Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

瞄准：与活跃类固醇依赖者 ulcerative 在病人与 10 个 granulocyteaphaeresis 会议相比评估 5 的功效。方法：在这名飞行员，未来，多集中使随机化的试用，有中等活跃的类固醇的 20 个病人 -- 依赖 ulcerative 被使随机化到 5 或 10 个 granulocyteaphaeresis 会议。主要目的是在 wk 的临床的宽恕 17。第二等的措施包括了内视镜的宽恕和类固醇消费。结果：九个病人被使随机化到 5 个 granulocyteaphaeresis 会议(组 1 ) 和 11 个病人到 10 个 granulocyteaphaeresis 会议(组 2 ) 。在 wk 17，在在组 2 的组 1 病人和 45.45% 的 37.5% 病人在临床的宽恕。临床的宽恕被内视镜的宽恕在所有情况中伴随。完成宽恕的百分之 86 个病人在 wk 是没有类固醇的 17。每日的类固醇要求在组 2 是显著地更低的。病人的 89% 在一年后续期间留在宽恕。一个严肃的不利事件不与学习治疗有关，被报导。结论：Granulocyteaphaeresis 为类固醇依赖者 ulcerative 的治疗安全、有效。在这张人口，增加 aphaeresis 会议的数字没与更高的宽恕率被联系，但是负担得起重要类固醇圆材效果。

Radiation-induced intestinal inflammation

Radiation induces an important inflammatory response in the irradiated organs, characterized by leukocyte infiltration and vascular changes that are the main limiting factor in the application of this therapeutic modality for the treatment of cancer. Recently, a considerable investigative effort has been directed at determining the molecular mechanisms by which radiation induces leukocyte recruitment, in order to create strategies to prevent intestinal inflammatory damage. In these review, we consider current available evidence on the factors governing the process of leukocyte recruitment in irradiated organs, mainly derived from experimental studies, with special attention to adhesion molecules, and their value as therapeutic targets.

Are we giving biologics too late? The case for early versus late use

Corticosteroids and immunomodulators have been the mainstay therapies for Crohn’s disease. Corticosteroids are highly effective to control symptoms in the short- term, but they are not effective in maintaining remission, they heal the mucosa in a reduced proportion of cases, and long-time exposure is associated with an increased risk of infections and mortality. Immunomodulators, azathioprine and methotrexate, heal the mucosa in a higher proportion of patients that corticosteroids but their onset of action is slow and they benefit less than half of patients with Crohn’s disease. In the last decade, medical therapy for Crohn’s disease has experienced a remarkable change due to the introduction of biologic therapy, and particularly the use of anti-tumour necrosis factor-alpha agents. Infliximab, adalimumab, and certolizumab pegol have demonstrated efficacy for induction and maintenance of remission in active Crohn’s disease. These agents have raised the bar for what is a suitable symptomatic response in Crohn’s disease and modification of the natural history of the disease has become a major goal in the treatment of Crohn’s disease. There are several data in the literature that suggest that early use of biologic therapy and achievement of mucosal healing contribute to disease course modification. However, many questions on early biological therapy for Crohn’s disease remain still unanswered.

Endoscopic response to tumor necrosis factor inhibitors predicts long term benefits in Crohn's disease

BACKGROUND Identifying predictors of therapeutic response is the cornerstone of personalized medicine.AIM To identify predictors of long-term mucosal healing(MH) in patients with Crohn's disease(CD) treated with tumor necrosis factor α(TNF-α) inhibitors.METHODS Prospective single center study. Consecutive patients with clinically active CD requiring treatment with a TNF-α inhibitor were included. A baseline segmental CD Endoscopic Index of Severity(CDEIS) ≥ 10 in at least one segment or the presence of ulcerations were required for inclusion. Clinical, biological and endoscopic data were obtained at baseline, weeks 14 and 46. Endoscopic response(ER) was defined as a decrease ≥ 50% from baseline CDEIS and MH as partial CDEIS ≤ 5 in all segments.RESULTS Of 62 patients were included. At baseline, median CD Activity Index and CDEIS were 201 and 6.7, respectively with a significant reduction after one year of treatment(53 and 3.0 respectively, P < 0.001). At week 14, 56% of patients achieved ER and 34% MH. At week 46, the corresponding percentages were 52%and 44%. Baseline disease characteristics or biomarkers did not predict MH. A decrease from baseline CDEIS at week 14 of at least 80% was the best predictor of MH at week 46(59% sensitivity and 91% specificity; area under the curve =0.778).CONCLUSION Clinical and biomarker data are not useful predictors of response to TNF-αinhibitors in CD, whereas ER to induction therapy, defined as 80% reduction in global CDEIS, is a robust predictor of long-term MH. Achievement of this endoscopic endpoint may be considered as a therapeutic target for anti-TNF-αtherapy.