Predicting Sustained Benefit From Tirzepatide in SURPASS-4: Who Benefits and Why?

Sustained cognitive benefit in patients with mild cognitive impairment (MCI) upon prolonged treatment with CHF5074

Sustained benefit at two years of primary femoral-popliteal stenting compared with balloon angioplasty with optional stenting

This case details a patient with PD who underwent bilateral STN DBS for refractory tremor who initially responded well to surgery with a bipolar programming configuration. Seven years after the initial surgery, the patient developed recurrent tremor symptoms and was found to have an open circuit at an active contact. Attempting to use similar settings at an adjacent contact did not sufficiently recapture benefit. While revision surgery was being considered, thorough re-evaluation of functioning contacts demonstrated benefit of tremor control when switching back to a monopolar configuration. The patient has had sustained benefit since that time (~2 years) without requiring a hardware revision. The case demonstrates that in the event of a stable hardware abnormality such as an open circuit, careful reprogramming can be used in select cases in an effort to provide sustained clinical benefit without the need for invasive or costly revision surgery.

Key clinical milestones 15 years and onwards after DBS-STN surgery—A retrospective analysis of patients that underwent surgery between 1993 and 2001

Primary stenting with self-expanding nitinol stents of the superficial femoral artery yielded improved morphological and clinical results compared with balloon angioplasty with optional stenting until 12 months in a randomized controlled trial. We now report 2-year data on restenosis and clinical outcomes of these patients. Of 104 patients with chronic limb ischemia and superficial femoral artery obstructions, 98 (94%) could be followed up until 2 years after intervention for occurrence of restenosis (>50%) by duplex ultrasound and for clinical and hemodynamic outcome by treadmill walking distance and ankle brachial index. Restenosis rates at 2 years were 45.7% (21 of 46) versus 69.2% (36 of 52) in favor of primary stenting compared with balloon angioplasty with optional secondary stenting by an intention-to-treat analysis (P=0.031). Consistently, stenting (whether primary or secondary; n=63) was superior to plain balloon angioplasty (n=35) with respect to the occurrence of restenosis (49.2% versus 74.3%; P=0.028) by a treatment-received analysis. Clinically, patients in the primary stent group showed a trend toward better treadmill walking capacity (average, 302 versus 196 m; P=0.12) and better ankle brachial index values (average, 0.88 versus 0.78; P=0.09) at 2 years, respectively. Reintervention rates tended to be lower after primary stenting (17 of 46 [37.0%] versus 28 of 52 [53.8%]; P=0.14). At 2 years, primary stenting with self-expanding nitinol stents for the treatment of superficial femoral artery obstructions yields a sustained morphological benefit and a trend toward clinical benefit compared with balloon angioplasty with optional stenting.

<b>Introduction:</b> Tracheobronchial stenosis secondary to endobronchial tuberculosis (TSTB) is a rare but devastating complication of TB. Endoscopic interventions (EI) might be an attractive alternative for patients unfit for surgery but little is known on whether the efficacy of EI can be affected by airway features. <b>Methods:</b> Retrospective study of EI performed for TSTB patients at interventional pulmonology unit of Serdang Hospital, Malaysia. <b>Results:</b> Our cohort comprised of 9 patients with mean age of 33.9years (SD10.43). All had dyspnoea, 33% had stridor, 44% had cough. Of CT and bronchoscopy performed, 67% had tracheal stenosis, 44% right main bronchus involvement, 22% left main bronchus involvement. 33% had multilevel airway involvement. Of airway features, 67% had pure short segment membranous concentric stenosis. Remaining 33% had extra adverse airway features (22% bronchomalacia;11% thick fibrotic band). All cases were performed with rigid bronchoscopy under general anaesthesia. All underwent balloon dilatation of stenotic segment; 78% had topical mitomycin-c (TMC) application and 11% did mechanical coring of stenotic segment. Procedure was deemed successful (sustained symptomatic benefits of ≥3 months) in 67% cases. All unsuccessful cases had adverse airway features. Of complications, 22% developed self-limiting airway tear (0.5cm) during procedure. None developed TMC related complications. <b>Conclusion:</b> EI appears to be an attactive option for TSTB patients. We postulate that EI might produce more sustainable benefits in those with pure short membranous concentric stenosis without adverse airway features. Future studies are needed to define the exact role of EI for TSTB patients.

BackgroundEvidence on whether the therapeutic effect and good safety profile of onabotulinumtoxinA (Botox®) in chronic migraine (CM) patients is maintained over long term treatment is still limited. We herein aimed at assessing whether there is a sustained benefit and good safety with repeated onabotulinumtoxinA sessions in CM over more than three years of treatment.MethodsWe prospectively enrolled 65 CM patients, who were classified as responders after three sessions of onabotulinumtoxinA and were eligible to further continue treatment. Data documenting longitudinal changes from the trimester after the third onabotulinumtoxinA administration (T1) to the trimester after completing two years of treatment (T2) and eventually to the trimester after completing three years of treatment (T3) in (i) mean number of monthly headache days (ii) migraine severity as expressed by the mean number of days with peak headache intensity of > 4/10, and (iii) mean number of days with use of any acute headache medication, were prospectively collected from patients’ headache diaries.ResultsA total of 56 (86.1%) of 65 patients achieved to attain onabotulinumtoxinA over three years. At T3, a significant reduction in mean monthly headache days was evident, compared to T1 (3.4 ± 1.7 vs 7.2 ± 3.8; P < 0.001) with diminished mean number of monthly days with peak headache intensity of more than 4/10 and a significant change in days using acute headache medications per month between T1 and T3 (2.8 ± 1.3 vs 4.7 ± 3.2; P < 0.001). Significant changes were also noticed in all efficacy variables from T2 to T3. Therapy was safe and well tolerated with low rates of adverse events or drop-outs.ConclusionThe long -term treatment with onabotulinumtoxinA proved effective, safe and well tolerated over three years. Our findings support the strategy to consistently deliver sessions of use of onabotulinumtoxinΑ over long time in CM patients (Trial registration NTC03606356, registered retrospectively, 28 July 2018).

Background and aims:This observational study assessed the long-term clinical benefit of infliximab (IFX) in 614 consecutive patients with Crohn’s disease (CD) from a single centre during a median follow-up of...

LONG-TERM OUTCOME OF TREATMENT WITH INFLIXIMAB IN 440 CROHN'S DISEASE PATIENTS: RESULTS FROM A SINGLE CENTER COHORT

162. Predictors of a sustained clinical benefit following adult spinal deformity correction with a minimum 3-year follow-up

IntroductionInfliximab (IFX) is licensed for use in Crohn's disease (CD) in the UK. Data from randomised controlled trials demonstrate that IFX is more effective than placebo at inducing remission of...

Aim was to assess the long-term clinical efficacy of infliximab therapy in patients with Crohn's disease treated in a cohort of 2 tertiary referral centers in the Netherlands. All consecutive patients with Crohn's disease treated with infliximab were assessed. Endpoints were primary clinical efficacy, sustained benefit, efficacy of retreatment, surgical intervention rates, and safety. Sustained benefit was determined by Kaplan-Meier analysis. The estimated 5-year benefit was calculated. A total of 469 patients were included. Median follow-up length was 4.5 years (interquartile range, 2.7-6.8). Seventy patients (15%) had unsuccessful remission induction, and 316 patients received maintenance therapy. Scheduled maintenance regimen was successful in 169 of 276 (61%). Episodic maintenance therapy was successful in 19 of 40 patients (48%). Estimated 5-year sustained benefit was 55.7% (95% confidence interval, 48.8-62.6). Concomitant thiopurines were associated with improved sustained benefit. A second course of infliximab after previous discontinuation was prescribed in 131 patients with similar efficacy rates. Abdominal surgical intervention rate per 100 patient-years was significantly reduced after infliximab initiation in patients with a scheduled maintenance regime (reduction, 2.70; 95% confidence interval, -4.82 to -0.35; P = 0.018). Mortality and malignancy rates were 1.9% (0.39/100 patient-years) and 3.4% (0.70/100 patient-years), respectively. The present study shows an estimated 5-year sustained benefit of 55.7% in patients with Crohn's disease treated with infliximab maintenance therapy. Remission induction and maintenance were equally successful in patients starting infliximab and patients who temporarily stopped and were retreated. Long-term use of infliximab was safe and reduced the need for surgery in patients on scheduled maintenance therapy.

Introduction: There are few reports on the efficacy of adalimumab in Japanese CD patients. In this study, we evaluated the long-term outcomes and related prognostic factors of adalimumab maintenance treatment in Japanese patients with CD. Methods: Retrospective data were collected from luminal CD patients who received adalimumab for ≥4 weeks between October 2010 and September 2015 at our hospital. All patients received 160 mg of adalimumab on day 1, 80 mg at week 2 and 40 mg every other week from week 4. The effectiveness of adalimumab maintenance treatment was evaluated using rate of sustained clinical benefit—defined as lack of treatment failure—which was estimated using the Kaplan-Meier method. Treatment failure was defined as either discontinuation of adalimumab, dose escalation, or surgery for CD. Prognostic factors associated with the rate of sustained clinical benefit were evaluated using log-rank tests and multivariate Cox regression analysis. Results: Of the 152 patients included in this study (mean age, 30.2 years), 57 were female. The mean duration of disease was 7.2 years. The mean C-reactive protein level was 1.99 mg/dl. One hundred five patients had ileocolitis, 27 had ileitis, and 20 had colitis. In addition, 47 patients had stricturing disease, 9 had intra-abdominal fistulas, and 82 had perianal disease. Concomitant treatment with azathioprine or 6-mercaptopurine and prednisolone was administered to 56 and 18 patients, respectively. Before initiating adalimumab therapy, 53 patients had undergone at least one intestinal resection and 65 had been previously exposed to infliximab. The 1-, 3-, and 5-year sustained clinical benefit rates were 65%, 45%, and 33%, respectively. In the univariate analysis, significant prognostic factors for lower rate of sustained clinical benefit were previous IFX use, disease duration of >2 years, stricturing disease, intra-abdominal fistulas, previous bowel resection, colitis type, and concomitant treatment with prednisolone. In the multivariate Cox regression analysis, previous infliximab use, stricturing disease, and colitis type were identified as independent predictors of sustained clinical benefit. Conclusion: Treatment failure was experienced by about 70% of Japanese patients with CD receiving adalimumab maintenance treatment over a 5-year period. Care should be taken when administering adalimumab maintenance treatment to CD patients as to previous infliximab use, stricturing disease, and colitis type.

Adalimumab as second line anti-tumour necrosis factor alpha therapy for Crohn's disease: A single centre experience

Influence of Trough Serum Levels and Immunogenicity on Long-term Outcome of Adalimumab Therapy in Crohn's Disease