Publications by authors named "Dean Seah"

5 Publications

  • Page 1 of 1

Systematic Review and Meta-analysis: Optimal Salvage Therapy in Acute Severe Ulcerative Colitis.

Inflamm Bowel Dis 2019 06;25(7):1169-1186

Department of Gastroenterology, Austin Hospital, Melbourne, Australia.

Background: Infliximab is an effective salvage therapy in acute severe ulcerative colitis; however, the optimal dosing strategy is unknown. We performed a systematic review and meta-analysis to examine the impact of infliximab dosage and intensification on colectomy-free survival in acute severe ulcerative colitis.

Methods: Studies reporting outcomes of hospitalized steroid-refractory acute severe ulcerative colitis treated with infliximab salvage were identified. Infliximab use was categorized by dose, dose number, and schedule. The primary outcome was colectomy-free survival at 3 months. Pooled proportions and odds ratios with 95% confidence intervals were reported.

Results: Forty-one cohorts (n = 2158 cases) were included. Overall colectomy-free survival with infliximab salvage was 79.7% (95% confidence interval [CI], 75.48% to 83.6%) at 3 months and 69.8% (95% CI, 65.7% to 73.7%) at 12 months. Colectomy-free survival at 3 months was superior with 5-mg/kg multiple (≥2) doses compared with single-dose induction (odds ratio [OR], 4.24; 95% CI, 2.44 to 7.36; P < 0.001). However, dose intensification with either high-dose or accelerated strategies was not significantly different to 5-mg/kg standard induction at 3 months (OR, 0.70; 95% CI, 0.39 to 1.27; P = 0.24) despite being utilized in patients with a significantly higher mean C-reactive protein and lower albumin levels.

Conclusions: In acute severe ulcerative colitis, multiple 5-mg/kg infliximab doses are superior to single-dose salvage. Dose-intensified induction outcomes were not significantly different compared to standard induction and were more often used in patients with increased disease severity, which may have confounded the results. This meta-analysis highlights the marked variability in the management of infliximab salvage therapy and the need for further studies to determine the optimal dose strategy.
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http://dx.doi.org/10.1093/ibd/izy383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783899PMC
June 2019

Predicting response after infliximab salvage in acute severe ulcerative colitis.

J Gastroenterol Hepatol 2018 Jul 27;33(7):1347-1352. Epub 2018 Feb 27.

Department of Gastroenterology, Austin Health, Melbourne, Australia.

Background And Aim: Acute severe ulcerative colitis (ASUC) is a medical emergency requiring prompt therapeutic intervention. Although infliximab has been used as salvage therapy for over 15 years, clinical predictors of treatment success are lacking. We performed a retrospective analysis to identify factors that predict colectomy and may guide dose intensification.

Methods: Fifty-four hospitalized patients received infliximab for ASUC at seven Australian centers (April 2014-May 2015). Follow-up was over 12 months. The data were primarily analyzed for predictors of colectomy. Accelerated (AI) versus standard (SI) infliximab induction strategies were also compared.

Results: Of 54 patients identified, the overall colectomy rate was 15.38% (8/52) at 3 months and 26.92% (14/52) at 12 months. Two patients were lost to follow-up. There was a numerically higher colectomy rate in those treated with AI compared with SI (P = 0.3); however, those treated with AI had more severe biochemical disease. A C-reactive protein (CRP)/albumin ratio cut-off of 0.37 post-commencement of infliximab and before discharge was a significant predictor of colectomy with an area under receiver operating curve of 0.73. Pretreatment CRP and albumin levels were not predictive of colectomy. A Mayo Endoscopic Score of 2 had a 94% PPV for avoidance of colectomy following infliximab salvage.

Conclusions: The baseline Mayo Endoscopic Score and the CRP/albumin ratio following infliximab salvage are significant predictors of treatment response for ASUC and identify patients at high risk of colectomy. Whether this risk can be mitigated using infliximab dose intensification requires prospective evaluation before the CRP/albumin ratio can be integrated into ASUC management algorithms.
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http://dx.doi.org/10.1111/jgh.14072DOI Listing
July 2018

Development and Evaluation of a Water-Based Flame Retardant Spray Coating for Cotton Fabrics.

ACS Appl Mater Interfaces 2017 Nov 7;9(46):40782-40791. Epub 2017 Nov 7.

School of Materials Science & Engineering (Blk N4.1), Nanyang Technological University , 50 Nanyang Avenue, Singapore 639798.

In this Research Article, we report on the development of water-based flame retardant coating based on phospho-nitrogen combination for cotton fabrics. A one-step spray-on process was employed to coat the fabrics by taking advantage of the spontaneous reaction between para-phenylenediamine (PDA) and tetrakis(hydroxymethyl)phosphonium chloride (THPC) resulting in an instantaneous precipitation of poly[1,4-diaminophenylene-tris(dimethyl hydroxymethyl)phosphine] (PApP) on the fabric surface. The effectiveness of PApP in improving the flame retardant properties like ignition resistance and lateral flame spread were evaluated in accordance with ASTM D6413 and BS EN ISO 15025 flammability tests. Despite the early (thermal) decomposition onset for coated fabrics under both oxidative and pyrolytic conditions, remarkably, self-extinguishing behavior (<3 s) without any lateral flame spread was observed. Possible reaction scheme was also proposed to correlate flame retardant mechanism of the coated fabrics with the observations. Additional analysis via pyrolysis combustion flow calorimetry and vertical flame testing before and after washing showed that flame retardant efficiency did decrease with washing, but the overall performance was still promising.
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http://dx.doi.org/10.1021/acsami.7b09863DOI Listing
November 2017

Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis.

J Gastroenterol Hepatol 2018 Jan;33(1):226-231

Department of Gastroenterology, Austin Health, Melbourne, Australia.

Background And Aim: Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy.

Methods: Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months.

Results: Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230).

Conclusion: Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined.
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http://dx.doi.org/10.1111/jgh.13850DOI Listing
January 2018

Acute Life-Threatening Portal Hypertension After Portosystemic Shunt Embolization.

Am J Gastroenterol 2017 May;112(5):816-818

Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1038/ajg.2017.62DOI Listing
May 2017