[Rituximab as rescue therapy in refractory esophageal lichen planus]. / Rescate con rituximab en paciente con liquen plano esofágico refractario.

Esophageal lichen planus (ELP) is a rare condition with unknown prevalence that can sometimes be underestimated due to the subtle and nonspecific findings of diagnostic workup. Oral lesions rarely extend to the esophageal mucosa, but when they do, the most frequent symptoms are dysphagia and odynophagia. There is often a significant delay in diagnosis and inadequate treatment. We report the case of a 59-year-old woman diagnosed with ELP, successfully treated with rituximab, a chimeric monoclonal antibody that depletes CD20+B cells. To our knowledge, this is only the second report of this treatment in ELP.

[High incidence rates of inflammatory bowel disease in Navarra (Spain). Results of a prospective, population-based study]. / Altas tasas de incidencia de enfermedad inflamatoria intestinal en Navarra. Resultados de un estudio prospectivo y poblacional.

INTRODUCTION: As reflected in the European Collaborative Study on Inflammatory Bowel Disease (1991-1993), differences between northern and southern European countries in the incidence of ulcerative colitis (UC) and Crohn's disease (CD) show a tendency to decrease. No data are available on the current incidence of these diseases in Navarre (northern Spain). AIM: To determine the present incidence of inflammatory bowel disease (IBD) in Navarra. PATIENTS AND METHODS: A prospective, population-based study was performed to determine the incidence of IBD in Navarra between 2001 and 2003. Total population: 569,628 inhabitants (284,620 males). All cases of IBD diagnosed in any public or private hospital in Navarre were included in the study. Crude rates and age- and sex-specific rates adjusted to the European standard population were calculated. RESULTS: A total of 288 cases were diagnosed (UC 176, CD 102, indeterminate colitis 10). Crude rates of UC, CD and indeterminate colitis were 10.29, 5.96 and 0.58 cases/100,000 inhabitants/year respectively (the population aged 0-14 years of age was included). Specific rates were 9.57 (95% CI, 7.27-12.57) and 5.85 (95% CI, 3.99-8.14) cases/100,000 inhabitants/year for UC and CD, respectively. CONCLUSIONS: The incidence of UC and CD in Navarra has increased in the last decade, with rates close to those of northern European countries and higher than those recently published in Spanish prospective studies.

Utilidad clínica de la cuantificación de infliximab y anticuerpos antiquiméricos humanos / Clinical usefulness in measuring infliximab and human anti-chimeric antibodies

Introducción: El infliximab (IFX), un anticuerpo quimérico contra el factor de necrosis tumoralalfa, es utilizado en el tratamiento de pacientes con diversas enfermedades inflamatorias, pero puede originar la formación de anticuerpos antiquiméricos humanos (HACA). La presencia de HACA y niveles séricos de IFX bajos se han asociado con falta o pérdida de respuesta y con laaparición de reacciones infusionales. Evaluamos la utilidad de la cuantificación de IFX y HACA. Material y métodos: IFX y HACA se midieron utilizando una técnica ELISA relativamente nueva en una cohorte de 110 pacientes tratados con IFX. Se recogieron muestras de suero inmediatamente antes de la siguiente infusión del fármaco. Los pacientes habían recibido una mediana de dosis de 5 mg/kg, con intervalos de dosis ajustados a la actividad de la enfermedad, habitualmente cada 8 semanas. La mediana del número de infusiones fue 17. Resultados: Los HACA se detectaron en 10 pacientes y se midieron concentraciones terapéuticas de IFX en 37 casos. Ocho de los 10 pacientes con HACA positivos tenían trastornos digestivos y en 9 de ellos el tratamiento fue suspendido. El uso concomitante de inmunosupresores no redujo el riesgo de formación de HACA. Entre los 100 pacientes sin HACA, 79 continuaron con la misma dosis, 16 requirieron un ajuste de dosis, en 2 se suspendió el tratamiento y 3 pacientes fueron cambiados a otro agente biológico. Conclusiones: Las concentraciones de IFX y HACA en sangre deberían ser monitorizadas en pacientes que reciben IFX, ya que puede ser útil para optimizar los regímenes de dosis o evitar el uso de terapias inadecuadas (AU)

Introduction: infliximab (IFX), a chimeric antibody against tumour necrosis factor-alpha, is used in the treatment of patients with several inflammatory diseases, but it can lead to the formation of human anti-chimeric antibodies (HACA). HACA and low IFX serum levels have been associated with lack or loss of response, and infusion reactions. The usefulness of measuring the IFX and HACA concentrations is evaluated. Material and methods: IFX and HACA were measured using a relatively new ELISA technique in a cohort of 110 patients treated with IFX. Serum samples were collected immediately before patients were given the next drug infusion. The patients had received a median dose of 5 mg/kg, with dose intervals adjusted to the patient’s disease activity, usually every 8 weeks. The median number of infusions was 17. Results: HACA were identified in 10 patients, and therapeutic IFX concentrations were observedin 37 patients. Eight out of 10 positive HACA patients had gastrointestinal disorders, and thetherapy was discontinued in 9 of them. The concomitant use of immunosuppressants did not reduce the risk of HACA formation. Among 100 patients with no HACA, 79 continued on the same dose, 16 required a dose adjustment, 2 discontinued treatment, and 3 were switched toanother biological agent. onclusions: Blood IFX and HACA concentrations should be monitored in patients receiving IFX, as it may be useful to optimize dose regimens or avoid use of inadequate therapy (AU)

Rescate con rituximab en paciente con liquen plano esofágico refractario / Rituximab as rescue therapy in refractory esophageal lichen planus

El liquen plano esofágico (LPE) es una entidad poco frecuente cuya prevalencia se desconoce, que puede en ocasiones estar subestimada por los hallazgos sutiles e inespecíficos en las exploraciones realizadas. Las lesiones orales rara vez se extienden para afectar a la mucosa esofágica pero, cuando lo hacen, provocan disfagia y odinofagia. Esta infrecuente afectación del liquen plano conlleva un retraso en el diagnóstico y un tratamiento inadecuado. Se presenta el segundo caso (en nuestro conocimiento) de una paciente de 59 años con LPE, con buena respuesta al tratamiento con rituximab, un anticuerpo monoclonal quimérico dirigido específicamente contra la proteína CD20 presente en los linfocitos B (AU)

Esophageal lichen planus (ELP) is a rare condition with unknown prevalence that can sometimes be underestimated due to the subtle and nonspecific findings of diagnostic workup. Oral lesions rarely extend to the esophageal mucosa, but when they do, the most frequent symptoms are dysphagia and odynophagia. There is often a significant delay in diagnosis and inadequate treatment. We report the case of a 59-year-old woman diagnosed with ELP, successfully treated with rituximab, a chimeric monoclonal antibody that depletes CD20+B cells. To our knowledge, this is only the second report of this treatment in ELP (AU)

Altas tasas de incidencia de enfermedad inflamatoria intestinal en Navarra. Resultados de un estudio prospectivo y poblacional / High incidence rates of inflammatory bowel disese in Navarra (Spain). Results of a prospective, population-based study

INTRODUCCIÓN: Tal como se reflejó en el Estudio CooperativoEuropeo del período 1991-1993, tienden a reducirse lasdiferencias norte/sur en las tasas de incidencia de colitis ulcerosa(CU) y enfermedad de Crohn (EC). No hay estudiosque hayan actualizado el estado de la cuestión en Navarra.OBJETIVOS: Nos planteamos conocer la incidencia actual dela enfermedad inflamatoria intestinal (EII) en Navarra.PACIENTES Y MÉTODOS: Estudio prospectivo y poblacional dela incidencia de EII en Navarra en el período 2001-2003, enuna población de 569.628 habitantes (284.620 varones). Serecogen la totalidad de los casos diagnosticados en todos loscentros públicos y privados de Navarra con capacidad dediagnosticar una EII. Se calculan las tasas crudas y las tasasespecíficas ajustadas a la población estándar europea.RESULTADOS: Se diagnosticaron 288 casos (176 CU, 102 EC y10 colitis indeterminadas [CI]). Las tasas crudas para CU,EC y CI fueron de 10,29, 5,96 y 0,58 casos/100.000 habitantes/año, respectivamente (incluida la población de 0-14 añosde edad). Las tasas específicas (intervalo de confianza del95%) fueron de 9,57 (7,27-12,57) y 5,85 (3,99-8,14) casos/100.000 habitantes/año para CU y EC, respectivamente.CONCLUSIONES: La incidencia de CU y EC en Navarra haaumentado en la última década, con tasas cercanas a las referidasen los países del norte de Europa y algo superiores alas de los últimos estudios prospectivos españoles

INTRODUCTION: As reflected in the European Collaborative Study on Inflammatory Bowel Disease (1991-1993), differencesbetween northern and southern European countries in theincidence of ulcerative colitis (UC) and Crohn’s disease (CD)show a tendency to decrease. No data are available on the currentincidence of these diseases in Navarre (northern Spain).AIM: To determine the present incidence of inflammatorybowel disease (IBD) in Navarra.PATIENTS AND METHODS: A prospective, population-basedstudy was performed to determine the incidence of IBD inNavarra between 2001 and 2003. Total population: 569,628inhabitants (284,620 males). All cases of IBD diagnosed inany public or private hospital in Navarre were included inthe study. Crude rates and age- and sex-specific rates adjustedto the European standard population were calculated.RESULTS: A total of 288 cases were diagnosed (UC 176, CD102, indeterminate colitis 10). Crude rates of UC, CD andindeterminate colitis were 10.29, 5.96 and 0.58 cases/100,000inhabitants/year respectively (the population aged 0-14 yearsof age was included). Specific rates were 9.57 (95% CI,7.27-12.57) and 5.85 (95% CI, 3.99-8.14) cases/100,000 inhabitants/year for UC and CD, respectively.CONCLUSIONS: The incidence of UC and CD in Navarra hasincreased in the last decade, with rates close to those of northernEuropean countries and higher than those recently published in Spanish prospective studies (AU)