6 results on '"Bouma, Gerd"'
Search Results
2. Therapeutic drug monitoring of methotrexate in patients with Crohn's disease.
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van de Meeberg, Maartje M., Fidder, Herma H., Oldenburg, Bas, Sundaresan, Janani, Struys, Eduard A., Montazeri, Nahid S. M., Mares, Wout G. N., Mahmmod, Nofel, van Asseldonk, Dirk P., Lutgens, Maurice W. M. D., Kuyvenhoven, Johan P., Rietdijk, Svend T., Nissen, Loes H. C., Koehestanie, Parweez, de Boer, Nanne K. H., de Jonge, Robert, Bouma, Gerd, Bulatović Ćalasan, Maja, van Schaik, Fiona, and van der Horst, Inge
- Subjects
CROHN'S disease ,DRUG monitoring ,PATIENT monitoring ,TERMINATION of treatment ,METHOTREXATE - Abstract
Summary: Background: Therapeutic drug monitoring (TDM) has the potential to improve efficacy and diminish side effects. Measuring methotrexate‐polyglutamate (MTX‐PG) in erythrocytes might enable TDM for methotrexate in patients with Crohn's disease (CD). Aim: To investigate the relationship between MTX‐PGs and methotrexate drug survival, efficacy and toxicity Methods: In a multicentre prospective cohort study, patients with CD starting subcutaneous methotrexate without biologics were included and followed for 12 months. Primary outcome was subcutaneous methotrexate discontinuation or requirement for step‐up therapy. Secondary outcomes included faecal calprotectin (FCP), Harvey Bradshaw Index (HBI), hepatotoxicity and gastrointestinal intolerance. Erythrocyte MTX‐PGs were analysed at weeks 8, 12, 24 and 52 or upon treatment discontinuation. Results: We included 80 patients with CD (mean age 55 ± 13y, 35% male) with a median FCP of 268 μg/g (IQR 73–480). After the 12‐month visit, 21 patients (26%) were still on subcutaneous methotrexate monotherapy. Twenty‐one patients stopped because of disease activity, 29 because of toxicity, and four for both reasons. Five patients ended study participation or stopped methotrexate for another reason. A higher MTX‐PG3 concentration was associated with a higher rate of methotrexate drug survival (HR 0.86, 95% CI 0.75–0.99), lower FCP (β −3.7, SE 1.3, p < 0.01) and with biochemical response (FCP ≤250 if baseline >250 μg/g; OR 1.1, 95% CI 1.0–1.3). Higher MTX‐PGs were associated with less gastrointestinal intolerance. There was no robust association between MTX‐PGs and HBI or hepatotoxicity. Conclusions: Higher MTX‐PG3 concentrations are related to better methotrexate drug survival and decreased FCP levels. Therefore, MTX‐PG3 could be used for TDM if a target concentration can be established. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Editorial: Monitoring methotrexate polyglutamates in Crohn's disease—Authors' reply.
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van de Meeberg, Maartje M., Fidder, Herma H., de Jonge, Robert, Bouma, Gerd, and Bulatović Ćalasan, Maja
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CROHN'S disease ,METHOTREXATE - Abstract
LINKED CONTENT: This article is linked to van de Meeberg et al papers. To view these articles, visit https://doi.org/10.1111/apt.17719 and https://doi.org/10.1111/apt.17743 [ABSTRACT FROM AUTHOR]
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- 2024
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4. Limited added value of laboratory monitoring in thiopurine maintenance monotherapy in inflammatory bowel disease patients.
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Kreijne, Joany E., Vries, Annemarie C., Veer, Rozanne C., Bouma, Gerd, Dijkstra, Gerard, Voskuil, Michiel D., West, Rachel, Moorsel, Sofia A. W., Jong, Dirk J., Boer, Nanne K., and Woude, C. Janneke
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INFLAMMATORY bowel diseases ,ALKALINE phosphatase - Abstract
Summary: Background: To timely detect myelotoxicity and hepatotoxicity, laboratory monitoring at 3‐month intervals is advised throughout thiopurine maintenance treatment for IBD. However, reported incidence rates of myelotoxicity and hepatotoxicity in maintenance treatment are low. Aim: To assess incidence rates and clinical consequences of myelotoxicity and hepatotoxicity in thiopurine maintenance therapy after at least 1 year of thiopurine treatment. Methods: Retrospective analysis of therapy adjustment for laboratory toxicity in adult IBD patients after 12 consecutive months of azathioprine (AZA) or mercaptopurine monotherapy (ie baseline) between 2000 and 2016. Incidence rates of laboratory toxicity (ie myelotoxicity [leucocyte count <4.0 × 10e9/L, and/or platelet count <150 × 10e9/L] and/or hepatotoxicity (gamma‐glutamyltransferase [GGT], alkaline phosphatase [AP], ALT and/or AST above ULN, excluding isolated increased AST/AP]) and associated diagnostic procedures and complications were assessed. Results: In total, 12,391 laboratory assessments were performed on 1132 patients (56% female, AZA 74%) during 3.3 years of median follow‐up. Median monitoring frequency was 3.1 assessments/treatment year. Only 83/12,391 (0.7%) assessments resulted in therapy adjustment, dose reduction in 46 patients, cessation in 28 and allopurinol initiation in nine; risk of therapy adjustment was 1.9% per treatment year. Incidence rates of myelotoxicity were 7.1% (5.1% mild/1.8% moderate/0.1% severe) and hepatotoxicity 5.1% (3.8% mild/1.1% moderate/0.2% severe) per treatment year. Treatment‐related complications with concurrent laboratory toxicity occurred in 12 patients (1.1%) and would not have been prevented by monitoring. Conclusion: Severe laboratory toxicity is uncommon after 1 year of thiopurine monotherapy at 4‐month monitoring intervals. Therapy adjustments are rare after detection of laboratory toxicity. After 1 year of thiopurine monotherapy, laboratory monitoring may be lowered to less than a 4‐month interval. [ABSTRACT FROM AUTHOR]
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- 2020
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5. Adverse events related to low dose corticosteroids in autoimmune hepatitis.
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Brand, Floris F., Veen, Koen S., Lissenberg‐Witte, Birgit I., Boer, Ynto S., Hoek, Bart, Drenth, Joost P. H., Verdonk, Robert C., Vrolijk, Jan M., Nieuwkerk, Carin M. J., Bouma, Gerd, van Gerven, N. M., Kuijvenhoven, J. Ph., Schreuder, T. C. M. A., van der Wouden, E. J., van Meyel, J. J. M., Baak, L. C., Stadhouders, P. H. G. M., Klemt‐Kropp, M., Verhagen, M. A. M. T., and Bhalla, A.
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CHRONIC active hepatitis ,ADVERSE health care events ,CORTICOSTEROIDS ,RHEUMATISM ,LOGISTIC regression analysis ,CATARACT - Abstract
Summary: Background: Autoimmune hepatitis requires long‐term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long‐term studies are mainly derived from studies in rheumatic diseases. Aim: To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long‐term maintenance treatment of patients with autoimmune hepatitis. Methods: We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results: A total of 6634 years, with a median of 13 (range 1‐40) per patient were recorded. The median age at diagnosis was 44 years (range 2‐88). Adverse events were documented in 120 (25%) patients. Low‐dose predniso(lo)ne (0.1‐5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions: Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses. [ABSTRACT FROM AUTHOR]
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- 2019
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6. Biochemical efficacy of tioguanine in autoimmune hepatitis: a retrospective review of practice in the Netherlands
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van den Brand, Floris F., primary, van Nieuwkerk, Carin M. J., additional, Verwer, Bart J., additional, de Boer, Ynto S., additional, de Boer, Nanne K. H., additional, Mulder, Chris J. J., additional, Bloemena, Elisabeth, additional, Bakker, Christine M., additional, Vrolijk, Jan M., additional, Drenth, Joost P. H., additional, Tan, Adriaan C. I. T. L., additional, ter Borg, Frank, additional, ter Borg, Martijn J., additional, van den Hazel, Sven J., additional, Inderson, Akin, additional, Tushuizen, Maarten E., additional, and Bouma, Gerd, additional
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- 2018
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