Immunomodulators Are Associated With a Lower Risk of First Surgery Among Patients With Non-Penetrating Non-Stricturing Crohn's Disease
ABSTRACT Early immunomodulator therapy may alter the natural history of Crohn's disease in certain patients. We determined whether immunomodulator use was associated with a lower risk of first surgery among patients with non-stricturing non-penetrating Crohn's disease.
A total of 159 consecutive patients with non-penetrating non-stricturing Crohn's disease from 1994 to 2005 were retrospectively identified and followed from diagnosis to either first surgery (surgery group) or last clinic follow-up (medication group) in a historical cohort analysis. Immunomodulator use, duration, disease location, age at diagnosis, smoking, family history, and decade of diagnosis were compared. Cox proportional hazards models were adjusted for propensity score to determine whether immunomodulator use lasting >6 months decreased the risk of first surgery and whether duration of therapy affected risk.
The median duration of follow-up was similar (6.0 vs. 5.5 years), age at diagnosis 10 years earlier, and isolated colonic disease three times less common (18 vs. 49%) in the surgery group as compared with the medication group. Immunomodulator use increased with time but overall was less common in the surgical group (24 vs. 48%). In the multivariate Cox proportional hazards model immunomodulator use was associated with a lower risk of surgery (hazard ratio, 0.41; 95% confidence interval 0.21-0.81) after adjustment for propensity score. Similarly, risk of surgery declined with duration of use.
Immunomodulator use is associated with a decreased risk of first surgery among patients with non-stricturing non-penetrating CD. Early immunomodulator therapy may be beneficial in preventing first surgery in this population that has yet to develop penetrating or fistulizing complications.
- SourceAvailable from: Marco Gasparetto
[Show abstract] [Hide abstract]
- "The anti-TNF-α Infliximab is at present the only proved drug to be able to modify the natural history of IBD     . "
ABSTRACT: Background. The challenging treatment of penetrating paediatric Crohn's disease (CD) involves pharmacological and surgical approaches. Despite a proved efficacy of anti-TNF agents for treatment of complex fistula, a large number of patients cannot achieve a complete healing and relapse during the followup. Aim. We report a paediatric case with CD and colonic perforation who was successfully treated with medical therapy only, including anti-TNFα. Case Presentation. During a colonoscopy performed on a 9-year-old girl with CD, a perforation occurred in correspondence of a fistula at the colonic splenic flexure. The formation of a collection was then detected (US, enteric-CT), as well as a fistula connecting the colon to the collection. The girl was kept fasting and treated with total parenteral nutrition and antibiotic therapy. Treatment with Infliximab was also started, and after the third dose a US control showed disappearance of the collection and healing of the enteric fistula. Parenteral nutrition was progressively substituted with enteral feeding, and no surgical treatments were needed. Discussion. In pubertal children with penetrating CD, the option of an efficacious medical treatment to avoid a major surgical approach on the bowel is to be aimed for growth improvement. This approach requires a strictly monitored long-term followup.10/2012; 2012:152414. DOI:10.1155/2012/152414
- [Show abstract] [Hide abstract]
ABSTRACT: In the integrated model, which is composed of the vehicle fill problem, VFP for short, and the vehicle scheduling problem, VSP for short, according to their interrelationship and interrestriction, the solution of VFP takes the key role to ensure the whole solutions of the model are high efficient and feasible. By researching on the problem of vehicle loading based on effective space, a method has been put forward for this kind of problems, and it has been proved that this method is valuable in practice.Machine Learning and Cybernetics, 2005. Proceedings of 2005 International Conference on; 09/2005
Conference Paper: Humanoid robot locomotion[Show abstract] [Hide abstract]
ABSTRACT: The objective of this paper is to propose a locomotion control method for humanoid robot to realize stable walking, which consisting of optimal joint generation and feedback error compensation. Using energy consumption as criteria, the proposed method can generate a series of joint trajectory for different walking steps and speed. Furthermore, to improve system stability and adaptability, a fuzzy-GA is trained to compensate system errors. Based on sensor information, humanoid robot can get environment and inherent situation and use the proposed method to adjust joint trajectory. The effectiveness of the method is shown with a 28 DOF humanoid robot in ADAMS.Machine Learning and Cybernetics, 2005. Proceedings of 2005 International Conference on; 09/2005