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Tianeze de Castro C, da Silva Oliveira D, Freire de Melo F, Lima Barreto M, de Souza Teles Santos CA, Barbosa Dos Santos D. Global prevalence of biologic drugs use in inflammatory bowel diseases: a systematic review and meta-analysis. Scand J Gastroenterol 2025; 60:439-453. [PMID: 40237230 DOI: 10.1080/00365521.2025.2491013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 02/17/2025] [Accepted: 04/04/2025] [Indexed: 04/18/2025]
Abstract
OBJECTIVES Biologics are increasingly essential in managing inflammatory bowel diseases (IBDs) worldwide, as they can modify disease progression and improve patients' quality of life. This study aimed to analyze the global prevalence of and geographic variations in the use of biological drugs for IBD. MATERIALS AND METHODS Articles published up to 21 July 2024, were identified from the PubMed/MEDLINE, Web of Science, Scopus, Embase, IBECS, WPRIM, BRISA/RedETSA and LILACS databases. Population-based studies (cohort, case-control and cross-sectional) and studies using administrative databases with data on the prevalence of biological medicine use in patients with IBD were included. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Estimates were pooled using a random-effects meta-analysis, whereas heterogeneity was evaluated using Cochran's Q test and I2. RESULTS Of the 8239 titles, 68 (n = 3,482,385 patients) were included. An increase in the number of studies on the subject has been reported since 2017, and these studies have been mostly concentrated in high-income countries. A 15.06% (95% CI 11.84-18.28%) prevalence of biologic use in IBD worldwide was reported, predominantly concentrated in the use of anti-TNF agents 15.01% (95% CI 10.35-19.67%). Furthermore, patients with Crohn's disease (CD) had a greater prevalence of biologic use (21.41%; 95% CI 16.31-26.50%) than ulcerative colitis (UC) patients (9.70%; 95% CI 6.20-13.18%). CONCLUSIONS Further studies using population-based and administrative data and stratifying their analyses by disease type are required to confirm our findings. Future studies should be conducted in Latin America, Asia and Africa.
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Affiliation(s)
| | | | | | - Mauricio Lima Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Carlos Antonio de Souza Teles Santos
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
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dos Reis Guerra JA, Magro DO, Rodrigues Coy CS, Valverde DA, de Oliveira ES, Quaresma AB, Kotze PG. Temporal Trends in Surgery and Hospitalization Rates for Crohn's Disease in Brazil: A Population-Based Study. CROHN'S & COLITIS 360 2025; 7:otae082. [PMID: 40207073 PMCID: PMC11979744 DOI: 10.1093/crocol/otae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Indexed: 04/11/2025] Open
Abstract
Introduction Biological therapy has transformed the natural course of inflammatory bowel disease, but there are still controversies regarding its potential to reduce surgical rates for Crohn's disease (CD). This study, conducted with the support of the Brazilian National Healthcare System, aimed to analyze temporal trends in surgery and hospitalization rates among patients with CD and to correlate these data with the dispensing of azathioprine (AZA), infliximab (IFX), and adalimumab (ADA). Methodology This retrospective observational study used data from the National Public Healthcare Department of Informatics through the TT Disease Explorer® platform from 2012 to 2022. Demographic data, medications used, and the prevalence of surgical procedures and hospitalizations associated with the International Classification of Diseases codes for CD were analyzed. Annual average percent changes (AAPCs) were calculated to assess temporal trends. Results Between 2012 and 2022, there was a significant increase of 288.07% in the diagnoses of CD, rising from 27 551 to 106 917 cases. Concurrently, there was an increase in the absolute number of patients treated with AZA, IFX, and ADA, with increasing rates of 65.79%, 251.09%, and 242.48%, respectively. However, the proportion of patients receiving AZA per CD patients decreased by 57.28%, from 44.79% to 19.13% (AAPC = -7.94%, 95% CI, -8.05 to -7.83; P < .001). The use of IFX remained relatively stable, with a slight change from 13.82% to 12.50% (AAPC = 0.01%, 95% CI, -0.20 to 0.22; P = .935), while the use of ADA decreased by 11.75%, from 11.65% to 10.28% (AAPC = -1.74%, 95% CI, -2.48 to -1.82; P < .001). The absolute number of hospitalizations related to CD increased by 57.71%. Despite the rise in the number of cases and the greater availability of biological treatments, the proportion of hospitalized patients decreased by 59.29%, from 6.19% to 2.52% (AAPC = -7.04%, 95% CI, -7.42 to -6.66; P < .001). Similarly, the proportion of surgical procedures relative to the total number of cases decreased by 55.08%, from 1.09% to 0.49% (AAPC = -5.73%, 95% CI, -6.68 to -4.77; P < .001). Conclusions Despite the cumulative increase in the prevalence of CD cases in the country and the absolute increase in the dispensing of biologics, the proportion of hospitalizations and surgical procedures among CD patients treated in the public health system in Brazil decreased.
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Affiliation(s)
| | | | | | | | | | - Abel Botelho Quaresma
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- IBD Outpatient Clinic, Colorectal Surgery Unit, Universidade do Oeste de Santa Catarina, UNOESC, Brazil
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Catholic University of Paraná, IBD Outpatient Clinics, Curitiba, Brazil
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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de Barros JR, Alencar RA, Saad-Hossne R, Sassaki LY. Development of the Nursing Assessment Tool for the Patient With Inflammatory Bowel Disease. Gastroenterol Nurs 2024; 47:92-100. [PMID: 38567852 DOI: 10.1097/sga.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/16/2023] [Indexed: 04/05/2024] Open
Abstract
This study aims to develop and validate a nursing assessment tool for patients with inflammatory bowel disease. In this cross-sectional descriptive study using a quantitative approach, nurses were invited to participate. The Delphi technique was used to obtain a consensus among expert nurses. Descriptive analysis was used for each item on the nursing assessment tool. Overall, 345 nurses were identified; 32 were eligible as experts and 13 validated the consultation. Of the 13 expert nurses, most were female (11, 84.62%), their mean age was 46.36 ± 10.59 years, eight (61.54%) graduated from public institutions, and eight (61.54%) had a master's degree. The initial version had 106 items, which was reduced to 95 items. The content of four domains (identification, health-disease profile, psychobiological needs, and physical examination) was validated in two rounds about the content with more than 80% of agreement. Two domains (sociodemographic data and health conditions, and personal cares) were validated in the first round with more than 80% of agreement. All domains were validated for their appearance during the first round with more than 80% of agreement. The Nursing Assessment Tool for Patients with Inflammatory Bowel Disease (IBD) had a considerable level of agreement regarding content and appearance validation in all dimensions.
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Affiliation(s)
- Jaqueline Ribeiro de Barros
- Jaqueline Ribeiro de Barros, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rúbia Aguiar Alencar, PhD, is from the Department of Nursing, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rogério Saad-Hossne, MD, PhD, is from the Department of Surgery, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Ligia Yukie Sassaki, MD, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
| | - Rúbia Aguiar Alencar
- Jaqueline Ribeiro de Barros, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rúbia Aguiar Alencar, PhD, is from the Department of Nursing, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rogério Saad-Hossne, MD, PhD, is from the Department of Surgery, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Ligia Yukie Sassaki, MD, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
| | - Rogério Saad-Hossne
- Jaqueline Ribeiro de Barros, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rúbia Aguiar Alencar, PhD, is from the Department of Nursing, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rogério Saad-Hossne, MD, PhD, is from the Department of Surgery, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Ligia Yukie Sassaki, MD, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
| | - Ligia Yukie Sassaki
- Jaqueline Ribeiro de Barros, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rúbia Aguiar Alencar, PhD, is from the Department of Nursing, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Rogério Saad-Hossne, MD, PhD, is from the Department of Surgery, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
- Ligia Yukie Sassaki, MD, PhD, is from the Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, Brazil
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Fróes RDSB, Andrade AR, Faria MAG, de Souza HSP, Parra RS, Zaltman C, Dos Santos CHM, Bafutto M, Quaresma AB, Santana GO, Luporini RL, de Lima Junior SF, Miszputen SJ, de Souza MM, Herrerias GSP, Junior RLK, do Nascimento CR, Féres O, de Barros JR, Sassaki LY, Saad-Hossne R. Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB. Sci Rep 2024; 14:4314. [PMID: 38383742 PMCID: PMC10881489 DOI: 10.1038/s41598-024-54332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn's Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.
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Affiliation(s)
| | | | | | - Heitor Siffert Pereira de Souza
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cyrla Zaltman
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Bafutto
- Department of Gastroenterology, Instituto Goiano de Gastroenterologia, Goiânia, Goiás, Brazil
| | - Abel Botelho Quaresma
- Universidade do Oeste de Santa Catarina - UNOESC - Department of Health Sciences, Joaçaba, Santa Catarina, Brazil
| | | | - Rafael Luís Luporini
- Department of Medicine, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | | | | | | | - Giedre Soares Prates Herrerias
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | | | | | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaqueline Ribeiro de Barros
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil.
| | - Rogerio Saad-Hossne
- Department of Surgery, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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da Silva Júnior RT, Apolonio JS, de Souza Nascimento JO, da Costa BT, Malheiro LH, Silva Luz M, de Carvalho LS, da Silva Santos C, Freire de Melo F. Crohn's disease and clinical management today: How it does? World J Methodol 2023; 13:399-413. [PMID: 38229938 PMCID: PMC10789097 DOI: 10.5662/wjm.v13.i5.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
Crohn's Disease (CD) is an Inflammatory Bowel Disease and is characterized by an immune-mediated nature. Its etiology results from the interaction between genetic, enviromental and microbial factors. Regarding pathophysiology, it involves high levels of interleukin (IL)-12, IL-17, and Th1 profile, along with loss of tolerance mechanisms, an increase in pro-inflammatory interleukins, beyond the possibility to affect any part of the gastrointestinal tract. Its symptoms include abdominal pain, chronic diarrhea, weight loss, anorexia, and fatigue, as well as blood in the stool or rectum. Additionally, conditions comprising musculoskeletal, cutaneous, ocular, hepatic, and hematological alterations may be associated with this scenario and extra-intestinal presentation, such as erythema nodosum, anterior uveitis, osteoporosis, and arthritis can also occur. Today, clinical history, exams as fecal calprotectin, ileocolonocopy, and capsule endoscopy can be performed in the diagnosis investigation, along with treatments to induce and maintain remission. In this sense, anti-inflammatory drugs, such as corticosteroids, immunomodulators, and biological agents, as well as surgery and non-pharmacological interventions plays a role in its therapy. The aim of this review is to bring more current evidence to clinical management of CD, as well as to briefly discuss aspects of its pathophysiology, surveillance, and associated disorders.
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Affiliation(s)
| | - Jonathan Santos Apolonio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Bruna Teixeira da Costa
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luciano Hasimoto Malheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Marcel Silva Luz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lorena Sousa de Carvalho
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cleiton da Silva Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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de Brito CAA, Celani LMS, de Araújo MVT, de Lucena MT, Vasconcelos GBS, Lima GAS, Nóbrega FJF, Diniz GTN, Lucena-Silva N, Toneto GT, Falcão JVDC, Barbosa PM, de Oliveira PRF, Dantas LSX, Fernandes LKC, de Araújo SA, Martinelli VF. A Multicentre Study of the Clinical and Epidemiological Profile of Inflammatory Bowel Disease in Northeast Brazil. Clin Exp Gastroenterol 2023; 16:87-99. [PMID: 37366396 PMCID: PMC10290862 DOI: 10.2147/ceg.s411936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBDs) with multifactorial causes. They are becoming more prevalent in developing countries such as Brazil; however, relevant studies in poorer regions of the country are limited. Here, we report the clinical-epidemiological profile of patients with IBD treated at reference centers in three states of Northeast Brazil. Patients and Methods This was a prospective cohort study involving patients at referral outpatient clinics for IBD from January 2020 through December 2021. Results Of 571 patients with IBD, 355 (62%) had UC, and 216 (38%) had CD. The patients were predominantly women (355, 62%) for both UC and CD. Extensive colitis was the pattern present in 39% of the UC cases. For CD, ileocolonic disease was the predominant manifestation (38%), with 67% of cases showing penetrating and/or stenosing behavior. The majority of patients were diagnosed between the ages of 17 and 40, corresponding to 60.2% in CD and 52.7% in UC. The median time between symptom onset and diagnosis was 12 months for CD and 8 months for UC (p=0.042). Joint involvement was the most frequent extraintestinal manifestation, with arthralgia and arthritis present in 41.9% and 18.6% of the patients, respectively. Biological therapy was prescribed to 73% of CD patients and 26% of UC patients. A progressive increase in new cases was observed in every 5-year interval over the last five decades, with 58.6% being diagnosed in the last 10 years. Conclusion More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD. A prolonged time to diagnosis may have contributed to these findings. A progressive increase in IBD incidence was observed and may be related to greater urbanization and better access to specialized outpatient clinics, resulting in improvements in diagnosis.
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Affiliation(s)
- Carlos Alexandre Antunes de Brito
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Internal Medicine, Centre of Medical Sciences of the Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | - Lívia Medeiros Soares Celani
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Marcelo Vicente Toledo de Araújo
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Graciana Bandeira Salgado Vasconcelos
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Gustavo André Silva Lima
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | - Fernando Jorge Firmino Nóbrega
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | | | - Germano Tose Toneto
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | | | | | | | - Luan Samy Xavier Dantas
- Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Luanna Karen Chagas Fernandes
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Samara Amorim de Araújo
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Valéria Ferreira Martinelli
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
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Sassaki LY, Martins AL, Galhardi-Gasparini R, Saad-Hossne R, Ritter AMV, Barreto TB, Marcolino T, Balula B, Yang-Santos C. Intestinal complications in patients with Crohn’s disease in the Brazilian public healthcare system between 2011 and 2020. World J Clin Cases 2023; 11:3224-3237. [PMID: 37274050 PMCID: PMC10237144 DOI: 10.12998/wjcc.v11.i14.3224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND This is a secondary database study using the Brazilian public healthcare system database.
AIM To describe intestinal complications (ICs) of patients in the Brazilian public healthcare system with Crohn’s disease (CD) who initiated and either only received conventional therapy (CVT) or also initiated anti-tumor necrosis factor (anti-TNF) therapy between 2011 and 2020.
METHODS This study included patients with CD [international classification of diseases – 10th revision (ICD-10): K50.0, K50.1, or K50.8] (age: ≥ 18 years) with at least one claim of CVT (sulfasalazine, azathioprine, mesalazine, or methotrexate). IC was defined as a CD-related hospitalization, pre-defined procedure codes (from rectum or intestinal surgery groups), and/or associated disease (pre-defined ICD-10 codes), and overall (one or more type of ICs).
RESULTS In the 16809 patients with CD that met the inclusion criteria, the mean follow-up duration was 4.44 (2.37) years. In total, 14697 claims of ICs were found from 4633 patients. Over the 1- and 5-year of follow-up, 8.3% and 8.2% of the patients with CD, respectively, presented at least one IC, of which fistula (31%) and fistulotomy (48%) were the most commonly reported. The overall incidence rate (95%CI) of ICs was 6.8 (6.5–7.04) per 100 patient years for patients using only-CVT, and 9.2 (8.8–9.6) for patients with evidence of anti-TNF therapy.
CONCLUSION The outcomes highlighted an important and constant rate of ICs over time in all the CD populations assessed, especially in patients exposed to anti-TNF therapy. This outcome revealed insights into the real-world treatment and complications relevant to patients with CD and highlights that this disease remains a concern that may require additional treatment strategies in the Brazilian public healthcare system.
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Affiliation(s)
- Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University - UNESP, Medical School, 18618687, Botucatu, Brazil
| | - Adalberta Lima Martins
- Department of Gastroenterology, State Office for Pharmaceutical Assistance at Espírito Santo Health Office, Vitoria 29017-010, Espirito Santo, Brazil
| | | | - Rogerio Saad-Hossne
- Department of Surgery, São Paulo State University - UNESP, Medical School, 18618687, Botucatu, Brazil
| | | | | | - Taciana Marcolino
- Medical Affairs, Takeda Pharmaceuticals Brazil, 04794-000, Sao Paulo, Brazil
| | - Bruno Balula
- Real World Evidence, IQVIA Brazil, 04719-002, Sao Paulo, Brazil
| | - Claudia Yang-Santos
- Clinical Research, Takeda Pharmaceuticals Brazil, 04794-000, Sao Paulo, Brazil
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Parra RS, da Costa Ferreira S, Machado VF, Nigro CMC, da Rocha JJR, de Almeida Troncon LE, Feres O. Access to High-Cost Biological Agents: Perceptions of Brazilian Patients with Inflammatory Bowel Diseases. J Clin Med 2023; 12:2672. [PMID: 37048755 PMCID: PMC10095198 DOI: 10.3390/jcm12072672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND AIMS Brazilian patients with inflammatory bowel diseases (IBD) requiring therapy with biological agents usually have access to medicines through the National Unified Health Care System (SUS). This study aimed to analyze Brazilian IBD patient perception regarding access (availability and provision quality) to high-cost drugs in the public health care system. METHODS A questionnaire-based survey was carried out in an IBD referral center in Brazil. All adult patients with an established diagnosis of ulcerative colitis (UC) or Crohn's disease (CD) that use biological therapy were invited to participate. Data were collected on the biological in use, lack of distribution (number of absences, average time to regularization, impairment in patient treatment), and difficulties reported by patients in obtaining the drugs. RESULTS Overall, 205 patients met the inclusion criteria and answered the questionnaire. Most of the patients had CD (n = 161, 78.5%), nearly half of them (n = 104, 50.7%) were female; 87 patients (42.4%) were unemployed, and of these, 40 patients (19.5%) had government assistance as the main source of income. Regarding the medications used, infliximab (n = 128, 62.5%) was the most used medication, followed by adalimumab (n = 39, 19.0%). Most patients (n = 172, 83.9%) reported at least one failed delivery of biological medicine in the last year, with a single shortage in forty-two patients (24.4%), at least two shortages in forty-seven patients (27.3%), and three or more shortages in seventy-eight patients (45.3%). The average time to regularize the distribution was up to 1 month in 44 cases (25.6%), up to 2 months in 64 cases (37.2%), and more than 3 months in 56 patients (32.6%). Among patients who reported delays, 101 patients (58.7%) felt that it may have impaired their treatment. CONCLUSION Brazilian IBD patients reported high rates of failure to dispense biological drugs by the national healthcare system within one year. Our data highlight the need for improvement in this system for the correct supply of medication to avoid treatment failure and relapse.
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Affiliation(s)
- Rogerio Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Sandro da Costa Ferreira
- Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Vanessa Foresto Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Cintia Maura Caseiro Nigro
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - José Joaquim Ribeiro da Rocha
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | | | - Omar Feres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
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9
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Martins AL, Galhardi Gasparini R, Sassaki LY, Saad-Hossne R, Ritter AMV, Barreto TB, Marcolino T, Yang Santos C. Intestinal complications in Brazilian patients with ulcerative colitis treated with conventional therapy between 2011 and 2020. World J Gastroenterol 2023; 29:1330-1343. [PMID: 36925457 PMCID: PMC10011965 DOI: 10.3748/wjg.v29.i8.1330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/09/2022] [Accepted: 02/14/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND This was an observational, descriptive, and retrospective study from 2011 to 2020 from the Department of Informatics of the Brazilian Healthcare System database.
AIM To describe the intestinal complications (IC) of patients with ulcerative colitis (UC) who started conventional therapies in Brazil´s public Healthcare system.
METHODS Patients ≥ 18 years of age who had at least one claim related to UC 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code and at least 2 claims for conventional therapies were included. IC was defined as at least one claim of: UC-related hospitalization, procedures code for rectum or intestinal surgeries, and/or associated disease defined by ICD-10 codes (malignant neoplasia of colon, stenosis, hemorrhage, ulcer and other rectum or anus disease, megacolon, functional diarrhea volvulus, intussusception and erythema nodosum). Descriptive statistics, annual incidence, and incidence rate (IR) [per 100 patient-years (PY)] over the available follow-up period were cal-culated.
RESULTS In total, 41229 UC patients were included (median age, 48 years; 65% women) and the median (interquartile range) follow-up period was 3.3 (1.8-5.3) years. Conventional therapy used during follow-up period included: mesalazine (87%), sulfasalazine (15%), azathioprine (16%) or methotrexate (1%) with a median duration of 1.9 (0.8-4.0) years. Overall IR of IC was 3.2 cases per 100 PY. Among the IC claims, 54% were related to associated diseases, 20% to procedures and 26% to hospitalizations. The overall annual incidence of IC was 2.9%, 2.6% and 2.5% in the first, second and third year after the first claim for therapy (index date), respectively. Over the first 3 years, the annual IR of UC-related hospitalizations ranged from 0.8% to 1.1%; associated diseases from 0.9% to 1.2% - in which anus or rectum disease, and malignant neoplasia of colon were the most frequently reported; and procedure events from 0.6% to 0.7%, being intestinal resection and polyp removal the most frequent ones.
CONCLUSION Study shows that UC patients under conventional therapy seem to present progression of disease developing some IC, which may have a negative impact on patients and the burden on the health system.
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Affiliation(s)
- Adalberta Lima Martins
- Espirito Santo Health Office, State Office for Pharmaceutical Assistance, Espirito Santos 29056-030, Brazil
| | | | - Ligia Yukie Sassaki
- Department of Gastroenterology, Sao Paulo State University, Medical School, Botucatu 18618-687, Brazil
| | - Rogerio Saad-Hossne
- Department of Gastroenterology, Sao Paulo State University, Medical School, Botucatu 18618-687, Brazil
| | | | - Tania Biatti Barreto
- Department of Gastroenterology, Takeda Pharmaceuticals Brazil, Sao Paulo 04794-000, Brazil
| | - Taciana Marcolino
- Department of Gastroenterology, Takeda Pharmaceuticals Brazil, Sao Paulo 04794-000, Brazil
| | - Claudia Yang Santos
- Department of Gastroenterology, Takeda Pharmaceuticals Brazil, Sao Paulo 04794-000, Brazil
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10
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Oliveira CRD, Alvarenga P, Paixão C. Repercussões das Doenças Inflamatórias Intestinais no Desenvolvimento Socioemocional de Pacientes Pediátricos. REVISTA PSICOLOGIA E SAÚDE 2023. [DOI: 10.20435/pssa.v14i3.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Este estudo descreve as repercussões dos sintomas das doenças inflamatórias intestinais (DII) nas emoções, na vida escolar e nas interações sociais de pacientes pediátricos. Participaram 20 cuidadores de crianças e adolescentes com idades entre cinco e 17 anos e diagnosticados com alguma DII. Os cuidadores, que tinham entre 26 e 54 anos, forneceram informações clínicas e sociodemográficas e responderam a um questionário sobre as repercussões dos sintomas das DII na vida das crianças e dos adolescentes. A análise das frequências absolutas e relativas e o teste de aderência revelaram que os impactos dos sintomas foram significativamente maiores nas emoções quando comparados aos impactos na vida escolar e nas interações sociais (X² = 6,14; df= 2; p= 0,04). O tratamento das DII deve incluir a construção de planos terapêuticos sensíveis às necessidades psicossociais dos pacientes pediátricos.
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11
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Facanali CBG, Sobrado Junior CW, Fraguas Junior R, Facanali Junior MR, Boarini LR, Sobrado LF, Cecconello I. The relationship of major depressive disorder with Crohn's disease activity. Clinics (Sao Paulo) 2023; 78:100188. [PMID: 36989545 PMCID: PMC10091387 DOI: 10.1016/j.clinsp.2023.100188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/02/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Crohn's disease (CD) has been related to an increased prevalence of psychiatric disorders and suicide risk (SR). However, the nature of their relationship still deserves clarification. The aim of this study is to assess the prevalence of major depressive disorder (MDD) in patients with CD, and to investigate the relationship between MDD and CD outcomes. METHODS A cross-sectional study involving CD patients was performed. CD activity was evaluated by the Harvey-Bradshaw index and CD phenotype by the Montreal classification. The presence of MDD was assessed by the Patient Health Questionnaire score-9 (PHQ-9). Sociodemographic data and other characteristics were retrieved from electronic medical records. RESULTS 283 patients with CD were included. The prevalence of MDD was 41.7%. Females had a risk of MDD 5.3 times greater than males. CD disease duration was inversely correlated with MDD severity. Individuals with active CD were more likely to have MDD (OR = 796.0; 95% CI 133.7‒4738.8) than individuals with CD remission. MDD was more prevalent in inflammatory behavior (45.5%) and there were no statistical differences regarding the disease location. 19.8% of the sample scored positive for SR. CONCLUSION The present results support data showing an increased prevalence of MDD in individuals with CD. Additionally, it indicates that MDD in CD might be related to the activity of CD. Prospective studies are warranted to confirm these results and to address whether MDD leads to CD activity, CD activity leads to MDD or both ways are existent.
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Affiliation(s)
- Carolina Bortolozzo Graciolli Facanali
- Colorectal Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Carlos Walter Sobrado Junior
- Colorectal Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renério Fraguas Junior
- Department and Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Divisão de Psiquiatria e Psicologia no Hospital Universitário da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcio Roberto Facanali Junior
- Colorectal Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lucas Rodrigues Boarini
- Colorectal Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lucas Faraco Sobrado
- Colorectal Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Colorectal Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Chebli JMF, Parra RS, Flores C, Moraes AC, Nones RB, Gomes TNF, Perdomo AMB, Scapini G, Zaltman C. Effectiveness and Safety of Ustekinumab for Moderate to Severely Active Crohn's Disease: Results from an Early Access Program in Brazil. J Clin Med 2022; 11:6481. [PMID: 36362709 PMCID: PMC9654680 DOI: 10.3390/jcm11216481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
This prospective, observational, open-label study aimed to provide access to ustekinumab prior to market authorization and assess its safety and effectiveness in patients with Crohn's disease (CD) refractory to anti-tumor necrosis factor-α and conventional drugs in Brazil. Patients with a diagnosis of moderate-to-severe active CD for ≥3 months before screening received ustekinumab in a single intravenous induction dose (~6 mg/kg) at week 0, and a 90 mg maintenance dose, subcutaneously, every 8 or 12 weeks, from week 8 through to 80. Serious adverse events (SAE), adverse drug reactions (ADR), clinical response (per CD Activity Index and Harvey Bradshaw Index (HBI) scores), remission (per HBI scores), biomarkers (C-reactive protein (CRP) and fecal calprotectin (FC)) and endoscopic improvement rate over 80 weeks were assessed. Patients with a mean age of 39.9 years were assessed. Discontinuation rate was low (23%) and most adverse events were mild (68.7%). The SAE rate was 21% (mostly infections/infestations or gastrointestinal disorder), and ADR rate was 44%. The CD Activity Index and HBI scores decreased (by 74% and 81%, respectively) with 50% of patients showing normalized CRP and FC, and 63% achieved endoscopic improvement. Ustekinumab was fairly safe, well tolerated and effective in a Brazilian cohort of CD patients.
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Affiliation(s)
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto 14049-900, Brazil
| | - Cristina Flores
- Reference Center in Crohn and Colitis, Digestive System Institute, Rio Grande do Sul 90560-002, Brazil
| | | | - Rodrigo Bremer Nones
- Gastroenterology Unit, Hospital of Nossa Senhora das Graças, Curitiba 80810-040, Brazil
| | | | | | - Gustavo Scapini
- Johnson-Johnson and Internal Former Janssen-Cilag Pharmaceutical, São Paulo 04543-011, Brazil
| | - Cyrla Zaltman
- Internal Medicine Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil
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13
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Shao B, Yang W, Cao Q. Landscape and predictions of inflammatory bowel disease in China: China will enter the Compounding Prevalence stage around 2030. Front Public Health 2022; 10:1032679. [PMID: 36388296 PMCID: PMC9641090 DOI: 10.3389/fpubh.2022.1032679] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/10/2022] [Indexed: 01/29/2023] Open
Abstract
Background This study aims to explore the epidemiological trends of inflammatory bowel disease (IBD) over the past three decades in China and further predict the trends of IBD in the next 25 years. Methods The prevalence, incidence, mortality, years of life lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and annual percentage changes of the above metrics of IBD in China from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019. The corresponding trends in the next 25 years were predicted. Results From 1990 to 2019, the cases of IBD in China raised to 484 thousand [95% uncertainty interval (UI) 411-571] and 427 thousand (366-498) among males and females, respectively. The age-standardized incidence rate of IBD increased from 1.72 per 100,000 population (1.44-2.05) to 3.35 per 100,000 population (2.88-3.88) among males and from 1.20 per 100,000 population (1.02-1.42) to 2.65 per 100,000 population (2.29-3.08) among females. The highest incidence rate occurred in people aged 35-39 years. The total YLDs attributed to IBD significantly increased, but the YLLs showed a decreasing trend, resulting in minor alterations of the DALYs. In the next 25 years, the incidence of IBD would continue to increase until a plateau by 2030, and IBD-related deaths would also increase to about 7.57 thousand by 2044 despite the decreasing age-standardized mortality rate. Similar trends were observed for both sexes, with a slight male predominance. Conclusions Although China is still a low-endemic area of IBD, the prevalence and incidence of IBD dramatically increased in the past three decades. The burden of IBD in China is expected to grow continuously in the next 25 years due to the large population base and severe aging problem. China is estimated to enter the Compounding Prevalence stage around 2030.
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Affiliation(s)
- Bule Shao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,*Correspondence: Bule Shao
| | - Wenjing Yang
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Qian Cao
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Cassol OS, Zabot GP, Saad-Hossne R, Padoin A. Epidemiology of inflammatory bowel diseases in the state of Rio Grande do Sul, Brazil. World J Gastroenterol 2022; 28:4174-4181. [PMID: 36157112 PMCID: PMC9403431 DOI: 10.3748/wjg.v28.i30.4174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/22/2022] [Accepted: 07/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This is the first study on the epidemiology of inflammatory bowel diseases (IBDs) in Rio Grande do Sul (RS), the southernmost state of Brazil with the country’s fifth largest population. Crohn’s disease (CD) and ulcerative colitis (UC) are collectively termed IBDs. They have high incidence and prevalence rates in high-income countries, although in recent years there has been a change in the classic geographical distribution of IBDs, with growing rates in traditionally low-incidence regions.
AIM To estimate the incidence and prevalence of IBDs in the RS state, Brazil, between 2014 and 2019.
METHODS This is a cross-sectional descriptive observational study. Patients with IBD who had initiated treatment and met the inclusion criteria of the RS state free drug distribution program were included. Data were obtained from registration or renewal records of the RS state specialty pharmacy. The male, female, and total populations were estimated according to mid-year data from the Brazilian Institute of Geography and Statistics, which served as a reference for calculating the incidence and prevalence rates of IBDs during the study period. Results were described using mean, standard deviation, and range.
RESULTS We included 1082 patients with IBD, of whom 57.5% were female and 42.5% were male. Patients with CD accounted for 72.45% of the sample, and those with UC accounted for 27.54%. IBD prevalence during the study period was 9.51 per 100000 population, of which 6.89 corresponded to people with CD and 2.62, to people with UC. Incidence rates per 100000 population/year were 2.54 in 2014, 2.61 in 2015, 1.91 in 2016, 0.80 in 2017, 0.83 in 2018, and 0.96 in 2019. The mean IBD incidence rate per 100000 population was 1.61, of which 1.17 corresponded to CD and 0.44, to UC. The mean age was 41 years, and patients were mostly aged 30-40 years. Prevalence by region was higher in the state capital metropolitan area: 12.69 per 100000 population.
CONCLUSION Our results demonstrated an IBD prevalence of 9.51% and incidence of 1.61 per 100000 population. The patients were predominantly female, and CD was more prevalent than UC.
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Affiliation(s)
- Ornella Sari Cassol
- Department of Coloproctology, IMED Medical School, Passo Fundo 99010260, RS, Brazil
- Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre 90610001, RS, Brazil
| | - Gilmara Pandolfo Zabot
- Department of Coloproctology, Coloprocto Canoas Clinic, Canoas 92310205, RS, Brazil
- Department of Coloproctology, Hospital Moinhos de Vento (HMV), Porto Alegre 90035000, RS, Brazil
| | - Rogerio Saad-Hossne
- Department of Surgery and Orthopaedics, Universidade Estadual Paulista (UNESP), Botucatu 18618687, SP, Brazil
| | - Alexandre Padoin
- Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre 90610001, RS, Brazil
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15
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Martins AL, Fróes RDSB, Zago-Gomes MDP. Prevalence, phenotype and medication for the pediatric inflammatory bowel disease population of a state in Southeastern Brazil. World J Clin Pediatr 2022; 11:341-350. [PMID: 36052115 PMCID: PMC9331404 DOI: 10.5409/wjcp.v11.i4.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/23/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) can lead to social and economic impacts worldwide. In Brazil, where its adult prevalence is increasing, the epidemiology of the pediatric population is not well known, although there is a documented increase in pediatric IBD incidence worldwide. Brazil has continental dimensions, and Espírito Santo is a state of southeastern Brazil, the region with the highest demographic densities and is the economically most important in the country.
AIM To assess the prevalence, incidence, phenotype and medications in a Southeastern Brazilian pediatric population.
METHODS Data were retrieved from the Public Medication-Dispensing System of the Department of Health in Espírito Santo state from documentation required to have access to highly expensive medication from August 1, 2012 to July 31, 2014. There were 1048 registered patients with IBD of all ages, and of these patients, the cases ≤ 17 years were selected. The data were obtained through the analysis of administrative requests for these medications and included medical reports, endoscopy exams, histopathology and imaging tests, which followed the Clinical Protocols and Therapeutic Guidelines of the Brazilian Government. Only confirmed cases of IBD were included in the study.
RESULTS There were 55 pediatric patients/1048 registered patients (5.34%), with Crohn's disease (CD) representing 30/55 (55%), ulcerative colitis (UC) 24/55 (43.6%) and 1 unclassified IBD, a significant difference from adult patients (P = 0.004). The prevalence of IBD in pediatric patients was 5.02 cases/100.000 inhabitants; the incidence in 2014 was 1.36 cases/100.000 inhabitants. The mean age at diagnosis was 12.2 years (± 4.2). There were 7 children diagnosed up to 6 years old, 7 between 7 to 10 years old and 41 between 11 and ≤ 17 years old. There was no difference in the distribution of UC and CD between these age categories (P = 0.743). There was no difference in gender distribution in relation to adults. Children and adolescents with UC had a predominance of pancolitis, unlike adults (P = 0.001), and used aminosalicylates and immunomodulators for their treatment. Pediatric patients with CD did not present a difference in disease location but had a higher frequency of fistulizing behavior (P = 0.03) and perianal disease phenotype (P = 0.007) than adult patients. Patients with CD used more immunomodulators and biological therapy. Treatment with biological therapy was more frequently used in pediatric patients than in adults (P < 0.001).
CONCLUSION Although the data from this study demonstrate that incidence and prevalence rates are low in southeastern Brazil, these data demonstrate the severity of IBD in pediatric patients, with the need for early diagnosis and therapy, avoiding serious damage.
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Affiliation(s)
- Adalberta Lima Martins
- Pharmaceutical Assistance, Health Department of Espírito Santo, Vitoria 29052-210, Espírito Santo, Brazil
| | | | - Maria da Penha Zago-Gomes
- Departament of Medical Clinical, Hospital Universitário Cassiano Antonio Moraes, Vitoria 29042-755, Espírito Santo, Brazil
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Renuzza SSS, Vieira ER, Cornel CA, Lima MN, Ramos Junior O. INCIDENCE, PREVALENCE, AND EPIDEMIOLOGICAL CHARACTERISTICS OF INFLAMMATORY BOWEL DISEASES IN THE STATE OF PARANÁ IN SOUTHERN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:327-333. [PMID: 36102427 DOI: 10.1590/s0004-2803.202203000-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The epidemiology of inflammatory bowel diseases (IBD) varies between different regions of Brazil. This cross-sectional study examined the epidemiological characteristics of IBD in the Southern Brazilian state of Paraná. METHODS We included patients with IBD (n=6.748) selected across 11,468,818 population of Paraná. All patients had a known diagnosis of either Crohn's disease (CD) or ulcerative colitis (UC) and had started treatment through the Government Program of the Brazilian Unified Health System (2010-2019). The primary outcomes were changes in the incidence and prevalence rates of IBD. RESULTS The study population consisted of 4.931 (73.1%) patients with UC and 1.817 (26.9%) patients with CD. In participants aged 11-30 years, CD was more common, while in participants aged 40-80 years, UC predominated. UC was more common in female compared to male patients, with a similar incidence between the sexes evident for CD. In 2010, the incidence of IBD was 2.00/100,00 population; this increased to 13.77/100,000 population by 2019. The highest concentration of IBD patients was found in the eastern macro-region of Paraná, which includes the 2nd Health Regional of Curitiba, where the capital of the state is located. CONCLUSION This is the first study to describe the epidemiological characteristics of IBD in the state of Paraná and showed an increase in its incidence and prevalence. We also identified that IBD was concentrated in the eastern macro-region of this Brazilian state.
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Affiliation(s)
| | - Elizabete Regina Vieira
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
| | - César Augusto Cornel
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
| | - Mônica Nunes Lima
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
| | - Odery Ramos Junior
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
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Quaresma AB, Damiao AO, Coy CS, Magro DO, Hino AA, Valverde DA, Panaccione R, Coward SB, Ng SC, Kaplan GG, Kotze PG. Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100298. [PMID: 36777324 PMCID: PMC9903988 DOI: 10.1016/j.lana.2022.100298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Population-based data on epidemiology of Inflammatory Bowel Diseases (IBD) in Brazil are scarce. This study aims to define temporal trends of incidence and prevalence rates of Crohn's disease (CD) and ulcerative colitis (UC) in Brazil. Methods All IBD patients from the public healthcare national system were included from January 2012 to December 2020. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using log-linear regression for incidence and binomial regression for prevalence. Moran's I autocorrelation index was used to analyse clustering of cities by level of prevalence. Findings A total of 212,026 IBD patients were included. Incidence of IBD rose from 9.4 in 2012 to 9.6 per 100,000 in 2020 (AAPC=0.8%; 95% CI -0.37, 1.99); for UC, incidence increased from 5.7 to 6.9 per 100,000 (AAPC=3.0%; 95% CI 1.51, 4.58) and for CD incidence decreased from 3.7 to 2.7 per 100,000 (AAPC=-3.2%; 95% CI -4.45, -2.02). Prevalence of IBD increased from 30.0 in 2012 to 100.1 per 100,000 in 2020 (AAPC=14.8%; CI 14.78-14.95); for UC, from 15.7 to 56.5 per 100,000 (AAPC=16.0%; CI 15.94, 16.17); for CD from 12.6 to 33.7 per 100,000 (AAPC=12.1% CI 11.95, 12.02). A south-north gradient was observed in 2020 prevalence rates of IBD [I=0.40 (p<0.0001)], CD [I=0.22 (p<0.0001)] and UC [I=0.42 (p<0.0001)]. Interpretation Incidence of CD is decreasing whereas of UC is increasing, leading to stabilization in the incidence of IBD from 2012 to 2020 in Brazil. Prevalence of IBD has been climbing with 0.1% of Brazilians living with IBD in 2020. Funding None.
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Key Words
- AAPC, Average Annual Percent Change
- AC, Acre
- AL, Alagoas
- AM, Amazonas
- AP, Amapá
- BA, Bahia
- Brazil
- CAAE, Certificate of Presentation for Ethical Appreciation
- CD, Crohn's disease
- CE, Ceará
- CI, confidence intervals
- Crohn's disease
- DATASUS, Department of Health Informatics/Ministry of Health
- DF, Distrito federal
- ES, Espírito Santo
- Epidemiology
- GO, Goiás
- IBD, Inflammatory Bowel Diseases
- IBDU, Inflammatory Bowel Diseases undetermined
- IBGE, National Institute of Geographics and Statistics (Instituto Brasileiro de Geografia e Estatística)
- ICD-10, Classification of Diseases and Related Health Problems, Tenth Revision
- Incidence
- Inflammatory bowel disease
- MA, Maranhão
- MG, Minas Gerais
- MS, Mato Grosso do Sul
- MT, Mato Grosso
- PA, Pará
- PB, Paraíba
- PE, Pernambuco
- PI, Piauí
- PR, Paraná
- Prevalence
- RN, Rio Grande do Norte
- RO, Rondônia
- RR, Roraima
- RS, Rio Grande do Sul
- SC, Santa Catarina
- SE, Sergipe
- SP, São Paulo
- SUS, national public health system (Sistema Único de Saúde)
- TO, Tocantins
- UC, ulcerative colitis
- UNOESC, University of the West of Santa Catarina
- Ulcerative colitis
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Affiliation(s)
- Abel B. Quaresma
- Universidade do Oeste de Santa Catarina, UNOESC, Colorectal Surgery, Joaçaba, Brazil,Corresponding author.
| | | | - Claudio S.R. Coy
- University of Campinas UNICAMP, Colorectal Surgery Unit, Campinas, Brazil
| | - Daniela O. Magro
- University of Campinas UNICAMP, Colorectal Surgery Unit, Campinas, Brazil
| | - Adriano A.F. Hino
- Catholic University of Paraná, Health Sciences Postgraduate Program, Curitiba, Brazil
| | | | - Remo Panaccione
- University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Calgary, Canada
| | - Stephanie B. Coward
- University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Calgary, Canada
| | - Siew C. Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Gilaad G. Kaplan
- University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Calgary, Canada
| | - Paulo G. Kotze
- Catholic University of Paraná, Health Sciences Postgraduate Program, Curitiba, Brazil,Catholic University of Paraná, IBD outpatient Clinics, Colorectal Surgery Unit, Curitiba, Brazil
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18
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Parra RS, Chebli JMF, Queiroz NSF, Damião AOMC, de Azevedo MFC, Chebli LA, Bertges ER, Alves Junior AJT, Ambrogini Junior O, da Silva BLPS, Lubini M, Bafutto M, Flores C, Vilela EG, Boratto SF, Gasparetti Junior NLT, Steinwurz F, Carvalho NS, Féres O, da Rocha JJR. Long-term effectiveness and safety of ustekinumab in bio-naïve and bio-experienced anti-tumor necrosis factor patients with Crohn's disease: a real-world multicenter Brazilian study. BMC Gastroenterol 2022; 22:199. [PMID: 35448949 PMCID: PMC9027080 DOI: 10.1186/s12876-022-02280-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effectiveness of ustekinumab (UST) in the treatment of Crohn's disease (CD) has been demonstrated in the pivotal Phase 3 UNITI 1 and 2 and IM-UNITI studies in both anti-TNF-naïve and anti-TNF-exposed patients. Given the selective nature of pivotal trial designs, real-world effectiveness and safety studies are warranted. We report our experience with UST treatment in a large, real-world multicenter cohort of Brazilian patients with CD. METHODS We performed a retrospective multicenter study including patients with CD, predominantly biologically refractory CD, who received UST. The primary endpoint was the proportion of patients in clinical remission at weeks 8, 24 and 56. Possible predictors of clinical and biological response/remission and safety outcomes were also assessed. RESULTS Overall, 245 CD (mean age 39.9 [15-87]) patients were enrolled. Most patients (86.5%) had been previously exposed to biologics. According to nonresponder imputation analysis, the proportions of patients in clinical remission at weeks 8, 24 and 56 were 41.0% (n = 98/239), 64.0% (n = 153/239) and 39.3% (n = 94/239), respectively. A biological response was achieved in 55.4% of patients at week 8, and 59.3% were in steroid-free remission at the end of follow-up. No significant differences in either clinical or biological remission were noted between bio-naïve and bio-experienced patients. Forty-eight patients (19.6%) presented 60 adverse events during the follow-up, of which 8 (13.3%) were considered serious adverse events (3.2% of 245 patients). Overall, a proximal disease location, younger age, perianal involvement, and smoking were associated with lower rates of clinical remission over time. CONCLUSIONS UST therapy was effective and safe in the long term in this large real-life cohort of Brazilian patients with refractory CD, regardless of previous exposure to other biological agents.
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Affiliation(s)
- Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Zip code: 14048-900, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | - Cristina Flores
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Zip code: 14048-900, Brazil
| | - José Joaquim Ribeiro da Rocha
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Zip code: 14048-900, Brazil
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19
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Roselli M, Maruszak A, Grimaldi R, Harthoorn L, Finamore A. Galactooligosaccharide Treatment Alleviates DSS-Induced Colonic Inflammation in Caco-2 Cell Model. Front Nutr 2022; 9:862974. [PMID: 35495925 PMCID: PMC9047546 DOI: 10.3389/fnut.2022.862974] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/04/2022] [Indexed: 12/19/2022] Open
Abstract
The biological activities of dietary bioactive polysaccharides have been largely explored. Studies on the immunomodulating effects of oligosaccharides and polysaccharides have shown that they are able to modulate innate immunity. Prebiotics are a class of poorly digested carbohydrates that are mainly produced from dietary fibers, which are carbohydrate polymers with ten or more monomeric units as defined by the Codex Alimentarius Commission in 2009. Considering the capacity of prebiotics in reducing gut inflammation, the aim of this study was to investigate the anti-inflammatory activity of galactooligosaccharide (Bimuno® GOS) in an in vitro model of ulcerative colitis (UC)-like inflamed intestinal cells. Differentiated Caco-2 cells were exposed to 2 % dextran-sulfate-sodium salt (DSS) to induce inflammation, and then with different concentrations of Bimuno GOS (1-1,000 μg/ml). Cell monolayer permeability, tight- and adherent junction protein distribution, pro-inflammatory cytokine secretion, and NF-kB cascade were assessed. Bimuno GOS at different concentrations, while not affecting cell monolayer permeability, was shown to counteract UC-like intestinal inflammatory responses and damages induced by DSS. Indeed, Bimuno GOS was able to counteract the detrimental effects of DSS on cell permeability, determined by transepithelial electrical resistance, phenol red apparent permeability, and tight- and adherent junction protein distribution. Furthermore, Bimuno GOS inhibited the DSS-induced NF-kB nuclear translocation and pro-inflammatory cytokine secretion. Further analyses showed that Bimuno GOS was able to revert the expression levels of most of the proteins involved in the NF-kB cascade to control levels. Thus, the prebiotic Bimuno GOS can be a safe and effective way to modulate the gut inflammatory state through NF-kB pathway modulation, and could possibly further improve efficacy in inducing remission of UC.
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Affiliation(s)
- Marianna Roselli
- Research Centre for Food and Nutrition, CREA (Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria), Rome, Italy
| | | | | | | | - Alberto Finamore
- Research Centre for Food and Nutrition, CREA (Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria), Rome, Italy
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20
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Serafini MA, Paz AH, Nunes NS. Cholinergic immunomodulation in inflammatory bowel diseases. Brain Behav Immun Health 2022; 19:100401. [PMID: 34977822 PMCID: PMC8683952 DOI: 10.1016/j.bbih.2021.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 12/28/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are chronic intestinal disorders characterized by dysregulated immune responses to resident microbiota in genetically susceptible hosts. The activation of the cholinergic system has been proposed for the treatment of IBD patients according to its potential anti-inflammatory effect in vivo. The α-7-nicotinic-acetylcholine receptor (α7nAChR) is involved in the inhibition of inflammatory processes, modulating the production of cytokines, suppressing dendritic cells and macrophage activity, leading to the suppression of T cells. In this review, we address the most recent studies and clinical trials concerning cholinergic signaling and its therapeutic potential for inflammatory bowel diseases.
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Affiliation(s)
- Michele A. Serafini
- Biological Sciences, Physiology Graduate Program, Federal University of Rio Grande do Sul, 90050170, Porto Alegre, Brazil
- Cells, Tissue and Genes Laboratory, Experimental Research Center, Hospital de Clinicas de Porto Alegre, 90035903, Porto Alegre, Brazil
| | - Ana H. Paz
- Morphological Sciences Department, Basic Health Sciences Institute, Federal University of Rio Grande do Sul, 90050170, Porto Alegre, Brazil
- Cells, Tissue and Genes Laboratory, Experimental Research Center, Hospital de Clinicas de Porto Alegre, 90035903, Porto Alegre, Brazil
| | - Natalia S. Nunes
- Experimental Transplantation Immunotherapy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 20852, Bethesda, MD, USA
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21
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Fucilini LMP, Genaro LM, Sousa DCE, Coy CSR, Leal RF, Ayrizono MDLS. EPIDEMIOLOGICAL PROFILE AND CLINICAL CHARACTERISTICS OF INFLAMMATORY BOWEL DISEASES IN A BRAZILIAN REFERRAL CENTER. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:483-490. [PMID: 34909854 DOI: 10.1590/s0004-2803.202100000-87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The increase in the incidence and prevalence rates of inflammatory bowel disease (IBD) is evident in many newly industrialized countries in Asia, Africa, Eastern Europe, and the American continent. In Brazil, records are still scarce, and further studies on this topic are needed. OBJECTIVE To evaluate the epidemiological profile and clinical characteristics of patients with IBD who were followed up at a reference service in the state of São Paulo. METHODS We retrospectively analyzed the medical records of patients with IBD who were followed up in a Brazilian Referral Center. RESULTS A total of 625 patients was evaluated, 416 with Crohn's disease (CD), 190 with ulcerative colitis (UC), and 19 with indeterminate colitis. The average age of the patients was 31.6 years, with a homogeneous distribution between males and females patients. In patients with CD, the most predominant Montreal classification was A2, L3, and B1, with 44.8% of patients presenting with perianal disease; in UC, it was E2, and S0. The main extraintestinal manifestation was rheumatologic, followed by cutaneous and ophthalmic lesions. The majority of patients (85.4%) used some type of medication, the most frequent being aminosalicylates in patients with UC and biological therapy in patients with CD. Regarding surgeries, in CD, a significant percentage of patients underwent some type of surgical procedure, unlike the UC patients, including fistulotomies and placement of seton, derivative ostomies, enterectomy, ileocecectomy/right colectomy, total or partial colectomy, and strictureplasty. Only 195 (31.2%) patients lived in the city of Campinas, while 443 (70.9%) were from the 7th Regional Health Department (RHD), which corresponds to the macro-region of Campinas. CONCLUSION In this study, most patients came from the 7th RHD of Campinas; the patients were young, with no predominance of either sex; there was a higher frequency of patients with CD (66.6%). Most of them (85.4%) were undergoing pharmacological treatment, and a significant percentage of CD patients had undergone surgery.
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Affiliation(s)
| | | | | | | | - Raquel Franco Leal
- Universidade de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
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22
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Martins KR, Araújo JMD, Cruz ÁC, Luiz-Ferreira A. EPIDEMIOLOGIC ASPECTS OF INFLAMMATORY BOWEL DISEASE IN THE WESTERN REGION OF MINAS GERAIS STATE. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:377-383. [PMID: 34705974 DOI: 10.1590/s0004-2803.202100000-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC), two of the main inflammatory bowel diseases (IBD), have been increasingly diagnosed in South America. Although IBD have been intensively studied in the last years, epidemiologic data in Brazil are scarce. OBJECTIVE To study the clinical and epidemiologic profile of IBD patients treated in the Clinical Hospital of the Federal University of Uberlândia from 1999 to 2014. METHODS We performed a retrospective study of the medical records of patients diagnosed with IBD, according to the international classification of diseases (ICD) - ICD K50 for CD and ICD K51 for UC - confirmed by endoscopic examination in the case of both diseases. We analyzed the following variables: age; sex; ethnicity; smoking habit; primary diagnosis; site of disease manifestation; main clinical manifestations; IBD-related complications; extraintestinal manifestations; and established drug and/or surgical treatment. RESULTS We evaluated 183 IBD cases (91 UC and 92 CD cases). The estimated prevalence rate of UC was 15.06/100.000 inhabitants and of CD was 15.23/100.000. The CU and CD female to male incidence ratios were 1.7 and 1.8, respectively. The average age of patients diagnosed with UC was 39.4 years and of those diagnosed with CD was 31.1 years. White-skinned people were the most affected by UC (66.0%) and CD (69.0%). Few patients were submitted to surgical procedures as treatment alternative. CONCLUSION The estimated prevalence of IBD in this population was low compared to that of populations of North America, but high compared to that of other regions considered to present low incidence, such as some Asian and Latin American countries.
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Affiliation(s)
- Kamila Rosa Martins
- Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Uberlândia, MG, Brasil.,Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
| | - Joniel Mendes de Araújo
- Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
| | - Álefe Cardoso Cruz
- Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
| | - Anderson Luiz-Ferreira
- Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
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23
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de Sá Brito Fróes R, da Luz Moreira A, Carneiro AJDV, Moreira JPL, Luiz RR, de Barros Moreira AMH, Monnerat CC, de Souza HSP, Carvalho ATP. Prevalence, Indirect Costs, and Risk Factors for Work Disability in Patients with Crohn's Disease at a Tertiary Care Center in Rio de Janeiro. Dig Dis Sci 2021; 66:2925-2934. [PMID: 33044678 DOI: 10.1007/s10620-020-06646-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) can lead to work disability with social and economic impacts worldwide. In Brazil, where its prevalence is increasing, we assessed the indirect costs, prevalence, and risk factors for work disability in the state of Rio de Janeiro and in a tertiary care referral center of the state. METHODS Data were retrieved from the database of the Single System of Social Security Benefits Information, with a cross-check for aid pension and disability retirement. A subanalysis was performed with CD patients followed up at the tertiary care referral center using a prospective CD database, including clinical variables assessed as possible risk factors for work disability. RESULTS From 2010 to 2018, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs of US$ 8,562,195.86. Permanent disability occurred more frequently in those aged 40 to 49 years. In the referral center, the prevalence of work disability was 16.7%, with a mean interval of 3 years between diagnosis and the first benefit. Risk factors for absence from work were predominantly abdominal surgery, anovaginal fistulas, disease duration, and the A2 profile of the Montreal classification. CONCLUSIONS In Rio de Janeiro, work disability affects one-sixth of CD patients, and risk factors are associated with disease duration and complications. In the context of increasing prevalence, as this disability compromises young patients after a relatively short period of disease, the socioeconomic burden of CD is expected to increase in the future.
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Affiliation(s)
- Renata de Sá Brito Fróes
- Disciplina de Gastroenterologia e Endoscopia Digestiva, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20551-900, Brazil
- Perícia Médica Federal (PMF), Superintendência Regional 9 da Subsecretaria de PMF do Ministério da Economia, Rio de Janeiro, RJ, 20030-030, Brazil
| | - André da Luz Moreira
- Disciplina de Proctologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20551-900, Brazil
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Antonio José de V Carneiro
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
| | - Jessica P L Moreira
- Instituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21944-970, Brazil
| | - Ronir R Luiz
- Instituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21944-970, Brazil
| | - Adriana Maria Hilu de Barros Moreira
- Perícia Médica Federal (PMF), Superintendência Regional 9 da Subsecretaria de PMF do Ministério da Economia, Rio de Janeiro, RJ, 20030-030, Brazil
| | - Camila Cesar Monnerat
- Perícia Médica Federal (PMF), Superintendência Regional 9 da Subsecretaria de PMF do Ministério da Economia, Rio de Janeiro, RJ, 20030-030, Brazil
| | - Heitor Siffert Pereira de Souza
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil.
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.
| | - Ana Teresa Pugas Carvalho
- Disciplina de Gastroenterologia e Endoscopia Digestiva, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20551-900, Brazil
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24
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Queiroz NSF, Teixeira FV, Motta MP, Chebli LA, Hino AAF, Martins CDA, Quaresma AB, Silva AADPD, Damião AOMC, Saad-Hossne R, Kotze PG. Risk stratification and geographical mapping of Brazilian inflammatory bowel disease patients during the COVID-19 outbreak: Results from a nationwide survey. World J Gastroenterol 2021; 27:1226-1239. [PMID: 33828396 PMCID: PMC8006093 DOI: 10.3748/wjg.v27.i12.1226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic is still evolving globally, and Brazil is currently one of the most affected countries. It is still debated whether patients with inflammatory bowel disease (IBD) are at a higher risk for developing COVID-19 or its complications. AIM To assess geographical distribution of IBD patients at the highest risk and correlate these data with COVID-19 mortality rates in Brazil. METHODS The Brazilian IBD Study Group (Grupo de Estudos da Doença Inflamatória Intestinal do Brasil) developed a web-based survey adapted from the British Society of Gastroenterology guidelines. The included categories were demographic data and inquiries related to risk factors for complications from COVID-19. Patients were categorized as highest, moderate or lowest individual risk. The Spearman correlation test was used to identify any association between highest risk and mortality rates for each state of the country. RESULTS A total of 3568 patients (65.3% females) were included. Most participants were from the southeastern and southern regions of Brazil, and 84.1% were using immunomodulators and/or biologics. Most patients (55.1%) were at moderate risk, 23.4% were at highest risk and 21.5% were at lowest risk of COVID-19 complications. No association between the proportion of IBD patients at highest risk for COVID-19 complications and higher mortality rates was identified in different Brazilian states (r = 0.146, P = 0.467). CONCLUSION This study indicates a distinct geographical distribution of IBD patients at highest risk for COVID-19 complications in different states of the country, which may reflect contrasting socioeconomic, educational and healthcare aspects. No association between high risk of IBD and COVID-related mortality rates was identified.
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Affiliation(s)
| | - Fábio Vieira Teixeira
- IBD Unit, Gastroenterology Department, Gastrosaúde Clinic, Marilia 17509190, SP, Brazil
| | | | - Liliana Andrade Chebli
- IBD Outpatient Clinics, Universidade Federal de Juiz de Fora, Juiz de Fora 36010-010, MG, Brazil
| | - Adriano Akira Ferreira Hino
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
| | - Camilla de Almeida Martins
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, SP, Brazil
| | - Abel Botelho Quaresma
- Departamento de Ciências da Saúde, Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba 89600-000, SC, Brazil
| | | | | | - Rogerio Saad-Hossne
- Botucatu Medical School, Paulista State University (UNESP), Botucatu 18600-050, SP, Brazil
| | - Paulo Gustavo Kotze
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
- IBD Outpatient Clinics, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
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25
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Gomes TNF, de Azevedo FS, Argollo M, Miszputen SJ, Ambrogini O. Clinical and Demographic Profile of Inflammatory Bowel Disease Patients in a Reference Center of São Paulo, Brazil. Clin Exp Gastroenterol 2021; 14:91-102. [PMID: 33762838 PMCID: PMC7982433 DOI: 10.2147/ceg.s288688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract with an increasing incidence in developing countries. Purpose To report clinical and demographic data of CD and UC at a referral center for inflammatory bowel disease (IBD) in São Paulo. Patients and Methods We conducted a retrospective cross-sectional study on adult patients with established IBD. Demographic and clinical data were obtained by medical records analysis from the IBD Outpatient Clinic of EPM-UNIFESP, from October 1997 to October 2017. Results Of 658 patients included, 355 had UC (54%) and 303 had CD (46%). UC was more prevalent in women than CD (219 [61.7%] vs 152 [50.2%], p=0.003). The median time between the onset of symptoms and diagnosis was 13 (5-38) months, with a longer duration for CD patients. CD mostly affected the ileocolonic location (47.9%). CD patients with stricture, fistula and/or perianal disease (213/303, 70.3%) were younger at diagnosis, had a longer disease duration, higher rates of corticosteroid, immunomodulatory, and biological therapy, hospitalization, and referral to surgery, compared to patients without complication. Extensive colitis was the most common extension of UC (50.6%), which was more frequently associated with younger age at diagnosis, hepatobiliary disease, increased need for hospitalization, higher use of immunomodulatory, and biologic therapy, compared to patients with less extensive disease. In the last 5 years, CD patients were more frequently on biologic and/or immunomodulatory (70.9%) therapy, and UC patients often received salicylates (78.1%) and immunomodulatory (28.1%) treatments. There was a consistent reduction in salicylate usage for CD in the last 5 years compared to the total period of follow-up. Conclusion Despite the increasing incidence, we highlight the diagnostic delay and a more complicated CD and extensive UC in this cohort, reflecting a high need for immunomodulatory and biological treatment, hospitalization, and surgery.
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Affiliation(s)
- Tarcia Nogueira Ferreira Gomes
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Fabio Silva de Azevedo
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marjorie Argollo
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sender Jankiel Miszputen
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Orlando Ambrogini
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Juliao-Baños F, Kock J, Arrubla M, Calixto O, Camargo J, Cruz L, Hurtado J, Clavijo A, Donado J, Schwartz S, Abreu MT, Damas OM. Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients. Medicine (Baltimore) 2021; 100:e24729. [PMID: 33607817 PMCID: PMC7899864 DOI: 10.1097/md.0000000000024729] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/18/2021] [Indexed: 01/05/2023] Open
Abstract
The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort.We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010-2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017.The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09-1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92-0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02-1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19-4.69 P < .001).Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.
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Affiliation(s)
| | - Joshua Kock
- Takeda Pharmaceuticals, Medical Department, Bogotá
- Department of Medicine, Universidad de La Sabana, Chía
| | - Mateo Arrubla
- Department of Internal Medicine, Pontificia Bolivariana University, Medellin
| | - Omar Calixto
- Department of Internal Medicine. Nueva Granada Militar University. Bogotá
| | | | - Lina Cruz
- General Medicine. Medellin Clinic, Medellin Colombia
| | - Juan Hurtado
- Department of Internal Medicine. Universidad de Antioquia
| | - Absalon Clavijo
- Department of Internal Medicine, Pontificia Bolivariana University, Medellin
| | - Jorge Donado
- Department of Internal Medicine, Pontificia Bolivariana University, Medellin
- Department of Epidemiology. Pablo Tobón Uribe Hospital
| | - Seth Schwartz
- Division of Public Health Sciences, University of Miami Miller School of Medicine and Departments of Kinesiology, Health Education, and Educational Psychology, College of Education, University of Texas at Austin
| | - Maria T. Abreu
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami FL USA
| | - Oriana M. Damas
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami FL USA
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Zaltman C, Parra RS, Sassaki LY, Santana GO, Ferrari MDLA, Miszputen SJ, Amarante HMBS, Kaiser Junior RL, Flores C, Catapani WR, Parente JML, Bafutto M, Ramos O, Gonçalves CD, Guimaraes IM, da Rocha JJR, Feitosa MR, Feres O, Saad-Hossne R, Penna FGC, Cunha PFS, Gomes TNF, Nones RB, Faria MAG, Parente MPPD, Scotton AS, Caratin RF, Senra J, Chebli JM. Real-world disease activity and sociodemographic, clinical and treatment characteristics of moderate-to-severe inflammatory bowel disease in Brazil. World J Gastroenterol 2021; 27:208-223. [PMID: 33510560 PMCID: PMC7807300 DOI: 10.3748/wjg.v27.i2.208] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases (IBD) is essential for improving disease management and patient outcomes. Brazil is the largest Latin American country, and it presents socioeconomic and health care differences across its geographical regions. This country has the highest increase in IBD incidence and prevalence in Latin America, but information about the clinical and treatment characteristics of IBD is scarce. AIM To describe the sociodemographic, clinical, and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast, South and Northeast/Midwest regions. METHODS Multicenter, cross-sectional study with a 3-year retrospective chart review component. Patients with moderate-to-severe Crohn's disease (CD) or ulcerative colitis (UC) were consecutively enrolled between October 2016 and February 2017. Active CD at enrollment was defined as a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or a calprotectin level > 200 μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year; active UC was defined as a partial Mayo score ≥ 5. Descriptive statistics were used to analyze all variables. RESULTS In a total of 407 included patients, CD was more frequent than UC, both overall (264 CD/143 UC patients) and by region (CD:UC ratios of 2.1 in the Southeast, 1.6 in the South and 1.2 in the Northeast/Midwest). The majority of patients were female (54.2% of CD; 56.6% of UC), and the mean ages were 45.9 ± 13.8 years (CD) and 42.9 ± 13.0 years (UC). The median disease duration was 10.0 (range: 0.5-45) years for both IBD types. At enrollment, 44.7% [95% confidence interval (CI): 38.7-50.7] of CD patients and 25.2% (95%CI: 18.1-32.3) of UC patients presented with active disease. More than 95% of IBD patients were receiving treatment at enrollment; CD patients were commonly treated with biologics (71.6%) and immunosuppressors (67.4%), and UC patients were commonly treated with mesalazine [5-Aminosalicylic acid (5-ASA)] derivates (69.9%) and immunosuppressors (44.1%). More than 50% of the CD patients had ileocolonic disease, and 41.7% presented with stricturing disease. One-quarter of CD patients had undergone CD-related surgery in the past 3 years, and this proportion was lower in the Northeast/Midwest region (2.9%). CONCLUSION In Brazil, there are regional variations in IBD management. CD outweighs UC in both frequency and disease activity. However, one-quarter of UC patients have active disease, and most are receiving 5-ASA treatment.
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Affiliation(s)
- Cyrla Zaltman
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, São Paulo, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu 18618-687, São Paulo, Brazil
| | | | - Maria de Lourdes Abreu Ferrari
- Department of Clinical Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Sender J Miszputen
- Department of Gastroenterology, Escola Paulista de Medicina, São Paulo 04023-900, Brazil
| | - Heda M B S Amarante
- Hospital de Clinicas, Universidade Federal do Parana, Curitiba 80060-900, Parana, Brazil
| | - Roberto Luiz Kaiser Junior
- Department of Proctology, Beneficencia Portuguesa Hospital/Kaiser Day Hospital, Sao Jose do Rio Preto 15015110, São Paulo, Brazil
| | - Cristina Flores
- Department of Gastroenterology and Hepatology Sciences, Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre 90560002, Rio Grande do Sul, Brazil
| | - Wilson R Catapani
- Department of Gastroenterology, Faculdade de Medicina do ABC, Santo Andre 09060-870, São Paulo, Brazil
| | - José Miguel Luz Parente
- Department of General Medicine, Gastroenterology Unit, University Hospital, Federal University of Piaui, Teresina 64049-550, Piauí, Brazil
| | - Mauro Bafutto
- Department of Gastroenterology, Faculdade de Medicina, Universidade Federal de Goiás, Goiania 74535-170, Goias, Brazil
| | - Odery Ramos
- Hospital de Clinicas, Universidade Federal do Parana, Curitiba 80060-900, Parana, Brazil
| | - Carolina D Gonçalves
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | | | - Jose J R da Rocha
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, São Paulo, Brazil
| | - Marley R Feitosa
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, São Paulo, Brazil
| | - Omar Feres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, São Paulo, Brazil
| | - Rogerio Saad-Hossne
- Department of Surgery, Botucatu Medical School at São Paulo State University (UNESP), Botucatu 18618687, São Paulo, Brazil
| | - Francisco Guilherme Cancela Penna
- Department of Clinical Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Pedro Ferrari Sales Cunha
- Department of Clinical Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Tarcia NF Gomes
- Department of Gastroenterology, UNIFESP, São Paulo 04040-002, Brazil
| | - Rodrigo Bremer Nones
- IBD unit, Gastroenterology Department, Hospital Nossa Senhora das Graças, Curitiba 80810-040, Parana, Brazil
| | | | | | - António S Scotton
- Department of Gastroenterology, CMIP Centro Mineiro de Pesquisa, Juiz de Fora 36010-570, Minas Gerais, Brazil
| | | | - Juliana Senra
- Clinical Research, Takeda Pharmaceuticals Brazil, São Paulo 04709-011, Brazil
| | - Júlio Maria Chebli
- Department of Medicine, University Hospital of Federal University of Juiz de Fora, Juiz de Fora 36036-247, Minas Gerais, Brazil
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Oliveira MC, Elias JB, Moraes DAD, Simões BP, Rodrigues M, Ribeiro AAF, Piron-Ruiz L, Ruiz MA, Hamerschlak N. A review of hematopoietic stem cell transplantation for autoimmune diseases: multiple sclerosis, systemic sclerosis and Crohn's disease. Position paper of the Brazilian Society of Bone Marrow Transplantation. Hematol Transfus Cell Ther 2021; 43:65-86. [PMID: 32418777 PMCID: PMC7910166 DOI: 10.1016/j.htct.2020.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 12/16/2022] Open
Abstract
Autoimmune diseases are an important field for the development of bone marrow transplantation, or hematopoietic stem cell transplantation. In Europe alone, almost 3000 procedures have been registered so far. The Brazilian Society for Bone Marrow Transplantation (Sociedade Brasileira de Transplantes de Medula Óssea) organized consensus meetings for the Autoimmune Diseases Group, to review the available literature on hematopoietic stem cell transplantation for autoimmune diseases, aiming to gather data that support the procedure for these patients. Three autoimmune diseases for which there are evidence-based indications for hematopoietic stem cell transplantation are multiple sclerosis, systemic sclerosis and Crohn's disease. The professional stem cell transplant societies in America, Europe and Brazil (Sociedade Brasileira de Transplantes de Medula Óssea) currently consider hematopoietic stem cell transplantation as a therapeutic modality for these three autoimmune diseases. This article reviews the evidence available.
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Affiliation(s)
- Maria Carolina Oliveira
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Juliana Bernardes Elias
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Belinda Pinto Simões
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | | | | | - Lilian Piron-Ruiz
- Associação Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Milton Arthur Ruiz
- Associação Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, SP, Brazil
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Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2021; 18:56-66. [PMID: 33033392 PMCID: PMC7542092 DOI: 10.1038/s41575-020-00360-x] [Citation(s) in RCA: 681] [Impact Index Per Article: 170.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease (IBD) is a global disease; its evolution can be stratified into four epidemiological stages: Emergence, Acceleration in Incidence, Compounding Prevalence and Prevalence Equilibrium. In 2020, developing countries are in the Emergence stage, newly industrialized countries are in the Acceleration in Incidence stage, and Western regions are in the Compounding Prevalence stage. Western regions will eventually transition to the Prevalence Equilibrium stage, in which the accelerating prevalence levels off as the IBD population ages and possibly as a result of an unexpected rise in mortality during the COVID-19 pandemic. Mitigating the global burden of IBD will require concerted efforts in disease prevention and health-care delivery innovations that respond to changing demographics of the global IBD population. In this Perspective, we summarize the global epidemiology of IBD and use these data to stratify disease evolution into four epidemiological stages.
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Affiliation(s)
- Gilaad G. Kaplan
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Joseph W. Windsor
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
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Kotze PG, Steinwurz F, Francisconi C, Zaltman C, Pinheiro M, Salese L, Ponce de Leon D. Review of the epidemiology and burden of ulcerative colitis in Latin America. Therap Adv Gastroenterol 2020; 13:1756284820931739. [PMID: 32695230 PMCID: PMC7350039 DOI: 10.1177/1756284820931739] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/12/2020] [Indexed: 02/04/2023] Open
Abstract
The incidence and prevalence of ulcerative colitis (UC) has been reported to be rising in newly industrialised regions, such as Latin America. Here, we review data from published studies reporting demographics and clinical aspects of UC in Latin America to further understand epidemiology and disease burden. The incidence and prevalence of UC in Latin America varied between regions and studies, ranging between 0.04 to 8.00/100,000 and 0.23 to 76.1/100,000, respectively, and generally increased over the period from 1986 to 2015. The majority of patients with UC were female (53.6-72.6%) and urban residents (77.8-97.4%). Extraintestinal manifestations were reported in approximately 26-89.4% of patients. Use of biologic therapies was generally low (0.8-16.2%), with the exception of Mato Grosso do Sul, Brazil, with a greater proportion of patients tending to receive 5-aminosalicylates, immunosuppressants or corticosteroids; colectomy rates varied between studies (1.5-22%). A high proportion of patients had moderate to severe UC (45.9-73.0%) and, in 11 of 19 studies, the greatest proportion of patients had extensive disease (pancolitis). Colorectal cancer (0-1.7%) and mortality rates (0-7.6%) were low. This evaluation of published studies may influence therapeutic approaches and the development of strategies to improve healthcare access and patient outcomes, although further high-quality studies are required in patients with UC in Latin America.
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Affiliation(s)
- Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Cajuru University Hospital, Catholic University of Paraná (PUCPR), Rua Bruno Filgueira, 369 cj.1205, Curitiba, PR, CEP 80440-220, Brazil
| | - Flavio Steinwurz
- Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Cyrla Zaltman
- IBD Outpatient Clinic, Division of Gastroenterology, Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Parra RS, Feitosa MR, Ferreira SDC, Rocha JJRD, Troncon LEDA, FÉres O. ANEMIA AND IRON DEFICIENCY IN INFLAMMATORY BOWEL DISEASE PATIENTS IN A REFERRAL CENTER IN BRAZIL: PREVALENCE AND RISK FACTORS. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:272-277. [PMID: 33027478 DOI: 10.1590/s0004-2803.202000000-51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data regarding the prevalence of anemia in inflammatory bowel disease (IBD) patients are scarce in Brazil. Anemia and iron deficiency anemia have been known to cause significant functional impairment, lower quality of life, and higher morbidity and mortality and may be correlated with an impact on the cost of treatment. OBJECTIVE The aim of this study was to estimate the prevalence and risk factors for anemia and iron deficiency anemia in patients with IBD in a tertiary IBD unit in Southeast Brazil. METHODS We conducted an Institutional Review Board-approved retrospective analysis of an adult IBD cohort (IBD Unit, Ribeirão Preto Medical School, University of São Paulo, Brazil) consisting of 579 patients between January 2014 and July 2018. Clinicoepidemiological data, hemoglobin measurements and serum ferritin were extracted from electronic medical records. Anemia prevalence was calculated among ulcerative colitis (UC) and Crohn's disease (CD) phenotypes. Risk factors for anemia were also calculated. RESULTS A total of 529 (91%) patients had complete blood counts available in their medical records. Only 35.5% of IBD patients were fully screened for anemia. The prevalence of anemia in IBD patients was 24.6% (29.1% in CD and 19.1% in UC, P=0.008). The anemia was moderate to severe in 16.9% (19.8% in CD and 11.4% in UC, P=0.34). The prevalence of iron deficiency was 52.3% (53.6% in CD and 51.2% in UC, P=0.95). Anemia of chronic disease was present in 14.1% of IBD patients. A total of 53.8% of patients with anemia were in clinical remission. CD was associated with an increased prevalence of anemia (P=0.008; OR=1.76; CI 95% =1.16-2.66) compared to UC. The penetrant disease phenotype in CD was associated with a lower risk of anemia (P<0.0001; OR=0.25; CI 95% =0.14-0.43). Active disease compared to the disease in clinical remission was associated with an increased risk of anemia (P=0.0003; OR=2.61; CI 95% =1.56-4.36) in CD. The presence of anemia was less frequent in patients with CD who underwent surgical bowel resection compared to those who did not undergo surgery (P<0.0001; OR=0.24; CI 95% =0.14-0.40). No differences in anemia prevalence were observed regarding CD localization, age at diagnosis, UC extension or biological therapy (P>0.05). CONCLUSION Despite the low levels of full screening, anemia and iron deficiency anemia were common manifestations of IBD. CD was associated with an increased risk of anemia, especially with active disease. In addition, patients with CD who underwent surgical bowel resection and penetrant disease phenotype in CD were associated with lower risk of anemia.
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Affiliation(s)
- Rogério Serafim Parra
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Marley Ribeiro Feitosa
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Sandro da Costa Ferreira
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - José Joaquim Ribeiro da Rocha
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Luiz Ernesto de Almeida Troncon
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Omar FÉres
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Kotze PG, Underwood FE, Damião AOMC, Ferraz JGP, Saad-Hossne R, Toro M, Iade B, Bosques-Padilla F, Teixeira FV, Juliao-Banos F, Simian D, Ghosh S, Panaccione R, Ng SC, Kaplan GG. Progression of Inflammatory Bowel Diseases Throughout Latin America and the Caribbean: A Systematic Review. Clin Gastroenterol Hepatol 2020; 18:304-312. [PMID: 31252191 DOI: 10.1016/j.cgh.2019.06.030] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence of inflammatory bowel diseases (IBD) is increasing in Latin America. We performed a systematic review to identify clinical and epidemiologic features of IBD in Latin America (including Mexico, Central America, and South America) and the Caribbean. METHODS We searched MEDLINE, EMBASE, and SciELO databases for clinical or epidemiologic studies of Crohn's disease (CD) or ulcerative colitis (UC) from Latin American and Caribbean countries and territories that reported incidence, prevalence, ratio of UC:CD, IBD phenotype, and treatment, through September 12, 2018. Data were extracted from 61 articles for analysis. RESULTS The incidence and prevalence of IBD have been steadily increasing in Latin America and the Caribbean. The incidence of CD in Brazil increased from 0.08 per 100,000 person-years in 1988 to 0.68 per 100,000 person-years in 1991-1995 to 5.5 per 100,000 person-years in 2015. The highest reported prevalence of IBD was in Argentina, in 2007, at 15 and 82 per 100,000 person-years for CD and UC, respectively. The ratio of UC:CD exceeded 1 in all regions throughout Latin America and the Caribbean with the exception of Brazil. Treatment with tumor necrosis factor antagonists increased steadily for patients with CD (43.4% of all patients in Brazil were treated in 2014) but less so for patients with UC (4.5% of all patients were treated in 2014). Surgery for IBD decreased with time. In Chile, surgeries were performed on 57.0% of patients with CD and 18.0% of patients with UC during the period of 1990-2002; these values decreased to 38.0% and 5.0%, respectively, during the period of 2012-2015. In Peru, 6.9% of patients with UC received colectomies in the period of 2001-2003 and 6.2% in 2004-2014. CONCLUSIONS In a systematic review, we found the incidence of IBD to be increasing throughout Latin America and the Caribbean. Population-based epidemiology studies are needed to evaluate the increase in IBD in these regions, which differ from other global regions in climate, culture, demographics, diet, healthcare delivery and infrastructure, and socioeconomic status.
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Affiliation(s)
- Paulo Gustavo Kotze
- IBD Outpatient Clinics, Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, Brazil.
| | - Fox E Underwood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Jose Geraldo P Ferraz
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | | | - Martin Toro
- Hospital Universitario de la Universidad Nacional de Cuyo, Mendoza, Argentina
| | | | | | | | | | | | - Subrata Ghosh
- Institute of Translational Medicine, NIHR Biomedical Research Centre, University of Birmingham and Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Abstract
PURPOSE OF REVIEW Once thought a disease of Western civilizations, the inflammatory bowel diseases (IBD) impose a global burden, now penetrating populations in Asia, Africa, and South America. We summarize similarities and differences in the epidemiology of IBD globally, highlighting gaps in knowledge where future study is needed. RECENT FINDINGS While incidence of IBD is stabilizing (or even decreasing) in many westernized regions, prevalence continues to grow due to a young age of onset and low mortality. In newly westernized regions, IBD is beginning to penetrate populations comparable to the rapid increases seen in North America, Europe, and Oceania in the last century. IBD imposes a significant fiscal and resource burden on healthcare systems. As global prevalence of these diseases continues to increase, we desperately need to anticipate the future burden to proactively prepare our healthcare systems for the challenges of increased patient load and aging populations with comorbid conditions and longer disease course.
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Quaresma AB, Kaplan GG, Kotze PG. The globalization of inflammatory bowel disease: the incidence and prevalence of inflammatory bowel disease in Brazil. Curr Opin Gastroenterol 2019; 35:259-264. [PMID: 30973356 DOI: 10.1097/mog.0000000000000534] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Epidemiological studies of inflammatory bowel disease (IBD) in newly industrialized countries are limited, due to a lack of medical surveillance systems and reliable and unified registries and databases. In Brazil, reliable data on the incidence and prevalence of Crohn's disease and ulcerative colitis is scarce. The objective of the present review is to describe in detail the available data on the incidence and prevalence of Crohn's disease and ulcerative colitis in Brazil. RECENT FINDINGS The authors identified the single four population-based studies which refer to incidence and prevalence of IBD in the country (two from São Paulo, one from Espírito Santo and one from the state of Piauí). These studies demonstrate a remarkable growth in the incidence and estimated prevalence of IBD in Brazil, with higher number of cases in more developed regions. SUMMARY The increase in incidence over time and the higher current prevalence are indicative of a historical progression in relation to the number of IBD patients in our country, similar to what was observed in countries from Asia and approximating those of the northern hemisphere. Epidemiological studies with more accurate methodology are needed in Brazil.
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Affiliation(s)
- Abel B Quaresma
- aWest Santa Catarina State University (UNOESC), Joaçaba, Brazil bUniversity of Calgary, Calgary, Alberta, Canada cCatholic University of Paraná (PUCPR), Curitiba, Brazil
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