Publications

Background

The gut-selective nature of vedolizumab has raised questions regarding increased joint pain or arthralgia with its use in inflammatory bowel disease (IBD) patients. As arthralgias are seldom coded and thus difficult to study, few studies have examined the comparative risk of arthralgia between vedolizumab and tumor necrosis factor inhibitor (TNFi). Our objectives were to evaluate the application of natural language processing (NLP) to identify arthralgia in the clinical notes and to compare the risk of arthralgia between vedolizumab and TNFi in IBD.

Methods

We performed a retrospective study using a validated electronic medical record (EMR)-based IBD cohort from 2 large tertiary care centers. The index date was the first date of vedolizumab or TNFi prescription. Baseline covariates were assessed 1 year before the index date; patients were followed 1 year after the index date. The primary outcome was arthralgia, defined using NLP. Using inverse probability of treatment weight to balance the cohorts, we then constructed Cox regression models to calculate the hazard ratio (HR) for arthralgia in the vedolizumab and TNFi groups.

Results

We studied 367 IBD patients on vedolizumab and 1218 IBD patients on TNFi. Patients on vedolizumab were older (mean age, 41.2 vs 34.9 years) and had more prevalent use of immunomodulators (52.3% vs 31.9%) than TNFi users. Our data did not observe a significantly increased risk of arthralgia in the vedolizumab group compared with TNFi (HR, 1.20; 95% confidence interval, 0.97-1.49).

Conclusions

In this large observational study, we did not find a significantly increased risk of arthralgia associated with vedolizumab use compared with TNFi.

Failure to achieve euvolemia before discharge in patients admitted with acute heart failure (HF) syndromes has gained attention as a marker for increased readmission risk. This study assessed whether variations in discharge documentation practices reflected the readmission risk of patients admitted for decompensated HF. This was a retrospective cohort study of 100 adult patients discharged from an admission for an acute HF syndrome from May 2014 to June 2015. Characteristics at discharge were retrieved from the discharge summaries (DS). Coprimary outcomes were 30-day and 6-month composites of all-cause readmissions or emergency department visits. Mean age was 62.1 years (SD 15.3), and 56% were men. Traditional cardiovascular risk factors were common. All-cause 30-day readmission occurred in 18%, and HF-related 30-day readmission occurred in 12% of the population. A DS physical exam in support of decongestion occurred more often in those not readmitted, for example, a normal jugular venous pulse (53.2 vs 12.5%, p = 0.03). Discussion of jugular venous pulse improvement occurred more frequently in those not readmitted (8.5 vs 0%, p = 0.03). No other markers of volume status reached statistical significance. A clear statement in the DS supporting euvolemia was uncommon, but tended to occur more commonly in those not readmitted (20.7 vs 5.6%, p = 0.13). In conclusion, documenting markers of euvolemia and incorporating these markers into the DS volume status assessment was associated with a reduced rate of 30-day readmission.