Publications by authors named "Ruth De Francisco"

Background And Objectives: Primary objectives: to compare the rates of sustained clinical remission at 12 months in patients treated with antitumour necrosis factor (anti-TNF) and immunomodulators who withdraw anti-TNF treatment versus those who maintain it.

Secondary Objectives: to evaluate the effect of anti-TNF withdrawal on relapse-free time, endoscopic and radiological activity, safety, quality of life and work productivity; and to identify predictive factors for relapse.

Design: Prospective, quadruple-blind, multicentre, randomised, controlled trial.

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Background: The coexistence of human immunodeficiency virus (HIV) infection and inflammatory bowel disease (IBD) is uncommon. Data on the impact of HIV on IBD course and its management is scarce.

Aim: To describe the IBD phenotype, therapeutic requirements and prevalence of opportunistic infections (OI) in IBD patients with a coexistent HIV infection.

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Article Synopsis
  • Researchers wanted to see how much people with inflammatory bowel disease (IBD) understood about other similar diseases they might have at the same time.
  • They had 1,620 people fill out a questionnaire about 54 immune-related diseases and then checked their medical records to see if what they said was correct.
  • They found that while many patients had other diseases, most didn't know about them well, especially those affecting bones and joints.
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Background: Ulcerative proctitis (UP) can have a milder, less aggressive course than left-sided colitis or extensive colitis. Therefore, immunosuppressants tend to be used less in patients with this condition. Evidence, however, is scarce because these patients are excluded from randomised controlled clinical trials.

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Background: some patients with inflammatory bowel disease (IBD) treated with antiTNF develop drug-induced psoriasis (antiTNF-IP). Several therapeutic strategies are possible.

Aims: to assess the management of antiTNF-IP in IBD, and its impact in both diseases.

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  • A study was conducted to evaluate the effectiveness and safety of ustekinumab and vedolizumab in treating complex perianal fistula in patients with Crohn's disease.
  • Out of 155 patients analyzed, ustekinumab achieved a remission rate of 54%, while vedolizumab had a remission rate of 46%, with some patients relapsing during the follow-up period.
  • Both medications exhibited mild adverse events and showed favorable safety profiles, indicating their potential effectiveness in managing this condition.
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  • Markers for personalized treatment options for patients with inflammatory bowel diseases (IBD) remain unidentified, prompting a study on real-life treatment trends.
  • The study analyzed data from 10,009 patients from the ENEIDA registry, revealing that anti-TNF drugs were the most commonly used first-line treatments, but their usage declined over time in Crohn's disease (CD) while remaining stable in ulcerative colitis (UC).
  • Despite exploring Machine Learning for treatment pattern prediction, researchers found that these models were ineffective, indicating distinct treatment approaches for CD and UC and highlighting the rising importance of drugs like ustekinumab and vedolizumab.
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Background & Aims: The impact of patient sex on the presentation of inflammatory bowel disease (IBD) has been poorly evaluated. Our aims were to assess potential disparities in IBD phenotype and progression between sexes.

Methods: We performed an observational multicenter study that included patients with Crohn's disease (CD) or ulcerative colitis from the Spanish Estudio Nacional en Enfermedad Inflamatoria intestinal sobre Determinantes genéticos y Ambientales registry.

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Introduction: Risk factors for developing pancreatitis due to thiopurines in patients with inflammatory bowel disease (IBD) are not clearly identified. Our aim was to evaluate the predictive pharmacogenetic risk of pancreatitis in IBD patients treated with thiopurines.

Methods: We conducted an observational pharmacogenetic study of acute pancreatitis events in a cohort study of IBD patients treated with thiopurines from the prospectively maintained ENEIDA registry biobank of GETECCU.

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  • Thromboembolic events, particularly splanchnic vein thrombosis (SVT), occur frequently in patients with inflammatory bowel disease (IBD), but there is limited data on their prevalence and outcomes.
  • A study using data from the Spanish ENEIDA registry analyzed 49 new cases of SVT and reviewed 318 additional cases from the literature, highlighting that most cases involved Crohn's disease and presented with abdominal pain, often identified incidentally.
  • The majority of patients received anticoagulation therapy, leading to a significant rate of resolution of SVT, indicating that while SVT is rare or underdiagnosed in IBD patients, it’s associated with disease activity and can have favorable outcomes with appropriate treatment.
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  • * A study of 520 adult patients showed that small abscesses (<30 mm) can be treated effectively with antibiotics, while larger abscesses require drainage methods, with surgical drainage being more effective but riskier.
  • * Post-treatment, luminal resection lowers the risk of abscess recurrence within a year, but anti-TNF therapy shows similar effectiveness for preventing recurrences regardless of resection.
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An increasing use of immunomodulatory drugs has led to a corresponding increase in treatment-related pathologies such as inflammatory bowel disease. Here, we present a case of ulcerative colitis due to Obinutuzumab, an antiCD20 monoclonal approved for the treatment of Non-Hodgkin lymphomas.

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Background And Aims: Inflammatory bowel disease (IBD) is a prevalent chronic noncurable disease associated with profound metabolic changes. The discovery of novel molecular indicators for unraveling IBD etiopathogenesis and the diagnosis and prognosis of IBD is therefore pivotal. We sought to determine the distinctive metabolic signatures from the different IBD subgroups before treatment initiation.

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Background: Both vedolizumab and ustekinumab are approved for the management of Crohn's disease [CD]. Data on which one would be the most beneficial option when anti-tumour necrosis factor [anti-TNF] agents fail are limited.

Aims: To compare the durability, effectiveness, and safety of vedolizumab and ustekinumab after anti-TNF failure or intolerance in CD.

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Article Synopsis
  • The study aimed to evaluate the effects of switching from the adalimumab (ADA) originator to its biosimilars on treatment persistence, clinical efficacy, and safety in patients with inflammatory bowel disease.
  • A total of 524 patients were analyzed, with some maintaining the ADA originator and others switching to biosimilars, showing similar rates of treatment discontinuation and relapse between the two groups.
  • The findings concluded that switching to ADA biosimilars did not negatively impact patient outcomes compared to continuing with the ADA originator.
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An increased risk of lymphoma has been described in patients with inflammatory bowel disease (IBD). The aims of our study were to determine the clinical presentation, the previous exposure to immunosuppressive and biologic therapies, and the evolution of lymphomas in patients with IBD. IBD patients with diagnosis of lymphoma from October 2006 to June 2021 were identified from the prospectively maintained ENEIDA registry of GETECCU.

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Introduction: The prevalence of penetrating complications in Crohn's disease (CD) increases progressively over time, but evidence on the medical treatment in this setting is limited. The aim of this study was to evaluate the effectiveness of biologic agents in CD complicated with internal fistulizing disease.

Methods: Adult patients with CD-related fistulae who received at least 1 biologic agent for this condition from the prospectively maintained ENEIDA registry were included.

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Drug-induced inflammatory bowel disease (IBD) is a clinical entity on the rise due to the frequent use of immunomodulatory therapy. Here we report the case of Crohn's disease due to Ocrelizumab, a humanized anti-CD20 monoclonal antibody approved for the treatment of multiple sclerosis. The exact mechanism by which anti-CD20 antibodies can trigger IBD is unknown, but since IBD and multiple sclerosis are processes included within the spectrum of immunomediated diseases, we could suggest that Ocrelizumab could trigger IBD in genetically predisposed patients.

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Recurrent abdominal pain is a common reason for consultation in Gastroenterology. The differential diagnosis includes hereditary angioedema (HAE), a rare disorder characterized by recurrent episodes of angioedema, without urticaria or pruritus, which most often affects the skin, but also mucosal tissues of the gastrointestinal tract, triggered by diverse factors such as infections, trauma, surgery, drugs, or stress. It is a disease with a difficult diagnosis due to its heterogeneous and transitory clinical features, so having a clinical suspicion in the appropriate context would allow the administration of a specific treatment and avoid unnecessary examinations.

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Vedolizumab is a monoclonal antibody that has demonstrated efficacy and a good safety profile in patients with inflammatory bowel disease. Varicella zoster virus encephalitis is a potentially serious complication not previously described with its use, highlighting the importance of vaccination, as well as early diagnosis and treatment of infections in this type of patients.

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Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning.

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Background And Aims: Clinical trials and real-life studies with ustekinumab in Crohn's disease [CD] have revealed a good efficacy and safety profile. However, these data are scarcely available in elderly patients. Therefore, we aim to assess the effectiveness and safety of ustekinumab in elderly patients with CD.

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  • This study assesses the risk of tuberculosis (TB) in patients with inflammatory bowel disease (IBD) undergoing anti-TNF therapy and evaluates various latent TB infection (LTBI) screening methods.
  • Out of 7,594 patients screened, 19% had LTBI, with findings indicating that combining early screening and dual tests (TST and IGRA) significantly improved detection rates, particularly in patients not on immunomodulatory treatment.
  • The best results for diagnosing LTBI came from using early screening alongside dual screening strategies, highlighting the effectiveness of these approaches in managing TB risk in IBD patients.
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Background: Previous studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain.

Methods: Prospective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients.

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Background: Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn's disease (CD) patients in real-world clinical practice.

Methods: A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety.

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