Pilar Nos

Publications (80) View all

• Article: [Locally acting corticosteroids in inflammatory bowel disease. Are they effective? Are they really less toxic?].

  Pilar Nos Mateu
  Gastroenterología y Hepatología 09/2008; 31 Suppl 3:16-21. · 0.73 Impact Factor
• Article: Long-term durability of response to adalimumab in Crohn's disease.

  M Chaparro, J Panés, V García, O Merino, P Nos, E Domènech, M Peñalva, E García-Planella, M Esteve, J Hinojosa, [......], J L Mendoza, J Barrio, M Barreiro-de, I Vera, P Vilar, J L Cabriada, M A Montoro, X Aldeguer, C Saro, J P Gisbert
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  ABSTRACT: Adalimumab is an effective treatment for Crohn's disease (CD), but may also be associated with loss of response. Few reports provide insight into the durability of treatment of CD with adalimumab for periods longer than 12 months in clinical practice. Aims: To evaluate the long-term durability of adalimumab maintenance treatment and to identify predictive factors associated with loss of response. CD patients who initially responded to adalimumab were evaluated in a historical cohort study. Maintenance of long-term response was estimated using Kaplan-Meier analysis. Cox regression analysis was performed to identify potential predictive factors for loss of efficacy. In all, 380 CD patients were included (mean age, 38 years; 52% female). Of these, 43% had ileocolic CD, 50% inflammatory CD, and 41% perianal CD. Median follow-up with adalimumab was 8 months (range, 4-75 months). The annual risk of loss of response to adalimumab was 18% per patient-year of follow-up. Twenty-eight percent of patients were anti-TNF-naïve and 72% anti-TNF-experienced. The loss of efficacy was 8% per patient-year of follow-up in the anti-TNF-naïve patients and 22% in the anti-TNF-experienced group (P < 0.01). In the multivariate analysis, the presence of extraintestinal manifestations (hazard ratio [HR] = 1.7; 95% confidence interval [CI] = 1.02-2.9) and previous experience with other anti-TNF agents (HR = 2.5,95% CI = 1.2-5.3) were associated with higher risk of loss of efficacy. A relevant proportion of CD patients on long-term adalimumab lost response. The risk of loss of response was higher (more than 2-fold) in anti-TNF-experienced than in anti-TNF-naïve patients (22% vs. 8% per patient-year of treatment). Having extraintestinal manifestations seems to increase the risk of loss of efficacy.
  Inflammatory Bowel Diseases 05/2011; 18(4):685-90. · 4.86 Impact Factor
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  Available from: eiialdia.com

  Article: Clinical outcome of newly diagnosed Crohn's disease: a comparative, retrospective study before and after infliximab availability.

  E Domènech, Y Zabana, E Garcia-Planella, A López San Román, P Nos, D Ginard, J Gordillo, F Martínez-Silva, B Beltrán, M Mañosa, E Cabré, M A Gassull
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  ABSTRACT: Infliximab (IFX) could change the course of Crohn's disease (CD) by reducing steroid use, surgery or prompting earlier introduction of immunomodulators (IMM). To evaluate the impact of IFX availability on the course of early CD. Two cohorts of newly diagnosed CD patients were identified: The first cohort included patients diagnosed from January 1994 to December 1997 and the second from January 2000 to December 2003. All patients were diagnosed, treated and followed up in the same centre until December 1999 (first cohort) or December 2005 (second cohort). Development of disease-related complications, steroid, IMM or IFX requirements and intestinal resections during follow-up were registered. A total of 328 patients were included (146 first cohort, 182 second cohort). A similar proportion of patients in both cohorts received steroids, but steroid exposure resulted significantly more intense in the first cohort (P = 0.001). In the second cohort, 14% of patients received IFX. Thiopurines were used more (P = 0.001) and earlier (P = 0.012) in the second cohort. No differences in surgical requirements or the development of disease-related complications were found. Following a step-up therapeutic algorithm, IFX availability did not reduce surgical requirements or the development of disease-related complications.
  Alimentary Pharmacology & Therapeutics 10/2009; 31(2):233-9. · 3.77 Impact Factor
• Article: Mucosal healing restores normal health and quality of life in patients with inflammatory bowel disease.

  Francesc Casellas, Manuel Barreiro de Acosta, Marta Iglesias, Virginia Robles, Pilar Nos, Mariam Aguas, Sabino Riestra, Ruth de Francisco, Michel Papo, Natalia Borruel
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  ABSTRACT: Inflammatory bowel disease (IBD) is a debilitating immune disorder that impairs function and health-related quality of life (HRQOL). A goal of IBD treatment is mucosal healing, but it is not known whether it achieves normalization of the patients' perception of health. This can be assessed by using a cut-off scoring threshold of the Inflammatory Bowel Disease Questonnaire-36 (IBDQ-36). To determine whether patients with Crohn's disease (CD) and ulcerative colitis (UC) in clinical remission and with mucosal healing normalize their HRQOL. This is a multicentric, prospective, observational, cross-sectional study of patients who are in stable clinical remission and having mucosal healing. Patients completed the IBDQ-36, the EuroQol-5D, and the Daily Fatigue Impact Scale fatigue questionnaires. Complete restoration of health was believed to have occurred when the global score in the IBDQ-36 was at least 209 points. A total of 115 patients (48 with CD, 67 with UC) were included. The median activity index (the Harvey-Bradshaw or the colitis activity index) was 1.0 and the median endoscopic index (Simple Endoscopic Score for Crohn's disease or Mayo) was 0. Eighty percent of the patients (79% in CD and 82% in UC patients, P=NS) normalized their HRQOL. Type of treatment was not related to normalization of HRQOL. The lack of restoration of health was significantly related to fatigue and anxiety/depression. Mucosal healing is associated with a normalization of the perception of health by most IBD patients independently of treatment. However, a significant group of patients do not achieve restoration of HRQOL, which reinforces the necessity of a global care addressed to all patient concerns to achieve patients' complete health restoration.
  European journal of gastroenterology & hepatology 04/2012; 24(7):762-9. · 1.66 Impact Factor
• Article: [Cyclic vomiting in association with chronic cannabis abuse].

  Adolfo Del Val, Ana Braithwaite, Michel Blé, Pilar Nos
  Medicina Clínica 11/2011; 139(1):42. · 1.38 Impact Factor