IBD Watch®

Timely Information for Practicing Physicians


 

AUGUST 2007

Combination antibiotic therapy in Crohn’s disease (CD). Mycobacterium avium subspecies paratuberculosis has been suggested as a cause of CD. Selby and coworkers conducted a study in which 213 patients with active CD were randomized to receive clarithromycin, rifabutin, clofazimine, or placebo. All patients were given a 16-week tapering course of prednisolone. Patients in remission at week 16 continued their study treatment in the maintenance phase of the trial. A greater proportion of patients receiving antibiotics than receiving placebo achieved remission at week 16 (66% vs 50%; P = 0.02). By week 52, 39% of antibiotic-treated patients and 56% of patients in the placebo group experienced at least one relapse (P = 0.054). At week 104 the relapse rates were 26% and 43% (P = 0.14) and, during the following year, 59% and 50% (P = 0.54) for the antibiotic and placebo groups, respectively. These findings show that, while short-term improvements were observed, antibiotic therapy did not result in sustained benefit compared with placebo. This does not support a significant role for M avium subspecies paratuberculosis in the pathogenesis of CD. (Selby W, et al. Gastroenterol. 2007;132:2313–2319.)

CD medication and birth outcomes. Nørgǻrd and others conducted a nationwide Danish cohort study to determine the effect of drug treatment on birth outcomes in 900 children born to women with CD between 1996 and 2004. Data were obtained from the Danish National Registry of Patients, Birth Registry, and nationwide prescription database. Preterm births occurred more frequently in azathioprine (AZA)/6-mercaptopurine (6-MP)– and steroid-exposed women than in women who did not receive medications (25% and 12.3% vs 6.5%, respectively). Similarly, congenital abnormalities were more prevalent in AZA/6-MP–exposed women than in unmedicated women (15.4% vs 5.7%). In an accompanying editorial, Friedman states that only a prospective pregnancy registry can adequately differentiate the effects of CD activity and medication use on adverse pregnancy outcomes. (Nørgǻrd B, et al. Am J Gastroenterol 2007;102:1406–1413; Friedman S. Am J Gastroenterol 2007;102:1414–1416.)

Medication adherence. Bokemeyer and colleagues assessed adherence to thiopurines in patients with CD treated in a single gastroenterology outpatient practice. Adherence was evaluated by patient reporting using a standardized questionnaire and by quantitation of thiopurine levels in red blood cells. Among 65 patients studied, 6 (9.2%) had metabolite profiles that indicated nonadherence. The self-assessed questionnaires revealed nonadherence in 4 (7.1%) of 56 patients. The results of this small study suggest that adherence to thiopurines among patients with CD is satisfactory (>90%). In contrast, a larger, longitudinal, population-based study (the Manitoba Inflammatory Bowel Disease Cohort Study), which included 326 patients, found that approximately one third of patients with IBD were nonadherent. Predictors of adherence differed between genders. Low adherence predictors in men included a diagnosis of ulcerative colitis and active employment. The most significant predictor of low adherence in women was younger age. (Bokemeyer B. et al. Aliment Pharmacol Ther 2007;26:217–225; Ediger JP, et al. Am J Gastroenterol 2007;102:1417–1426.)

Push-and-pull enteroscopy. Pohl and associates evaluated a new endoscopic tool, push-and-pull enteroscopy, in the treatment of 19 consecutive patients who had CD and symptomatic small bowel strictures. Nine patients were found at endoscopic assessment to be ineligible for endoscopic therapy for anatomic reasons or because of severe stenotic inflammation. Among ten patients with 13 strictures, technical success was achieved in eight and symptomatic relief lasting for a mean of 10 months was afforded to six. This is the first report of the use of push-and-pull enteroscopy to manage CD patients with small bowel strictures. These encouraging results warrant further study in a larger number of patients. (Pohl J, et al. Eur J Gastroenterol Hepatol 2007;19:529–534.)

Infliximab and risk of latent virus reactivation. Lavagna and others investigated the effect of infliximab on the reactivation of latent viruses in 60 patients scheduled for infliximab induction treatment. Blood samples were obtained prior to infliximab infusions at 0, 2, 6, and 14 weeks. Polymerase chain reaction (PCR) analyses to detect JC-polyomavirus (JCV), Epstein-Barr virus (EBV), human herpes virus (HHV)-6, -7, and -8, and cytomegalovirus (CMV) were performed. All patients were negative for JCV and HHV-6, -7, and -8 at all time points. EBV and CMV serologies were positive in 59 (98%) and 42 (70%) of 60 patients, respectively. EBV-PCR tests were transiently positive in 4 patients (7%), and no patients were found to be CMV-PCR–positive. No clinical viral infections were observed, thus supporting the safety of short-term infliximab treatment in patients with CD who may have latent viruses. (Lavagna A, et al. Inflamm Bowel Dis 2007;13:896–902.)

Immune-mediated disease clustering in IBD patients. Weng and coworkers identified 12,601 patients in a managed care program between 1996 and 2005 who had IBD and a common immune-mediated disorder (asthma, psoriasis, type 1 diabetes, rheumatoid arthritis [RA], multiple sclerosis [MS], systemic lupus erythematosus, vitiligo, autoimmune thyroiditis, or chronic glomerulonephritis). Among patients with IBD, 17% had at least one immune-mediated disease compared with 10% of patients without IBD. Asthma, RA, psoriasis, and MS were more commonly associated with IBD. The results of this study suggest that IBD shares common etiologic factors with other immune-mediated diseases. (Weng X, et al. Am J Gastroenterol 2007;102:1429–1435.)

 

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