Objective
Anti-tumour necrosis factor (TNF) agents are associated with increased infection risk among elderly IBD patients, but little is known about non anti-TNF biologics in this cohort. We examined the safety and effectiveness of ustekinumab in elderly Crohn’s patients.
Methods
This retrospective multi-centre cohort study included Crohn’s patients ≥60-years old who commenced ustekinumab. We recorded Harvey-Bradshaw index (HBI), concomitant steroid therapy, treatment persistence and new infections or malignancies. Primary outcome was serious infections requiring hospitalisation.
Results
Seventy patients were included, with median age of 68 years. 43 (61.4%) had prior anti-TNF exposure, and 15 (21.4%) vedolizumab. Median treatment duration was 12 months, totalling 84 patient-years. Nine serious infections were reported, incidence 106.7/1000 patient-years. Systemic steroids were associated with increased risk of serious infections [odds ratio (OR) 7.83, 95% confidence interval (CI): 1.44–44.32, P = 0.02]. There were 27 “non-serious” infections; 321.4/1000 patient-years. Charlson co-morbidity index (OR 1.49, 95% CI: 1.05–2.12, P = 0.03) and steroid exposure (OR 44.10, 95% CI: 1.75–1112.10, P = 0.02) increased non-serious infection risk (P < 0.05). Mean HBI improved from 8.13 to 4.64 at 6 months and 4.10 at last follow up (P < 0.0001). 12-month treatment persistence was 55.7% (N = 39); 34 (48.6%) were steroid-free.
Conclusion
Ustekinumab was safe and effective in a cohort of elderly Crohn’s disease patients. Infections were mostly mild, not resulting in therapy discontinuation. Serious infection risk was comparable to previously reported rates with anti-TNF agents. Steroid exposure was associated with an increased serious infection risk.
Background: Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD).Aim: To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to the second, irrespective of drug sequence Methods: We conducted a UK-wide, multicentre, retrospective cohort study to report rates of immunogenicity and treatment failure of second anti-TNF therapies in 1058 patients with IBD who underwent therapeutic drug monitoring for both infliximab and adalimumab. The primary outcome was immunogenicity to the second anti-TNF agent, defined at any timepoint as an anti-TNF antibody concentration ≥9 AU/ml for infliximab and ≥6 AU/ml for adalimumab.
The past two decades witnessed a broad-increase in web technology and on-line gaming. Enhancing the broadband confinements is viewed as one of the most significant variables that prompted new gaming technology. The immense utilization of web applications and games additionally prompted growth in the handled devices and moving the limited gaming experience from user devices to online cloud servers. As internet capabilities are enhanced new ways of gaming are being used to improve the gaming experience. In cloud-based video gaming, game engines are hosted in cloud gaming data centers, and compressed gaming scenes are rendered to the players over the internet with updated controls. In such systems, the task of transferring games and video compression imposes huge computational complexity is required on cloud servers. The basic problems in cloud gaming in particular are high encoding time, latency, and low frame rates which require a new methodology for a better solution. To improve the bandwidth issue in cloud games, the compression of video sequences requires an alternative mechanism to improve gaming adaption without input delay. In this paper, the proposed improved methodology is used for automatic unnecessary scene detection, scene removing and bit rate reduction using an adaptive algorithm for object detection in a game scene. As a result, simulations showed without much impact on the players' quality experience, the selective object encoding method and object adaption technique decrease the network latency issue, reduce the game streaming bitrate at a remarkable scale on different games. The proposed algorithm was evaluated for three video game scenes. In this paper, achieved
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