Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort.

INTRODUCTION: Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population. METHODS: Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus). RESULTS: A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab. CONCLUSIONS: Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.

Continuous Renal Replacement Therapy: What Have We Learned And What Are Key Milestones For The Years To Come?

UNASSIGNED: Continuous renal replacement therapy (CRRT) is the main extracorporeal kidney support therapy used in critical ill patients in the intensive care unit (ICU). Since its conceptualization ~50 years ago, there have been major improvements in its technology and utilization. The last decade, and particularly since the COVID-19 pandemic, has been marked by a growing interest and demand of CRRT in worldwide ICUs. This has underpinned the need for improvements in nomenclature and process standardization, optimization of CRRT deliverables, and the development and validation of key performance indicators. Further, how to leverage digital health technologies to build clinical decision support for CRRT and improve personalized bedside decisions is a subject of intense investigation. Herein, we summarize notable advancements in the provision of CRRT and propose areas in need of further development. (Rev Invest Clin. 2023;75(6):348-58).

The Natural History of Patients With Pre-Existing and De Novo Inflammatory Bowel Disease After Solid Organ Transplantation: EITOS Study of GETECCU.

BACKGROUND: Limited data are available on the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). We describe the natural history of pre-existing IBD and de novo IBD after SOT. METHODS: This was a retrospective, multicenter study that included patients with pre-existing IBD at the time of SOT and patients with de novo IBD after SOT. The primary outcome was IBD progression, defined by escalation of medical treatment, surgical therapy, or hospitalization due to refractory IBD. Risk factors were identified using multivariate Cox proportional hazard analysis. RESULTS: A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) were included. Most patients with pre-existing IBD (92.5%) were in remission before SOT. During follow-up, 32% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 (interquartile range, 1.3-4.6) years. In the de novo cohort, 55% of patients had disease progression with a median time to flare of 1.9 (interquartile range, 0.8-3.9) years after diagnosis. In the pre-existing IBD cohort, active IBD at the time of SOT (hazard ratio, 1.80; 95% confidence interval, 1.14-2.84; P = .012) and the presence of extraintestinal manifestations (hazard ratio, 3.10; 95% confidence interval, 1.47-6.54; P = .003) were predictive factors for IBD progression. CONCLUSIONS: One-third of patients with pre-existing IBD and about half of patients with de novo IBD have disease progression after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for IBD progression.

Clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in patients with ulcerative colitis treated with two consecutive anti-TNF agents: data from the ENEIDA registry.

Background: Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC) but little is known when it is used as the second anti-TNF. Objectives: To compare the clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients. Design: Retrospective observational study. Methods: Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially). Results: Overall, 473 UC patients were included (330 IVi and 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4% in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission. Conclusion: The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.

OBJECTIVES: To compare the clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients. DESIGN: Retrospective observational study. METHODS: Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially). RESULTS: Overall, 473 UC patients were included (330 IVi, 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4%, in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission. CONCLUSION: The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.

Clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in patients with ulcerative colitis treated with two consecutive anti-TNF agents. Data from the ENEIDA registry Background: Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC), but little is known when it is used as the second anti-TNF.

Continuous Renal Replacement Therapy: What Have We Learned And What Are Key Milestones For The Years To Come?

ABSTRACT Continuous renal replacement therapy (CRRT) is the main extracorporeal kidney support therapy used in critical ill patients in the intensive care unit (ICU). Since its conceptualization ~50 years ago, there have been major improvements in its technology and utilization. The last decade, and particularly since the COVID-19 pandemic, has been marked by a growing interest and demand of CRRT in worldwide ICUs. This has underpinned the need for improvements in nomenclature and process standardization, optimization of CRRT deliverables, and the development and validation of key performance indicators. Further, how to leverage digital health technologies to build clinical decision support for CRRT and improve personalized bedside decisions is a subject of intense investigation. Herein, we summarize notable advancements in the provision of CRRT and propose areas in need of further development.

Metástasis a colon de un carcinoma de pulmón, una presentación inusual: Reporte de un caso y revisión de la literatura / Colonic metastases from carcinoma of the lung, an unusual presentation: Case report and literature review

Las metástasis sintomáticas al colon de un carcinoma de pulmón son raras, a pesar de ser una neoplasia que representa el 12,9% de la incidencia mundial de cáncer. El colon es un sitio infrecuente de metástasis, con una prevalencia reportada menor al 0,5% en pacientes con carcinomas de pulmón, existiendo en la literatura mundial pocos casos. Es inusual que sea la forma de presentación de este tipo de neoplasia. Con respecto a las manifestaciones clínicas que se reportan pueden cursar con obstrucción intestinal como síntoma cardinal. Se presenta el caso de un paciente que curso con hemorragia de vías digestivas bajas como manifestación inicial de múltiples lesiones metastásicas a colon de un carcinoma de pulmón de célula no pequeña.

The symptomatic metastasis of the colon from a pulmonary cancer is rare; however, the global incidence of pulmonary cancer is 12.9%. It is an infrequent site of metastasis, with a prevalence of less than 0.5% in patients with pulmonary cancer. One of the most common manifestation is intestinal obstruction. We present a case report of a patient with an acute lower intestinal bleeding from multiple metastasis lesion of the colon as the initial manifestation of a non-small cell lung carcinoma.

Hemobilia secundaria a aneurisma de la arteria hepática / Hemobilia Secondary to Aneurysm of the Hepatic Artery

Resumen Se presenta el caso de un paciente con hemorragia de vías digestivas altas e ictericia asociadas a un aneurisma de la arteria hepática derecha.

Abstract We present the case of a patient with upper digestive tract hemorrhaging and jaundice due to an aneurysm of the right hepatic artery.