No abstract

No abstract

No abstract

Background: Infliximab (IFX) is indicated for the treatment of inflammatory bowel disease (IBD) (ulcerative colitis (UC) or Crohn disease (CD)). Nevertheless, a significant proportion of patients will experience a loss of response (LOR) to IFX over time which may require despite optimization a switch to another anti-TNF or to swap out to another biotherapy. We have recently reported that week 2 and 6 IFX trough levels (TLs) can be predictive of treatment failure and long term response. Only one study has shown that week 14 TLs can be predictive of long term response on re-initiation of IFX therapy. Our objective is to evaluate early on at induction IFX TLs and antibodies to IFX (ATI) in patients previously exposed to anti-TNF Methods: 269 IBD patients (194 CD -75 UC) have been treated with IFX on follow-up. 2331 samples were prospectively collected but measured retrospectively by ELISA in parallel with clinical data. 91 samples (TL measured <1μg/ml) were analyzed for IFX ATI using drug-sensitive bridging ELISA Results: At follow-up, patients were subdivided into three groups: long-term responders, patients who had LOR but responded to optimization or patients who had LOR but did not respond to optimization and were switched to another biotherapy. Each group was subdivided according to naïve or previous treatment with anti-TNF (IFX or Adalimumab) status. During induction, in the LOR switched group, median IFX TL was significantly lower in previously exposed patients than in naïve patients (0.92μg/ml vs 6.6μg/ml, p=0.044) ( Figure 1A). Inversely, there was no statistical difference between median TL in the LOR optimized group between naïve and previously exposed patients (9.38μg/ml vs 11.82μg/ml, p=0.52) as well as in naïve and previously exposed Long-term responders (9.57μg/ml vs 11.91μg/ml, p=0.92). Overall, among the previously exposed patients, the LOR switched group had a lower median IFX TL (0.92μg/ml) compared to the Long-term responders (9.57μg/ml, p=0.015) and LOR optimized group (11,82μg/ml, p=0.005) ( Figure 2). The percentage of ATI occurrence was statistically lower in the Long-term responders (5.7%) than in the LOR optimized (37.5%), p=0.002 and LOR switched groups (40%) (p=0.002). Interestingly, among the LOR switched group, the percentage of ATI occurrence was similar in patients whether naïve or previously exposed to anti-TNF (38.8% vs 42.9%, p=0.86) ( Figure 1B). The same observation was found in the LOR optimized group (25% vs 45%, p=0.45). Conclusions: In LOR switched group, patients previously exposed to anti-TNF seem to have lower IFX TLs at induction than naïve patients. This may not be related to immunogenicity as the presence of ATI was similar in patients whether naïve or previously exposed to anti-TNF. P561Can we predict adherence to treatment in IBD patients?

Background: Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities. Methods: We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all eleven medical centers in central Massachusetts. Our sample consisted of the following four groups: DM with CKD (n=587), CKD without DM (n=524), DM without CKD (n=1,442), and non-DM/non-CKD (n=3,465). Results: Diabetic patients with CKD were more likely to have a higher prevalence of previously diagnosed comorbidities, to have developed heart failure acutely, and to have a longer hospital stay compared with non-DM/non-CKD patients. Between 1999 and 2009, there were marked increases in the prescribing of beta-blockers, statins, and aspirin for patients with CKD and DM as compared to those without these comorbidities. In-hospital death rates remained unchanged in patients with DM and CKD, while they declined markedly in patients with CKD without DM (20.2% dying in 1999; 11.3% dying in 2009). Conclusion: Despite increases in the prescribing of effective cardiac medications, AMI patients with DM and CKD continue to experience high in-hospital death rates.

No abstract