Predicting outcomes to optimize disease management in inflammatory bowel disease in Japan: their differences and similarities to Western countries

Hisamatsu, Tadakazu; Suzuki, Yasuo; Ogata, Haruhiko; Andoh, Akira; Araki, Toshimitsu; Hokari, Ryota; Iijima, Hideki; Ikeuchi, Hiroki; Ishiguro, Yoh; Kato, Shingo; Kunisaki, Reiko; Matsumoto, Takayuki; Motoya, Satoshi; Nagahori, Masakazu; Nakamura, Shirô; Nakase, Hiroshi; Tsujikawa, Tomoyuki; Sasaki, Makoto; Yokoyama, Keitaro; Yoshimura, Naoki; Watanabe, Kenji; Katafuchi, Miiko; Watanabe, Mamoru; Hibi, Toshifumi

doi:10.5217/ir.2018.16.2.168

Cited by 8 publications

(6 citation statements)

References 58 publications

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“…Widely used endoscopic scores, such as the MES, the Ulcerative Colitis Endoscopic Index of Severity, 20 the Baron score, 21 and the Matts endoscopic score, 22 only grade inflammation in the most severely affected area and do not consider the extent of disease, despite the fact that the extent of disease has been clearly reported to be a risk factor for the refractory course of UC. [23][24][25][26] Similarly, the concepts of mucosal healing and endoscopic response have not yet been explored in the context of the extent of active inflammation. 4,27 Furthermore, previous studies did not answer clinical questions relating to whether the relapse rate in patients with MES of 1 is higher compared to thos with MES of 0 even when a clinical benefit has been achieved in the most affected area, with the distally remaining active endoscopic inflammation defined as MES of 1.…”

Section: Discussionmentioning

confidence: 99%

Residual Short-Segment Distal Inflammation Has No Significant Impact on the Major Relapse of Extensive Ulcerative Colitis

Asonuma

Nakano

Sagami

et al. 2021

Inflammatory Bowel Diseases

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Background Mucosal healing is a treatment target for patients with ulcerative colitis. However, the relevance of proactive treatment for residual inflammation limited to the distal colon is unclear. Materials and Methods Patients with ulcerative colitis who had extensive colitis in clinical remission and underwent colonoscopy were retrospectively enrolled and followed up for 2 years. Patients with complete endoscopic remission (CER; Mayo endoscopic subscore [MES] of 0) and those with short-segment distal inflammation (SS; active inflammation only in the sigmoid colon and/or rectum with a proximal MES of 0) were compared for the incidence of minor (only symptomatic) and major (need for induction treatments or hospitalization) relapses. Results A total of 91 patients with CER and 54 patients with SS were identified and 63 relapses (47 minor and 16 major) were analyzed. Univariate analysis showed that minor relapses were significantly more frequent in the SS group than in the CER group (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.25-3.97), but major relapses were not more frequent in the SS group than in the CER group (HR, 1.78; 95% CI, 0.65-4.83). Multivariable analysis showed that SS was the only risk factor significantly associated with minor relapse (HR, 2.38; 95% CI, 1.31-4.36). When the SS group was stratified by MES of 1 vs 2/3, minor relapses were significantly more frequent in the subgroup with MES of 2/3 than in the CER group, whereas the incidence of major relapse remained similar. Conclusions Residual short-segment distal inflammation is not a risk factor for major relapses as long as endoscopic remission is achieved in the proximal colon. Therefore, reactive but not proactive treatment may be appropriate for such lesions.

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Section: Discussionmentioning

confidence: 99%

Residual Short-Segment Distal Inflammation Has No Significant Impact on the Major Relapse of Extensive Ulcerative Colitis

Asonuma

Nakano

Sagami

et al. 2021

Inflammatory Bowel Diseases

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“…The global consensus for the surveillance of CRC in patients with CD appears to be consistent. A recent Japanese consensus for CRC surveillance states that a longer disease duration, extensive disease, or family history of CRC is related to a higher risk of CRC development in patients with inflammatory bowel disease (IBD) 82 . However, we must evaluate the validity of these potential risk factors to determine the target patients for surveillance, because the prevalence of SBC and CRC in patients with CD is not high.…”

Section: Discussionmentioning

confidence: 99%

“…Colonoscopy for ARC might have a low efficacy for early detection. The Japanese consensus stated that surveillance is required for rectal cancer and fistula cancer in patients with CD presenting with intractable anal lesions 82 . Additionally, an annual examination under anesthesia, magnetic resonance imaging, and examinations by expert IBD surgeons have been recommended by the Japanese guidelines for intractable disease affiliated with the Japan Ministry of Health, Labor and Welfare, as stated by Higashi et al 83 .…”

Section: Discussionmentioning

confidence: 99%

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Uchino

Ikeuchi

Hata

et al. 2020

J of Gastro and Hepatol

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Background and Aim Although surveillance colonoscopy is recommended by several guidelines for Crohn's disease (CD), the evidence is insufficient to support the validity of this recommendation. Moreover, the efficacy of surveillance colonoscopy for anorectal cancer remains unclear. Therefore, we performed a systematic review of cancer in patients with CD before considering the proper surveillance methods. Methods We conducted a systematic review and meta‐analysis examining the incidence of intestinal cancer and a literature review to clarify the characteristic features of cancer in CD. We performed the systematic literature review of studies published up to May 2019. Results Overall, 7344 patients were included in eight studies. The standardized incidence ratios (95% confidence intervals) of colorectal cancer (CRC) and small bowel cancer (SBC) were 2.08 (1.43–3.02) and 22.01 (9.10–53.25), respectively. The prevalence of CRC and SBC was 57/7344 (0.77%) and 17/7344 (0.23%), respectively, during a median follow‐up of 12.55 years. Additionally, 54 studies reporting 208 anorectal cancer cases were identified. In patients with anorectal cancer, the prognosis for survival was 2.1 ± 2.3 years, and advanced cancer greater than stage T3 occurred in 46/74 patients (62.1%). Many more reports of anorectal cancer were published in Asia than in Western countries. Conclusion Although we were unable to state a recommendation for surveillance for SBC, we should perform cancer surveillance for CRC in patients with CD. However, the characteristics of cancer may differ according to geography or race. We must establish proper and effective surveillance methods that are independently suitable to detect these differences.

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“…The results of this study must be reviewed in light of the small number of patients recruited, a design that was not intended to allow efficacy conclusions, and the fact that all patients were Japanese, limiting extrapolation of the results to other populations given possible ethnic differences [24]. In addition, the effect of prior anti-TNF agents on the efficacy of abrilumab could not be evaluated due to the small number of patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of abrilumab, an α4β7 integrin inhibitor, in Japanese patients with moderate-to-severe ulcerative colitis: a phase II study

et al. 2019

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Background/Aims Inhibition of α4β7 integrin has been shown to be effective for induction and maintenance therapy in patients with ulcerative colitis (UC). We investigated the effects of varying doses of the α4β7 inhibitor abrilumab in Japanese patients with moderate-to-severe UC despite conventional treatments. Methods In this randomized, double-blind, placebocontrolled study, 45 UC patients were randomized to abrilumab 21 mg (n=11), 70 mg (n=12), 210 mg (n=9), or placebo (n=13) via subcutaneous (SC) injection for 12 weeks. The double-blind period was followed by a 36-week open-label period, in which all patients received abrilumab 210 mg SC every 12 weeks, and a 28-week safety follow-up period. The primary efficacy variable was clinical remission at week 8 (total Mayo score ≤2 points with no individual subscore >1 point). Results Clinical remission at week 8 was 4 out of 31 (12.9%) overall in the abrilumab groups versus 0 out of 13 in the placebo group (abrilumab 21 mg, 1/10 [10.0%]; 70 mg, 2/12 [16.7%]; 210 mg, 1/9 [11.1%]). In both the double-blind and open-label periods, fewer patients in the abrilumab groups experienced ≥1 adverse event compared with those in the placebo group. There were no cases of progressive multifocal leukoencephalopathy and no deaths. Conclusions Abrilumab 70 mg and 210 mg yielded numerically better results in terms of clinical remission rate at Week 8 than placebo, with the 210 mg dose showing more consistent treatment effects. Abrilumab was well tolerated in Japanese patients with UC.

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Predicting outcomes to optimize disease management in inflammatory bowel disease in Japan: their differences and similarities to Western countries

Cited by 8 publications

References 58 publications

Residual Short-Segment Distal Inflammation Has No Significant Impact on the Major Relapse of Extensive Ulcerative Colitis

Residual Short-Segment Distal Inflammation Has No Significant Impact on the Major Relapse of Extensive Ulcerative Colitis

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Efficacy and safety of abrilumab, an α4β7 integrin inhibitor, in Japanese patients with moderate-to-severe ulcerative colitis: a phase II study

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