Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis‐associated inflammatory bowel disease (PSC‐IBD): A matched analysis from the Paediatric PSC Consortium
Summary Background Data on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited. Aims Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity. Methods In this retrospective multi‐centre cohort stud...
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Published in | Alimentary pharmacology & therapeutics Vol. 59; no. 10; pp. 1236 - 1247 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Wiley Subscription Services, Inc
01.05.2024
Wiley |
Series | Alimentary Pharmacology and Therapeutics |
Subjects | |
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Abstract | Summary
Background
Data on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited.
Aims
Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity.
Methods
In this retrospective multi‐centre cohort study, we matched vancomycin‐treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE.
Results
113 PSC‐IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin‐treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97–6.31; adjusted OR [aOR] 5.24, 95% CI 2.68–10.22). Benefit was maintained in sensitivity analyses restricted to non‐transplanted patients and those with baseline moderate–severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002–7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01).
Conclusion
Vancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing.
Results of matched analysis of vancomycin‐treated and untreated children with PSC‐IBD from the Pediatric PSC Consortium, showing higher rates of clinical remission (unadjusted and adjusted for covariates including other medication exposure; in UC and CD) and endoscopic remission in the subset with endoscopic data available. |
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AbstractList | BackgroundData on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited.AimsUsing data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity.MethodsIn this retrospective multi‐centre cohort study, we matched vancomycin‐treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE.Results113 PSC‐IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin‐treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97–6.31; adjusted OR [aOR] 5.24, 95% CI 2.68–10.22). Benefit was maintained in sensitivity analyses restricted to non‐transplanted patients and those with baseline moderate–severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002–7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01).ConclusionVancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing. Data on oral vancomycin for primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) are limited. Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity. In this retrospective multi-centre cohort study, we matched vancomycin-treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE. 113 PSC-IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin-treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97-6.31; adjusted OR [aOR] 5.24, 95% CI 2.68-10.22). Benefit was maintained in sensitivity analyses restricted to non-transplanted patients and those with baseline moderate-severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002-7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01). Vancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing. Data on oral vancomycin for primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) are limited.BACKGROUNDData on oral vancomycin for primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) are limited.Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity.AIMSUsing data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity.In this retrospective multi-centre cohort study, we matched vancomycin-treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE.METHODSIn this retrospective multi-centre cohort study, we matched vancomycin-treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE.113 PSC-IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin-treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97-6.31; adjusted OR [aOR] 5.24, 95% CI 2.68-10.22). Benefit was maintained in sensitivity analyses restricted to non-transplanted patients and those with baseline moderate-severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002-7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01).RESULTS113 PSC-IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin-treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97-6.31; adjusted OR [aOR] 5.24, 95% CI 2.68-10.22). Benefit was maintained in sensitivity analyses restricted to non-transplanted patients and those with baseline moderate-severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002-7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01).Vancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing.CONCLUSIONVancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing. Summary Background Data on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited. Aims Using data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity. Methods In this retrospective multi‐centre cohort study, we matched vancomycin‐treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE. Results 113 PSC‐IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin‐treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97–6.31; adjusted OR [aOR] 5.24, 95% CI 2.68–10.22). Benefit was maintained in sensitivity analyses restricted to non‐transplanted patients and those with baseline moderate–severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002–7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01). Conclusion Vancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing. Results of matched analysis of vancomycin‐treated and untreated children with PSC‐IBD from the Pediatric PSC Consortium, showing higher rates of clinical remission (unadjusted and adjusted for covariates including other medication exposure; in UC and CD) and endoscopic remission in the subset with endoscopic data available. |
Author | Loomes, Kathleen M. Liu, Kuan Perito, Emily R. Papadopoulou, Alexandra Soufi, Nisreen Amin, Mansi Schwarz, Kathleen B. El‐Matary, Wael Laborda, Trevor J. Ovchinsky, Nadia Montano‐Loza, Aldo Rodrigues Ferreira, Alexandre Furuya, Katryn N. Ricciuto, Amanda Guthery, Stephen Druve Tavares Fagundes, Eleonora Taylor, Amy Lee, Christine K. Shteyer, Eyal Woynarowski, Marek Auth, Marcus Shah, Uzma Horslen, Simon P. Koot, B. G. P. Jensen, Kyle Martinez, Mercedes Di Guglielmo, Matthew D. Deneau, Mark Tessier, M. Elizabeth Kamath, Binita M. Mack, Cara Valentino, Pamela Gupta, Nitika Sathya, Pushpa Stevens, James Patrick Amir, Achiya Z. Aumar, Madeleine Kerkar, Nanda |
Author_xml | – sequence: 1 givenname: Amanda orcidid: 0000-0001-9538-3005 surname: Ricciuto fullname: Ricciuto, Amanda email: amanda.ricciuto@sickkids.ca organization: University of Toronto – sequence: 2 givenname: Kuan surname: Liu fullname: Liu, Kuan organization: University of Toronto – sequence: 3 givenname: Wael surname: El‐Matary fullname: El‐Matary, Wael organization: Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba – sequence: 4 givenname: Mansi surname: Amin fullname: Amin, Mansi organization: Duke University Medical Center – sequence: 5 givenname: Achiya Z. surname: Amir fullname: Amir, Achiya Z. organization: Tel‐Aviv University – sequence: 6 givenname: Madeleine surname: Aumar fullname: Aumar, Madeleine organization: CHU de Lille – sequence: 7 givenname: Marcus surname: Auth fullname: Auth, Marcus organization: University of Liverpool – sequence: 8 givenname: Matthew D. surname: Di Guglielmo fullname: Di Guglielmo, Matthew D. organization: Nemours Children's Health – sequence: 9 givenname: Eleonora surname: Druve Tavares Fagundes fullname: Druve Tavares Fagundes, Eleonora organization: Faculty of Medicine of Federal University of Minas Gerais (UFMG), Hospital das Clinicas of UFMG – sequence: 10 givenname: Alexandre surname: Rodrigues Ferreira fullname: Rodrigues Ferreira, Alexandre organization: Hospital das Clinicas of UFMG – sequence: 11 givenname: Katryn N. surname: Furuya fullname: Furuya, Katryn N. organization: University of Wisconsin‐Madison School of Medicine and Public Health – sequence: 12 givenname: Nitika surname: Gupta fullname: Gupta, Nitika organization: Emory University School of Medicine, Children's Healthcare of Atlanta – sequence: 13 givenname: Stephen surname: Guthery fullname: Guthery, Stephen organization: Intermountain Primary Children's Hospital, University of Utah – sequence: 14 givenname: Simon P. surname: Horslen fullname: Horslen, Simon P. organization: UPMC Children's Hospital of Pittsburgh – sequence: 15 givenname: Kyle surname: Jensen fullname: Jensen, Kyle organization: Intermountain Primary Children's Hospital, University of Utah – sequence: 16 givenname: Binita M. surname: Kamath fullname: Kamath, Binita M. organization: University of Toronto – sequence: 17 givenname: Nanda surname: Kerkar fullname: Kerkar, Nanda organization: Golisano Children's Hospital, University of Rochester Medical Center – sequence: 18 givenname: B. G. P. surname: Koot fullname: Koot, B. G. P. organization: University of Amsterdam – sequence: 19 givenname: Trevor J. surname: Laborda fullname: Laborda, Trevor J. organization: Intermountain Primary Children's Hospital, University of Utah – sequence: 20 givenname: Christine K. surname: Lee fullname: Lee, Christine K. organization: Boston Children's Hospital – sequence: 21 givenname: Kathleen M. surname: Loomes fullname: Loomes, Kathleen M. organization: The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania – sequence: 22 givenname: Cara surname: Mack fullname: Mack, Cara organization: University of Colorado Anschutz Medical Campus, Children's Wisconsin, Medical College of Wisconsin – sequence: 23 givenname: Mercedes surname: Martinez fullname: Martinez, Mercedes organization: Columbia University Irving Medical Center, New York‐Presbyterian – sequence: 24 givenname: Aldo orcidid: 0000-0002-2511-7980 surname: Montano‐Loza fullname: Montano‐Loza, Aldo organization: Zeidler Ledcor Centre, University of Alberta – sequence: 25 givenname: Nadia surname: Ovchinsky fullname: Ovchinsky, Nadia organization: NYU Grossman School of Medicine – sequence: 26 givenname: Alexandra surname: Papadopoulou fullname: Papadopoulou, Alexandra organization: Athens Children's Hospital “AGIA SOFIA”, University of Athens – sequence: 27 givenname: Emily R. surname: Perito fullname: Perito, Emily R. organization: University of California San Francisco – sequence: 28 givenname: Pushpa surname: Sathya fullname: Sathya, Pushpa organization: Memorial University of Newfoundland – sequence: 29 givenname: Kathleen B. surname: Schwarz fullname: Schwarz, Kathleen B. organization: Rady Children's Hospital San Diego – sequence: 30 givenname: Uzma surname: Shah fullname: Shah, Uzma organization: Henry Ford Health – sequence: 31 givenname: Eyal surname: Shteyer fullname: Shteyer, Eyal organization: Shaare Zedek Medical Center – sequence: 32 givenname: Nisreen surname: Soufi fullname: Soufi, Nisreen organization: Children's Hospital Los Angeles – sequence: 33 givenname: James Patrick surname: Stevens fullname: Stevens, James Patrick organization: Emory University School of Medicine – sequence: 34 givenname: Amy surname: Taylor fullname: Taylor, Amy organization: Cincinnati Children's Hospital Medical Center – sequence: 35 givenname: M. 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Notes | Amanda Ricciuto and Kuan Liu co‐first authorship/equal contribution. The Handling Editor for this article was Professor Peter Gibson, and it was accepted for publication after full peer‐review. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
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Snippet | Summary
Background
Data on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited.
Aims
Using data... Data on oral vancomycin for primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) are limited. Using data from the Paediatric PSC... BackgroundData on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited.AimsUsing data from the... Data on oral vancomycin for primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) are limited.BACKGROUNDData on oral vancomycin for... BackgroundData on oral vancomycin for primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) are limited.AimsUsing data from the... |
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StartPage | 1236 |
SubjectTerms | Cholangitis Consortia Endoscopy Hemoglobin Inflammatory bowel disease Inflammatory bowel diseases Intestine Life Sciences Pediatrics Remission Remission (Medicine) Sensitivity analysis Vancomycin |
Title | Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis‐associated inflammatory bowel disease (PSC‐IBD): A matched analysis from the Paediatric PSC Consortium |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fapt.17936 https://www.ncbi.nlm.nih.gov/pubmed/38462727 https://www.proquest.com/docview/3043896678 https://www.proquest.com/docview/2955268462 https://hal.univ-lille.fr/hal-04690334 |
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