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Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
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Biologic de-escalation tied to clinical relapse

23 Nov 2020

Dose de-escalation of biologic therapy appears to result in higher rates of clinical relapse, according to results of a systematic review, but the quality of evidence is very low.

“De-escalation of biologic therapy is a commonly encountered clinical scenario,” the investigators said.

The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to October 2019. Randomized controlled trials and observational studies assessing dose de-escalation of biologic therapy in adults with inflammatory bowel disease were eligible. Those analysing biologic discontinuation only and those lacking outcomes after dose de-escalation were excluded. The Newcastle-Ottawa Scale was used to evaluate risk of bias.

A total of 1,537 unique citations with 20 eligible studies after full-text review were identified. Overall, 995 patients were included from 18 observational studies (four prospective and 14 retrospective), one nonrandomized controlled trial, and one subgroup analysis of a randomized controlled trial. Seven studies included patients with Crohn’s disease, one included those with ulcerative colitis, and 12 included both.

Clinical relapse occurred in 0–54 percent of patients who dose de-escalated their biologic therapy (17 studies). The clinical relapse rate at 1 year ranged from 7 to 50 percent (six studies). However, 18 studies were found to have high risk of bias, driven primarily by the lack of a control group.

Additional controlled prospective studies are needed to clarify the effectiveness of biologic de-escalation and identify predictors of success.

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 3 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
3 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.