Efficacy, safety and cost-efficiency of adalimumab 80 mg every other week in previously intensified IBD patients under treatment with adalimumab 40 mg every week

Background Dose escalation is often recommended for loss of response in patients with inflammatory bowel disease (IBD) under maintenance treatment with anti-TNF, but in normal conditions this strategy considerably increases the cost. A new presentation of Adalimumab (ADA) 80 mg has been approved in our hospital with the same price per unit as the ADA 40 mg presentation. The aim of this study was to evaluate the efficacy, safety and cost-efficiency of ADA 80 mg every other week (eow) in IBD patients under previously intensified treatment with ADA 40 mg every week. Methods A prospective and observational study was performed. Inclusion criteria were all IBD patients under intensified maintenance therapy with ADA 40 mg every week. Physicians informed all patients the reasons (cost and convenience) for changing to a ADA 80 mg eow dose and asked for their consent. So far we have evaluated a period of 1 month, although the complete follow-up period will be 12 months. The Harvey?Bradshaw index (HBI ?4) and the Mayo partial index (Mayo partial index ?2) were used to evaluate clinical remission in Crohn?s disease (CD) and ulcerative colitis (UC) patients, respectively. Adverse events were monitored. Faecal calprotectin (FC) and C reactive protein (CRP) were collected at baseline (week 0, before first dose of subcutaneous injection of ADA 80 mg) and after 1 month. Biological remission was defined as clinical remission and FC < 250 ?g/g and CRP < 5 mg/dl. A descriptive analysis was performed and data are shown as percentage, median and range. Cost efficiency analysis was also performed. Results We offered to 18 consecutive IBD patients the possibility of participating in the study, but only 16 agreed to participate. We included 15 CD and 1 extensive UC with a median age of 40. 56.3% were male, 37.5% non-smokers and 31.3% ex-smokers. In CD, 46.7% had ileal disease, 13.3% colonic disease and 40% ileocolonic disease. 46.7% CD patients presented fistulising behaviour. At baseline, 86.7% of patients were in clinical remission and 92.3% were in clinical remission after 1 month. Median FC concentration at inclusion was 210 (range 6?1900) and 1 month later 91 (range 10?3754). Median CRP concentration at inclusion was 0.14 (range 0?19) and 0.21 (range 0.01?2.94) at month 1. 60% of patients at month 0 and 53.3% at month 1 were in biological remission. No adverse events were registered. After 1 month in total we had saved more than 13.000 euros and if all patients complete 1 year of treatment we predict savings of more than 150.000 euros with our new schedule of treatment. Conclusions Changing to a single dose ADA 80 mg eow is an efficacy, safety and cost-efficient strategy in IBD patients under intensified maintenance therapy with ADA 40 mg every week

Acid suppression therapy, gastrointestinal bleeding and infection in acute pancreatitis - An international cohort study

BACKGROUND: Acid suppressing drugs (ASD) are generally used in acute pancreatitis (AP); however, large cohorts are not available to understand their efficiency and safety. Therefore, our aims were to evaluate the association between the administration of ASDs, the outcome of AP, the frequency of gastrointestinal (GI) bleeding and GI infection in patients with AP. METHODS: We initiated an international survey and performed retrospective data analysis on AP patients hospitalized between January 2013 and December 2018. RESULTS: Data of 17,422 adult patients with AP were collected from 59 centers of 23 countries. We found that 23.3% of patients received ASDs before and 86.6% during the course of AP. ASDs were prescribed to 57.6% of patients at discharge. ASD administration was associated with more severe AP and higher mortality. GI bleeding was reported in 4.7% of patients, and it was associated with pancreatitis severity, mortality and ASD therapy. Stool culture test was performed in 6.3% of the patients with 28.4% positive results. Clostridium difficile was the cause of GI infection in 60.5% of cases. Among the patients with GI infections, 28.9% received ASDs, whereas 24.1% were without any acid suppression treatment. GI infection was associated with more severe pancreatitis and higher mortality. CONCLUSIONS: Although ASD therapy is widely used, it is unlikely to have beneficial effects either on the outcome of AP or on the prevention of GI bleeding during AP. Therefore, ASD therapy should be substantially decreased in the therapeutic management of AP