P026 The association between corticosteroid exposure and long-term clinical and economic outcomes among patients diagnosed with ulcerative colitis
0
Citation
0
Reference
10
Related Paper
Abstract:
BACKGROUND: Despite their long-term risks, corticosteroids are often used in the management of ulcerative colitis (UC) to help patients achieve and maintain disease remission. The aim of this study was to describe the frequency of high-level corticosteroid exposure and the association between this exposure and both clinical and economic outcomes. METHODS: This retrospective analysis used the IQVIA Real-World Data Adjudicated Claims—US database from January 1, 2006 to June 30, 2017. Patients aged ≥18 years with ≥2 medical claims for UC (ICD9:556.* or ICD10 K51.*) who initiated their first UC therapy (considered the “index” date) between July 1, 2006 and June 30, 2013 and had continuous enrollment 6 months prior to (pre-index) and 4 years after (post-index) this therapy were included. The first 3 years of the post-index window was the corticosteroid exposure observation period; the fourth (and last) year was the outcomes assessment period. Patients were categorized into one of 2 corticosteroid use cohorts: “frequent” (>30 days of continuous corticosteroid exposure in at least 2 of the 3 observation years) versus “infrequent” (all others). Cohorts were compared with respect to the incidence of clinical outcomes (known disease and corticosteroid-related sequelae including infections, osteoporosis etc.), healthcare resource utilization, and costs in the outcomes assessment period. Analyses included chi-square tests and 2-sample t tests. RESULTS: A total of 22,841 patients with UC were included (53.1% female; mean age = 45.2 years [SD = 11.5]). Among them, 4,098 (17.9%) patients met criteria for frequent corticosteroid use. Compared with patients in the infrequent cohort, patients in the frequent cohort were significantly more likely to be younger (28.0% vs 22.7% were 18–39 years), male (48.9% vs 46.5%), and had greater total pre-index costs ($17,294 vs $8,257) (all P < 0.05). Patients in the frequent cohort were significantly more likely to develop gastrointestinal conditions (e.g., ulcers, gastrointestinal bleeding; 87.5% vs 74.0%), infections (e.g., herpes zoster; 53.5% vs 44.3%), musculoskeletal conditions (e.g., osteoporosis; 59.7% vs 51.5%), and dermatologic conditions (e.g., acne, abdominal striae; 34.9% vs 29.8%) (all P < 0.05) during the subsequent outcomes assessment period compared with patients in the infrequent cohort. Patients in the frequent cohort were also more likely to experience a future emergency room visit (24.8% vs 17.9%), an inpatient hospitalization (16.9% vs 8.2%), longer average length of hospital stays (5.9 vs 5.4 days), and higher costs (pharmacy: $17,243 vs $7,939; outpatient: $9,998 vs $6,363; inpatient: $7,299 vs $2,769) compared with patients in the infrequent cohort (all P < 0.05). CONCLUSION(S): Frequent corticosteroid exposure was common among patients with UC and subsequently associated with an increased likelihood of adverse clinical outcomes and greater healthcare resource utilization, and costs.Fifteen patients with ulcerative colitis and 11 patients with ulcerative proctitis have been observed and studied for periods ranging from one to 15 years. It is suggested that the clinical course of the two disorders is quite distinct. Further, while the serum immunoglobulins were within normal limits in ulcerative proctitis, significant increases in the serum alpha(2)-, beta-, and gamma-globulins and in the IgA and IgG concentrations were found in ulcerative colitis. Despite total colectomy for ulcerative colitis, the serum IgG and IgA concentration remained high and even after subsequent rectal resection the relative IgA concentration continued to increase. The significance of these findings is discussed.
Cite
Citations (15)
Combined Signature of the Fecal Microbiome and Plasma Metabolome in Patients with Ulcerative Colitis
BACKGROUND Ulcerative colitis is a chronic, idiopathic inflammatory disease that destroys the colon structure. Nevertheless, the exact pathogenesis is not clear and needs to be fully elucidated. MATERIAL AND METHODS Stool and plasma samples were used for 16S ribosomal RNA sequencing and liquid chromatography mass spectrometry, respectively. In addition, we detected the level of trimethylamine N-oxide. Finally, we performed Pearson correlation analysis between the microbiome and the metabolome. RESULTS Twenty-three active ulcerative colitis, 25 inactive ulcerative colitis, and 30 control cases were included. Thirty-four significantly different metabolites were found between the active ulcerative colitis and control groups, 38 were found between the inactive ulcerative colitis and control groups, and only 1 was found between the active ulcerative colitis and inactive ulcerative colitis groups. The plasma trimethylamine N-oxide level of the inactive ulcerative colitis and active ulcerative colitis groups was significantly higher than that of the control group. Moreover, we identified significant changes in 24, 18, and 12 bacterial genera for active ulcerative colitis-control, inactive ulcerative colitis-control, and active ulcerative colitis-inactive ulcerative colitis, respectively. Cross-correlation indicated an association between sphingosine 1-phosphate and Roseburia, Klebsiella, and Escherichia-Shigella. Through the pathway analysis, we found sphingolipid metabolism was one of the most significantly increased pathways. CONCLUSIONS Although levels of trimethylamine N-oxide were higher in ulcerative colitis patients, they did not achieve statistical significance in active ulcerative colitis and inactive ulcerative colitis groups. Sphingosine 1-phosphate was increased in ulcerative colitis patients and there were several microbiota associated with it. Although further study is still needed, sphingosine 1-phosphate will probably become a new target for treatment of ulcerative colitis.
Metabolome
Gut microbiome
Cite
Citations (42)
IM To study the action and significance of serum tumor necrosis factorα (TNFα) and interleukin8 (IL8) in patients with ulcerative colitis. METHODS Serum TNFα (2622ng/L±20ng/L vs 1462ng/L±25ng/L, P005) and IL8 (1118ng/L±26ng/L vs 575ng/L±40ng/L, P005) in 33 patients with active ulcerative colitis and in 40 normal subjects were detected using a Sandwich ELISA. RESULTS Serum TNFα and IL8 levels in patients with ulcerative colitis were elevated significantly and related to the severity of the disease and area of lesions (P005).CONCLUSION Immune dysfunction exists in patients with ulcerative colitis. The increased serum TNFα and IL8 are related to the development of ulcerative colitis and may serve as an indicator of ulcerative colitis.
Interleukin 8
Cite
Citations (0)
Many studies have been conducted for the role of Ahara (~dietary habits), Vihara (~abnormal Physical activity) and Manas (~Psychological factors) and their association with pathogenesis of Ulcerative colitis, which is a subtype of inflammatory bowel disease, which pursue a protracted relapsing and remitting course, usually extending over years. The causes of relapsing of ulcerative colitis are not known. Dietary factors have been associated in the pathogenesis of ulcerative colitis as well as associated with an increased risk of relapse of ulcerative colitis. Here, we have reviewed the probable mechanisms of the role of diet and its association with pathogenesis of Ulcerative colitis (UC). In Ayurveda, on the basis of signs and symptoms ulcerative colitis can be best compared with Raktatisara. This article is an attempt to do critical review and put a light on the role of diet, faulty lifestyle and Psychological factors in occurrence and progression of Ulcerative colitis (UC), and try to explain Etiopathogenesis of Raktatisara in relation to ulcerative colitis by going through Ayurvedic texts, Google Scholar, PubMed journals etc.
Pathogenesis
Cite
Citations (1)
Objective To observe the levels of plasma P-selection(P-sel) and in patients with ulcerative colitis and to study the clinical significance of them. Methods the concentrations of P-sel in 18 patients with active ulcerative colitis and 13 relief ulcerative colitis were determined with ELISA method. Results The results shown that the levels of P-sel in active ulcerative colitis patients were markedly elevated and were correlated with the severity of the disease. But the levels of P-sel in relief ulcerative colitis patients have no difference with normal controls. Conclusion It is suggested that the occurrence and development of ulcerative colitis may be related to the increase of plasma P-sel. Measurement of levels of plasma P-sel and might therefore provide a tool for monitoring the clinical course and for gaiding the treatment of ulcerative colitis.
Clinical Significance
Cite
Citations (0)
Objective To investigate action and significance of serum nitric oxide(NO) in patients with ulcerative colitis.Methods Levels of serum NO in active stage of 33 patients with ulcerative colitis and 40 healthy controls were detected.Results Levels of serum NO in patients with ulcerative colitis were significantly high and related to severe degrees of the disease (P0.05).Conclusion Immune dysfunction exists in patients with ulcerative colitis, There are relationship between higher levels of serum NO and ulcerative colitis pathogenesis and elevation of serum NO level may be as an indicator of ulcerative colitis.
Pathogenesis
Cite
Citations (0)
Objective:To investigate the action of TNF-a,IL-6 and sIL-2R in the mechanism of ulcerative colitis.Methods:Bi-antibody radioimmune methods and ELISA methods were used to analysis the samples in TNF-a,IL-6 and sIL-2R of 25 cases with active ulcerative colitis.30 normal persons were assigned as the contrast group.The data of cytokines(TNF-a,IL-6,sIL-2R)among contrast group,the active and catabolic phases of ulcerative colitis were compared.That in catabolic phases of ulcerative colitis was also compared with that in contrast group,the difference were compared among slight,moderate and severe groups,The relativity among the serum level in TNF-a,IL-6 of active ulcerative colitis had been observed.Results:The level of serum TNF-a,IL-6 and sIL-2R in active ulcerative colitis was much more higher than catabolic ulcerative colitis and contrast group(P0.05).The level had no significant difference between catabolic ulcerative colitis and contrast group(P0.005).The level in severe group is higher than that in moderate and slight group(P0.05).Serum cytokines,TNF-a and IL-6 are positively related to active ulcerative colitis.(r=0.8476,P0.05).Conclusion:There is a severe disorders of cellular immunity in the patients with active ulcerative colitis.TNF-a,IL-6,sIL-2R etc play the very important roles in the genesis and development of ulcerative colitis.The serum level of the above cytokines not only reflected the development of ulcerative colitis but also could be used as biological index of the effect and estimate the prognosis.
Cite
Citations (1)
This paper discusses the treatment of ulcerative colitis with Traditional Chinese Medicine, and expounds the specific pathogenesis of ulcerative colitis. In addition, we put forward the application of some new technologies and methods for the scientific research on the treatment of ulcerative colitis, and summarizes the research hotspots of ulcerative colitis, hoping to provide reference for other scholars to study ulcerative colitis. Keywords: Chinese traditional; ulcerative colitis; techniques and methods; medicine treatment.
Cite
Citations (1)
Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, deregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually present with bloody diarrhoea and is diagnosed by colonoscopy and histological findings. Treatment for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, and immune-suppressant. The therapeutic armamentarium for ulcerative colitis is expanding. A total of 60 respondents were interviewed and were investigated for ulcerative colitis. A predesigned and pretested was used to collect the information about the participants. For the research survey method was used for the collection of data. Results shows that mostly 70 (%) respondents were aware of ulcerative colitis and 30 (%) respondents were not aware of ulcerative colitis. In conclusion that studies ulcerative colitis.
Bloody
Pathogenesis
Genetic predisposition
Cite
Citations (0)
Objective To observe the severity correlation of TNF-α、IL-6 and IL-8 levels in plasma in patients with ulcerative colitis and investigate mechanism of ulcerative colitis.Methods TNF-α,IL-6 and IL-8 levels in plasma were measured with ELISA methods in 56 patients with ulcerative colitis and 20 normal persons as a control group.The active and catabolic phases of ulcerative colitis were compared and the difference were compared among slight,moderate and sever groups.Results The level of serum TNF-α,IL-6 and IL-8 in active ulcerative colitis was much more higher than catabolic ulcerative colitis and contrast group(P0.05).The level had no significant differences between catabolic ulcerative colitis and contrast group(P0.05).The level in severe group was higher than that in moderate and slight group(P0.05).Conclusions There is a sever disorders of cellular immunity in the patients with active ulcerative colitis.TNF-α,IL-6 and IL-8 play the very important roles in the genesis and development of ulcerative colitis.The measurement of TNF-α,IL-6 and IL-8 levels in plasma may contribute to predict the severity of ulcerative colitis.
Cite
Citations (0)