Frequency, predictors, and consequences of maintenance infliximab therapy intensification in ulcerative colitis.

INTRODUCTION: Infliximab (IFX) therapy intensification in ulcerative colitis (UC) is more common than established in pivotal studies. OBJECTIVES: To establish the frequency and form of intensification for UC in clinical practice, as well as predictors, and to compare outcomes between intensified and non-intensified treatment. METHODS: A retrospective study of 10 hospitals and 144 patients with response to infliximab (IFX) induction. Predictive variables for intensification were analyzed using a Cox regression analysis. Outcome, loss of response to IFX, and colectomy were compared between intensified and non-intensified therapy. RESULTS: Follow-up time from induction to data collection: 38 months [interquartile range (IQR), 20-62]. Time on IFX therapy: 24 months (IQR, 10-44). In all, 37% of patients required intensification. Interval was shortened for 36 patients, dose was increased for 7, and 10 subjects received both. Concurrent thiopurine immunosuppressants (IMM) and IFX initiation was an independent predictor of intensification [Hazard ratio, 0.034; p, 0.006; CI, 0.003-0.371]. In patients on intensified therapy IFX discontinuation for loss of response (30.4% vs. 10.2%; p, 0.002), steroid reintroduction (35% vs. 18%; p, 0.018), and colectomy (22% vs. 6.4%; p, 0.011) were more common. Of patients on intensification, 17% returned to receiving 5 mg/kg every 8 weeks. CONCLUSIONS: Intensification is common and occasionally reversible. IMM initiation at the time of induction with IFX predictsnon-intensification. Intensification, while effective, is associated with poorer outcome.

[Malabsorption syndrome due to Strongyloides stercoralis associated with Loeffler syndrome in a 29-year-old woman]. / Síndrome de malabsorción intestinal producido por Strongyloides stercoralis asociado con el síndrome de Loeffler en una mujer de 29 años de edad.

We report a case of chronic infection by Strongyloides stercoralis in a 29-year-old Colombian woman who had been living in Spain for 2 years. The patient had recurrent abdominal pain and malabsorption syndrome. The diagnosis was made through intestinal biopsy in upper gastrointestinal endoscopy. Transport of the parasite through the lung parenchyma (Loeffler syndrome) was visible on simple chest X-ray. Bronchoalveolar lavage, bronchoalveolar aspirate and repeated stool examination were negative.

Frecuencia, factores predictores y consecuencias de la intensificación del tratamiento de mantenimiento con infliximab en la colitis ulcerosa / Frequency, predictors, and consequences of maintenance infliximab therapy intensification in ulcerative colitis

INTRODUCCIÓN: la intensificación del tratamiento con infliximab (IFX) en la colitis ulcerosa (CU) es más frecuente de lo establecido en estudios pivotales. OBJETIVOS: establecer la frecuencia y forma con la que intensificamos en CU en práctica clínica, los factores predictores y comparar la evolución entre los pacientes con tratamiento intensificado y no intensificado. MÉTODOS: estudio retrospectivo de 10 hospitales y 144 pacientes con respuesta a la inducción con IFX. Se analizaron variables predictoras de la intensificación con análisis de regresión de Cox. Se comparó la evolución, pérdida de respuesta a IFX y colectomía según tratamiento intensificado o no intensificado. RESULTADOS: tiempo de seguimiento desde la inducción hasta la recogida de datos: 38 meses [rango intercuartil (RIC) 20-62]. Tiempo de tratamiento con IFX: 24 meses (RIC, 10-44). El 37% de los pacientes requirió intensificación. Se acortó el intervalo en 36 pacientes, se aumentó la dosis en 7, ambas en 10. La introducción simultánea de inmunosupresores tiopurínicos (INM) e IFX predijo la intensificación de forma independiente [Hazard ratio (HR) 0,034 p 0,006 IC 0,003-0,371]. En los pacientes con tratamiento intensificado fue más frecuente la suspensión de IFX por pérdida de respuesta (30,4% vs. 10,2% p 0,002), la reintroducción de corticoides (35% vs. 18%, p 0,018) y la colectomía (22% vs. 6,4% p 0,011). El 17% de los pacientes intensificados volvió a recibir 5 mg/kg cada 8 semanas. CONCLUSIONES: la intensificación es frecuente y en ocasiones reversible. La introducción del INM en el momento de la inducción con IFX predice la no intensificación. La intensificación, aunque eficaz, se asocia a una peor evolución

INTRODUCTION: Infliximab (IFX) therapy intensification in ulcerative colitis (UC) is more common than established in pivotal studies. OBJECTIVES: To establish the frequency and form of intensification for UC in clinical practice, as well as predictors, and to compare outcomes between intensified and non-intensified treatment. METHODS: A retrospective study of 10 hospitals and 144 patients with response to infliximab (IFX) induction. Predictive variables for intensification were analyzed using a Cox regression analysis. Outcome, loss of response to IFX, and colectomy were compared between intensified and non-intensified therapy. RESULTS: Follow-up time from induction to data collection: 38 months [interquartile range (IQR), 20-62]. Time on IFX therapy: 24 months (IQR, 10-44). In all, 37% of patients required intensification. Interval was shortened for 36 patients, dose was increased for 7, and 10 subjects received both. Concurrent thiopurine immunosuppressants (IMM) and IFX initiation was an independent predictor of intensification [Hazard ratio, 0.034; p, 0.006; CI, 0.003-0.371]. In patients on intensified therapy IFX discontinuation for loss of response (30.4% vs. 10.2%; p, 0.002), steroid reintroduction (35% vs. 18%; p, 0.018), and colectomy (22% vs. 6.4%; p, 0.011) were more common. Of patients on intensification, 17% returned to receiving 5 mg/kg every 8 weeks. CONCLUSIONS: Intensification is common and occasionally reversible. IMM initiation at the time of induction with IFX predicts non-intensification. Intensification, while effective, is associated with poorer outcome

Doble invaginación yeyunogástrica en un varón joven / No disponible

No disponible

Síndrome de malabsorción intestinal producido por Strongyloides stercoralis asociado con el síndrome de Loeffler en una mujer de 29 años de edad / Malabsorption syndrome due to Strongyloides stercoralis associated with Loeffler syndrome in a 29-year-old woman

Presentamos un caso de infección crónica por Strongyloides stercoralis en una mujer de 29 años de edad, natural de Colombia, con 2 años de residencia en España. Presentaba dolor abdominal recurrente y síndrome de malabsorción. El diagnóstico fue obtenido a través de biopsia duodenal con endoscopia digestiva alta. En nuestra paciente se pudo observar el paso del parásito a través del parénquima pulmonar mediante radiografías simple de tórax, fenómeno conocido como síndrome de Loeffler. Tanto el lavado como el aspirado broncoalveolar fueron negativos, así como los parásitos en heces

We report a case of chronic infection by Strongyloides stercoralis in a 29-year-old Colombian woman who had been living in Spain for 2 years. The patient had recurrent abdominal pain and malabsorption syndrome. The diagnosis was made through intestinal biopsy in upper gastrointestinal endoscopy. Transport of the parasite through the lung parenchyma (Loeffler syndrome) was visible on simple chest X-ray. Bronchoalveolar lavage, bronchoalveolar aspirate and repeated stool examination were negative