FROM THE PEDIATRIC LITERATURE

Teduglutide and Short Bowel Syndrome in Children

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Intestinal failure due to short bowel syndrome (SBS) is disabling as well as life-threatening in children. Teduglutide is a glucagon-like peptide-2 which promotes intestinal growth and bowel adaption. There is minimal data in children regarding the efficacy of this new medication, and the authors of this prospective, multi-center study followed 17 children with SBS who were treated with teduglutide at 0.05mg/kg/day via the subcutaneous route. All included patients had less than 100 cm of remaining bowel (except for 2 patients), were on parenteral nutrition (PN), and had no surgical intervention or changes in PN for 3 months prior to teduglutide use. At each clinic visit (baseline, 3 months, 6 months, and 12 months after therapy), information on PN volume, nutritional support, recorded stool losses, plasma citrulline levels, and the presence of adverse events were recorded. Any patient with a reduction in PN by 20% was defined as a “responder”. All patients were older than one year of age, and all patients developed intestinal failure after birth. The most common cause of intestinal failure was necrotizing enterocolitis. These patients were receiving an average 55 mL/kg/day of fluid volume daily (range 8-210 mL/kg/day) and were receiving 33 kcal/k/ day of nutritional support (range 0-65 kcal/kg/ day). Their mean initial citrulline level was 20 micromoles/L (range 7.8-51 micromoles/L).

A total of 15 of the 17 patients were able to complete one year of teduglutide. By the 3-month follow up, 3 patients had achieved full enteral autonomy. This trend continued with an additional 4 patients and then 3 patients reaching full enteral autonomy at 6 months and 12 months, respectively. Most patients were able to reduce their fluid volume and nutritional support, and in total, 14 of the 15 patients who finished the therapeutic study were responders to teduglutide. A 20% or greater reduction in PN support was noted in 47%, 87%, and 93% of patients at 3, 6, and 12 months respectively, while 17%, 44%, and 60% of patients were able to wean off of PN at 3, 6, and 12 months respectively. Stool output improved and citrulline levels increased in all patients throughout the study. The most common adverse events consisted of abdominal pain occurring in 30% of patients, followed by injection-site reactions, nausea, headaches, abdominal distention, and the presence of upper respiratory tract infections. Most of these side effects were mild or moderate.

This small study demonstrates promising results regarding the efficacy of teduglutide in the treatment of pediatric intestinal failure. More research is needed for children with an even greater loss of bowel as well as determination of cost savings associated with teduglutide use.

Boluda E, Ferreiro S, Moral O, Romero R, Terradillows I, Ramos R, Diaz M, Miquel B, Pinera I, Sanchez A, Sacristan R, Barea M, Villares J. Experience with teduglutide in pediatric short bowel syndrome: first real-life data. Journal of Pediatric Gastroenterology and Nutrition 2020; 71: 734-739.

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FROM THE PEDIATRIC LITERATURE

How Common are Pediatric Feeding Disorders?

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Feeding disorders in children commonly are seen in both the primary care and pediatric gastroenterology setting. There is no good epidemiologic data about the prevalence of pediatric feeding disorders in children in the United States. Thus, the authors of this study used de-identified data from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database (Ann Arbor, Michigan) for patients with private insurance as well as Arizona and Wisconsin Medicaid data for patients with Medicaid covering the time period from 2009 to 2014. Children between 2 months and 18 years were included in the study, and the authors used 25 International Classification of Diseases (ICD)-9 and ICD-10 codes to identify potential study subjects as there is no specific “feeding disorder” diagnosis code for children. Children who had been diagnosed with one of these codes and not with an eating disorder were included. The authors evaluated all such patients for comorbid conditions, the presence of malnutrition/ failure to thrive, and the presence of a gastrostomy tube. Children were identified as having a complex chronic condition (CCC) based on known ICD codes if they had a medical condition expected to last at least 12 months and had at least one organ system involvement which could require pediatric subspecialty care and potential hospitalization.

The presence of feeding disorders increased in all databases during the time period with significantly more children covered by Medicaid having feeding disorders (Arizona, 16.97 per 1000 child-years; 95% CI, 16.84-17.10 and Wisconsin, 21.43 per 1000 child-years; 95% CI, 21.27-21.60) compared to children covered with private insurance (9.38 per 1000 child-years; 95% CI, 9.35-9.40). A lower prevalence of feeding disorders was present in older patients (defined as 12-18 years old), and more males had feeding disorders compared to females throughout the study. Specific patients with CCC (including children with respiratory, gastrointestinal, miscellaneous technology dependency, prematurity/neonatal risk, and organ transplantation) had higher rates of feeding disorders, and the prevalence of feeding disorders in children with a CCC increased throughout the study despite no increase in the number of children with a feeding disorder and without a CCC. Although the prevalence of malnutrition in children with a feeding disorder decreased in all databases throughout the study, children with an associated CCC had a higher prevalence of a malnutrition. The prevalence of gastrostomy tubes decreased in this population throughout the study period, and most children who had both a feeding disorder and a gastrostomy tube also had an associated CCC. This study demonstrates that pediatric feeding disorders are increasing in children in the United States, and this disorder is commonly associated with the presence of a CCC. Thus, we need early intervention as well as improved long-term treatment options for this population as well as better accuracy in ICD coding in order to track and to care for these children over time.

Kovacic K, Rein L, Szabo A, Kommareddy S, Bhagavatula P, Goday P. Pediatric feeding disorder: a nationwide prevalence study. Journal of Pediatrics 2021; 228: 126-131.

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FROM THE LITERATURE

Gastric Cancer Incidence Among Races and Ethnicities in Patients Age 50 Years and Older

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To evaluate the racial and ethnic differences in the incidence of gastric adenocarcinoma worldwide and in the United States, based on a decision analysis, screening for noncardia gastric adenocarcinoma might be cost-effective for non-White individuals 50 years or older. A lack of precise contemporary information on gastric adenocarcinoma incidence in specific anatomic sites for this age group has impeded prevention and early detection programs in the U.S.

To estimate the differences in gastric adenocarcinoma incidence in specific anatomic sites among races and ethnicities in individuals 50 years or older, the California Cancer Registry data from 2011 through 2015 was evaluated to estimate incidences of gastric adenoma in specific anatomic sites for non-Hispanic White (NHW), non-Hispanic black, Hispanic and the seventh largest Asian-American populations. Calculation was carried out as to the differential incidence between non-White groups and NHW, using incidence rate ratios and 95% confidence intervals (CIs).

Compared with NHW subjects, all non-White groups had significantly higher incidences of noncardiac gastric adenocarcinoma. The incidence was highest among Korean-American men 50 years and older (70 cases per 100,000). Compared with NHW subjects 50 years and older, the risk of noncardiac gastric adenocarcinoma was 1.8-fold to 7.3-fold, higher in most non-White groups and 12- fold to 14.5-fold higher among Korean-American men and women 50 years and older, respectively.

Compared with NHW men 50 years and older, all non-White men, except Japanese and KoreanAmerican men had a significantly lower risk of cardia gastric adenocarcinoma.

There was identification of several-fold differences in evidence of gastric adenocarcinoma in specific anatomic sites among racial and ethnic groups, with significant age and sex differences. These findings should be used to develop targeted risk reduction programs for gastric adenocarcinoma.

Shah, S., McKinley, M., Gupta, S., et al. “Population-Based Analysis of Differences in Gastric Cancer Incidence Among Races and Ethnicities in Individuals Aged 50 Years and Older.” Gastroenterology 2020; Vol. 159, pp. 1705-1714.

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FROM THE LITERATURE

Effects of Statin Drugs in Nonalcoholic Fatty Liver Disease

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To investigate the role of statins on the development of de novo NAFLD and progression of significant liver fibrosis, a study was carried out, including 11,593,409 subjects from the NHI database of the Republic of Korea. This was entered in 2010 and followed until 2016. NAFLD was diagnosed by calculating fatty liver index (FLI) and significant liver fibrosis was evaluated using the BARD score. Controls were randomly selected at a ratio of 1:5 from individuals who were at risk of becoming case subjects at the time of selection.

Among 5,339,901 subjects that had FLI less than 30 and included in the non-NAFLD cohort, a total of 164,856 subjects eventually had NAFLD develop. The use of statin was associated with a reduced risk of NAFLD development (adjusted odds ratio; AOR 0.66), and was independent of associated diabetes mellitus {DM}; AOR 0.44, without DM, AOR 7.1). From 712,262 subjects with FLI greater than 60 and selected in the NAFLD cohort, 111,257 subjects showed a BARD score greater than 2 and were defined as liver fibrosis cases.

The use of statins reduces the risk of significant liver fibrosis (AOR 0.43, independent of diabetes, with DM; AOR 0.31, without DM, AOR 0.52).

In this large population-based study, statin use decreased the risk of NAFLD occurrence and the risk of liver fibrosis once NAFLD developed.

Lee, J., Lee, H., Lee, K., Lee, H., Park, J. “Effects of Statin Use on the Development and Progression of Nonalcoholic Fatty Liver Disease: A Nationwide, Nested Case-Controlled Study.” American Journal of Gastroenterology, Vol. 116, January 2021, pp. 116-124.

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FROM THE LITERATURE

Mortality in Patients with Cirrhosis and COVID-19

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To evaluate the impact of COVID-19 on the clinical outcome of patients with cirrhosis in a multi-center, retrospective study, patients with cirrhosis and the confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were enrolled between 3/1/2020 and 3/31/2020. Clinical and biochemical data and diagnosis of COVID-19 at the last outpatient visit were obtained through review of medical records.

A total of 50 patients with cirrhosis and with confirmed SARS-CoV-2 infection were enrolled (age 67, 70% men, 38% virus-related, 52% previously compensated cirrhosis), 64% of patients presented fever, 42% shortness of breath, polypnea, 22% encephalopathy, 96% either hospitalization or a prolonged stay if already in hospital. Respiratory support was necessary in 71%, 52% received antivirals, 80% heparin.

Serum albumin significantly decreased while bilirubin, creatinine and prothrombin time significantly increased at COVID-19 diagnosis, compared to last available data.

The proportion of patients with a MELD score greater than 15 increased from 13% to 26%, acuteon-chronic liver failure and de novo acute liver injury occurred in 14 (28%), and 10 patients, respectively. A total of 17 patients died after a median of 10 days from COVID-19 diagnosis with a 30-day mortality rate of 34%. The severity of lung and liver disease has independently predicted mortality. In patients with cirrhosis, mortality was significantly higher in those with COVID-19 than in those hospitalized for bacterial infections.

It was concluded that COVID-19 is associated with liver function deterioration and elevated mortality in patients with cirrhosis.

Lavarone, M., D’Ambrosio, R., Soria, A., et al. “High Rates of 30-Day Mortality in Patients with Cirrhosis and COVID-19.” Journal of Hepatology 2020; Vol. 73, pp. 1063-1071.

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FROM THE LITERATURE

Risk Factors for Cirrhosis in Long-Term Alcohol Utilization

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In order to assist in the discovery of mechanisms and prediction of risk, apart from lifetime alcohol exposure to produce alcohol-related cirrhosis, patients were evaluated, noting that sustained alcoholic intake is necessary, but not sufficient to produce alcohol related cirrhosis

A multi-center, case-controlled study (GenomALC) comparing 1293 cases (with alcoholrelated cirrhosis, 75.6% male), and 754 controls (with equivalent alcohol exposure, but no evidence of liver disease, 73.6% male) was carried out. Information confirming or excluding cirrhosis and on alcoholic intake and other potential risk factors was obtained from clinical recurs and by interview. Case-control differences and risk factors discovered in the GenomALC participants was validated using similar data from 407 cases and 6573 controls from UK Biobank.

The GenomALC case and control groups reported similar lifetime alcoholic intake (1374 vs 1412 kg). Cases had a higher prevalence of diabetes (20.5% vs 6.5%), and higher pre-morbid body mass index (26.37), than controls (24.4). Controls are significantly more likely to have been wine drinkers, coffee drinkers, smokers, and cannabis users than cases. Cases reported a higher proportion of parents who died of liver disease than controls (OR 2.25). Data from UK Biobank confirmed these findings with diabetes, BMI, proportion of alcohol as wine, and coffee consumption.

If these relationships can be identified as causal, measures such as weight loss, intensive treatment of diabetes or prediabetic states, and coffee consumption should reduce the risk of alcohol-related cirrhosis.

Whitfield, J., Masson, S., Liangpunsakul, S., et al. for the GenomALC Consortium. “Obesity, Diabetes, Coffee, Tea, and Cannabis Use Alter Risk for Alcohol-Related Cirrhosis in Two Large Cohorts of High-Risk Drinkers.” American Journal of Gastroenterology; January 2021, Vol. 16, pp. 106-115.

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FROM THE LITERATURE

Risk Factors for Delta Hepatitis in a North American Cohort with Indications for Screening

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A study of American patients with hepatitis B (HBV) referred to the NIH was performed to identify risk factors associated with HDV infection. Active HDV was “confirmed” by serum HDV-DNA or histologic HDV antigen staining.

A total of 652 patients were studied, of which 91 were HDV “confirmed.” Independent risk factors for HDV included: intravenous drug users, HDV-DNA less than 2000 i.u./mL, ALT greater than 40 units per liter and HDV endemic country of origin.

The discussion indicated that North American patients with HBV and significant risk factors should be screened for HDV.

Da, B., Rahmen, F., Lai, W., et al. “Risk Factors for Delta Hepatitis in a North American Cohort: Who Should Be Screened?” American Journal of Gastroenterology; Vol. 116, January 2021, pp. 206-209.

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Case Report Guidelines for Authors

Practical Gastroenterology Case Report Guidelines for Authors

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  • The aim of Case Reports is to provide challenging yet clinically relevant and informative cases to primary care physicians.
  • The Case should center around one (1) to three (3) high quality images that are completely described in the report. Images should be endoscopic, pathologic, and/or radiographic (without any patient identifiers) with clear labeling as appropriate.
  • The Case must be a concise report submitted as a Word document consisting of no more than 1250 words.
  • The images must be submitted as .jpg files separate from the Word document.
  • There should be a brief introduction/abstract, relevant presentation of the case, relevant case discussion and conclusion.
  • The conclusion should include one or two clinical pearls that the reader may apply to their practice or add to their knowledge set.
  • References should be limited to 8. References should follow AMA style and journal names should be abbreviated according to Index Medicus practice. Inclusive page ranges should be indicated.
  • Authors should be limited to 3 on each submission. No author photographs are necessary. All authors must provide their names, addresses, phone numbers, complete titles and affiliations.
  • Case Reports must not have been published previously. Each Case Report is subject to review by members of our Editorial Board. Case Reports are subject to final editing. Upon publication, Case Reports will be copyrighted by Practical Gastroenterology Publishing, Inc.
  • Please submit your Case Report to:

Adrien Mahl, Editor
Practical Gastroenterology
practicalgastro@aol.com

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Guidelines for Authors

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Practical Gastroenterology publishes articles for the primary care physician, and your article should therefore have a nuts-and-bolts slant. We urge you to keep the nonspecialist in mind as you write your article. We cannot stress strongly enough the importance of focusing your article on information that will be useful and instructive to the primary care physician. In this regard, it would be helpful for you to emphasize prevention and cost (of tests, drugs, surgery, hospital stay, procedures, techniques, etc.) whenever and wherever possible.

We offer the following list to help you conform to our mechanical requirements:

  1. Please submit one copy of your manuscript as a Microsoft Word file, typed on 8½″ × 11″ pages with 1″ margins, double-spaced throughout, including references, tables and figure legends. Ideally, the length of the manuscript should be 2000–2500 words (10–13 pages). Manuscripts should be submitted via e-mail to: PracticalGastro@aol.com
  2. Manuscripts must be submitted as Microsoft Word files without automatic footnoting and as final format documents (without indications of markup).
  3. Tables should be submitted with titles. If the table has been previously published, identify the source and provide all information that would be included in a standard reference list (see below), along with indication that permission to republish has been obtained. It is your responsibility to obtain permission.
  4. Figures and illustrations (photographs, drawings, charts) help explain the text, add to the visual appeal of the published article, and are very welcome. Each table should have a title, and each figure should have an accompanying legend. If figures and illustrations have been previously published, you should identify the source and provide all information that would be included in a standard reference list (see below), along with indication that permission to republish has been obtained. It is your responsibility to obtain permission. All figures and illustrations must be supplied in JPEG format and must be identified as Figure 1, Figure 2, etc. When e-mailing figures and illustrations, do not embed them into a text document. Each JPEG should be sent as a separate document attached to the e-mail. Tables, figures and Illustrations should not be submitted as Excel spreadsheets or in Power Point.
  5. The title page should include the names, addresses, phone numbers, complete titles and affiliations of all authors.
  6. A color head-shot photograph of each author should accompany the manuscript. These will be published with your article. These must be submitted as JPEG files.
  7. An abstract of 125–150 words should also accompany your paper. This will be published at the beginning of your article. Please do not exceed the 150-word limit.
  8. References should be used sparingly and cited in the body of the paper using consecutive superscript (raised) numbers. The references section should be numbered consecutively in the order in which the references are cited in the text. References should follow AMA style, and journal names should be abbreviated according to Index Medicus practice. Inclusive page ranges should be indicated. The following references illustrate AMA style:
  1. Jacobson IM, McHutchison JG, Dusheiko GM, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364:2405–2416.
  2. Bernatsky S, Clarke AE, Suissa S. Hematologic malignant neoplasms after drug exposure in rheumatoid arthritis. Arch Intern Med. 2008;168:378-81

9. Articles will be copyrighted upon publication by Practical Gastroenterology Publishing, Inc. The manuscript must not have been published previously. Each article we publish is subject to review by members of our Editorial Board. Articles are also subject to final editing.

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MEDICAL BULLETIN BOARD

Risankizumab (Skyrizi®) Demonstrates Significant Improvements in Clinical Remission and Endoscopic Response in Two Phase 3 Induction Studies in Patients with Crohn’s Disease

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  • A significantly greater proportion of patients with Crohn’s disease treated with either dose of risankizumab (600 mg or 1200 mg) achieved both primary endpoints, demonstrating statistically significant results for clinical remission and endoscopic response at week 12 compared to placebo1,2
  • The overall safety results in these studies were generally consistent with the known safety profile of risankizumab, with no new safety risks observed1-6
  • Risankizumab (SKYRIZI), an interleukin-23 (IL-23) inhibitor, is being evaluated as a treatment for adults with moderate to severe Crohn’s disease and several other immune-mediated conditions1,2,7,8
  • More than 3.5 million people globally live with inflammatory bowel diseases (IBD), including Crohn’s disease, and the incidence continues to rise9

NORTH CHICAGO, Ill., January, 2021 /PRNewswire/ – AbbVie (NYSE: ABBV) announced positive results from two Phase 3 induction studies, ADVANCE and MOTIVATE, showing both doses of risankizumab (600 mg and 1200 mg) met both primary endpoints of clinical remission and endoscopic response at week 12 in adult patients with moderate to severe Crohn’s disease.1,2 The ADVANCE study enrolled patients who had an inadequate response or were intolerant to conventional and/or biologic therapy.1 The MOTIVATE study evaluated patients who had responded inadequately or were intolerant to biologic therapy.2

“The progressive nature of Crohn’s disease makes it critical that treatment options go beyond symptoms to help patients achieve endoscopic response,” said Michael Severino, M.D., vice chairman and president, AbbVie. “Despite the availability of current treatments, many patients still do not achieve disease control. These positive results show how targeting IL-23 can rapidly induce improvements for people living with this condition. We look forward to advancing research showing risankizumab’s potential to improve clinical and endoscopic outcomes and minimize the burden of Crohn’s disease for patients.”

In both studies, clinical remission was measured by CDAI (Crohn’s Disease Activity Index) and PRO2 (two-component patient-reported outcome).1,2 In the ADVANCE study, a significantly greater proportion of patients treated with risankizumab 600 mg or 1200 mg achieved clinical remission per CDAI at week 12 (45 and 42 percent of patients, respectively, compared to 25 percent of patients receiving placebo; p<0.001).1 Similar results were seen with clinical remission per PRO-2 (43 and 41 percent, respectively, compared to 21 percent of patients receiving placebo; p<0.001).1 A significantly greater proportion of patients treated with either dose of risankizumab achieved endoscopic response at week 12 (40 and 32 percent of patients receiving risankizumab 600 mg or 1200 mg, respectively, versus 12 percent in the placebo group; p<0.001).1

In the MOTIVATE study, 42 and 41 percent of patients treated with risankizumab 600 mg or 1200 mg achieved clinical remission (per CDAI) at week 12, respectively, versus 19 percent of patients receiving placebo (p<0.001).2 A significantly greater proportion of patients in MOTIVATE also achieved clinical remission (per PRO-2) (35 and 39 percent of risankizumab 600 mg or 1200 mg-treated patients, respectively, compared to 19 percent of patients receiving placebo; p=0.001 for 600 mg; p<0.001 for 1200 mg).2 In addition, 29 and 34 percent of patients receiving risankizumab 600 mg or 1200 mg achieved endoscopic response, respectively, versus 11 percent in the placebo group (p<0.001).2

Additionally, multiplicity-adjusted key secondary endpoints showed significant clinical and endoscopic outcomes, with symptom improvement observed as early as week 4.1,2 After 4 weeks of treatment in both studies, a greater proportion of patients receiving either dose of risankizumab achieved clinical response (per CDAI) compared to placebo.1,2 Specifically, in ADVANCE, 41 and 37 percent of patients receiving risankizumab 600 mg or 1200 mg achieved clinical response (per CDAI) compared to 25 percent in the placebo group (p<0.001 for 600 mg; p=0.008 for 1200 mg).1 In MOTIVATE, 36 and 33 percent of patients receiving risankizumab 600 mg or 1200 mg achieved clinical response (per CDAI), respectively, compared to 21 percent in the placebo group (p=0.002 for 600 mg; p=0.012 for 1200 mg).2

“Helping patients achieve both clinical remission and endoscopic response early is paramount when treating Crohn’s disease,” said Remo Panaccione, M.D., professor of medicine and director of the IBD unit, University of Calgary. “It was exciting to see that a significant proportion of patients treated with risankizumab achieved both measures after 12 weeks of treatment, as well as achieving symptom improvement at week 4. These data are encouraging as we continue to evaluate the potential of risankizumab in Crohn’s disease.”

During the 12-week induction period, the safety profile of risankizumab in both studies was generally consistent with the known safety profile of risankizumab.1-6 No new safety risks were observed.1-6

In ADVANCE, serious adverse events (SAEs) occurred in 7.2 percent of patients in the risankizumab 600 mg group and 3.8 percent of patients in the risankizumab 1200 mg group compared to 15.1 percent of patients in the placebo group.1 The most common adverse events (AEs) observed in the risankizumab treatment groups were headache, nasopharyngitis and fatigue.1

Rates of serious infections were 0.8 and 0.5 percent in those treated with risankizumab 600 mg or 1200 mg, respectively, and 3.8 percent in patients who received placebo.1 The rates of AEs leading to discontinuation of the study drug were 2.4 and 1.9 percent of patients treated with risankizumab 600 mg or 1200 mg, respectively, compared with 7.5 percent on placebo.1 In ADVANCE, there were two deaths reported in the placebo group.1 There were no adjudicated major adverse cardiac events (MACE) or adjudicated anaphylactic reaction events reported.1

In MOTIVATE, SAEs occurred in 4.9 percent of patients in the risankizumab 600 mg group and 4.4 percent of patients in the risankizumab 1200 mg group compared to 12.6 percent of patients in the placebo group.2 The most common AEs observed in the risankizumab treatment groups were headache, arthralgia and nasopharyngitis.2 Rates of serious infections were 0.5 and 1.0 percent in those treated with risankizumab 600 mg or 1200 mg, respectively, and 2.4 percent in patients who received placebo.2 The rates of AEs leading to discontinuation of the study drug were 1.0 and 2.4 percent of patients treated with risankizumab 600 mg or 1200 mg, respectively, compared with 8.2 percent on placebo.2 There was one death in the risankizumab 1200 mg group due to squamous cell carcinoma of the lung diagnosed on study day 8, which was assessed as unrelated to the study drug by the investigator.2 There were no adjudicated MACE or adjudicated anaphylactic reaction events reported.2

Full results from the ADVANCE and MOTIVATE studies will be presented at upcoming medical conferences and published in a peer-reviewed medical journal. Use of risankizumab in Crohn’s disease is not approved and its safety and efficacy have not been evaluated by regulatory authorities. The maintenance study for Crohn’s disease is ongoing and once completed will be submitted to regulatory authorities with the induction studies.

Risankizumab (SKYRIZI) is part of a collaboration between Boehringer Ingelheim and AbbVie, with AbbVie leading development and commercialization globally.

For additional information, visit:
news.abbvie.com

References

  1. AbbVie. Data on File: ABVRRTI71474.
  2. AbbVie. Data on File: ABBVRRI71526.
  3. Gordon K., et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. The Lancet. 2018 Aug 25;392(10148):650-661.
  4. Reich, K., et al. Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial. Lancet. 2019 Aug 17;394(10198):576-586. doi: 10.1016/S0140-6736(19)30952-3.
  5. Blauvelt, A., et al. Efficacy and Safety of Continuous Q12W Risankizumab Versus Treatment Withdrawal: 2-Year Double-Blinded Results from the Phase 3 IMMhance Trial. Poster #478. 24th World Congress of Dermatology. 2019.
  6. Feagan, B., et al. Induction therapy with the selective interleukin-23 inhibitor risankizumab in patients with moderate-to-severe Crohn’s disease: a randomised, double-blind, placebocontrolled phase 2 study. Lancet. 2017 Apr 29;389(10080):1699-1709. doi: 10.1016/S0140- 6736(17)30570-6. Epub 2017 Apr 12.
  7. A Study to Assess the Safety and Efficacy of Risankizumab for Maintenance in Moderate to Severe Plaque Type Psoriasis (LIMMITLESS). ClinicalTrials.gov. 2020. Available at: https:// clinicaltrials.gov/ct2/show/NCT03047395. Accessed on December 18, 2020.
  8. A Study Comparing Risankizumab to Placebo in Participants With Active Psoriatic Arthritis Including Those Who Have a History of Inadequate Response or Intolerance to Biologic Therapy(ies) (KEEPsAKE2). ClinicalTrials.gov. 2020. Available at: https://clinicaltrials.gov/ ct2/show/NCT03671148. Accessed on December 18, 2020.
  9. Kaplan, G. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015 Dec;12(12):720-7. doi: 10.1038/nrgastro.2015.150.
  10. The Facts about Inflammatory Bowel Diseases. Crohn’s & Colitis Foundation of America. 2014. Available at: https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/ Updated%20IBD%20Factbook.pdf. Accessed on December 18, 2020.
  11. Crohn’s disease. Symptoms and Causes. Mayo Clinic. 2020. Available at: https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304. Accessed on December 18, 2020.
  12. The Economic Costs of Crohn’s Disease and Ulcerative Colitis. Access Economics Pty Limited. 2007. Available at: https://www.crohnsandcolitis.com.au/site/wp-content/uploads/ Deloitte-Access-Economics-Report.pdf. Accessed on December 18, 2020.
  13. A Study of the Efficacy and Safety of Risankizumab in Participants With Moderately to Severely Active Crohn’s Disease. ClinicalTrials.gov. 2020. Available at: https://clinicaltrials. gov/ct2/show/record/NCT03105128. Accessed on December 18, 2020.
  14. A Study to Assess the Efficacy and Safety of Risankizumab in Participants With Moderately to Severely Active Crohn’s Disease Who Failed Prior Biologic Treatment. ClinicalTrials. gov. 2020. Available at: https://clinicaltrials.gov/ct2/show/record/NCT03104413. Accessed on December 18, 2020.
  15. Duvallet, E., Sererano, L., Assier, E., et al. Interleukin-23: a key cytokine in inflammatory diseases. Ann Med. 2011 Nov;43(7):503-11.
  16. SKYRIZI (risankizumab) [Package Insert]. North Chicago, Ill.: AbbVie Inc.

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