3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 2: Surgical Management and Special Situations

Gionchetti, Paolo; Dignaß, Axel; Danese, Silvio; Dias, Fernando José Magro; Rogler, Gerhard; Lakatos, László; Adamina, Michel; Ardizzone, Sandro; Buskens, Christianne J.; Sebastian, Shaji; Laureti, Silvio; Sampietro, Gianluca; Vucelić, Boris; Woude, C. Janneke van der; Acosta, Manuel Barreiro‐de; Maaser, Christian; Portela, Francisco; Vavricka, Stephan R.; Gomollón, Fernando

doi:10.1093/ecco-jcc/jjw169

Cited by 635 publications

(625 citation statements)

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“…28,33 However, it is of note that the publication year of all trials is mainly before the implementation of VTE guidelines and consensus statements. 41,54 Finally, if pharmacokinetic measurements had been used in the studies, it would have been possible to determine the plausible effect of drug levels and anti-drug antibodies on VTE risk.…”

Section: Discussionmentioning

confidence: 99%

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Steroid but not Biological Therapy Elevates the risk of Venous Thromboembolic Events in Inflammatory Bowel Disease: A Meta-Analysis

Patrícia

Szemes

Hegyi

et al. 2017

Journal of Crohn's and Colitis

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Background and Aims: Inflammatory bowel disease [IBD] is associated with a 1.5-to 3-fold increased risk of venous thromboembolism [VTE] events. The aim of this study was to determine the risk of VTE in IBD as a complication of systemic corticosteroids and anti-tumour necrosis factor alpha [TNFα] therapies. Methods: A systematic review and meta-analysis was conducted, which conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses [PRISMA] statement. PubMed, EMBASE, Cochrane Library and Web of Science were searched for English-language studies published from inception inclusive of 15 April 2017. The population-intervention-comparisonoutcome [PICO] format and statistically the random-effects and fixed-effect models were used to compare VTE risk during steroid and anti-TNFα treatment. Quality of the included studies was assessed using the Newcastle-Ottawa scale. The PROSPERO registration number is 42017070084. Results: We identified 817 records, of which eight observational studies, involving 58 518 IBD patients, were eligible for quantitative synthesis. In total, 3260 thromboembolic events occurred. Systemic corticosteroids were associated with a significantly higher rate of VTE complication in IBD patients as compared to IBD patients without steroid medication (odds ratio [OR]: 2.202; 95% confidence interval [CI]: 1.698-2.856, p < 0.001). In contrast, treatment with anti-TNFα agents resulted in a 5-fold decreased risk of VTE compared to steroid medication [OR: 0.267; 95% CI: 0.106-0.674, p = 0.005]. Conclusion: VTE risk should be carefully assessed and considered when deciding between anti-TNFα and steroids in the management of severe flare-ups. Thromboprophylaxis guidelines should be followed, no matter the therapy choice.

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Section: Discussionmentioning

confidence: 99%

“…41,54,55 Anticoagulant thromboprophylaxis is recommended with low-molecular-weight heparin, low-dose unfractioned heparin or fondaparinux. 41 Recently, a risk assessment algorithm for IBD patients at risk of developing VTE has been proposed.…”

Section: Discussionmentioning

confidence: 99%

Steroid but not Biological Therapy Elevates the risk of Venous Thromboembolic Events in Inflammatory Bowel Disease: A Meta-Analysis

Patrícia

Szemes

Hegyi

et al. 2017

Journal of Crohn's and Colitis

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“…These are mainly localized at the perianal region but can also occur at other sites (e.g., entercutaneous, enteroenteric) [77]. …”

Section: Fistulae – Prominence Of Medical Therapymentioning

confidence: 99%

“…In the case of a symptomatic simple perianal fistula, a combination of an antibiotic therapy (ciprofloxacin and/or metronidazole) and Seton placement is the standard therapy. Some meta-analyses were able to demonstrate a positive effect of these antibiotic therapies; however, this impact endures only for a limited period of time [77, 78]. …”

Section: Fistulae – Prominence Of Medical Therapymentioning

confidence: 99%

“…In patients with simple perianal fistulas and therapy failure or in patients with complex perianal fistulae, the addition of infliximab or adalimumab and more extensive surgical methods are recommended [77, 79]. For infliximab, a randomized placebo controlled study showed a significant improvement concerning the complete closure of fistulae after 54 weeks (36 vs. 19%) [80].…”

Section: Fistulae – Prominence Of Medical Therapymentioning

confidence: 99%

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Treatment Perspectives in Crohn’s Disease

Vetter¹

2018

Digestion

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Background: Crohn’s disease (CD) is a chronic immune-mediated disorder of the gastrointestinal tract. The pathophysiological understanding of this disease is limited and no curative therapy is available so far. Therefore, most patients require long-lasting or even life-long immunosuppressive therapies for the suppression of symptoms to improve quality of life and reduction of long-term risks. However, in a relevant subgroup of patients, these therapeutic goals cannot be sufficiently attained. Summary: Clinically established therapies in active CD comprise corticosteroids and immunosuppressants such as azathioprine. After the introduction of anti-TNFα (Tumor necrosis factor alpha) antibodies, other biologicals (e.g., vedolizumab and ustekinumab) have also been approved. New drugs in the pipeline like filgotinib, upadacitinib, risankizumab or rifaximin could improve the therapy of CD in the near future. Thus, an individualized therapy management, based on optimal selection of therapeutic agents will become more important. Additionally, the local application of mesenchymal stem cells might be helpful in the management of fistulas. Key Messages: The targeted biological therapeutic agents (anti-TNFα antibodies, vedolizumab, ustekinumab) are well established for therapy in CD. There are several new substances in the pipeline with promising results in phase II trials (filgotinib, rifaximin, risankizumab, upadacitinib). The upcoming extension of the therapeutic arsenal will require methods for an optimized selection of substances, thus enabling a more individualized therapy.

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Azathioprine and 6-mercaptopurine for maintenance of surgically-induced remission in Crohn's disease

Gjuladin-Hellon

Iheozor‐Ejiofor

Gordon

et al. 2019

Cochrane Database of Systematic Reviews

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3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 2: Surgical Management and Special Situations

Cited by 635 publications

References 0 publications

Steroid but not Biological Therapy Elevates the risk of Venous Thromboembolic Events in Inflammatory Bowel Disease: A Meta-Analysis

Steroid but not Biological Therapy Elevates the risk of Venous Thromboembolic Events in Inflammatory Bowel Disease: A Meta-Analysis

Treatment Perspectives in Crohn’s Disease

Azathioprine and 6-mercaptopurine for maintenance of surgically-induced remission in Crohn's disease

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