, p=0.60). Results were similar in sensitivity analyses investigating concomitant immunomodulator use and duration of 5-ASA treatment before initiating anti-TNF.ConclusionIn two national databases, stopping 5-ASA in patients with UC starting anti-TNF therapy did not increase the risk of adverse clinical events. These results should be validated in a prospective clinical trial.

scholarly journals P536 Early prediction of intravenous corticosteroid therapy failure in moderate–severe ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S458-S458
Author(s):  
A Croft ◽  
A Lord ◽  
G Radford-Smith
Keyword(s):  
Ulcerative Colitis ◽  
High Risk ◽  
Clinical Outcomes ◽  
Corticosteroid Therapy ◽  
Risk Score ◽  
Risk Scores ◽  
Albumin Concentration ◽  
Therapy Failure ◽  
Severe Ulcerative Colitis ◽  
Intravenous Corticosteroid

Abstract Background An episode of acute severe ulcerative colitis (UC) is a watershed event during the disease course with a heightened risk of colectomy during and following these episodes.1 The prompt identification of these events followed by the early implementation of appropriate treatment is essential to obtaining the best clinical outcomes for these unwell patients. The majority of published risk scores predicting the important clinical outcomes of intravenous corticosteroid therapy failure and colectomy-by-discharge rely on clinical data from days 1–3 of therapy.2 There is a paucity of tools that allow for a simple and individualised prediction of risk of corticosteroid therapy failure during the earliest stages of admission. Methods Data were prospectively obtained from 349 presentations of moderate–severe UC requiring hospital admission to a tertiary referral hospital. The failure of intravenous corticosteroid therapy was strictly defined by the (Oxford) Day 3 and Day 7 criteria.3 Seventeen clinical, laboratory and endoscopic variables all available within 24 h of hospital presentation were assessed for their ability to differentiate intravenous corticosteroid therapy responders from non-responders. A stepwise generalised linear model was formulated based on the results of the initial univariate analyses. Results Intravenous corticosteroid therapy failure occurred in 208/349 (60%) of presentations. The formulated risk score included the variables of oral corticosteroid therapy failure, bowel frequency and serum albumin concentration with or without the Mayo endoscopic subscore (MES). With the addition of the MES, the area under the curve (AUC) of the risk score was 0.758. When the positive predictive value of the score (threshold) for correctly predicting intravenous corticosteroid therapy failure was set at 85%, 105/275 (38%) of presentations with available data were identified as high risk for corticosteroid therapy failure (Figure 1). Conclusion This practical risk assessment tool provides clinicians with a personalised prediction of the likelihood of success of a course of intravenous corticosteroid therapy in moderate–severe UC. It enables the identification of individuals at high risk of treatment failure who may be suitable for consideration of early treatment escalation or screening for appropriate clinical trials. References

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