442 research outputs found

    Evolution of Endoscopic Lesions in Steroid-Refractory Acute Severe Ulcerative Colitis Responding to Infliximab or Cyclosporine

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    BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS: Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS: Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS >= 6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p CONCLUSION: In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.Peer reviewe

    Withdrawal of infliximab or concomitant immunosuppressant therapy in patients with Crohn's disease on combination therapy (SPARE): a multicentre, open-label, randomised controlled trial.

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    BACKGROUND: The combination of infliximab and immunosuppressant therapy is a standard management strategy for patients with Crohn's disease. Concerns regarding the implications of long-term combination therapy provided the rationale for a formal clinical trial of treatment de-escalation. Our aim was to compare the relapse rate and the time spent in remission over 2 years between patients continuing combination therapy and those stopping infliximab or immunosuppressant therapy. METHODS: This multicentre, open-label, randomised controlled trial was performed in 64 hospitals in seven countries in Europe and Australia. Adult patients with Crohn's disease in steroid-free clinical remission for more than 6 months, on combination therapy of infliximab and immunosuppressant therapy for at least 8 months were randomly assigned (1:1:1) to either continue combination therapy (combination group), discontinue infliximab (infliximab withdrawal group), or discontinue immunosuppressant therapy (immunosuppressant withdrawal group). Randomisation was stratified according to disease duration before start of first anti-TNF treatment (≤2 or >2 years), failure of immunosuppressant therapy before start of infliximab, and presence of ulcers at baseline endoscopy. The patient number and group of each stratum were assigned by a central online randomisation website. Treatment was optimised or resumed in case of relapse in all groups. Participants, those assessing outcomes, and those analysing the data were not masked to group assignment. The coprimary endpoints were the relapse rate (superiority analysis) and time in remission over 2 years (non-inferiority analysis, non-inferiority margin 35 days). Analyses were done on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, NCT02177071, and with EU Clinical Trials Register, EUDRACT 2014-002311-41. The trial was completed in April, 2021. FINDINGS: Between Nov 2, 2015, and April 24, 2019, 254 patients were screened. Of these, 211 were randomised and 207 were included in the final analysis (n=67 in the combination group, n=71 in the infliximab withdrawal group, and n=69 in the immunosuppressant withdrawal group). 39 patients had a relapse (eight [12%] of 67 in the combination group, 25 [35%] of 71 in the infliximab withdrawal group, six [9%] of 69 in the immunosuppressant withdrawal group). 2-year relapse rates were 14% (95% CI 4-23) in the combination group, 36% (24-47) in the infliximab withdrawal group, and 10% (2-18) in the immunosuppressant withdrawal group (hazard ratio [HR] 3·45 [95% CI 1·56-7·69], p=0·003, for infliximab withdrawal vs combination, and 4·76 [1·92-11·11], p=0·0004, for infliximab withdrawal vs immunosuppressant withdrawal). Of 28 patients who had a relapse and were retreated or optimised according to protocol, remission was achieved in 25 patients (one of two in the combination group, 22 of 23 in the infliximab withdrawal group, and two of three in the immunosuppressant withdrawal group). The mean time spent in remission over 2 years was 698 days (95% CI 668-727) in the combination group, 684 days (651-717) in the infliximab withdrawal group, and 706 days (682-730) in the immunosuppressant withdrawal group. The difference in restricted mean survival time in remission was -14 days (95% CI -56 to 27) between the infliximab withdrawal group and the combination group and -22 days (-62 to 16) between the infliximab withdrawal group and the immunosuppressant withdrawal group. The 95% CIs contained the non-inferiority threshold (-35 days). We recorded 31 serious adverse events, in 20 patients, with no difference in frequency between groups. The most frequent serious adverse events were infections (four in the combination group, two in the infliximab withdrawal group, and one in the immunosuppressant withdrawal group) and Crohn's disease exacerbation (three in the combination group, four in the infliximab withdrawal group, and one in the immunosuppressant withdrawal group). No death nor malignancy was recorded. INTERPRETATION: In patients with Crohn's disease in sustained steroid-free remission under combination therapy with infliximab and immunosuppressant therapy, withdrawal of infliximab should only be considered after careful assessment of risks and benefits for each patient, whereas withdrawal of immunosuppressant therapy could generally represent a preferable strategy when considering treatment de-escalation. FUNDING: European Union's Horizon 2020

    PPARγ et homéostasie intestinale

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    PPARγ is a ligand-activated nuclear receptor that controls, in various organs, numerous cellular functions, involved in the control of inflammation, carcinogenesis or metabolism. In intestinal epithelial cell, some functions of PPARγ, as its metabolic role, remain unknown. The genomic effects of PPARγ ligands are also poorly known in this cell. Our objective was to compare the genomic expression induced by different PPARγ agonists in the intestinal epithelial cells by a microarrays technique, and thus to identify new PPARγ target genes and the different cellular functions controlled by this nuclear receptor. We have identified the lactase gene, whose lack of expression is responsible for lactose intolerance, as a target gene of PPARγ. We then showed that PPARγ agonists were able to increase lactase expression and activity in vitro and in vivo, identifying PPARγ agonists as potentially the first pharmacological treatment of lactose intolerance. We then confirmed the antineoplastic effect of 5ASA in intestinal epithelial cell, both in vivo and in vitro, and confirmed that this action was PPARγ-dependent. As in other organs, PPARγ regulates in intestinal epithelial cell inflammation, cell differentiation and maturation as well as metabolic functions, confirming the key role of PPARγ in the control of intestinal homeostasis, and the potential therapeutic effect of PPARγ agonistsPPARγ est un récepteur nucléaire ligand-activé qui contrôle, dans différents organes, de nombreuses fonctions cellulaires, impliquées notamment dans le contrôle de l'inflammation, de la carcinogenèse ou du métabolisme. Au niveau de la cellule épithéliale intestinale, certaines fonctions de PPARγ, comme son rôle métabolique, reste méconnu. Les effets génomiques des ligands de PPARγ sont eux aussi très mal connus dans cette cellule. L'objectif de ce travail était de comparer l'expression génomique induite par différents agonistes de PPARγ dans la cellule épithéliale intestinale par la technique de microarrays, et ainsi identifier de nouveaux gènes cibles de PPARγ et les différentes fonctions cellulaires contrôlées par ce récepteur nucléaire. Nous avons pu identifier le gène lactase, dont le déficit d'expression est responsable de l'intolérance au lactose, comme un gène cible de PPARγ. Nous avons ensuite pu montrer que les agonistes de PPARγ étaient capables d'augmenter l'expression et l'activité de la lactase in vitro et in vivo, ainsi que d'améliorer les symptômes d'intolérance au lactose dans un modèle animal ; identifiant les agonistes de PPARγ comme potentiellement le premier traitement pharmacologique de l'intolérance au lactose. Nous avons pu ensuite confirmer l'effet antinéoplasique du 5ASA au niveau de la cellule épithéliale intestinale, in vivo et in vitro, et confirmer que cette action était dépendante de PPARγ. Comme dans d'utres organes, PPARγ régule dans la cellule épithéliale intestinale les voies de l'inflammation, la différenciation et la maturation cellulaire mais aussi des fonctions métaboliques, confirmant le rôle clé de PPARγ dans le contrôle de l'homéostasie intestinale, et le potentiel thérapeutique des agonistes de PPAR

    PPARγ et homéostasie intestinale

    No full text
    PPARγ est un récepteur nucléaire ligand-activé qui contrôle, dans différents organes, de nombreuses fonctions cellulaires, impliquées notamment dans le contrôle de l'inflammation, de la carcinogenèse ou du métabolisme. Au niveau de la cellule épithéliale intestinale, certaines fonctions de PPARγ, comme son rôle métabolique, reste méconnu. Les effets génomiques des ligands de PPARγ sont eux aussi très mal connus dans cette cellule. L'objectif de ce travail était de comparer l'expression génomique induite par différents agonistes de PPARγ dans la cellule épithéliale intestinale par la technique de microarrays, et ainsi identifier de nouveaux gènes cibles de PPARγ et les différentes fonctions cellulaires contrôlées par ce récepteur nucléaire. Nous avons pu identifier le gène lactase, dont le déficit d'expression est responsable de l'intolérance au lactose, comme un gène cible de PPARγ. Nous avons ensuite pu montrer que les agonistes de PPARγ étaient capables d'augmenter l'expression et l'activité de la lactase in vitro et in vivo, ainsi que d'améliorer les symptômes d'intolérance au lactose dans un modèle animal ; identifiant les agonistes de PPARγ comme potentiellement le premier traitement pharmacologique de l'intolérance au lactose. Nous avons pu ensuite confirmer l'effet antinéoplasique du 5ASA au niveau de la cellule épithéliale intestinale, in vivo et in vitro, et confirmer que cette action était dépendante de PPARγ. Comme dans d'utres organes, PPARγ régule dans la cellule épithéliale intestinale les voies de l'inflammation, la différenciation et la maturation cellulaire mais aussi des fonctions métaboliques, confirmant le rôle clé de PPARγ dans le contrôle de l'homéostasie intestinale, et le potentiel thérapeutique des agonistes de PPARγPPARγ is a ligand-activated nuclear receptor that controls, in various organs, numerous cellular functions, involved in the control of inflammation, carcinogenesis or metabolism. In intestinal epithelial cell, some functions of PPARγ, as its metabolic role, remain unknown. The genomic effects of PPARγ ligands are also poorly known in this cell. Our objective was to compare the genomic expression induced by different PPARγ agonists in the intestinal epithelial cells by a microarrays technique, and thus to identify new PPARγ target genes and the different cellular functions controlled by this nuclear receptor. We have identified the lactase gene, whose lack of expression is responsible for lactose intolerance, as a target gene of PPARγ. We then showed that PPARγ agonists were able to increase lactase expression and activity in vitro and in vivo, identifying PPARγ agonists as potentially the first pharmacological treatment of lactose intolerance. We then confirmed the antineoplastic effect of 5ASA in intestinal epithelial cell, both in vivo and in vitro, and confirmed that this action was PPARγ-dependent. As in other organs, PPARγ regulates in intestinal epithelial cell inflammation, cell differentiation and maturation as well as metabolic functions, confirming the key role of PPARγ in the control of intestinal homeostasis, and the potential therapeutic effect of PPARγ agonist

    Histological Scores in Inflammatory Bowel Disease: A New Kid in the Block

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