Adalimumab Reduces Extraintestinal Manifestations in Patients with Crohn’s Disease: A Pooled Analysis of 11 Clinical Studies

Introduction

Extraintestinal manifestations (EIMs) in patients with Crohn’s disease (CD) are common and associated with additional morbidity. This study aimed to evaluate the effect of adalimumab therapy on EIM resolution and identify potential predictors of EIM resolution in adult and pediatric patients with moderate to severe CD.

Methods

EIM data were pooled from 11 induction, maintenance, and open-label extension studies of adalimumab. Resolution of EIMs was evaluated at approximately 6 months and 1 year. Median time to initial EIM resolution and first EIM recurrence (reflecting durable resolution) of any EIM and specific categories of EIMs (arthritis/arthralgia, ocular, cutaneous) were calculated. A Cox model was used to determine predictors of initial and durable EIM resolution.

Results

At baseline, 54% (1137/2094) of patients receiving adalimumab and 51% (297/586) receiving placebo had EIMs. EIM resolution occurred in a significantly greater proportion of adalimumab versus placebo patients at 6 months (54% vs 31%; P < .001) and 1 year (60% vs 42%; P = .008). Median time to initial resolution of any EIM, arthritis/arthralgia, and cutaneous EIMs was significantly shorter in patients receiving adalimumab versus placebo. Durable resolution of any EIM and arthritis/arthralgia was significantly longer for patients receiving adalimumab versus placebo. Clinically meaningful predictors of EIM resolution included adalimumab treatment, male sex, and moderate (versus severe) disease activity at baseline.

Conclusion

Adalimumab is effective for achieving initial and durable resolution of any EIM and, in particular, arthritis/arthralgia in patients with moderate to severe CD. Predictors of EIM resolution included adalimumab treatment and moderate disease severity.

Funding

AbbVie.

     

Predictors of Peritonitis and the Impact of Peritonitis on Clinical Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients in Taiwan—10 Years’ Experience in a Single Center

♦ Objective: Peritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes.♦ Methods: Our retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality.♦ Results: The peritonitis rate was 0.196 episodes per patient-year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis (p < 0.001). Kaplan-Meier analysis revealed that the group experiencing peritonitis tended to survive longer than the group that was peritonitis-free (p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD (p = 0.03).♦ Conclusions: The peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive “peritonitis paradox” remain to be clarified.     

Moments of ‘touch’ as a way for mental support in Traditional Chinese Medicine consultations: Analysis of the interactional process of co-constructing understanding of the patient’s body conditions in Hong Kong

Traditional Chinese Medicine (TCM) is a growing phenomenon around the world. However, despite its historical role in Chinese society, there has been limited research on exploring the nature of TCM practitioner-patient interactions in the Chinese context. This study used 10 hours audio recordings of consultations to elucidate how a TCM practitioner used moments of ‘touch’ (where the term is used to represent the nature of holistic TCM interactions) for co-constructing understanding of the patients’ body conditions. In these moments, the practitioner interacted with patients in order to explore their ‘Zheng’, the outcome of an in-depth analysis of all symptoms such as an imbalance in the pulse, lack of energy. This study illustrates how TCM practitioner strategically used discourse features in shaping the patient’ understanding of their current body’s conditions, and thus opened up space to elaborate their concerns or seek clarifications, leading to a holistic understanding and compliance with the recommended treatments. Specifically, the data show how the TCM practitioner through using the moments of ‘touch’ to shape the ongoing discourse so that the patients can have a better understanding of their illnesses. The results suggest that the long-term relationships between TCM practitioners and their patients can be developed through recognising the specific communication strategies used by the TCM practitioners in shaping the patient’s understanding. If TCM practitioners can learn better communication skills, it will lead to better quality of interactions and reach better clinical outcomes such as high patient satisfaction and compliance with treatments.     

Outcomes of a community intervention program based on Pivotal Response Treatment and Positive Behavior Support are promising,particularly for higher functioning children with ASD,but this finding should be interpreted in the light of the study’s shortcomings

Smith, I. M., Flanagan, H. E., Garon, N., & Bryson, S. E. (2015). Effectiveness of community-based early intervention based on pivotal response treatment. Journal of Autism and Developmental Disorders, 45, 1858–1872. 

Source of funding and disclosure of interests: The project was supported by grants from the Canadian Institutes of Health Research, and the Nova Scotia Health Research Foundation. No conflicts of interests were declared.