Comparison of the therapeutic efficacy and safety between tacrolimus and infliximab for moderate-to-severe ulcerative colitis: a single center experience

Nuki, Yoichiro; Esaki, Motohiro; Asano, Kouichi; Maehata, Yuji; Umeno, Junji; Moriyama, Tomohiko; Nakamura, Shotaro; Matsumoto, Takayuki; Kitazono, Takanari

doi:10.3109/00365521.2016.1138239

Cited by 15 publications

(19 citation statements)

References 28 publications

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“…Serum albumin and CRP levels at baseline were not statistically different between groups. Nuki et al [11] reported in their retrospective study of 46 patients with moderate to severe UC the clinical remission rate after 10 weeks was 76% and 67% in the IFX and Tac groups, respectively. They reported CRP levels at baseline were not statistically different between groups, but serum albumin levels were not discussed.…”

Section: Discussionmentioning

confidence: 95%

“…Tacrolimus (Tac), a calcineurin inhibitor that has a mechanism of action similar to CsA, also has therapeutic efficacy for moderate to severe UC [7,8]. Several retrospective studies showed IFX and Tac had equal efficacy for moderate to severe UC [9][10][11]. These studies were retrospective and therefore the background characteristics of the patients were not randomized.…”

Section: Introductionmentioning

confidence: 99%

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A comparison of short-term therapeutic efficacy between infliximab and tacrolimus for moderate to severe ulcerative colitis

Yamagami

Nagami

et al. 2017

Romanian Journal of Internal Medicine

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Introduction. Both infliximab (IFX) and tacrolimus (Tac) are effective for inducing clinical remission in patients with ulcerative colitis (UC). However, no randomized study has addressed the relative efficacies of IFX and Tac for patients with moderate to severe UC. This study aimed to conduct a retrospective study on the relative efficacy of IFX and Tac in patients with moderate to severe UC, using an inverse probability of treatment weighting (IPTW) technique to adjust background factors statistically.Methods. Between July 2009 and March 2016, data obtained from 122 patients with moderate to severe UC who were treated with either IFX (n = 58) or Tac (n = 64) were analyzed retrospectively. We compared the short-term therapeutic efficacy between the IFX group and Tac group using IPTW technique.Results. The clinical remission rate at 14 weeks after treatment was 37.9% (22/58) in the IFX group and 50% (32/64) in the Tac group, respectively. The efficacy of IFX and Tac for clinical remission rate was not different according to univariate (Odds ratio [OR] 1.64, 95% confidence interval [CI] 0.80-3.37 P = 0.18) and multivariate analyses (OR 2.19, 95% CI 0.85-5.61, P = 0.10). After the background and confounders factors were adjusted by using IPTW based on propensity score, the efficacy of IFX and Tac for clinical remission rate was not differed statistically (OR, 1.483; 95% CI, 0.581-3.785; P = 0.409) Conclusion. IFX and Tac have equivalent short-term efficacies for induction in patients with moderate to severe UC.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

A comparison of short-term therapeutic efficacy between infliximab and tacrolimus for moderate to severe ulcerative colitis

Yamagami

Nagami

et al. 2017

Romanian Journal of Internal Medicine

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“…Renal dysfunction was also observed in the TAC group; however, creatinine levels returned to the normal range after reducing the dose of TAC [9]. IFX therapy was temporarily ceased in several patients with infections such as pneumonia and herpes zoster [8].…”

Section: Safety and Adverse Eventsmentioning

confidence: 94%

“…In this review, TAC was switched to azathioprine at 3 months in the majority of patients. However, indeed, a few patients received TAC for more than 3 months at the physicians' discretion [7,9,10]. Nevertheless, the long-term efficacy of TAC as maintenance therapy could not be properly evaluated because of a small sample size.…”

Section: Long-term Efficacy (Maintenance Efficacy)mentioning

confidence: 99%

Comparison of Safety and Efficacy of Tacrolimus versus Infliximab for Active Ulcerative Colitis

Takeuchi

Shimoyama

Yamamoto³

2017

Dig Dis

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Background: This narrative review was to determine which medication, tacrolimus (TAC) or infliximab (IFX), is safer and more effective in the management of active UC. Our literature search identified 5 studies directly comparing the outcomes of TAC versus IFX for active UC. A review of the 5 studies was undertaken. Summary: The incidence of serious adverse events was not significantly different between the TAC and IFX groups. The short-term clinical remission and response rates and the colectomy-free rates were similar between the groups. TAC was usually withdrawn at week 12 and, therefore, the long-term efficacy of TAC could not be properly evaluated. The majority of patients in the IFX group maintained clinical remission in the long-term. The efficacy of IFX as second-line salvage therapy after failure of TAC appeared to be favourable, but the efficacy of TAC after failure of IFX was questionable. Key Messages: Both TAC and IFX appeared to be equally safe and effective in the short-term for patients with active UC. For the moment, treatment choice, TAC or IFX, should be guided by physician and centre experience. Randomised controlled trials are urgently warranted to rigorously compare the efficacy of TAC versus IFX for active UC.

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“…Figure 1 shows the flow diagram which describes the reasons for citations exclusion. Finally, 22 studies (4)(5)(6)(9)(10)(11)(12)(13)(14)(15)(16)(17)(20)(21)(22)(23)(24)(25)28,30,32,33) that fulfilled eligibility criteria were included. Only two studies were randomized controlled trials (24,25) (Ogata 2006 and Ogata 2012); these were included for meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Tacrolimus for Induction of Remission in Patients With Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Lasa

Olivera

2017

Arq. Gastroenterol.

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-Background -There is evidence that shows that calcineurin inhibitors may be useful for the treatment of severe ulcerative colitis. However, evidence regarding the efficacy of tacrolimus for remission induction in this setting is scarce. Objective -To develop a systematic review on the existing evidence regarding the clinical efficacy of tacrolimus for the induction of remission in patients with moderate-to-severe ulcerative colitis. Methods -A literature search was undertaken from 1966 to August 2016 using MEDLINE, Embase, LILACS and the Cochrane Library. The following MeSH terms were used: "Inflammatory Bowel Diseases" or "Ulcerative Colitis" and "Calcineurin Inhibitors" or "Tacrolimus" or "FK506". Studies performed in adult ulcerative colitis patients that evaluated the clinical efficacy of tacrolimus for the induction of remission were considered for revision. A meta-analysis was performed with those included studies that were also placebo-controlled and randomized. Clinical response as well as clinical remission and mucosal healing were evaluated. Results -Overall, 755 references were identified, from which 22 studies were finally included. Only two of them were randomized, placebo-controlled trials. A total of 172 patients were evaluated. A significantly lower risk of failure in clinical response was found for tacrolimus versus placebo ]; moreover, a lower risk of failure in the induction of remission was also found versus placebo ]. Conclusion -Tacrolimus seems to be a valid therapeutic alternative for the induction of remission in patients with moderate-to-severe ulcerative colitis. HEADINGS -Inflammatory bowel diseases. Tacrolimus. Calcineurin inhibitors.

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Comparison of the therapeutic efficacy and safety between tacrolimus and infliximab for moderate-to-severe ulcerative colitis: a single center experience

Abstract: Tac and IFX may be equally efficacious for the induction and maintenance of remission in patients with UC while minor adverse events are more frequent with the former treatment.

Cited by 15 publications

References 28 publications

A comparison of short-term therapeutic efficacy between infliximab and tacrolimus for moderate to severe ulcerative colitis

A comparison of short-term therapeutic efficacy between infliximab and tacrolimus for moderate to severe ulcerative colitis

Comparison of Safety and Efficacy of Tacrolimus versus Infliximab for Active Ulcerative Colitis

Efficacy of Tacrolimus for Induction of Remission in Patients With Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

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