ABSTRACT
Doxycycline is a bacteriostatic antibiotic of the tetracycline group widely indicated in the treatment of numerous infections (skin, soft tissues...). Given its acid nature, doxycycline is able to potentially generate mucous damage acting as a caustic; therefore, when the capsule of doxycycline (high concentrated substance) is taken inappropriately (with a small quantity of liquid or just before laying down) and remains for a longer time in contact with the esophagus, doxycycline may cause esophagitis-type lesions and ulcerations.
Subject(s)
Colon/injuries , Colonic Diseases/etiology , Gastroscopy/adverse effects , Gastrostomy/adverse effects , Intestinal Perforation/etiology , Intubation, Gastrointestinal/adverse effects , Aged , Colon/diagnostic imaging , Colonic Diseases/diagnosis , Colonic Diseases/diagnostic imaging , Conservative Treatment , Delayed Diagnosis , Device Removal , Enteral Nutrition/adverse effects , Female , Gastric Fistula/diagnostic imaging , Gastric Fistula/etiology , Humans , Incidental Findings , Intestinal Fistula/diagnostic imaging , Intestinal Fistula/etiology , Intestinal Perforation/diagnosis , Intestinal Perforation/diagnostic imaging , Intubation, Gastrointestinal/instrumentation , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Ustekinumab is approved for ulcerative colitis (UC). AIMS: To assess the durability of ustekinumab in patients with UC and its short-term effectiveness, durability and tolerability in clinical practice. METHODS: Retrospective, multicentre study of patients who had received their first ustekinumab dose at least 16 weeks before inclusion. Patients were followed until treatment discontinuation or last visit. Only patients with active disease at the start of ustekinumab treatment were considered in the effectiveness analysis. Patients who stopped ustekinumab before their last visit were considered not to be in subsequent remission. RESULTS: We included 620 patients; 155 (25%) discontinued ustekinumab during follow-up (median 12 months). Rate of discontinuation was 20% per patient-year of follow-up. Anaemia at baseline (hazard ratio, HR 1.5; 95% confidence interval [CI] 1.1-2.1), steroids at baseline (HR 1.5; 95% CI 1.06-2.08) and more severe clinical activity at baseline (HR 1.5; 95% CI 1.09-2.06) were associated with higher risk of discontinuation. At the end of induction, 226 (40%) patients were in steroid-free clinical remission. Moderate-severe vs mild disease activity at baseline (odds ratio [OR] 0.3; 95% CI 0.2-0.5), male sex (OR 0.5; 95% CI 0.4-0.8), and increased number of previous biologics (OR 0.6; 95% CI 0.6-0.8) were associated with lower likelihood of steroid-free clinical remission at week 16. One hundred and seventy-six patients (28%) had at least one adverse event. We observed no negative impact of ustekinumab on extraintestinal manifestations and/or immune-mediated diseases. CONCLUSIONS: Ustekinumab durability in UC was relatively high, and treatment was effective in highly refractory patients. The safety profile was consistent with previous studies.