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Master Thesis

What is the impact of infliximab metaoptimization on surgical rates and need-to-change therapy in real world practice for severe inflammatory bowel disease?

Abstract : Objective: current evidence-bases recommendations do not recommend intensified infliximab (ifx) regimens for patients with severe IBD. Nethertheless, retrospective single-centers analysis observed markedly lower early surgical rate. Our aim was to evaluate the efficacy of metaoptimized ifx (Mifx), ie combined intensified induction and maintenance regimen as compared to a standard ifx (Sifx) schedule historical cohort on 1 year surgical rates and need to change therapy in severe hospitalized IBD patients.Methods: In this retrospective single center study, two cohorts of patients with CD and UC who were hospitalized at our single teaching hospital for an acute severe flare were identified from 20014 to 2016 (Mifx cohort) and 2007 to 2014 (Sifx cohort) were identified. Severe UC and CD were defined per clinical assessment with a Lichtiger Index > 12 for UC, a Harvey Bradshaw Index (HBI) > 12 for CD and according to ECCO classification. Results: 28 Mifx patients and 67 SIFX were included. A total of 5 of the 26 Mifx patients (18%) had a surgery, as compared with 10/64 Sifx (31%), patients with ifx metaoptimization had almost a two-fold chance of being surgery-free at 1 year while not reaching statistical significance (OR: 0.48 [95%CI: 0.16-1.42], p=0.18) Mifx patients had a three-fold chance to change their medical therapy at 1 year (25% ) as compared with Sifx patients (9%) (OR: 3.39 [95%CI: 1.02-11.22], p=0.05 ) The 1year infections rate was greater in Mifx patients (OR: 2.21 [95%CI: 0.61-7.95], p=0.11).Conclusion: Our underpowered data suggest that an ifx metaoptimization provides benefits in relation to 1-year surgery rates, but does not reduce need for biologics at that disease stage.
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Master Thesis
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Submitted on : Friday, March 30, 2018 - 4:29:30 PM
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Thomas Lefebvre. What is the impact of infliximab metaoptimization on surgical rates and need-to-change therapy in real world practice for severe inflammatory bowel disease?. Human health and pathology. 2017. ⟨dumas-01755536⟩

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