Carla Felice

Publications (11)37.65 Total impact

• Article: Comparison of Quantiferon-TB Gold versus tuberculin skin test for tuberculosis screening in inflammatory bowel disease patients.

  Gianluca Andrisani, Alessandro Armuzzi, Alfredo Papa, Manuela Marzo, Carla Felice, Daniela Pugliese, Italo De Vitis, Gian Lodovico Rapaccini, Luisa Guidi
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  ABSTRACT: Screening for latent tuberculosis (LTB) is recommended before starting anti-TNF-alpha therapy. We compared the performance of Quantiferon-TB Gold (QFT-G) with the tuberculin skin test (TST) for the screening of LTB in a population of inflammatory bowel disease (IBD) patients who were candidates for anti-TNF-α therapy. Ninety-two IBD patients who were candidates for anti-TNF-α therapy were tested with QTF-G and TST. Concomitant therapy and laboratory parameters were recorded. One subject was vaccinated with Bacille Calmette Guèrin (BCG), 76% of patients were on immunosuppressive therapy (IST), and all patients had a negative TB history and negative chest X-ray. Agreement between the two tests was observed in 89.2% of patients (79.4% +/+, 9.8% -/-), QFT-G+/TST- was observed in 4.4% (4) patients, and QFT-G-/TST+ was observed in 5.5%, one of which was previously vaccinated. All disagreements were observed in patients on IST (14.3% in this group). The agreement analysis showed moderate strength among the patients (k=0.508), while the agreement was only fair in the subgroup of patients on IST (k=0.388). Given the high risk of LTB reactivation in patients subjected to anti-TNF-α therapy, our results suggest that in our population, with low TB rate and very low BCG vaccination rate, both tests could be employed.
  Journal of gastrointestinal and liver diseases: JGLD 03/2013; 22(1):21-5. · 1.81 Impact Factor
• Article: Infliximab in Steroid-dependent Ulcerative Colitis: Effectiveness and Predictors of Clinical and Endoscopic Remission.

  Alessandro Armuzzi, Daniela Pugliese, Silvio Danese, Gianluca Rizzo, Carla Felice, Manuela Marzo, Gialuca Andrisani, Gionata Fiorino, Orsola Sociale, Alfredo Papa, Italo De Vitis, Gian Lodovico Rapaccini, Luisa Guidi
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  ABSTRACT: BACKGROUND:: Up to 20% of patients with ulcerative colitis (UC) become steroid-dependent during their course. Thiopurines are recommended in steroid-dependent UC, but their efficacy is debated. Data exploring the use of infliximab in these patients are scarce. Aims of this study were to evaluate the effectiveness of infliximab in steroid-dependent UC and identify predictors of steroid-free remission, mucosal healing (MH), and colectomy. METHODS:: Steroid-dependent UC patients were enrolled and intentionally treated with infliximab. The prospectively designed analyses evaluated (1) steroid-free clinical remission at 6 and 12 months, (2) steroid-free clinical remission and MH at 12 months, and (3) colectomy within 12 months. RESULTS:: One hundred and twenty-six active steroid-dependent UC patients were studied. Of the 126 patients, 36 patients were retrospectively included and 90 patients prospectively enrolled. Steroid-free remission was 53% and 47% at 6 and 12 months, respectively. Predictors of steroid-free remission at 6 and 12 months were thiopurine-naive status (hazard ratio [HR], 2.5 and HR, 2.8, respectively) and combination therapy (HR, 2.1 and HR, 2.2, respectively). At 12 months, 32% were in steroid-free remission and MH. Thiopurine-naive status predicted steroid-free remission and MH (odds ratio, 3.6). C-reactive protein drop to normal after infliximab induction was predictive of steroid-free remission at 6 (HR, 5.9) and 12 months (HR, 4.6) and steroid-free remission and MH at 12 months (odds ratio, 6.0). Twelve patients underwent colectomy after a median of 4.7 months. Steroid sparing significantly reduced the risk of colectomy within 12 months (HR, 0.14). CONCLUSIONS:: Infliximab seems effective in steroid-dependent UC. Thiopurine-naive status and combination therapy significantly increase the rate of steroid-free remission up to 12 months.
  Inflammatory Bowel Diseases 02/2013; · 4.86 Impact Factor
• Article: Inducing remission of ulcerative colitis: are clinicians better equipped than ever?

  Alessandro Armuzzi, Carla Felice
  Expert review of gastroenterology & hepatology 02/2013; 7(2):95-7.
• Article: AID in aging and autoimmune diseases.

  Daniela Frasca, Gianluca Andrisani, Alain Diaz, Carla Felice, Luisa Guidi, Bonnie B Blomberg
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  ABSTRACT: The aim of this study was to evaluate the quality of B cell responses in patients with Inflammatory Bowel Disease (IBD) and healthy individuals of different ages, vaccinated with the pandemic (p)2009 influenza vaccine. The in vivo response was measured by the hemagglutination inhibition (HAI) assay, which represents the most established correlate with vaccine protectiveness. The in vitro response was measured by activation-induced cytidine deaminase (AID) in cultures of vaccine-stimulated PBMC. Both responses are somewhat impaired in IBD patients undergoing anti-TNF-α treatment but these are much more decreased in IBD patients undergoing treatment with anti-TNF-α and immunosuppressive (IS) drugs. These latter patients had in vivo and in vitro B cell responses similar to those of elderly individuals. Moreover, as we have previously demonstrated in healthy subjects, the in vitro response to the polyclonal stimulus CpG may be used as a biomarker for subsequent vaccine response and AID activation is correlated with the serum response in IBD patients, as it is in healthy individuals. These results altogether indicate that IBD patients on anti-TNF-α and IS have significantly impaired in vivo and in vitro B cell responses, as compared to those on monotherapy. This is the first report to demonstrate that B cell defects, as measured by the autonomous AID reporter, in IBD patients contribute to reduced humoral responses to the influenza vaccine, as we have previously shown for elderly individuals.
  Autoimmunity 11/2012; · 2.47 Impact Factor
• Article: Prevalence and natural history of hepatitis B and C infections in a large population of IBD patients treated with anti-tumor necrosis factor-α agents.

  Alfredo Papa, Carla Felice, Manuela Marzo, Gianluca Andrisani, Alessandro Armuzzi, Marcello Covino, Giammarco Mocci, Daniela Pugliese, Italo De Vitis, Antonio Gasbarrini, Gian Lodovico Rapaccini, Luisa Guidi
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  ABSTRACT: BACKGROUND: The prevalence rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients with inflammatory bowel disease (IBD) have been reported to be higher than rates of infection among the general population. Although several cases of HBV infection reactivation in IBD patients treated with anti-TNF-α agents have been described, no evidence exists that anti-TNF-α therapy exacerbates the course of HCV. The aims of this study were to assess the prevalence of HBV and HCV and the rate of HBV vaccination in a population of IBD patients; and to investigate the long-term effects of anti-TNF-α therapy in the subgroup with HBV or HCV infections. METHODS: 301 patients were studied. Prior to the initiation of anti-TNF-α therapy, serum samples were tested for HBsAg and anti-HBc, anti-HBs and anti-HCV antibodies. During the follow-up, HBsAg and anti-HBc positive patients underwent periodic blood testing for viral markers, HBV-DNA and liver function; anti-HCV positive patients were assessed for liver function and HCV-RNA. RESULTS: One patient was HBsAg positive (0.3%), and 22 (7.3%) tested positive for anti-HBc. Seventy-two patients (23.9%) had been vaccinated for HBV. Four patients tested positive for anti-HCV (1.3%). During anti-TNF-α therapy, none of the patients experienced HBV or HCV reactivation. CONCLUSIONS: HBV and HCV infection rates were similar to infection rates among the general population. Less than one quarter of the patients had been vaccinated against HBV. Anti-TNF-α agents appear to be safe for patients with HBV infection; more data are needed for patients with HCV infection.
  Journal of Crohn s and Colitis 03/2012; · 2.57 Impact Factor
• Article: Ileal Crohn's disease: CEUS determination of activity.

  Antonio De Franco, Manuela Marzo, Carla Felice, Daniela Pugliese, Alessandra Di Veronica, Lorenzo Bonomo, Alessandro Armuzzi, Luisa Guidi
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  ABSTRACT: Transabdominal ultrasound is currently accepted as a clinical first-line tool in the assessment of Crohn's disease activity. During recent years, great improvements have been achieved in ultrasound examination with the introduction of high-frequency transducers, ultrasonographic microbubble contrast agents, and dedicated contrast-specific ultrasound software. Therefore, contrast-enhanced ultrasonography (CEUS) is emerging as one of the most important imaging techniques in the diagnosis and follow-up of patients with ileal Crohn's disease. It is non-invasive and non-ionizing, easily repeatable, well-tolerated by patients and has significant diagnostic accuracy. Moreover, the possibility to monitor response to therapies, describing, and quantifying contrast enhancement behavior by specific software, represents an interesting aspect of its utilization, considering the still open questions about the correct use of immunosuppressive and biological agents. The aim of our review is to provide an updated overview of the role of CEUS in the patients who have an ileal localization of Crohn's disease, defining its qualitative and quantitative features.
  Abdominal Imaging 01/2012; 37(3):359-68. · 1.73 Impact Factor
• Article: A case of hereditary hemorrhagic telangiectasia associated with Crohn's disease successfully treated with infliximab.

  Alfredo Papa, Carla Felice, Manuela Marzo, Luisa Guidi
  The American Journal of Gastroenterology 08/2010; 105(8):1904. · 7.28 Impact Factor
• Article: Use of infliximab in particular clinical settings: management based on current evidence.

  Alfredo Papa, Giammarco Mocci, Michele Bonizzi, Carla Felice, Gianluca Andrisani, Italo De Vitis, Luisa Guidi, Antonio Gasbarrini
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  ABSTRACT: With the increasingly widespread use of the anti-tumor necrosis factor-alpha agent infliximab for the treatment of Crohn's disease and ulcerative colitis, there have been some concerns raised about the potential consequences of such therapy in particular clinical settings. In this review, we report the current strategies for optimizing treatment outcomes and minimizing the risks of some of the most serious events attributable to infliximab therapy. In particular, an up-to-date overview is provided on how to treat patients with inflammatory bowel disease using infliximab therapy, with regard to the diagnosis and management of latent tuberculosis infection and the risk of reactivation of hepatitis B and C infections. Furthermore, based on the available evidence, we evaluate the possibility of using infliximab during pregnancy. Finally, we evaluate whether patients with malignancies or pre-neoplastic lesions could be candidates for infliximab therapy. Overall, this review will provide physicians who use infliximab for the treatment of inflammatory bowel disease with several practical recommendations for the management of some complex situations that may occur in daily clinical practice.
  The American Journal of Gastroenterology 07/2009; 104(6):1575-86. · 7.28 Impact Factor
• Article: Biological therapies for inflammatory bowel disease: controversies and future options

  Alfredo Papa, Giammarco Mocci, Michele Bonizzi, Carla Felice, Gianluca Andrisani, Gianfranco Papa, Antonio Gasbarrini
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  ABSTRACT: Over the last few years, advances in understanding the pathogenesis of inflammatory bowel disease, together with progress in biotechnology, have led to the availability of several biological drugs that have dramatically changed the therapeutic approach to these disorders. Indeed, several molecules targeting crucial inflammatory cytokines, blocking T-cell activation/proliferation or the recruitment of inflammatory cells into the inflamed bowel, have been discovered and commercialized. However, the increasing use of biological agents has raised some concerns regarding their short- and long-term safety. This review offers a critical evaluation of the efficacy and safety of biological agents in the management of both Crohn's disease and ulcerative colitis. In addition, promising therapeutic options are discussed.
  Expert Review of Clinical Pharmacology 06/2009; 2(4):391-403.
• Article: Intima-media thickness in inflammatory bowel disease patients: a still open question.

  Alfredo Papa, Michele Bonizzi, Gianluca Andrisani, Carla Felice, Giammarco Mocci, Antonio Gasbarrini
  The American Journal of Gastroenterology 03/2008; 103(2):490; author reply 490-1. · 7.28 Impact Factor
• Article: Vascular involvement in inflammatory bowel disease: pathogenesis and clinical aspects.

  Alfredo Papa, Franco Scaldaferri, Silvio Danese, Simona Guglielmo, Italia Roberto, Michele Bonizzi, Giammarco Mocci, Carla Felice, Caterina Ricci, Gianluca Andrisani, Giuseppe Fedeli, Giovanni Gasbarrini, Antonio Gasbarrini
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  ABSTRACT: Crohn's disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel disease (IBD), are chronic inflammatory conditions, characterized by a microvascular and also macrovascular involvement. Chronically inflamed intestinal microvessels of IBD patients have demonstrated significant alterations in their physiology and function compared with vessels from healthy and uninvolved IBD intestine. Recently, some studies have revealed that the poor mucosal healing, refractory inflammatory ulcerations and damage in the IBD intestine could depend on microvascular dysfunction, resulting in diminished vasodilatory capacity and tissue hypoperfusion in the IBD gut. Furthermore, several data show that the activation of intestinal endothelium plays a critical role in the pathogenesis and/or in perpetuating and amplifying the inflammatory process in IBD and, consequently, it is now emerging as a potential use of anticoagulant or coagulation-related drugs in treating IBD. IBD is also associated with an increased risk of macrovascular venous and arterial thrombosis. Thrombotic events occur prevalently as deep vein thrombosis and pulmonary embolism. They happen at an earlier age than in non-IBD patients. Prothrombotic risk factors in IBD patients could be distinguished as acquired, such as active inflammation, immobility, surgery, steroid therapy, and use of central venous catheters, and inherited. Furthermore, it has been found that IBD, per se, is an independent risk factor for thrombosis. The prevention of thromboembolic events in IBD patients includes the elimination of removable risk factors and, if thrombosis occurs, a pharmacological therapy similar to that used for thromboembolic events occurring in the general population.
  Digestive Diseases 02/2008; 26(2):149-55. · 2.37 Impact Factor