Ailsa Hart

Publications (2)9.71 Total impact

• Source

  Available from: Peter Dr Higgins

  Article: Doubling the infliximab dose versus halving the infusion intervals in Crohn's disease patients with loss of response.

  Lior Katz, Javier P Gisbert, Beth Manoogian, Kirk Lin, Casper Steenholdt, Gerassimos J Mantzaris, Ashish Atreja, Yulia Ron, Arun Swaminath, Somal Shah, [......], Epameinondas V Tsianos, Torben Nathan, Maria Abreu, Iris Dotan, Bret Lashner, Jorn Brynskov, Jonathan P Terdiman, Peter D R Higgins, Maria Chaparro, Shomron Ben-Horin
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  ABSTRACT: Intensifying infliximab therapy is often practiced in Crohn's disease (CD) patients losing response to the drug but there are no data if halving the interval is superior to doubling the dose. We aimed to assess the efficacy of infliximab dose intensification by interval-halving compared with dose-doubling. A multicenter retrospective study of CD patients losing response to infliximab was undertaken. The clinical outcome of patients whose infusion intervals were halved (5 mg/kg/4 weeks) was compared with patients treated by dose-doubling (10 mg/kg/8 weeks). In all, 168 patients were included from 18 centers in Europe, USA, and Israel. Of these, 112 were intensified by dose-doubling and 56 received interval-halving strategy. Early response to dose-escalation was experienced by 86/112 (77%) patients in the dose-doubling group compared with 37/56 patients (66%) in the interval-halving group (odds ratio [OR] 1.7, 95% confidence interval [CI] 0.8-3.4, P = 0.14). Sustained clinical response at 12 months postescalation was maintained in 50% of patients in the dose-doubling group compared with 39% in the interval-halving group (OR 1.5, 95% CI 0.8-2.9, P = 0.2). On multivariate analysis, predictors of long-term response to escalation were a nonsmoking status, CD diagnosis between 16-40 years of age, and normal C-reactive protein (CRP). Dose intensification leads to a sustained regained response in 47% of CD patients who lost response to standard infliximab dose, but halving the infusion intervals is probably not superior to dose-doubling. Given the costs and patient inconvenience incurred by an additional infusion visit, the dose-doubling strategy may be preferable to the interval-halving strategy. (Inflamm Bowel Dis 2012;).
  Inflammatory Bowel Diseases 01/2012; 18(11):2026-33. · 4.86 Impact Factor
• Article: Long-term MRI-guided combined anti-TNF-α and thiopurine therapy for crohn's perianal fistulas.

  Phil Tozer, Siew C Ng, Muhammed R Siddiqui, Sophie Plamondon, David Burling, Arun Gupta, Anna Swatton, Sherrill Tripoli, Carolynne J Vaizey, Michael A Kamm, Robin Phillips, Ailsa Hart
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  ABSTRACT: Anti-tumor necrosis factor (TNF) therapy heals many Crohn's disease (CD) anal fistulas clinically but the rate, extent, and durability of deep tissue healing and factors influencing long-term outcome are unknown. Consecutive patients with CD-related perianal (anal, rectovaginal, anolabial) fistulas treated with infliximab or adalimumab were monitored prospectively both clinically and radiologically using magnetic resonance imaging (MRI). Forty-one consecutive patients with CD-related perianal fistulas were treated with infliximab (n = 32) or adalimumab (n = 9; following infliximab failure) in combination with a thiopurine (unless intolerant). Fifty-eight percent of all patients, comprising 66% and 43% of infliximab and adalimumab-treated patients, respectively, demonstrated remission or response at 3 years. Thirty-three percent of infliximab treated patients maintained clinical remission at 3 years. Radiological healing lagged behind clinical remission by a median of 12 months. The likelihood of clinical remission at any time was five times greater in patients who had early clinical response within 6 weeks than those without. A higher number of fistula tracts was associated with reduced clinical remission. All patients who achieved radiological healing maintained healing on infliximab treatment, while only 43% maintained healing after cessation of anti-TNF therapy. Combination anti-TNF and thiopurine therapy provides sustained benefit in patients with perianal CD fistula. Early clinical response is associated with subsequent clinical remission. Radiological healing is slower than clinical healing. Radiologically healed fistula tracts maintain healing on infliximab but can recur after cessation of therapy. (Inflamm Bowel Dis 2012).
  Inflammatory Bowel Diseases 01/2012; 18(10):1825-34. · 4.86 Impact Factor