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See detailUstekinumab in bio-naïve and bio-failure Crohn's disease patients: Results from a « real-life » monocentric cohort.
Monin, Lucie ULiege; Dubois, Simon ULiege; REENAERS, Catherine ULiege et al

in Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (2020)

BACKGROUND: The pivotal clinical trials have largely demonstrated the efficacy and safety of ustekinumab in Crohn's disease. Real-life cohorts published so far only include very few bio-naïve patients ... [more ▼]

BACKGROUND: The pivotal clinical trials have largely demonstrated the efficacy and safety of ustekinumab in Crohn's disease. Real-life cohorts published so far only include very few bio-naïve patients. This study assesses effectiveness and safety of ustekinumab in bio-naïve and bio-failure patients treated with ustekinumab in routine practice and look for predictors of response. METHODS: We performed a retrospective monocentric study. Initial response was assessed by maintenance therapy beyond week 16. Sustained response was assessed by the continuation or cessation of therapy over time for another reason than stopping in sustained remission. Treatment persistence was assessed by Kaplan Meier curves and predictors of treatment persistence were studied by univariate and multivariate Cox model. RESULTS: Out of 156 recorded patients, three patients were still in their induction phase at time of analysis and 5 patients were lost to follow-up, leaving 148 patients for clinical effectiveness analyses, including 35 bio-naïve when starting ustekinumab. A maintenance therapy was initiated in 79.7%. At one year, the probability to be still treated with ustekinumab was 73.8%. Treatment cessation increased with smoking in multivariate analysis. Previous biologic failure (as a whole), CRP and fecal calprotectin baseline levels did not influence initial response and treatment persistence. CONCLUSION: A large proportion of CD patients initially respond to ustekinumab and continue this treatment beyond one year. Treatment persistence is as high in bio-failure as in bio-naïve patients. [less ▲]

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See detailDiet as an environmental trigger in inflammatory bowel disease: A retrospective comparative study in two European cohorts
Preda, C.; Manuc, T.; Chifulescu, A. E. et al

in Revista Espanola de Enfermedades Digestivas (2020), 112(6), 440-447

Background and aims: inflammatory bowel disease development has been associated with several environmental factors, among which, diet can play a key role, probably due to a westernized lifestyle. However ... [more ▼]

Background and aims: inflammatory bowel disease development has been associated with several environmental factors, among which, diet can play a key role, probably due to a westernized lifestyle. However, its involvement in the pathogenesis of inflammatory bowel disease (IBD) is difficult to demonstrate. The aim of this study was to analyze dietary composition in a Romanian and Belgian population with IBD. Methods: An observational retrospective comparative study was performed using two European cohorts (Romanian and Belgian). The IBD group included 76 Romanian and 53 Belgian patients with an IBD diagnosis, while the control group included a total of 56 healthy people (35 Romanians and 21 Belgians). All subjects were interviewed and asked to fill in a questionnaire regarding diet. Results: in the entire IBD cohort (Romanian + Belgian), a significantly increased consumption of sweets (OR 3.36 [95 % CI 1.6,7]), processed and high fat meat (OR 2.5 [95 % CI 1.4, 4.7], fried food (OR 9.5 [3.8, 23.6]), salt (OR 2.8 [1.5, 5.3]), ice cream (OR 3.25 [1.1, 9.8]), mayonnaise (OR 3.49 [1.1, 10.3]), margarine (OR 5.63 [1.64, 19.33]) and chips/nachos/other snacks (OR 2.3 [0.97, 5.73]) were found compared to the healthy control group. The intake of seeds, nuts (OR 0.26 [0.14, 0.52]) and yoghurt consumption (OR 0.44 [0.23, 0.83]) was lower in the IBD group compared to the control group. Conclusion: A westernized diet with increased consumption of sweets, processed food, high fat meat, fried food, salt, margarine, snacks, ice cream and mayonnaise seems to be a risk factor for IBD in Romanian and Belgian IBD patients. Intake of seeds, nuts and yoghurt may be a protective factor. © 2020. SEPD y © ARÁN EDICIONES, S.L. [less ▲]

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See detailRisques néoplasiques majorés dans la rectocolite ulcéro-hémorragique associée à la cholangite sclérosante primitive.
Kouam, C.; WARLING, Odile ULiege; VAN KEMSEKE, Catherine ULiege et al

in Revue medicale de Liege (2020), 75(11), 724-730

Ulcerative ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by the presence of continuous, uniform, gapless lesions of healthy mucous membrane extending integrally from the ... [more ▼]

Ulcerative ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by the presence of continuous, uniform, gapless lesions of healthy mucous membrane extending integrally from the anus over a variable portion of the colon. It is a multisystemic pathology for which we will describe one of its hepatic manifestations, primary sclerosing cholangitis (PSC). We present here the story of a patient, a carrier of the Breast Cancer type 1 gene mutation (BRCA1), who initially presented with epigastric and peri-umbilical abdominal pain associated with several episodes of bloody diarrhea. The initial assessment made it possible to diagnose BRCA1 and the fortuitous discovery of biliary tract stenosis of an undetermined nature. Further investigations led to the conclusion that there was a strong presumption of UC associated with PSC or even cholangiocarcinoma (CCA). In the course of treatment, cancer of the gallbladder was also detected. This clinical case makes it possible to review, in the light of recent publications, the pathophysiological link existing between UC and PSC. This article also presents an in-depth analysis of this entity with malignant potential that can affect different sites of the digestive tract, and its own management, which is the subject of new recommendations. [less ▲]

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See detailGanglionic tuberculosis in a Crohn’s disease patient treated by infliximab despite anti-tuberculosis chemoprophylaxis
VIEUJEAN, Sophie ULiege; BURY, Thierry ULiege; GASPARD, Laura ULiege et al

Conference (2019, February)

Infliximab is an IgG1κ monoclonal antibody against tumor necrosis factor-α (anti-TNFα) who have significantly improved the management of patients with Inflammatory Bowel Diseases (IBD), but with an ... [more ▼]

Infliximab is an IgG1κ monoclonal antibody against tumor necrosis factor-α (anti-TNFα) who have significantly improved the management of patients with Inflammatory Bowel Diseases (IBD), but with an increased risk of opportunistic infection, especially tuberculosis (TB). We report a case of a 54 years-old man with an ileal Crohn’s disease (CD) diagnosed in July 2014 (Montreal classification at diagnosed: A2L1B1p-). Patient was an active smoker and was treated by budesonide for several flares. Two years after diagnosis, since he has been hospitalised for subocclusion treated with methylprednisolone, combination therapy by mercaptopurine and anti-TNFα was discussed for steroid dependence. Patient was screened for tuberculosis (TB). A latent tuberculosis (LTB) was highlighted based on a positive interferon-gamma release assay (QuantiFERON TB) without clinical, microbiological and radiological evidence of active disease. A nine-month course of isoniazid (INH) 300 mg/day was started 4 weeks before the combination therapy with thiopurine/infliximab at the recommended doses. This treatment allowed a clinical remission and thiopurine could be stopped. Six months after completing INH for LTB and 1 month after cessation of thiopurine, patient was admitted in our emergency department for fever, dyspnoea and cough. Chest tomography showed large lymphadenopathies in the right pulmonary hilum and in the mediastinum. A fibroscopy with a bronchoalveolar lavage (with looking for bacillus of Koch) and an endobronchial ultrasound with biopsies were performed, both negative. Finally, a diagnosis of ganglionic tuberculosis was settled by a positive microscopic exam (auramine coloration) on an excised cervical lymphadenopathy. No resistance to usual anti-tuberculosis treatment was highlighted. Infliximab was immediately discontinued and anti-tuberculosis 4-drug regimen was initiated. Patient received Vedolizumab as IBD treatment 1 month later and he did not present any recurrence of TB infection or new flare of Crohn's disease up until now. This case report emphasizes that chemoprophylaxis for LTB does not completely protect against reactivation of TB in IBD patients treated by anti-TNF. It could be useful to study risk factors for reactivation of LTB in this treated by biologics population (monotherapy or combination therapy) to establish a case-by-case monitoring. [less ▲]

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See detailEnvironmental Factors in Romanian and Belgian Patients with Inflammatory Bowel Disease - a Retrospective Comparative Study.
Preda, Carmen Monica; Manuc, Teodora; Istratescu, Doina et al

in Maedica (2019), 14(3), 233-239

Background:Several environmental factors have been associated with onset of inflammatory bowel diseases (IBD): smoking, hygiene, microorganisms, oral contraceptive pills (OCPs), non-steroid anti ... [more ▼]

Background:Several environmental factors have been associated with onset of inflammatory bowel diseases (IBD): smoking, hygiene, microorganisms, oral contraceptive pills (OCPs), non-steroid anti-inflammatory drugs, antibiotics, appendectomy, diet, breastfeeding, vitamin D, stress and ambient air pollution. The aim of this study was to investigate the prevalence of these factors in a Romanian and Belgian population with IBD. Material and methods:A total of 129 patients with an IBD diagnosis (76 from Romania and 53 from Belgium) participated in an interview and were asked to fill in a questionnaire regarding environmental factors before and after the onset of IBD; 35 Romanian and 21 Belgian healthy individuals constituted the control group. Results:A total of 40 patients with ulcerative colitis (UC) and 89 with Crohn's disease (CD) were included. Gender distribution was 43% males and 57% females. They had a median age of 42 years (range between 19-74 years), a median disease duration of eight years and 79% were in clinical remission. Both Romanian and Belgian IBD patients reported an increased antibiotic consumption before IBD onset compared to controls: 58% vs 10% (p<0.001) and 51% vs 5% (p<0.001), respectively. Belgian IBD patients declared significantly more frequent OCP use (53% vs 9%, p <0.001), they were breastfed in a lower proportion (49% vs 76%, p <0.001) and had experienced a higher level of psychosocial stress (p<0.001). Conclusion:Antibiotic consumption before IBD onset may play a pivotal role in IBD development in both Romanian and Belgian populations. In Belgian patients, OCP consumption, a higher level of psychosocial stress and lack of breastfeeding may also be involved. [less ▲]

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See detailLong-term Clinical Effectiveness of Ustekinumab in Patients with Crohn's Disease Who Failed Biologic Therapies: A National Cohort Study.
Liefferinckx, Claire; Verstockt, Bram; Gils, Ann et al

in Journal of Crohn's & colitis (2019), 13(11), 1401-1409

BACKGROUND: Ustekinumab [UST] was recently approved in Europe for the treatment of moderate to severe Crohn's disease [CD]. Long-term real-world data are currently scarce for CD patients previously ... [more ▼]

BACKGROUND: Ustekinumab [UST] was recently approved in Europe for the treatment of moderate to severe Crohn's disease [CD]. Long-term real-world data are currently scarce for CD patients previously exposed to several biologics. METHODS: This is an observational, national, retrospective multicentre study. Patients received intravenous UST ~6 mg/kg at baseline, with 90 mg subcutaneously thereafter every 8 weeks. Response and remission rates were assessed at Weeks 8, 16, and 52. RESULTS: Data from 152 patients were analysed. All patients were exposed to at least one anti-TNFalpha agent, with 69.7% were exposed to even two anti-TNFalpha and vedolizumab. After 1 year, 42.1% and 25.7% of patients had experienced clinical response and clinical remission, respectively, and 38.8% and 24.3% had achieved steroid-free clinical response and remission, respectively; 38.8% of patients discontinued therapy during the 12 months of follow-up. Colonic location was predictive of clinical response at 1 year, and low body mass index [BMI] at baseline was a negative predictor of clinical remission. Resolution of arthralgia was associated with clinical response over time. De novo arthralgia was reported by 17.9% of patients at Week 8 and 13.5% of patients at Week 52. No impact of UST on arthralgia was observed in patients with concomitant ankylosing spondylitis [n = 17]. Others adverse events were reported in 7.2% of patients. CONCLUSIONS: This real-world cohort study confirms the effectiveness of UST in CD patients previously exposed to several biologics. Ustekinumab was well tolerated with respect to adverse events. PODCAST: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast. [less ▲]

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See detailProteomics highlights common and distinct pathophysiological processes associated with ileal and colonic ulcers in Crohn's disease.
Pierre, Nicolas ULiege; Salee, Catherine ULiege; MASSOT, Charlotte ULiege et al

in Journal of Crohn's & colitis (2019)

BACKGROUND AND AIMS: Based on genetics and natural history, Crohn's disease can be separated in two entities, an ileal and a colonic disease. Protein based-approaches are needed to elucidate whether such ... [more ▼]

BACKGROUND AND AIMS: Based on genetics and natural history, Crohn's disease can be separated in two entities, an ileal and a colonic disease. Protein based-approaches are needed to elucidate whether such subphenotypes are related to distinct pathophysiological processes. METHODS: The proteome of ulcer edge was compared to the one of paired control tissue (n=32 biopsies) by differential proteomics in the ileum and the colon of Crohn's disease patients (n=16). The results were analysed though a hypothesis-driven (based on literature) and a hypothesis-free approach (pathway enrichment analysis). To confirm one of the key pathway highlighted by proteomics, two proteins were also studied by immunochemistry in tissue biopsies. RESULTS: In the ileum and the colon, 4428 and 5204 proteins, respectively, were identified and quantified. Ileal and colonic ulcer edge differed by a distinct distribution of proteins of epithelial-mesenchymal transition, neutrophil degranulation and ribosome. Ileal and colonic ulcer edge were similarly characterised by an increase of the proteins implicated in the pathway of protein processing in endoplasmic reticulum and a decrease of mitochondrial proteins. Immunochemistry confirmed the presence of endoplasmic reticulum stress in the mucosa of ileal and colonic ulcer edge. CONCLUSION: This study provides protein-based evidences showing partly distinct pathophysiological processes associated to ileal and colonic ulcer edge in Crohn's disease patients. This could constitute a first step toward the development of gut segment-specific diagnostic markers and therapeutics. [less ▲]

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See detailCurious intra-rectal “laterally spreading tumor” in immunosuppressed patient with ulcerative colitis
VIEUJEAN, Sophie ULiege; LATOUR, Pascale ULiege; COIMBRA MARQUES, Carla ULiege et al

Conference (2018, February)

A 46-year-old man was admitted in June 2015 for the first time in our department for a colonoscopy in a context of ulcerative colitis, diagnosed 4 years earlier (ulcerative proctitis). At time of ... [more ▼]

A 46-year-old man was admitted in June 2015 for the first time in our department for a colonoscopy in a context of ulcerative colitis, diagnosed 4 years earlier (ulcerative proctitis). At time of diagnosis (2011), he was treated by oral Mesalazine, 5ASA suppositories and enema, Budesonide enema and then Azathioprine. Patient was asymptomatic for a long time but no follow-up had been achieved for at least 3 years. A colonoscopy was performed prior to potential immunosuppressive treatment discontinuation. This examination showed a kind of circumferential “laterally spreading tumor” with villous appearance located in the rectum 4 to 7 centimeters from the anal margin with a little triangular extension to the dentate line. Surprisingly rectal biopsies revealed a condyloma acuminatum with very focally high-grade intra-epithelial lesion and an overexpression of the p16 protein (cell marker induced by oncogenic HPV). Azathioprine was stopped and a transanal surgical resection was performed. This led to a scarring rectal substenosis and further rectoscopies permitted destruction of some little condylomatous persistent lesions. At guided anamnesis on sexual behavior, patient confirmed to be an active “men who have sex with men” (MSM). No recurrence of active ulcerative proctitis occured despite Azathioprine discontinuation. Condyloma acuminatum is a manifestation of Human Papillomavirus (HPV) infection and usually occurs in the genital and perianal regions. Involvement of the rectal mucosa is a rare condition and treatment strategy is not well established. This may have been in this case promoted by immunosuppressive treatment. As sexually transmitted anorectal disease may mimic inflammatory bowel disease, first diagnosis of ulcerative proctitis may be questioned even more with absence of recurrence despite treatment. [less ▲]

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See detailComment j'explore ... la maladie de Crohn par imagerie.
DESIR, Colin ULiege; COIMBRA MARQUES, Carla ULiege; Decker, M. et al

in Revue Médicale de Liège (2017), 72(1), 51-56

Crohn's disease is a chronic inflammatory condition characterized by recurrent and/or chronic lesions, leading to cumulative structural bowel damage. It is established that the correlation between ... [more ▼]

Crohn's disease is a chronic inflammatory condition characterized by recurrent and/or chronic lesions, leading to cumulative structural bowel damage. It is established that the correlation between symptoms and intestinal lesions is weak. Therefore, monitoring by frequent cross-sectional imaging is proposed to assess the disease activity. There is no consensus about the preferred imaging option. Priority is given to non-radiating modalities, such as ultrasonography and MRI. Tomodensitometry will be reserved for emergency cases. Ultrasonography can be useful, in emergency as well as for the monitoring of lesions of known topography. Entero-MRI is henceforth considered the standard imaging technique for the diagnosis and follow-up of Crohn's disease. Its high contrast resolution allows an accurate assessment of disease activity, therapeutic efficacy, cumulative structural bowel damage and complications. [less ▲]

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See detailObjective assessment of clinical disease activity
Louis, Edouard ULiege; VAN KEMSEKE, Catherine ULiege; REENAERS, Catherine ULiege

in Baumgart, Daniel C. (Ed.) Crohn's Disease and Ulcerative Colitis: From Epidemiology and Immunobiology to a Rational Diagnostic and Therapeutic Approach (2017)

An objective assessment of disease activity is an important prerequisite to clinical trials establishing the efficacy of new drugs or treatment strategies. Furthermore, while new objectives are developed ... [more ▼]

An objective assessment of disease activity is an important prerequisite to clinical trials establishing the efficacy of new drugs or treatment strategies. Furthermore, while new objectives are developed for the global management of inflammatory bowel disease, leading to new treatment strategies aiming at a tighter control of the disease, it becomes important to have available user-friendly tools adequate for disease activity quantification and helping the clinician in treatment decisions. In ulcerative colitis, clinical activity of the disease has been rather well correlated to endoscopic activity and a large number of indices including or not an endoscopic assessment have been developed for a specific use in clinical trials. The simpler amongst them, like the Mayo score are also adapted for routine practice. In Crohn’s disease, the Crohn’s disease activity index has almost been the unique index used in clinical trials for more than 30 years. However, due to its poor correlation to intestinal lesions assessed either by endoscopy or cross-sectional imaging it is now abandoned in pivotal clinical trial, being replaced by a combination of endoscopic assessment and patients reported symptoms. For everyday routine practice, a simple score mainly based on patient’s symptoms, like the Harvey Bradshaw index or close variants potentially recorded by the patient him/herself, seems appropriate. [less ▲]

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See detailUsability of a home-based test for the measurement of fecal calprotectin in asymptomatic IBD patients.
Bello, Caroline; Roseth, Arne; Guardiola, Jordi et al

in Digestive and Liver Disease (2017), 49(9), 991-996

The aim of our work was to test the usability of fecal calprotectin (FC) home-based test in inflammatory bowel disease (IBD) patients. METHODS: IBD patients were prospectively recruited. They had to ... [more ▼]

The aim of our work was to test the usability of fecal calprotectin (FC) home-based test in inflammatory bowel disease (IBD) patients. METHODS: IBD patients were prospectively recruited. They had to measure FC with a dedicated tool and smartphone application, 5 times at two weeks intervals over an 8 weeks period. They had to fill in a usability questionnaire at the first and the last FC measurement. A System Usability Scale (SUS: 0-100) and the Global Score of Usability (GSU: 0-85) were calculated. FC was also centrally measured by ELISA. RESULTS: Fifty-eight patients were recruited. Forty-two performed at least one FC measurement and 27 performed all the FC requested measurements. The median (IQR) SUS (0-100) at the first and last use were 85 (78-90) and 81 (70-88), respectively; the median (IQR) GSU (0-85) at the first and last use were 74 (69-80) and 77 (68-83), respectively. Adherence to the planned measurements and usability of the tool were higher in females and in less severe disease. The intra-class correlation coefficient between home-based and centrally measured FC was 0.88. CONCLUSION: The adherence to home-based measurement of FC was fair. Usability scores for the home-based test were high. There was a good correlation with the centrally measured FC by ELISA. [less ▲]

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See detailEndomicroscopie confocale dans la prise en charge des maladies inflammatoires chroniques de l'intestin.
LOLY, Jean-Philippe ULiege; SOMJA, Joan ULiege; REENAERS, Catherine ULiege et al

in Revue Médicale Suisse (2017), 13(571), 1431-1434

Inflammatory bowel diseases are chronic diseases whose long-term evolution depends on the depth of remission. Their clinical and endoscopic evaluation is imperfect. The development of confocal ... [more ▼]

Inflammatory bowel diseases are chronic diseases whose long-term evolution depends on the depth of remission. Their clinical and endoscopic evaluation is imperfect. The development of confocal endomicroscopy allows microscopic images to be obtained in vivo. These microscopic data are correlated with the activity of the disease. They predict a possible relapse of the disease and also predict the response to treatment with a biological agent, which allows to modify the therapy before the relapse or to make a rational choice between the different biological agents before introducing a new treatment. [less ▲]

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See detailLong-term evolution and predictive factors of mild inflammatory bowel disease.
REENAERS, Catherine ULiege; Pirard, C.; VAN KEMSEKE, Catherine ULiege et al

in Scandinavian Journal of Gastroenterology (2016), 51(6), 712-9

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are potentially progressive diseases. Few data are available on the prevalence and the factors associated with mild inflammatory bowel diseases ... [more ▼]

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are potentially progressive diseases. Few data are available on the prevalence and the factors associated with mild inflammatory bowel diseases (IBD). AIM: Our aim was to assess the natural history of mild CD and mild UC and to identify predictive factors of mild evolution over the long term. METHODS: Retrospective study of IBD patients registered in the database of the university hospital CHU of Liege, Belgium. Mild CD was defined as an inflammatory luminal disease (no stricture, abdominal or perianal fistulae) requiring no immunomodulator (IM), anti-TNF and no surgery. Mild UC was defined as no requirement for IM, anti-TNF and no colectomy. RESULTS: Four hundred and seventy-three CD and 189 UC were included (median follow-up: 13 and 11 years respectively). At 1 year, 147 patients had mild CD. At 5 years and the maximum follow-up, 56% and 13% patients still had mild CD, respectively. At 1 year, 142 patients had mild UC. At 5 years and the maximum follow-up, 72% and 44% still had a mild UC, respectively. Factors associated with long-term mild CD and UC were older age at diagnosis and absence of corticosteroids in the first year. In UC proctitis location was associated with mild UC. CONCLUSIONS: In this cohort, 90% of CD patients and 3/4 of UC with mild disease at 1 year lost their mild disease status over time. An old age at diagnosis was predictive of the persistence of a mild CD and UC. [less ▲]

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See detailLE MEDICAMENT DU MOIS. Vedolizumab (Entyvio(R)), nouveau traitement des maladies inflammatoires intestinales.
Van Kemseke, Catherine ULiege; Louis, Edouard ULiege; REENAERS, Catherine ULiege

in Revue Médicale de Liège (2015), 70(11), 575-82

Anti-TNF agents are highly effective in treating inflammatory bowel diseases, but loss of response and side-effects leading to drug interruption are often reported. New molecules are needed to treat these ... [more ▼]

Anti-TNF agents are highly effective in treating inflammatory bowel diseases, but loss of response and side-effects leading to drug interruption are often reported. New molecules are needed to treat these patients. Vedolizumab is a fully humanized anti-body inhibiting the migration of circulating lymphocytes to the gut by binding the integrin alpha4beta7. In ulcerative colitis, clinical response, remission and mucosal healing were observed at 6 weeks in 47%, 17% and 40% of the patients, respectively. The maintenance study demonstrated 42% and 52% of clinical remission and response at week 52. In Crohn's disease, clinical response and remission were respectively observed in 15% and 31% of the patients at 6 weeks. Clinical remission at week 52 was 39%. The time to clinical response was longer in patients who had failed anti-TNF. The safety profile is excellent with the same proportion of side-effects in the placebo and in the treated groups. The most frequently reported adverse events were pharyngitis and headaches. [less ▲]

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See detailPrise en charge actuelle du lymphome de la zone marginale
Bonnet, Christophe ULiege; LEJEUNE, Marie ULiege; VAN KEMSEKE, Catherine ULiege et al

in Revue Médicale Suisse (2015), 11

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See detailDe l'"Evidence-based Medecine" à la médecine personnalisée dans la maladie de Crohn
Louis, Edouard ULiege; REENAERS, Catherine ULiege; VAN KEMSEKE, Catherine ULiege et al

in Revue Médicale de Liège (2015), 70(5-6), 316-320

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See detailPersisting signs of disease activity at magnetic resonance enterocolonography predict clinical relapse and disease progression in quiescent Crohn's disease
MEUNIER, Paul ULiege; COUSIN, François ULiege; VAN KEMSEKE, Catherine ULiege et al

in Acta Gastro-Enterologica Belgica (2015), 73(3), 274-81

INTRODUCTION: Deep remission including clinical remission and tissue healing has been advocated as the therapeutic target in Crohn's disease. Yet, the definition of deep remission remains unclear. The aim ... [more ▼]

INTRODUCTION: Deep remission including clinical remission and tissue healing has been advocated as the therapeutic target in Crohn's disease. Yet, the definition of deep remission remains unclear. The aim of this study was to assess the persisting lesions at magnetic resonance enterocolonography (MREC) in clinically quiescent Crohn's disease as well as their relapse predictive value. METHODS: we performed a prospective monocentre cohort study. We included patients with clinical remission. At baseline, these patients had blood tests, the measurement of fecal calprotectin and underwent a MREC. They were then followed up clinically for a minimum of 1 year. A relapse was defined by a HBI > 4 with an increase of at least 3 points. Correlations between clinical, demographic, biological parameters and MREC signs were assessed as well as the time-to-relapse predictive value of the studied variables. RESULTS: Twenty seven patients were recruited. Fourteen out of 27 had persisting disease activity at MREC. MREC signs only partly correlated with biomarkers. Ten out of 27 patients relapsed over a median follow up of 25 months. In univariate analysis, relative contrast enhancement of the most affected segment (HR: 2.56; P = 0.046), ulcers (HR: 12.5; P = 0.039), fistulas (HR: 14.1; P = 0.009) and target sign (HR: 3.63; P = 0.049) were associated with relapse. In multivariate analysis, fistula was the only one. CONCLUSIONS: Half of the patients with clinically quiescent Crohn's disease had persisting signs of disease activity at MREC. These signs predicted time-to-relapse. [less ▲]

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See detailDepth of remission in Crohn's disease patients seen in a referral centre : associated factors and impact on disease outcome.
Poncin, Maxime ULiege; REENAERS, Catherine ULiege; VAN KEMSEKE, Catherine ULiege et al

in Acta Gastro-Enterologica Belgica (2014), 77(1), 41-6

INTRODUCTION: Our goals were to assess the prevalence of biological and tissue remission in routine practice in Crohn's disease, and to evaluate the correlation between biological or tissue remission and ... [more ▼]

INTRODUCTION: Our goals were to assess the prevalence of biological and tissue remission in routine practice in Crohn's disease, and to evaluate the correlation between biological or tissue remission and clinical or demographic characteristics as well as their impact on disease outcome. METHODS: We performed a retrospective monocenter study. Biological remission was defined by a CRP < 5 mg/I. Tissue remission was defined by the absence of ulcer at endoscopy and/or absence of signs of acute inflammation at MRI. Association with demographic, clinical and laboratory markers was studied by logistic regression models and rates of relapses, hospitalizations and surgeries were compared using the logrank test. RESULTS: Among the 263 patients included, 147 were in clinical remission; 102/147 (69%) were in biological remission. Fifty-six patients also had morphological evaluation: 37 (66%) were in tissue remission. Biological remission was associated with older age, higher hemoglobin and lower BMI. Tissue remission was associated with older age, lower platelets count, absence of previous surgery, and the use of immunosuppressant. Time-to-relapse was significantly longer in patients with biological remission and in patients with tissue remission as compared to patients without biological or tissue remission. CONCLUSIONS: Among the patients in clinical remission seen as outpatients, two thirds were either in biological and/or tissue remission. Biological and/or tissue remission was associated with a better outcome than clinical remission alone. [less ▲]

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