Marc Ferrante

Universitair Ziekenhuis Leuven, Louvain, Flanders, Belgium

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Publications (196)1832.79 Total impact

  • C. De Bie · M. Ferrante

    No preview · Article · Feb 2016 · Alimentary Pharmacology & Therapeutics
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    ABSTRACT: Background and aim: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring medical therapy to maintain clinical remission. Low adherence to therapy leads to poorer disease outcome. Therefore, we aimed to identify predictors of low adherence in the Belgian IBD population. Patients and methods: Between November 2013 and March 2014, 570 ambulatory patients (471 patients with IBD and 99 non-IBD controls) visiting a tertiary IBD-referral centre were requested to complete the Morisky 8-Item Medication Adherence Scale (MMAS-8) questionnaire as well as a survey of sociodemographic data (smoking, educational level, marital status and occupation). On the basis of the self-reported MMAS questionnaire, adherence was categorized as low (MMAS-8 score: >2), medium (MMAS-8 score: 1-2) or high (MMAS-8 score: 0). Results: The response rate in the IBD population was as high as 99%. Low adherence was reported less frequently in the IBD population than in the non-IBD controls (36 vs. 49%, P=0.021). In multivariate analysis, factors associated independently with low adherence in the IBD population were age younger than 40 [odds ratio: 1.589 (95% confidence interval: 1.057-2.389), P=0.026], higher educational level [1.961 (1.305-2.946), P=0.001], being single [1.641 (1.020-2.639), P=0.041] and the use of mesalamine [1.591 (1.018-2.487), P=0.041]. Self-employment was identified as a protective factor for low adherence [0.397 (0.167-0.946), P=0.041]. Conclusion: Approximately one-third of the IBD patients were low adherers. Predictors of low adherence were aged younger than 40 years, higher educational level, being single and mesalamine use, whereas being self-employed was a protective factor. On the basis of these data, personalized algorithms may be developed to improve patient education, empowerment and follow-up.
    No preview · Article · Jan 2016 · European journal of gastroenterology & hepatology
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    ABSTRACT: Background & aims: Golimumab is approved recently to treat refractory moderate-to-severe ulcerative colitis (UC). To date it is not clear why a considerable fraction of patients do not respond, or lose initial response, to golimumab therapy. Our aim was to investigate whether a low golimumab serum concentration and/or a positive anti-golimumab antibody status reduces the efficacy of this drug in patients with UC. Methods: Serum samples of 21 patients with moderate-to-severe UC were collected during the first 14 weeks of golimumab therapy. For measurement of golimumab serum concentrations, both a TNF-coated ELISA and a sandwich-type ELISA were developed. Anti-golimumab antibodies were measured using a bridging ELISA and a newly-developed drug-tolerant immunoassay. Clinical response and mucosal healing were assessed 14 weeks after start of treatment. Results: Out of 21 patients, 10 (48%) reached partial clinical response at week 14. Median [interquartile range] serum golimumab concentration was significantly higher in partial clinical responders than in non-responders: 10.0 [7.8-10.5] μg/ml versus 7.4 [4.8-8.3] μg/ml at week 2 (P=0.035) and 5.1 [4.0-7.9] μg/ml versus 2.1 [1.8-4.2] μg/ml at week 6 (P=0.037). Four out of 21 UC patients developed anti-golimumab antibodies, detectable only using a drug-tolerant immunoassay, and three had a partial clinical response at that time. Clinical non-responders had a significantly more severe colitis, indicated by a higher endoscopic mayo score at baseline compared to partial clinical responders (P=0.048). Conclusion: Adequate exposure to golimumab drives clinical response. A worse disease at baseline influences clinical response rate negatively.
    No preview · Article · Jan 2016 · Journal of Crohn s and Colitis
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    ABSTRACT: Background: A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative for ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn's disease (CD). Methods: This type of strictureplasty was proposed to all patients with an extensive strictured (neo-)terminal ileal segment (> 20cm). Short- and long-term outcome data were retrieved from a prospectively maintained database. Safety and medium-term efficacy were studied, using both postoperative magnetic resonance enterography (MRE) and ileocolonoscopy at 6 months. Results: Between June 2009 and September 2014, 29 CD patients had a modified strictureplasty (male 9/29, median age 38 (range: 16-64) years). The median length of strictureplasty was 50 (27-110) cm. Twelve patients underwent a total of 30 additional procedures during surgery, mainly additional short strictureplasties, but also segmental resections. The majority had a laparoscopic assisted procedure. Median length of hospital stay was 9 (6-17) days. Two patients had an early rescue procedure to oversew a small anastomotic leak. MRE and ileocolonoscopy at follow up, showed a remarkable regression of inflammation and bowel wall thickness. Clinical recurrence, necessitating initiation or modification of medical therapy, and surgical recurrence were reported in 11 and 1 patient after a median follow up of 21 (1-54) months respectively. Conclusion: A modified long Michelassi strictureplasty appears to be safe in patients with extensive stricturing Crohn's ileitis. Significant mucosal and bowel wall healing is observed and suggest that clearance of microbial stasis may play a role in this process.
    No preview · Article · Dec 2015 · Journal of Crohn s and Colitis
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    ABSTRACT: Background: A subgroup of patients with inflammatory bowel disease (IBD) treated with anti-tumor necrosis factor (TNF) antibodies develop skin lesions, but the lesions and their clinical course are not well-characterized. Objective: To describe patients treated with anti-TNF antibodies who did and did not develop skin lesions. Design: Retrospective cohort. Setting: Single IBD tertiary referral center. Patients: 917 consecutive patients with IBD who initiated anti-TNF therapy. Measurements: Skin lesions, patient demographic characteristics, treatments, clinical course, and serologic and genetic markers. Results: During a median follow-up of 3.5 years (interquartile range [IQR], 0.5 to 7.4 years), skin lesions associated with the use of anti-TNF therapy developed in 264 of 917 (29%) patients (psoriasiform eczema, 30.6%; eczema, 23.5%; xerosis cutis, 10.6%; palmoplantar pustulosis, 5.3%; psoriasis, 3.8%; other, 26.1%). Lesions typically developed at flexural regions, genitalia, and the scalp, especially the psoriasiform lesions. Thirty-one percent of women and 26% of men developed lesions. Median cumulative doses (2864 mg/y [IQR, 2203 to 3819 mg/y] and 2927 mg/y [IQR, 2377 to 3667 mg/y]) and trough levels (4.2 µg/mL [IQR, 2.6 to 5.8 µg/mL] and 4.0 µg/mL [IQR, 1.6 to 5.9 µg/mL]) of infliximab were similar in patients with and without lesions. All but 28 patients (11%) were successfully managed without needing to stop therapy because of lesions. Limitation: Retrospective nature and no matched control group of patients not receiving anti-TNF therapy. Conclusion: Skin lesions occur frequently in association with anti-TNF therapy but rarely require discontinuation of therapy. Close surveillance and early referral to a dedicated dermatologist are recommended. Primary funding source: Research Foundation Flanders (FWO), Belgium; Geconcerteerde Onderzoekacties of KU Leuven; and Janssen Biologics.
    No preview · Article · Dec 2015 · Annals of internal medicine
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    ABSTRACT: Mucosal healing is an independent predictor of sustained clinical remission in patients with ulcerative colitis (UC) treated with infliximab. We investigated whether infliximab concentrations during induction therapy are associated with short-term mucosal healing (STMH) in patients with UC.
    No preview · Article · Dec 2015
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    ABSTRACT: Background: Patients with inflammatory bowel disease (IBD) have a higher risk of developing thromboembolic events (TE) compared with the healthy population. Aim: This study aimed to describe a cohort of IBD patients with a history of TE focusing on recurrence of TE, disease activity and IBD medication at the time of TE and surgery before TE. Materials and methods: In a retrospective monocentric cohort study, we included IBD patients in whom an arterial and/or venous TE occurred. Results: Eighty-four IBD patients with a history of TE (63% Crohn's disease, 44% men) and a mean age of 45±15 years were included; 25/84 patients (30%) were identified to have recurrent TE. Seventy out of 84 (83%) developed a venous TE, with a deep vein thrombosis as the major manifestation (28/70, 40%), followed by a pulmonary embolism (16/70, 23%). At the time of TE, 60/84 (71%) patients were diagnosed with active disease. In all, 23% patients were on 5-aminosalicylic acids, 36% on steroids, 18% on azathioprine, 5% on methotrexate, 12% on biologicals and 23% were not receiving specific IBD treatment. Moreover, within a 6-month period preceding the TE, 28/84 (33%) patients underwent surgery, of whom 17% received thromboprophylaxis at hospital discharge. Conclusion: We confirm the association between disease activity and the occurrence of TE. A substantial number of patients had additional risk factors such as recurrence of TE. In all, 36% received steroids at the time of TE and 33% underwent recent surgery, of whom only a minority received thromboprophylaxis at hospital discharge. Further efforts are required to increase thromboprophylaxis in at-risk patients.
    No preview · Article · Oct 2015 · European journal of gastroenterology & hepatology
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    ABSTRACT: Background and aims: Fecal microbiota transplantation is a successful therapy for patients with refractory Clostridium difficile infections. It has also been suggested as a treatment option for inflammatory bowel disease, given the role of the intestinal microbiota in this disease. We assessed the impact of fecal microbiota transplantation in patients with inflammatory bowel disease and studied predictors of clinical (non)response in microbial profiles of donors and patients. Methods: Fourteen refractory patients (8 ulcerative colitis and 6 Crohn's disease) underwent ileocolonoscopy with fecal microbiota transplantation through naso-jejunal (n=9) or rectal tube (n=5). Efficacy was assessed by endoscopic healing at week 8, clinical activity scores and C-reactive protein measurement. Fecal microbiota was analyzed by 16S rDNA pyrosequencing. Results: There was no significant improvement among the 6 patients with Crohn's disease at week 8 following fecal microbiota transplantation. One patient experienced temporary clinical remission for 6 weeks. In contrast, 2/8 patients with ulcerative colitis had endoscopic remission at week 8 and of the 6 remaining patients with ulcerative colitis, one reported temporary remission for 6 weeks. The donor microbiota richness and the number of transferred phylotypes were associated with treatment success. Persistent increased C-reactive protein two weeks after transplantation was predictive for failure of response. Conclusion: Fecal microbiota transplantation led to endoscopic and long-term (> 2 years) remission in 2 out of 8 ulcerative colitis patients. Higher donor richness was associated with successful transplant. Therefore, fecal microbiota transplantation with donor pre-screening could be a treatment option for selected refractory ulcerative colitis patients.
    No preview · Article · Oct 2015 · Journal of Crohn s and Colitis
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    ABSTRACT: Objective: Pouchitis is the most common complication after colectomy with ileal pouch-anal anastomosis (IPAA) for UC and the risk is the highest within the 1st year after surgery. The pathogenesis is not completely understood but clinical response to antibiotics suggests a role for gut microbiota. We hypothesised that the risk for pouchitis can be predicted based on the faecal microbial composition before colectomy. Design: Faecal samples from 21 patients with UC undergoing IPAA were prospectively collected before colectomy and at predefined clinical visits at 1 month, 3 months, 6 months and 12 months after IPAA. The predominant microbiota was analysed using community profiling with denaturing gradient gel electrophoresis followed by quantitative real-time PCR validation. Results: Cluster analysis before colectomy distinguished patients with pouchitis from those with normal pouch during the 1st year of follow-up. In patients developing pouchitis, an increase of Ruminococcus gnavus (p<0.001), Bacteroides vulgatus (p=0.043), Clostridium perfringens (p=0.011) and a reduction of two Lachnospiraceae genera (Blautia (p=0.04), Roseburia (p=0.008)) was observed. A score combining these five bacterial risk factors was calculated and presence of at least two risk factors showed a sensitivity and specificity of 100% and 63.6%, respectively. Conclusions: Presence of R. gnavus, B. vulgatus and C. perfringens and absence of Blautia and Roseburia in faecal samples of patients with UC before surgery is associated with a higher risk of pouchitis after IPAA. Our findings suggest new predictive and therapeutic strategies in patients undergoing colectomy with IPAA.
    Full-text · Article · Oct 2015 · Gut

  • No preview · Article · Oct 2015 · Journal de Chirurgie Viscerale
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    ABSTRACT: Background The detrimental effect of smoking on development and progression of Crohn's disease (CD) is generally accepted.AimWe evaluated the awareness of smoking risks in the Belgian inflammatory bowel disease (IBD) population.Methods In the out-patient clinic of a tertiary referral centre, 625 consecutive patients with CD, 238 patients with ulcerative colitis (UC) and 289 non-IBD controls, filled out a simple questionnaire. This questionnaire included data on smoking behaviour and awareness of smoking-related health effects, including effects on IBD.ResultsAt diagnosis, more CD patients were active smokers compared to UC (40% vs. 17%, P < 0.001). Remarkably, smoking cessation rates after diagnosis were similar for CD and UC (both 56%, P = 0.997). The great majority recognised a detrimental influence of smoking on general health (98–99%), lung cancer (95–97%), myocardial infarction (89–92%) and stroke (78–87%). Although CD patients more frequently acknowledged risks of smoking on their disease, only 37% were aware of a link with CD development, 30% of increased surgical rates and 27% of increased post-operative CD recurrence. Active smokers more frequently denied an increased risk of surgery and higher post-operative CD recurrence. Intriguingly, within the active smokers with CD, those not willing to quit smoking most often denied a potential bad influence of smoking. Taking into account disease duration, previous surgery, education level, working status and nicotine dependence, we were unable to define specific subgroups of patients requiring extra education.Conclusion Although patients with Crohn's disease were better informed on the detrimental effects of smoking, the awareness rate was still low.
    No preview · Article · Oct 2015 · Alimentary Pharmacology & Therapeutics
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    ABSTRACT: Background: Anti-tumor necrosis factor (TNF) therapy has become a standard therapy for severe inflammatory bowel diseases (IBD), but its effect on B lymphocytes is largely unexplored. In this study we investigated peripheral blood B cells, B-cell subsets, and CD40 expression in patients with IBD before and during anti-TNF therapy with infliximab (IFX). Methods: Blood was taken from healthy controls (n = 52) and patients with active IBD before (n = 46) and/or during anti-TNF therapy (n = 55). B-cell markers were detected by immunofluorescent staining and FACS analysis. Patients were classified as responders or nonresponders to anti-TNF therapy. Results: We found a numerical deficiency of circulating CD19 B cells, a lower activation state (CD40 expression) and lower proportions of CD5 B cells and IgMIgDCD27 preswitched memory cells among B cells in active patients with IBD before IFX therapy compared with healthy controls. IFX treatment increased CD19 B-cell numbers as well as the proportions of named B-cell subsets in responders but not in nonresponders. IFX more effectively upregulated CD40 expression in responders than in nonresponders. Restoration of B cells correlated with the biological response to therapy (C-reactive protein). Trough serum levels of IFX correlated with the number of B cells during therapy. Conclusions: A lower number of circulating B cells, a low CD40 expression, and a decrease in the proportion of CD5 and in the preswitched memory subset characterize active IBD. Restoration of these abnormalities correlates with the clinical response to anti-TNF therapy. The mechanism for this effect on B cells should be further explored.
    No preview · Article · Sep 2015 · Inflammatory Bowel Diseases
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    ABSTRACT: Background and aims: Surgery for Crohn's disease (CD) can be complicated by an enhanced inflammatory response. This retrospective study aims to compare the inflammatory response measured by C-reactive protein (CRP) in patients operated for CD with patients undergoing similar surgery for colorectal cancer (CRC). Methods: All CD patients undergoing an ileocaecal resection between February 2001 and December 2013 were retrieved from a prospectively maintained database. The same number of patients with a CRC of the ascending colon, undergoing a laparoscopic right hemicolectomy between March 2009 and June 2014, were retrieved from a CRC database. CRP level during the first 7 postoperative days was used as primary outcome. Results: 112 consecutive CD patients (male 40.2%; median age: 32.3 yrs; interquartile range, IQR: 25.2 - 45.1) and 112 consecutive CRC patients (male 53.6%, median age 71.6 yrs; IQR: 64.7 - 77.5) were included. Postoperative CRP level in the CD group was on average 27% higher compared to the CRC group (p=0.02). The day-specific differences in CRP values were 21% (p = 0.021, 95% CI: 3% - 41%), 41% (p = 0.005, 95% CI: 11% - 79%), 49% (p = 0.007, 95% CI: 11% - 96%) and 49% (p = 0.006, 95% CI: 12% - 100%) higher for CD patients at day 1, 4, 5 and 6 respectively. The difference in postoperative CRP level was partially due to differences in preoperative CRP level.ConclusionCD patients develop a higher postoperative CRP level, probably reflecting an enhanced postoperative inflammatory response, which may be triggered by a higher preoperative inflammatory state.
    No preview · Article · Sep 2015 · Journal of Crohn s and Colitis
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    ABSTRACT: Background & aims: Prediction of primary non-response (PNR) to anti-TNFs in inflammatory bowel disease (IBD) is direly needed to select the most optimal therapeutic class for a given patient. We developed a matrix-based prediction tool to predict response to infliximab (IFX) in Crohn's disease (CD) patients. Methods: This retrospective single-center study included 201 anti-TNF naïve CD patients who started with IFX induction therapy. PNR occurred in 16 (8%) patients. Clinical, biological (including serum TNF and the IBD serology 6 panel (Prometheus Laboratories)) and genetic (the 163 validated IBD risk loci) markers were collected prior to start. Based on the best fitted regression model, probabilities of primary response to IFX were calculated and arranged in a prediction matrix tool. Results: Multiple logistic regression withheld three final independent predictors (P<0.05) for PNR: age at first IFX, (OR [95% CI] of 1.1 [1.0-1.1]), BMI (0.86 [0.7-1.0]) and prior surgery (4.4 [1.2-16.5]). The accuracy of this prediction model did not improve when the genetic markers were added (AUC from 0.80 [0.67-0.93] to 0.78 [0.65-0.91]). The predicted probabilities for PNR to IFX increased from 1% to 53% depending on the combination of final predictors. Conclusions: Readily available clinical factors (age at first IFX, BMI and prior surgery) outperform serologic and IBD risk loci in prediction of primary response to infliximab in this real-life cohort of CD patients. This matrix tool could be useful for guiding physicians and may avoid unnecessary or inappropriate exposure to IFX in IBD patients unlikely to benefit.
    No preview · Article · Sep 2015 · Journal of Crohn s and Colitis
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    ABSTRACT: A defect in regulatory T cells (Tregs) may be involved in the pathogenesis of inflammatory bowel diseases (IBD). Several subsets of human Foxp3 Tregs (activated and resting Tregs) have now been identified, as well as an IL-10 and IFN-γ double producing Foxp3 type 1 regulatory-like T cell (Tr1L). We have quantified these Tregs in patients with active IBD and during therapy with infliximab (IFX). Blood samples were obtained from healthy controls (n = 54) and patients with active IBD, either before (n = 62) or during IFX therapy (n = 75). Tregs were identified by immunofluorescent staining and flow cytometry analysis. Resting and activated Foxp3 Tregs can be differentiated from Foxp3effector T cells (Foxp3 Teff) by the expression of CD45RA. Tr1L are identified as CD4CD45RACD25CD127Foxp3 T cells. A numerical deficiency of circulating resting Tregs, activated Treg cells, and Tr1L was documented in patients with active IBD. Baseline levels of these Treg subsets predicted clinical responses to IFX. We documented an upregulation of all 3 subsets during IFX therapy. Moreover, after therapy, significant differences in Treg subsets were seen between responders and nonresponders to IFX. Restoration of Tregs correlated with the clinical and biological response to IFX therapy. Trough serum levels of IFX positively correlated with the proportion of activated Treg cells and Tr1L during therapy. IFX therapy, when successful, results in upmodulation of the different types of Treg cells in the blood of patients with IBD. This effect might be relevant for understanding the mechanism of action of anti-TNF agents.
    No preview · Article · Aug 2015 · Inflammatory Bowel Diseases
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    ABSTRACT: Background: The occurrence of thromboembolic events (TE) is an important extraintestinal manifestation in patients with inflammatory bowel disease (IBD). The aim of this study was to compare fibrinolysis and clot lysis parameters between (1) patients with IBD and healthy controls and (2) patients with IBD with TE (IBD + TE) and without TE (IBD − TE). Methods: One hundred thirteen healthy controls and 202 patients with IBD, of which 84 patients with IBD + TE and 118 patients with IBD − TE, were included in this case–control study. Three clot lysis parameters (area under the curve, 50% clot lysis time, and amplitude) were determined using a clot lysis assay. Plasminogen activator inhibitor 1 (PAI-1) and thrombin activatable fibrinolysis inhibitor concentrations were determined by enzyme-linked immunosorbent assay. Results: PAI-1 antigen, active PAI-1, and intact thrombin activatable fibrinolysis inhibitor concentrations, as well as 50% clot lysis time and area under the curve, were significantly associated with the presence of IBD (all P < 0.05). The median time between TE and plasma collection was 5.0 (1.8–11.0) years. Comparing IBD + TE versus IBD − TE, active to total PAI-1 ratio (0.36 [0.24–0.61] versus 0.24 [0.13–0.40]), area under the curve (31 [24–49] versus 22 [13-31]), 50% clot lysis time (110 [64–132] versus 95 [70–126] minutes), and amplitude (0.295 [0.222–0.436] versus 0.241 [0.168–0.308]) were significantly higher in IBD + TE (all P <0.05) and remained higher after adjustment for age, gender, C-reactive protein, type of disease, presence of comorbidities, and disease activity. Conclusions: Patients with IBD have an altered clot lysis profile compared with healthy controls. Clot lysis parameters differ significantly between patients with IBD with and without a history of TE and should be included in the risk assessment.
    No preview · Article · Aug 2015 · Inflammatory Bowel Diseases

  • No preview · Article · Jun 2015 · Acta gastro-enterologica Belgica

  • No preview · Conference Paper · May 2015
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    ABSTRACT: Prophylactic azathioprine (AZA) is efficacious in preventing postoperative Crohn's disease (CD) recurrence. However, it is unknown if AZA should be started immediately after surgery. We compared efficacy of systematic versus endoscopy-driven AZA in preventing CD recurrence at week 102. CD patients undergoing curative resection with ileocolonic anastomosis and at higher risk of recurrence were included in this prospective, multicenter trial. Patients were randomized to systematic AZA initiated ≤2 weeks from surgery, or endoscopy-driven AZA where therapy was only initiated in case of endoscopic recurrence (Rutgeerts' score ≥i2) at weeks 26 or 52 following surgery. The primary endpoint was endoscopic remission (i0-i1) at week 102. Secondary endpoints included complete endoscopic remission (i0), and clinical remission. The study was prematurely stopped due to slow recruitment. Between 2005 and 2011, 63 patients (28 male, median age 36 years) were randomized to systematic (n=32) or endoscopy-driven AZA (n=31). Twenty-one patients withdrew prematurely (8 clinical recurrence, 6 adverse reactions to AZA, 7 patient's preference). In the endoscopy-driven AZA group, 14 patients had to initiate AZA (11 at week 26, 3 at week 52). Endoscopic remission was achieved by 50% in the systematic and 42% in the endoscopy-driven AZA group (p=0.521). No difference in secondary endpoints could be determined. Systematic AZA therapy in patients at higher risk of postoperative CD recurrence is not superior to endoscopy-driven treatment. Early postoperative endoscopic evaluation between week 26-52 seems most appropriate to guide further therapy, but larger studies are warranted. (ClinicalTrials.gov, Number NCT02247258). Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
    No preview · Article · Apr 2015 · Journal of Crohn s and Colitis
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    ABSTRACT: Dear Editor, We read with great interest the manuscript by Ungar and colleagues describing the temporal evolution of antibodies to infliximab (ATI) in patients with IBD treated with infliximab (IFX).1 By prospectively following 125 patients with IBD, they showed that ATI formation is a dynamic process. Clinically relevant ATI were typically formed within the first 12 months but transient ATI, which are of little clinical significance, can be formed at any time during treatment. They furthermore demonstrated that the evolution of ATI correlates with clinical loss of response and that concomitant immunomodulator use prolonged ATI-free survival, which is in line with previous reports. Nevertheless, patient-related factors possibly influencing ATI formation weren't considered and haven't been studied extensively. We hypothesised that ATI formation may be triggered by HLA-DRB1 alleles, as was shown for immunogenicity to interferon-β therapy in multiple sclerosis.2 We retrospectively analysed 192 patients with IBD: 76 patients developed ATI during IFX maintenance treatment (=ATI+) (44 Crohn's disease (CD), 32 UC) and these were matched with 116 patients (64 CD, 52 UC) who never developed ATI (=ATI−). All patients were antitumour necrosis factor naïve before IFX … [Full text of this article]
    No preview · Article · Apr 2015 · Gut

Publication Stats

4k Citations
1,832.79 Total Impact Points

Institutions

  • 2004-2016
    • Universitair Ziekenhuis Leuven
      • Department of Gastroenterology
      Louvain, Flanders, Belgium
  • 2004-2015
    • University of Leuven
      • Department of Clinical and Experimental Medicine
      Louvain, Flanders, Belgium
  • 2014
    • The University of Edinburgh
      • Institute of Immunology and Infection Research
      Edinburgh, Scotland, United Kingdom
    • Tel Aviv Sourasky Medical Center
      Tell Afif, Tel Aviv, Israel
  • 2013
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom
  • 2012-2013
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 2005-2010
    • Universitair Ziekenhuis Ghent
      Gand, Flanders, Belgium
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 2008
    • University of Pennsylvania
      • Department of Medicine
      Filadelfia, Pennsylvania, United States