Video
In the case of failure of biologics: combination with azathioprine
Video report of the presentation given by Dr. Shomron Ben-Horin, Sheba Medical Center, Tel-Hashomer, Israel, at the Falk Symposium 190 “Challenges in the Care of IBD in Patients of all Ages” in London, October 2 – 3, 2013.
© Falk Foundation e.V., Freiburg. All rights reserved.
Summary
Secondary failure is common in anti-inflammatory treatment with tumour necrosis factor (TNF)-alpha antagonists. 30 – 50% of patients require a dose increase within 12 months and, more rarely, treatment may even be discontinued (Ben-Horin and Chowers, 2011).
It is possible to mitigate the risk of secondary treatment failure and dose increases by combining the TNF-alpha antagonist with azathioprine from the outset: In a study by Kiss et al., 2011 involving 201 Crohn’s disease patients who were treated with adalimumab for a period of one year, the parallel administration of azathioprine was inversely associated with increases in dose. The same applies to loss of efficacy with infliximab: if the TNF-alpha inhibitor is combined with the immunosuppressant, the probability of treatment failure is reduced (Ungar et al., 2013).
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Latest research in brief:
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Editor: Prof. W. Kreisel, Medical University Hospital, 79106 Freiburg, Germany
Bowel
http://www.drfalkpharma.de/fileadmin/media/logos_falk/abstracts/Bowel-Logo-FGR.gif
Text:
Seminerio JL et al, Dig Dis Sci. 2013;58(3):797–806
Long-term follow-up of patients with Crohn’s disease who were treated with infliximab initially between 1998 and 2002 in the Mayo Clinic showed persistence of therapy (due to clinical benefit) and an acceptable safety profile.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25367
Text:
Vazquez-Roque MI et al, Gastroenterology. 2013;144(5):903–11
Gluten alters bowel barrier functions in patients with diarrhea-predominant irritable bowel syndrome, particularly in HLA-DQ2/8-positive patients. Therefore, a gluten free diet may be an option for a subgroup of patients with irritable bowel syndrome.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25368
Text:
Narula N et al, Aliment Pharmacol Ther. 2013;37(11):1057–64
Anti-TNFα therapies appear to increase the risk of postoperative complications. The increase in risk is small, and may well reflect residual confounding rather than a true biological effect.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25369
Liver
Biliary Tracts
Text:
Deterding K et al, Lancet Infect Dis. 2013;13(6):497–506
Delayed treatment of acute hepatitis C with pegylated interferon-α2b is effective although not of equal efficacy to immediate treatment.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25370
Text:
Hosaka T et al, Hepatology. 2013;58(1):98–107
Long-term entecavir treatment may reduce the incidence of hepatocellular carcinoma in patients with chronic hepatitis B.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25371
Text:
Trépo E et al, J Hepatol. 2013;59(2):344–50
Low 25-hydroxyvitamin D levels are associated with increased liver damage and mortality in alcoholic liver disease. Vitamin D might be both a biomarker of severity and a potential therapeutic target in alcoholic liver disease.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25376
Oesophagus
Stomach
Duodenum
Text:
Lo WK et al, Clin Gastroenterol Hepatol. 2013;11(5):483–90
Proton-pump inhibitor use statistically was associated with small intestinal bacterial overgrowth risk, but only when the diagnosis was made by a highly accurate test (duodenal or jejunal aspirate culture).
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25373
Text:
Kate V et al, Drugs. 2013;73(8):815–24
Sequential therapy for eradication of H. pylori infection has good efficacy; however, further trials other than those from Asia and Italy are required to assess its superiority over existing regimens.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25374
Text:
Peterson KA et al, Am J Gastroenterol. 2013;108(5):759–66
Eosinophilic esophagitis in adults is substantially triggered by foods.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25375
Pancreas
Text:
Park SH et al, J Clin Gastroenterol. 2013;47(6):520–5
Autoimmune pancreatitis patients seem to have a higher risk of ulcerative colitis compared with the general population.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18249#c25372