Real-world disease activity and sociodemographic, clinical and treatment characteristics of moderate-to-severe inflammatory bowel disease in Brazil

Zaltman, Cyrla; Parra, Rogério Serafim; Sassaki, Lígia Yukie; Santana, Genoile Oliveira; Ferrari, Maria de Lourdes Abreu; Miszputen, Sender Jankiel; Amarante, Heda Maria Barska dos Santos; Kaiser, Roberto Luiz; Flores, Cristina; Catapani, Wilson Roberto; Parente, José Miguel Luz; Boiocchi, Mauro; Junior, Odery Ramos; Gonçalves, Carolina D; Guimaraes, Isabella M; Rocha, José Joaquim Ribeiro da; Feitosa, Marley Ribeiro; Féres, Omar; Saad-Hossne, Rogério; Penna, Francisco Guilherme Cancela e; Cunha, Pedro Ferrari Sales; Gomes, Tárcia N.; Nones, Rodrigo Bremer; Faria, Mikaell Alexandre Gouvêa; Parente, Mírian Perpétua Palha Dias; Scotton, Antônio Scafuto; Caratin, Rosana Fusaro; Senra, Juliana; Chebli, Júlio Maria Fonseca

doi:10.3748/wjg.v27.i2.208

Cited by 12 publications

(16 citation statements)

References 41 publications

(41 reference statements)

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“…The variability, however, seemed to persist, even between very specialized centres. This and other studies [ 16 , 17 , 20 ] suggest that there is a significant variation in the management of CD disease even between experts.…”

Section: Discussionsupporting

confidence: 57%

“…These differences may influence patients’ outcomes: for example, whether they undergo surgery, or whether they are hospitalized [ 24 ]. Regarding disease outcomes, epidemiological studies have also reported notable differences in surgery rates between European countries [ 25–27 ], which were also observed between Brazilian regions in a recent study [ 20 ].…”

Section: Introductionmentioning

confidence: 72%

“…Recently, Zaltman et al. published a cross-sectional multicentre study observing also marked regional variations in IBD management in Brazil [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Heterogeneity in pharmacological treatment and outcomes in Crohn’s disease patients in Catalonia: a population-based observational study

Brunet

Vela

Melcarne³

et al. 2022

Annals of Medicine

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Background Heterogeneity in the treatment of a disease is a marker of suboptimal quality of care. The aim of this study is to evaluate the heterogeneity in the treatment used and the outcomes for Crohn’s disease (CD) in Catalonia. Methods All patients with CD included in the Catalan Health Surveillance System (data on more than seven million individuals from 2011 to 2017) were identified. The different Catalonian health areas were grouped into 19 district groups (DG). Treatments used rates (systemic corticosteroids, non-biological and biological immunosuppressant) and outcomes rates (hospitalization and surgery) were calculated. Results The use of systemic corticosteroids presented a decreasing trend over the study period, with an average rate of use in the different territories between 11% and 17%. The use of non-biological immunosuppressant treatment has remained stable, with an average rate of use ranging from 22% to 40% per year depending on the DG. The use of biological immunosuppressant treatment increased with an average rate of use in the different territories ranging from 10 to 23%. Hospitalizations for any reason showed an increasing trend between 2011 and 2017 with an average rate of between 23% and 32% per year depending on the area. Hospitalizations for CD presented a decreasing trend, with an average rate of between 5% and 11% per year. Surgical treatment remained stable over time, rates per year were between 0.5% and 2%. Conclusion A remarkable geographical heterogeneity in the use of different treatments and in outcomes of CD was observed between different geographical areas of Catalonia. KEY MESSAGE There is a notable geographical heterogeneity in the administration of biological and immunosuppressive treatments to Crohn’s disease patients in Catalonia. There is also a geographical heterogeneity in their rates of hospitalization and surgical intervention.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 72%

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Heterogeneity in pharmacological treatment and outcomes in Crohn’s disease patients in Catalonia: a population-based observational study

Brunet

Vela

Melcarne³

et al. 2022

Annals of Medicine

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“…Since individuals with low levels of D vitamin show an increased risk of developing IBD, and D vitamin synthesis is consequent to UV-B exposure (which is highly sensitive to the scattering caused by air particulate and pollutants), this might justify the increased risk of IBD in individuals living in urban settings in highly industrialized countries ( Ananthakrishnan et al., 2012 ; Kimlin et al., 2007 ; MacLaughlin et al., 1982 ; Ng et al., 2019 ; Piovani et al., 2019 ). Accordingly, epidemiologic studies in Brazil reported that the most developed, higher economy activity state also presented the highest IBD incidence rate, comparable to European countries such as Portugal and Ireland ( Gasparini et al., 2018 ; Zaltman et al., 2021 ). Nevertheless, the incidence of IBD is increasing in several low income countries throughout Latin America and the Caribbean ( Kotze et al., 2020 ).…”

Section: Inflammatory Bowel Diseasesmentioning

confidence: 99%

Cholinergic immunomodulation in inflammatory bowel diseases

Serafini

Paz

Nunes

2022

Brain, Behavior, & Immunity - Health

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Inflammatory bowel diseases (IBD) are chronic intestinal disorders characterized by dysregulated immune responses to resident microbiota in genetically susceptible hosts. The activation of the cholinergic system has been proposed for the treatment of IBD patients according to its potential anti-inflammatory effect in vivo. The α-7-nicotinic-acetylcholine receptor (α7nAChR) is involved in the inhibition of inflammatory processes, modulating the production of cytokines, suppressing dendritic cells and macrophage activity, leading to the suppression of T cells. In this review, we address the most recent studies and clinical trials concerning cholinergic signaling and its therapeutic potential for inflammatory bowel diseases.

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“…This is of utmost relevance in developing countries such as Brazil, where the prevalence of IBD is increasing but access to biologic treatment may be restricted, and information on IBD treatment, in general, and associated outcomes is scarce[ 14 , 15 ]. The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil (RISE BR) study was a noninterventional study designed to evaluate disease control, treatment patterns, burden of disease and health-related quality of life in patients with a previous diagnosis of moderate-to-severe active IBD[ 16 , 17 ]. Here, we report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD and aim to describe the real-world treatment patterns and outcomes of IBD-related therapies during a 12-mo follow-up period.…”

Section: Introductionmentioning

confidence: 99%

Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil

Sassaki

Miszputen

Kaiser

et al. 2021

WJG

Self Cite

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BACKGROUND Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBDs) with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden, especially in patients with moderate-to-severe disease. The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil (RISE BR) study was a noninterventional study designed to evaluate disease control, treatment patterns, disease burden and health-related quality of life in patients with moderate-to-severe active IBD. We report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD. AIM To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in Brazil. METHODS This was a prospective, noninterventional study of adult patients with active Crohn’s disease (CD: Harvey-Bradshaw Index ≥ 8, CD Activity Index ≥ 220), inadequate CD control ( i.e., calprotectin > 200 µg/g or colonoscopy previous results), or active ulcerative colitis (UC: Partial Mayo score ≥ 5). Enrollment occurred in 14 centers from October 2016 to February 2017. The proportion of active IBD patients after 9-12 mo of follow-up, Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation, discontinuation and dose changes were examined. RESULTS The study included 118 CD and 36 UC patients, with mean ± SD ages of 43.3 ± 12.6 and 44.9 ± 16.5 years, respectively. The most frequent drug classes at index were biologics for CD (62.7%) and 5-aminosalicylate derivates for UC patients (91.7%). During follow-up, 65.3% of CD and 86.1% of UC patients initiated a new treatment at least once. Discontinuations/dose changes occurred in 68.1% of CD patients [median 2.0 (IQR: 2-5)] and 94.3% of UC patients [median 4.0 (IQR: 3-7)]. On average, CD and UC patients had 4.4 ± 2.6 and 5.0 ± 3.3 outpatient visits, respectively. The median time to first mild or no activity was 319 (IQR: 239-358) d for CD and 320 (IQR: 288-358) d for UC patients. At 9-12 mo, 22.0% of CD and 20.0% of UC patients had active disease. CONCLUSION Although a marked proportion of active IBD patients achieved disease control within one year, the considerable time to achieve this outcome represents an unmet medical need of the current standard of care in a Brazilian real-world setting.

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Real-world disease activity and sociodemographic, clinical and treatment characteristics of moderate-to-severe inflammatory bowel disease in Brazil

Cited by 12 publications

References 41 publications

Heterogeneity in pharmacological treatment and outcomes in Crohn’s disease patients in Catalonia: a population-based observational study

Heterogeneity in pharmacological treatment and outcomes in Crohn’s disease patients in Catalonia: a population-based observational study

Cholinergic immunomodulation in inflammatory bowel diseases

Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil

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