Real-life efficacy and safety of Ustekinumab as second- or third-line therapy in Crohn's disease: results from a large Italian cohort study.

OBJECTIVE: Ustekinumab (UST) is an anti-IL12/23 antibody for the treatment of Crohn's Disease (CD). The aim of this study was to compare the efficacy and safety of UST in a large population-based cohort of CD patients who failed previous treatment with other biologics. PATIENTS AND METHODS: 194 CD patients (108 males and 86 females, mean age 48 years (range 38-58 years) were retrospectively reviewed. 147 patients were already treated with anti-TNFα (75.8%), and 47 (24.2%) patients were already treated with anti-TNFα and vedolizumab. Concomitant treatment with steroids was present in 177 (91.2%) patients. RESULTS: At week 12, clinical remission was achieved in 146 (75.2%) patients. After a mean follow-up of 6 months, clinical remission was maintained in 135 (69.6%) patients; at that time, mucosal healing was assessed in 62 (31.9%) patients, and it was achieved in 33 (53.2) patients. Three (1.5%) patients were submitted to surgery. Steroid-free remission was achieved in 115 (59.3%) patients. Both serum C-Reactive Protein and Fecal Calprotectin (FC) levels were significantly reduced with respect to baseline levels during follow-up. A logistic regression, UST therapy as third-line therapy (after both anti-TNFα and vedolizumab), FC >200 µg/g, and HBI ≥8 were significantly associated with lack of remission. Adverse events occurred in 5 (2.6%) patients, and four of them required suspension of treatment. CONCLUSIONS: UST seemed to be really effective and safe in CD patients unresponsive to other biologic treatments, especially when used as second-line treatment.

[CT and MR virtual colonscopy: indications, limits and comparison with conventional colonscopy]. / Colonscopia virtuale TC e RM: indicazioni, limiti e confronto con la colonscopia tradizionale.

Virtual endoscopy is a new method for studying the colon; it consists in acquisition of CT and MR images and to elaborate them with a workstation, to create endoluminal vision as like as traditional colonscopy, permitting the complete exploration of colonic lumen, also with stenotic tumors. The analysis of the differences between CT and MR colography shows like these two techniques present both advantages and disadvantages, such as the impossibility to perform MR in patients with pace-maker or in claustrophobic patients and the impossibility to perform CT with iodated agents in patients with renal failure or with a story of adverse reactions. The increased use of these techniques is due to the high sensitivity of last-generation CT and MR machine, to the increased spatial resolution, to specific softwares for digital cleaning of colon, to the introduction of high-end workstations and to the possibility of computed assisted diagnosis (CAD). So, it is desiderable that the increasing spread of multidetector CT devices and the future technical innovations, should have the effect to increase culture and experience in various diagnostic centers about CT-colography, making possible the spreading of virtual endoscopy as a screening tool.

[The role of endomysium antibodies in the diagnosis and monitoring of celiac disease]. / Ruolo degli anticorpi anti endomisio nella diagnosi e nel monitoraggio della malattia celiaca.

Coeliac disease is a common cause of chronic diarrhea in children and adults. It is also frequently detected in children exclusively affected by iron deficiency anemia, hypocalcemia, short stature, dental enamel defects, epilepsy and intracranial calcifications, etc. The coeliac disease diagnosis may be facilitated by the use of some immunological tests like anti endomysial (AEA) or anti gliadin (AGA) antibodies detection. From December 1990 to September 1992 anti endomysial IgA and anti gliadin IgG antibodies were respectively detected in 1680 and 1598 sera from children and adults affected by chronic diarrhea, failure to thrive or other symptoms compatible with coeliac disease diagnosis. According to ESPGAN criteria at that time coeliac disease diagnosis was made in 73 cases. In our experience AEA IgA show to have a better sensitivity and specificity in the diagnosis of coeliac disease rather than AGA IgG (97.5% vs 95.1% and 99.5% vs 98.3% respectively).