RESUMEN
Both psoriasis and inflammatory bowel disease (IBD) are immunomediated diseases. Some of their therapeutic tools are monoclonal antibodies. Ixekizumab is an interleukin-17 (IL-17) inhibitor approved for the treatment of psoriasis. Cases of IBD onset have been reported in patients treated with this drug. We present the case of a 35-year-old patient with the onset of ulcerative colitis (UC) type of IBD after starting ixekizumab treatment.
RESUMEN
BACKGROUND: ustekinumab has proven effective in Crohn's disease (CD). However, some patients will partially respond or lose response over time. Data supporting the effectiveness of dose escalation in this scenario is scarce. AIM: to evaluate the effectiveness of ustekinumab dose escalation in CD. METHODS: patients with active CD (Harvey-Bradshaw ≥ 5) who had received intravenous (IV) induction and at least a subcutaneous (SC) dose were included in this retrospective observational study. Ustekinumab dose was escalated, either via shortening of the interval to six or four weeks or IV reinduction plus shortening to every four weeks. RESULTS: ninety-one patients were included, and ustekinumab dose was escalated after a median of 35 weeks of treatment. At week 16 after intensification, steroid-free clinical response and remission were observed in 62.6 % and 25.3 % of patients, respectively. Systemic corticosteroids were discontinued in 46.7 % of patients who were on corticosteroids at baseline. Follow-up data beyond week 16 were available for 78 % of patients; at the last visit, 66.2 % and 43.7 % were in steroid-free clinical response and remission, respectively. After a median follow-up of 64 weeks, 81 % of patients were still treated with ustekinumab. Adverse events were reported in 4.3 % of patients; these were all mild and did not lead to hospitalization or discontinuation of treatment. Five patients (5.5 %) underwent surgical resection, with no immediate postsurgical complications. CONCLUSION: ustekinumab dose escalation was effective in recapturing response in over half of the patients. These findings suggest that dose escalation should be considered in patients who experience loss or partial response to the standard maintenance.
Asunto(s)
Enfermedad de Crohn , Ustekinumab , Humanos , Ustekinumab/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Inducción de Remisión , Estudios Retrospectivos , Corticoesteroides/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: tofacitinib is a Janus kinase inhibitor approved for the treatment of moderate-severe ulcerative colitis (UC). This study aimed to evaluate its efficacy in a real-life setting. METHODS: a retrospective and multicenter observational study was performed with UC patients treated with tofacitinib. Short and long-term treatment effectiveness, treatment survival, need for dose escalation and safety were analyzed. Clinical response and remission were defined in accordance with the partial Mayo score. RESULTS: seventy-four patients were included, 98.3 % had received prior biological treatment, 55.4 % with three or more biologicals and up to 64.9% with two or three different mechanisms of action. Clinical remission and response rates were 37.8 % and 77 % at eight weeks, and 41.8 % and 70.1 % at 16 weeks. With regard to non-responders at eight weeks, 37.5 % achieved a delayed clinical response at 16 weeks. Mean treatment duration was 19 months (95 % CI: 16-22), with a treatment survival of 56 % at 28 months, and remission and response rates at 24 months of 53.8 % and 61.5 %. Twenty-three treatments were withdrawn, most of them (18) during the induction period. There were adverse events in a quarter of the patients; only four were severe and led to treatment discontinuation. CONCLUSION: tofacitinib has a demonstrated efficacy in clinical practice to induce and maintain clinical response in treatment-refractory UC patients, with an acceptable safety profile.
Asunto(s)
Colitis Ulcerosa , Colitis Ulcerosa/inducido químicamente , Colitis Ulcerosa/tratamiento farmacológico , Humanos , Piperidinas/efectos adversos , Pirimidinas/efectos adversos , Estudios RetrospectivosRESUMEN
Liver cirrhosis is a disease related to numerous severe complications such as portal hypertension or collateral circulation. Varices that are located outside the gastroesophageal region (ectopic varices) such as the anorectal region, colon, ileum or gallbladder are unusual. In many cases, they are related to the existence of portal vein thrombosis. We report the case of a patient with a severe hemorrhage of gallbladder varices due to alcohol-related cirrhosis.
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Vesícula Biliar/irrigación sanguínea , Hemorragia/etiología , Cirrosis Hepática/complicaciones , Várices/complicaciones , Resultado Fatal , Vesícula Biliar/diagnóstico por imagen , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/terapia , Hemorragia/diagnóstico por imagen , Humanos , Cirrosis Hepática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Várices/diagnóstico por imagenAsunto(s)
Pancreatitis , Enfermedades Vasculares , Enfermedad Aguda , Humanos , Páncreas , Pancreatitis/etiologíaAsunto(s)
Várices Esofágicas y Gástricas , Síndrome de la Vena Cava Superior , Várices , Várices Esofágicas y Gástricas/complicaciones , Hemorragia , Humanos , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Várices/complicaciones , Várices/diagnóstico por imagenAsunto(s)
Neoplasias Colorrectales/genética , Genes BRCA1 , Enfermedades Inflamatorias del Intestino/genética , Síndromes Neoplásicos Hereditarios/genética , Adenocarcinoma/genética , Adenocarcinoma/cirugía , Adulto , Edad de Inicio , Antiinflamatorios/uso terapéutico , Azatioprina/uso terapéutico , Neoplasias de la Mama/genética , Colitis Ulcerosa/genética , Neoplasias del Colon/genética , Neoplasias del Colon/cirugía , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Mesalamina/uso terapéutico , Proctocolectomía RestauradoraAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Colitis/inducido químicamente , Neoplasias Óseas/secundario , Colitis/diagnóstico por imagen , Colitis/tratamiento farmacológico , Colitis Ulcerosa/diagnóstico por imagen , Colonoscopía , Humanos , Neoplasias Pulmonares/secundario , Masculino , Melanoma/tratamiento farmacológico , Melanoma/secundario , Persona de Mediana Edad , Neoplasias Cutáneas/tratamiento farmacológicoAsunto(s)
Neoplasias de los Conductos Biliares/diagnóstico por imagen , Conductos Biliares Extrahepáticos/diagnóstico por imagen , Carcinoma de Células Escamosas/diagnóstico por imagen , Anciano , Neoplasias de los Conductos Biliares/patología , Conductos Biliares Extrahepáticos/patología , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Imagen por Resonancia MagnéticaAsunto(s)
Enfermedades Autoinmunes del Sistema Nervioso/etiología , Enfermedades Cerebelosas/etiología , Enfermedad de Crohn/complicaciones , Enfermedad Aguda , Adulto , Anticuerpos Antinucleares/sangre , Enfermedades Autoinmunes del Sistema Nervioso/diagnóstico por imagen , Enfermedades Autoinmunes del Sistema Nervioso/inmunología , Ataxia Cerebelosa/etiología , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/inmunología , Enfermedad de Crohn/inmunología , Diplopía/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Reflejo Anormal , Tomografía Computarizada por Rayos XAsunto(s)
Equinococosis Hepática/complicaciones , Hipertensión Portal/etiología , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Angiografía por Tomografía Computarizada , Equinococosis Hepática/diagnóstico por imagen , Equinococosis Hepática/cirugía , Procedimientos Quirúrgicos Electivos , Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/etiología , Hepatectomía , Humanos , Imagen por Resonancia Magnética , Masculino , RecurrenciaRESUMEN
BACKGROUND: Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit. METHODS: From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist. RESULTS: A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients. CONCLUSIONS: The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started.
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Fosfatasa Alcalina/sangre , Hepatopatías/sangre , Hepatopatías/enzimología , Hígado/enzimología , Transaminasas/sangre , gamma-Glutamiltransferasa/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico , Adulto JovenRESUMEN
Inflammatory bowel disease is accompanied by extraintestinal manifestations in a high percentage of patients. Cutaneous lesions are the second most prevalent of these manifestations, and within these, metastatic Crohn's disease is one of the least common, being the least frequent specific cutaneous manifestation of Crohn's disease. This entity includes cutaneous and subcutaneous lesions with a non-caseating granulomatous appearance on histological analysis identical to that of Crohn's disease. These lesions are not found adjacent to the digestive tract. Due to the low prevalence of these manifestations, conclusive trials on the treatment of choice have not been performed and there is no well-defined therapeutic strategy. Distinct therapies with varying results have been reported. We report the case of a female patient with longstanding and complex Crohn's disease who developed metastatic cutaneous manifestations while receiving adalimumab. The cutaneous manifestations responded well to dose intensification of this drug. A review of the literature is provided.