Review
Pharmacology & Pharmacy
Alix Demaris, Ella S. K. Widigson, Johan F. K. F. Ilvemark, Casper Steenholdt, Jakob B. Seidelin, Wilhelm Huisinga, Robin Michelet, Linda B. S. Aulin, Charlotte Kloft
Summary: This review aims to analyze the population PK models of infliximab (IFX) in patients with ulcerative colitis (UC) and acute severe UC (ASUC), and assess the impact of disease activity on IFX PK. The results showed that there are still many gaps in the current research, such as a limited number of models specifically developed for UC patients, a lack of studies on severe UC patients, and a lack of evaluation of predictive performance for the models. Therefore, more comprehensive research and adequate reporting and evaluation of the models are needed for clinical application.
Review
Medicine, General & Internal
Benjamin L. Gordon, Robert Battat
Summary: Therapeutic drug monitoring (TDM) is a useful strategy in ulcerative colitis (UC), particularly in acute severe UC (ASUC). While there is limited data available for the use of TDM of infliximab in ASUC, observational data suggest that higher serum infliximab concentrations and lower clearance are associated with better clinical outcomes and decreased rates of colectomy. However, more studies are needed to evaluate optimal dosing and TDM targets in this population.
JOURNAL OF CLINICAL MEDICINE
(2023)
Review
Gastroenterology & Hepatology
Casper Steenholdt, Pernille Dige Ovesen, Jorn Brynskov, Jakob Benedict Seidelin
Summary: This systematic review analyzed the efficacy, safety, and integration of Tofacitinib in the treatment of acute severe ulcerative colitis (ASUC). The results showed that Tofacitinib has promising results in ASUC with high short-term colectomy-free survival. However, larger and high-quality studies are still needed to further evaluate its effectiveness.
JOURNAL OF CROHNS & COLITIS
(2023)
Article
Gastroenterology & Hepatology
Alex Adams, Vipin Gupta, Waled Mohsen, Thomas P. Chapman, Deloshaan Subhaharan, Pradeep Kakkadasam Ramaswamy, Sudheer Kumar, Saurabh Kedia, Colleen G. C. McGregor, Tim Ambrose, Bruce D. George, Rebecca Palmer, Oliver Brain, Alissa Walsh, Vineet Ahuja, Simon P. L. Travis, Jack Satsangi
Summary: The changes in acute severe colitis (ASC) management have resulted in improved outcomes. A simple predictive model can be used to identify patients who will not respond to steroids upon admission.
Article
Gastroenterology & Hepatology
Robert Gilmore, Wei Lian Tan, Richard Fernandes, Yoon-Kyo An, Jakob Begun
Summary: This study found that upadacitinib may be a safe and effective salvage therapy for patients with steroid-refractory acute severe ulcerative colitis who have previously failed to respond to infliximab therapy. Prospective studies are needed to determine the safety and efficacy of upadacitinib use in this setting before routine use can be recommended.
JOURNAL OF CROHNS & COLITIS
(2023)
Article
Gastroenterology & Hepatology
Maia Kayal, Hannah Posner, Hadar Meringer Milwidsky, Michael Plietz, Sergey Khaitov, Patricia Sylla, Alexander Greenstein, Marla C. Dubinsky, Saurabh Mehandru, Jean Frederic Colombel
Summary: A retrospective cohort analysis of 416 patients found that acute severe ulcerative colitis was significantly associated with subsequent acute pouchitis. The risk of pouchitis may be influenced by immune activation and disease severity prior to colectomy.
INFLAMMATORY BOWEL DISEASES
(2023)
Article
Gastroenterology & Hepatology
Nathaniel A. Cohen, Maryam Zafer, Namrata Setia, Michael J. Anderson, Atsushi Sakuraba, Sushila Dalal, Joel Pekow, Russell D. Cohen, David T. Rubin, Dejan Micic
Summary: This study found that serum CMV PCR can be used as a non-invasive test for diagnosing CMV colitis in UC patients, and it has excellent negative predictive value and a strong correlation with CMV positivity on histology.
DIGESTIVE DISEASES AND SCIENCES
(2023)
Review
Gastroenterology & Hepatology
Javier P. Gisbert, Maria Jose Garcia, Maria Chaparro
Summary: For patients with steroid-refractory ASUC, both standard treatment (cyclosporine and infliximab) and newly developed agents (such as vedolizumab and ustekinumab) are effective options.
JOURNAL OF CROHNS & COLITIS
(2023)
Article
Gastroenterology & Hepatology
Gaurav Syal, Lori Robbins, Amir Kashani, Nirupama Bonthala, Edward Feldman, Phillip Fleshner, Eric Vasiliauskas, Dermot McGovern, Christina Ha, Stephan Targan, Gil Y. Melmed
Summary: Serum albumin and band neutrophil percentage are independent predictors of failure of infliximab rescue therapy in patients with acute severe ulcerative colitis. The combination of serum albumin <= 2.5 g/dl and band neutrophil count >= 13% has a 100% positive predictive value for 90-day colectomy.
DIGESTIVE DISEASES AND SCIENCES
(2021)
Article
Gastroenterology & Hepatology
D. Laharie, J. Y. Mary
Summary: This study aimed to quantify the association between achieving Mayo endoscopic sub-score (MES) of 0 or 1 and long-term disease outcome in patients with acute severe ulcerative colitis (ASUC). The results showed that patients who achieved complete endoscopic healing had better survival and longer time without disease relapse.
JOURNAL OF CROHNS & COLITIS
(2023)
Article
Gastroenterology & Hepatology
Saurabh Kedia, Tarini Shankar Ghosh, Saransh Jain, Anbumani Desigamani, Ashok Kumar, Vipin Gupta, Sawan Bopanna, Dawesh P. Yadav, Sandeep Goyal, Govind Makharia, Simon P. L. Travis, Bhabatosh Das, Vineet Ahuja
Summary: The gut microbiome of patients with acute severe colitis (ASC) is characterized by lower diversity compared to mild-moderate UC or healthy controls (HCs). The microbiome composition in ASC is increasingly unstable, with distinct abundance of specific genera compared to UC and HCs. Mild-moderate UC falls within the spectrum of gut microbial diversity.
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
(2021)
Article
Gastroenterology & Hepatology
Robert Gilmore, Patrick Hilley, Ashish Srinivasan, Matthew Choy, Peter De Cruz
Summary: This study found that high-dose tofacitinib may have a role as salvage therapy in patients with steroid-refractory ASUC.
JOURNAL OF CROHNS & COLITIS
(2022)
Article
Gastroenterology & Hepatology
David Laharie, Arnaud Bourreille, Julien Branche, Matthieu Allez, Yoram Bouhnik, Jerome Filippi, Frank Zerbib, Guillaume Savoye, Lucine Vuitton, Jacques Moreau, Aurelien Amiot, Laurent Beaugerie, Elena Ricart, Olivier Dewit, Antonio Lopez-Sanroman, Mathurin Fumery, Franck Carbonnel, Anthony Buisson, Benoit Coffin, Xavier Roblin, Gert van Assche, Maria Esteve, Martti Farkkila, Javier P. Gisbert, Philippe Marteau, Stephane Nahon, Martine de Vos, Laurent Peyrin-Biroulet, Jean-Yves Mary
Summary: In patients with steroid-refractory ASUC responding to second-line medical therapy, the process of endoscopic remission started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
(2021)
Review
Gastroenterology & Hepatology
Konstantinos Mpakogiannis, Fotios S. Fousekis, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Neeraj Narula
Summary: Tofacitinib appears to be a promising option for the treatment of ASUC. Randomized clinical trials are required to further evaluate the efficacy, safety, and optimal dose of tofacitinib in cases of ASUC.
DIGESTIVE AND LIVER DISEASE
(2023)
Article
Gastroenterology & Hepatology
Richard Hansen, Susanna Meade, R. Mark Beattie, Marcus Kh Auth, Nick Croft, Philip Davies, David Devadason, Conor Doherty, Jenny Epstein, Lucy Howarth, Fevronia Kiparissi, Rafeeq Muhammed, Vinay Shivamurthy, Christine Spray, Michael P. Stanton, Franco Torrente, Arun Urs, David Wilson, Peter M. Irving, Mark Samaan, Jochen Kammermeier
Summary: Pediatric acute severe colitis (ASC) management during the COVID-19 pandemic involves challenges due to the reliance on immunosuppression and potential for surgery. A RAND panel of experts recommended COVID-19-specific adaptations to ASC guidelines, including SARS-CoV-2 testing, expedited biological screening, isolation, and appropriate use of medications such as methylprednisolone and infliximab. The panel also suggested routine prophylactic anticoagulation and avoidance of delaying colectomy in patients with SARS-CoV-2 infection.