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P424 Analysis of the intestinal microbiome using an Endoscopic Brush in Ulcerative colitis P424 利用内镜刷分析溃疡性结肠炎患者的肠道微生物群
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0554
B Lee, B Keum, S Kim, H Jeon, Y Jeen, C Hoonjai
Background The precise pathogenesis of the Ulcerative colitis is still yet unknown, but one of its cause is known to be microbial dysbiosis. The mucosa-associated microbiota are more deeply involved in the pathogenesis of UC. However, the optimal sampling of mucosa-associated microbiome has yet to be investigated. In this study, we investigated the mucosa-associated microbiome in patients with ulcerative colitis, using endoscopic brush samples. We hypothesized that endoscopic brushing is precise and noninvasive method to get sample of mucosa-associated microbiome. Methods Patients with UC who visited the gastroenterology department of Korea University Anam hospital were screened for this study. Clinical data such as medical records, colonoscopy and fecal samples were reviewed. Using a stool and saliva sample collector kit respectively, the subjects provided stool and saliva samples. Brushing samples were collected during the sigmoidoscopy procedure with 3-4 brush strokes on the colon mucosa using the cytology brush. The samples were analyzed for microbiome in the Korea University Medical Center. Results From July 2022 to January 2023, we prospectively enrolled 19 patients with UC. Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria were the most common species in microbiota of brush, stool and saliva.(Fig.1-1) The microbiome between stool and brush was no significant difference in alpha and beta diversities.(Fig.1-2) However, Oral microbiome was different from stool and brush in beta diversities.(Fig.1-3) Patients were categorized into to analyze the oral microbiome. A trend was observed where increased disease severity was associated with an increase in Firmicutes.(Fig.1-4) Conclusion The microbiome of stool and brush was no significantly different. However, the novel sampling of mucosa-associated microbiome, endoscopic brush, is not inferior compared to currently used sampling of stool. Also the analysis of the oral microbiome suggested that Firmicutes could be considered a useful biomarker for assessing disease severity. Therefore, it is necessary to conduct followup research by increasing the number of subjects.
背景 溃疡性结肠炎的确切发病机制尚不清楚,但已知其病因之一是微生物菌群失调。粘膜相关微生物群与溃疡性结肠炎的发病机制关系更为密切。然而,粘膜相关微生物群的最佳取样方法仍有待研究。在这项研究中,我们使用内镜刷取样研究了溃疡性结肠炎患者的粘膜相关微生物群。我们假设内镜刷取样本是获取粘膜相关微生物组样本的精确且无创的方法。方法 本研究筛选了在韩国大学安南医院消化内科就诊的 UC 患者。研究人员审查了病历、结肠镜检查和粪便样本等临床数据。受试者分别使用粪便和唾液样本采集器提供粪便和唾液样本。在乙状结肠镜检查过程中,使用细胞学刷子在结肠粘膜上刷3-4下,收集刷子样本。样本在韩国大学医学中心进行微生物组分析。结果 从 2022 年 7 月到 2023 年 1 月,我们对 19 名 UC 患者进行了前瞻性研究。在刷子、粪便和唾液的微生物群中,固着菌、类杆菌、蛋白菌和放线菌是最常见的菌种。(图 1-1)粪便和刷子的微生物群在α和β多样性方面没有显著差异。(图 1-2)但是,口腔微生物群在β多样性方面与粪便和刷子不同。图 1-4 结论 粪便和刷子中的微生物组没有明显差异。不过,与目前使用的粪便取样相比,内窥镜刷取样粘膜相关微生物群的新方法并不逊色。此外,对口腔微生物群的分析表明,固形菌可被视为评估疾病严重程度的有用生物标志物。因此,有必要通过增加研究对象的数量来开展后续研究。
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引用次数: 0
P706 Tofacitinib in Moderate to Severe Ulcerative Colitis patients naïve to biological therapy: A prospective real world analysis of efficacy and safety P706 托法替尼治疗未接受生物疗法的中重度溃疡性结肠炎患者:对疗效和安全性的前瞻性真实世界分析
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0836
R Banerjee, M Dhanush, N Raghunathan, P Pal, V Joshi, R Patel, S Godbole, Y Akki, S Valluri, P Nagasuri, A Haridas
Background Tofacitinib is an oral non-selective Janus Kinase inhibitor approved for Ulcerative colitis (UC) after the failure of biological therapy. Tofacitinib as first line therapy in biologic naive patients has not been evaluated. Methods We conducted a prospective study to assess the safety and efficacy of Tofacitinib as first line therapy in biologic naive moderate to severe UC. Tofacitinib was given at a dose of 10mg BD for 8 weeks followed by de-escalation to 5mg BD maintenance in responders. Dose escalation was done for relapses. Demographics, disease characteristics, concomitant medication, adverse events, severity and time to relapse were recorded. Clinical response and remission (defined as partial Mayo score: PMS decrease ≥2 and PMS ≤1 respectively) were measured at 4 weeks, 8 weeks, 24 weeks and 52 weeks. Endoscopic response (UCEIS score decrease ≥2) and remission (UCEIS 0-1) were assessed at 1 year. Time to event analysis was done to evaluate the cumulative rate of clinical response. Results 176 patients (136 biologic naive, 58% male; median age 40y [IQR:31-48y]) were included. Median baseline PMS and UCEIS score were 5 (IQR: 5-7 and 4-6 respectively) (Table 1). Of the biologic naïve cohort, clinical response was achieved in 68.4% and 79.4% at 4 and 8 weeks respectively. Clinical remission was achieved in 45.6%(4-weeks) and 55% (8-weeks). Maintenance of remission was seen in 44.1% and 32.4% in 24 and 52 weeks respectively (Fig1A). There was a significant reduction in PMS from baseline to end of 8-weeks (p<0.001) (Fig 1B). Corticosteroid-free clinical remission was achieved in 64.8% at 24-weeks. 106 patients (77.9%) maintained response till last follow-up. 11 relapsed after dose de-escalation (median time of 5m [range 3-22m]. 7/11 responded to dose escalation to 10mg. Endoscopic response was noted in 62.5% and remission in 33.9% with significant reduction in UCEIS from baseline to 52-weeks(p<0.001) (Fig 1B). Severe and minor adverse events were noted in 4 and 3 patients respectively (Table 1). Overall 1/3 of patients discontinued therapy at 24-weeks (14%) and 52 weeks (10%). No significant difference in proportion of clinical or endoscopic remission was observed between the biologic naïve and those with history of prior biologic usage (n=31, median time from withdrawal of biologics to Tofacitnib initiation=9 months). Conclusion Tofacitinib was effective in induction of clinical remission in more than half of biologic naive, moderate to severe UC . Three-fourth of these patients continued to be in remission at one year with few serious adverse events. Tofacitinib can be considered as upfront oral therapy after failure of conventional management.
背景 托法替尼是一种口服非选择性 Janus 激酶抑制剂,已被批准用于生物疗法失败后的溃疡性结肠炎(UC)治疗。目前尚未对托法替尼作为一线疗法用于生物制剂治疗失败的患者进行评估。方法 我们进行了一项前瞻性研究,以评估托法替尼作为生物制剂天真型中度至重度 UC 一线疗法的安全性和有效性。托法替尼的剂量为 10 毫克 BD,疗程为 8 周,有反应者可降至 5 毫克 BD 维持治疗。复发者则进行剂量升级。记录人口统计学、疾病特征、伴随用药、不良事件、严重程度和复发时间。分别在 4 周、8 周、24 周和 52 周测量临床反应和缓解(定义为部分梅奥评分:PMS 下降≥2 和 PMS ≤1)。内镜反应(UCEIS 评分下降≥2)和缓解(UCEIS 0-1)在 1 年时进行评估。对事件发生时间进行分析,以评估临床反应的累积率。结果 共纳入 176 例患者(136 例未接受过生物治疗,58% 为男性;中位年龄 40 岁 [IQR:31-48 岁])。基线 PMS 和 UCEIS 评分中位数为 5(IQR:分别为 5-7 和 4-6)(表 1)。在生物制剂新药组中,分别有 68.4% 和 79.4% 的患者在 4 周和 8 周时获得了临床应答。45.6%(4 周)和 55%(8 周)的患者获得临床缓解。在 24 周和 52 周内,分别有 44.1% 和 32.4% 的患者病情得到了维持(图 1A)。从基线到 8 周结束,PMS 明显减少(p<0.001)(图 1B)。在 24 周时,64.8% 的患者实现了无皮质类固醇临床缓解。106名患者(77.9%)在最后一次随访时仍有反应。11例患者在减小剂量后复发(中位时间为5米[范围3-22米]。7/11 名患者对剂量升级至 10 毫克有反应。62.5%的患者有内镜反应,33.9%的患者病情缓解,UCEIS从基线到52周显著下降(p<0.001)(图1B)。分别有 4 名和 3 名患者出现严重和轻微不良反应(表 1)。总体而言,1/3 的患者在 24 周(14%)和 52 周(10%)停止了治疗。未使用过生物制剂的患者和曾使用过生物制剂的患者(31人,从停用生物制剂到开始使用托法替尼的中位时间=9个月)的临床或内镜缓解比例无明显差异。结论 托法替尼能有效诱导半数以上未使用过生物制剂的中度至重度 UC 患者获得临床缓解。其中四分之三的患者在一年后病情继续缓解,且很少出现严重不良反应。在常规治疗失败后,可考虑将托法替尼作为前期口服治疗药物。
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引用次数: 0
P264 The utility of ANCA in Ulcerative Colitis and Crohn’s Disease: A Retrospective Cohort Study in Taiwan P264 ANCA 在溃疡性结肠炎和克罗恩病中的作用:台湾的一项回顾性队列研究
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0394
Y H Wu, C P Wang, P J Huang, H C Lai, K S Cheng, J W Chou
Background Inflammatory bowel disease (IBD) includes two chronic idiopathic inflammatory diseases: ulcerative colitis (UC) and Crohn disease (CD). The diagnosis of IBD depends on clinical, endoscopic, histological, radiological and biochemical criteria, which may be invasive, time consuming and usually not accepted by patients with IBD. Antineutrophil cytoplasmic antibodies (ANCAs) is believed to be related to IBD. The aim of this study was to investigate these serological markers and the evidence for their use in the diagnosis and management of IBD in Taiwan. Methods We conducted a retrospective cohort study in adult IBD patients who had received the serum examinations using the medical records of China Medical University Hospital between 1 January 1980 and 31 October. 2023. Results A total of 301 IBD patients (194 with UC, 107 with CD) were included in this current study. A high proportion were male (IBD 70.41%; UC 65.63%, and CD 76.71%). The mean diagnostic age of these enrolled patients was 42.9 years. In our patients, the prevalence of positive anti-HCV Ab is 0.0% in UC patients and 0.96% in CD patients. However, the prevalence of positive HBsAg was 14.5% in UC patients and 9.4% in CD patients. The prevalence of pANCA was 21.2% in UC patients and 1.4% in CD patients, respectively. The prevalence of cANCA was 3.1% in UC patients and 0.0% in CD patients. This pattern of low sensitivity and high specificity for pANCA is also seen in UC patients in various cohort studies. The serum positivity of p-ANCA was significantly higher in UC patients (Figure 1). UC patients with positive p-ANCA were older than CD patients with positive p-ANCA (44.9 vs. 37.3 years). Furthermore, we found that the incidence of positive p-ANCA in UC patients with E1, E2, and E3 at diagnosis was 3.5%, 39.2%, and 57.1%, respectively (Table 1). The serum levels of ANCA-IgG were indeed higher in patients in the severe group than those in the moderate and mild groups. Conclusion Serological biomarkers have been demonstrated to be a series of rapid, non-invasive approaches for assessments of early diagnosis, disease activity and prognosis for IBD. ANCA may be helpful in the early diagnosis of UC and in differentiating it from CD. UC patients with positive ANCA have a higher rate of intestinal mucosal vasculitis than UC patients with negative ANCA. Furthermore, ANCA may also contributes to the pathogenesis of HBV-related systemic vasculitis. Therefore, the management of HBV-related vasculitis includes control the immune complex formation and reaction as well as antiviral agents to reduce the antigenic load resulting in reduction of inflammation. Moreover, effective biomarkers with high sensitivity and specificity need to be investigated in the future.
背景 炎症性肠病(IBD)包括两种慢性特发性炎症疾病:溃疡性结肠炎(UC)和克罗恩病(CD)。IBD 的诊断取决于临床、内窥镜、组织学、放射学和生化标准,这些标准可能具有侵入性,耗费时间,而且通常不被 IBD 患者接受。抗中性粒细胞胞浆抗体(ANCAs)被认为与 IBD 有关。本研究旨在调查这些血清学标记物及其在台湾 IBD 诊断和管理中的应用证据。方法 我们利用中国医科大学附属医院在 1980 年 1 月 1 日至 2023 年 10 月 31 日期间的病历,对接受过血清检查的成年 IBD 患者进行了一项回顾性队列研究。2023.结果 本次研究共纳入 301 名 IBD 患者(194 名 UC 患者,107 名 CD 患者)。男性患者比例较高(IBD 70.41%;UC 65.63%;CD 76.71%)。这些患者的平均诊断年龄为 42.9 岁。在我们的患者中,UC 患者抗-HCV Ab 阳性率为 0.0%,CD 患者为 0.96%。然而,UC 患者的 HBsAg 阳性率为 14.5%,CD 患者为 9.4%。在 UC 患者中,pANCA 的发病率为 21.2%,在 CD 患者中为 1.4%。cANCA 在 UC 患者中的发病率为 3.1%,在 CD 患者中的发病率为 0.0%。在各种队列研究中,这种 pANCA 低敏感性和高特异性的模式也出现在 UC 患者中。UC 患者血清中 p-ANCA 阳性率明显更高(图 1)。p-ANCA 阳性的 UC 患者比 p-ANCA 阳性的 CD 患者年龄更大(44.9 岁对 37.3 岁)。此外,我们还发现,在诊断时为 E1、E2 和 E3 的 UC 患者中,p-ANCA 阳性的发生率分别为 3.5%、39.2% 和 57.1%(表 1)。重度组患者血清中的 ANCA-IgG 水平确实高于中度组和轻度组患者。结论 血清学生物标志物已被证明是评估 IBD 早期诊断、疾病活动性和预后的一系列快速、无创方法。ANCA 可能有助于 UC 的早期诊断以及与 CD 的鉴别。与 ANCA 阴性的 UC 患者相比,ANCA 阳性的 UC 患者发生肠粘膜血管炎的比例更高。此外,ANCA 也可能是 HBV 相关全身性血管炎的发病机制之一。因此,HBV 相关性血管炎的治疗包括控制免疫复合物的形成和反应,以及使用抗病毒药物减少抗原负荷,从而减轻炎症。此外,未来还需要研究具有高灵敏度和特异性的有效生物标志物。
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引用次数: 0
P169 Circulating eNAMPT predicts anti-TNF response in IBD patients: possible place in therapy of anti-eNAMPT antibody P169 循环中的 eNAMPT 可预测 IBD 患者的抗肿瘤坏死因子反应:抗 eNAMPT 抗体在治疗中的可能作用
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0299
C Travelli, G Cascetta, G colombo, A Alessi, E Caputo, M V Lenti, A Pasini, C Porta, D Ribaldone, L Pastorelli, A Di Sabatino, A Genazzani, G P Caviglia, G Stocco
Background extracellular Nicotinamide phosphoribosyltrasferase (eNAMPT) is a cytokine with paracrine and autocrine effects on different cell types. Importantly, eNAMPT levels are increased in patients suffering of Inflammatory Bowel Diseases (IBD). Biologic drugs have been found effective in many IBD patients; however, a large proportion of patients with severe disease fail to achieve remission due to lack of drug response, loss of response, drug intolerance, or severe side effects that require cessation of therapy. Therefore, there is a clinical need for predictive response biomarkers as well as for new therapeutic strategies. Methods First, we investigated the expression of NAMPT in biopsies, in stools and the secretion of eNAMPT in serum in four cohorts of IBD patients. Second, we investigated if circulating eNAMPT levels correlate with the clinical response to biologics (infliximab, adalimumab, ustekinumab, vedolizumab). Clinical response is defined as a reduction of >2 points in HBI (for CD) and in pMAYO (for UC) from baseline. Third, we have developed a monoclonal anti-eNAMPT antibody and we have evaluated its preclinical efficacy in acute and chronic preclinical models of IBD. Results We have determined the levels of circulating eNAMPT in three cohorts of patients that were not controlled by DMARDs and were treated with infliximab (IFX, cohort 1 and 3) or adalimumab (ADA, cohort 2). Notably, we confirmed a pronounced variability through the cohorts, identifying a group of patients with eNAMPT serum levels comparable with healthy adult populations and a group that showed elevated levels of eNAMPT. Performing a ROC curve analysis, a cutoff of 4.5 ng/ml can be extrapolated to discriminate these two populations. Noteworthy, 100% patients with levels of eNAMPT below 4.5 ng/ml were responsive to infliximab/adalimumab. In contrast, anti-TNF therapy failed either at 14 or 22 weeks in some patients with high circulating levels of eNAMPT, indicating that high systemic eNAMPT might be associated with an increased risk of resistance to anti-TNF therapy. Notably, we found also that eNAMPT levels in stools of IBD patients are elevated compared to healthy subjects. Then, we have developed and validated a candidate monoclonal antibody (called C269) which bind to eNAMPT, block is cytokine activity and reduces IBD symptoms, immune infiltrate and fibrosis in DSS and DNBS models. Conclusion Our data demonstrate that eNAMPT serum levels correlate with the clinical response to anti-TNF therapies suggesting that eNAMPT is not a simple by- stander of IBD, and that local and serum eNAMPT could be define as a biomarker to define the responsiveness to biologics. Notably, its neutralization might be a pharmacological strategy worth investigating.
背景细胞外烟酰胺磷酸核糖基转移酶(ENAMPT)是一种细胞因子,对不同类型的细胞具有旁分泌和自分泌作用。重要的是,炎症性肠病(IBD)患者体内的ENAMPT水平会升高。生物药物对许多 IBD 患者有效,但很大一部分病情严重的患者由于对药物缺乏反应、失去反应、对药物不耐受或严重的副作用而需要停止治疗,导致病情无法缓解。因此,临床需要预测反应的生物标志物以及新的治疗策略。方法 首先,我们调查了四组 IBD 患者活检组织、粪便中 NAMPT 的表达情况以及血清中 eNAMPT 的分泌情况。其次,我们研究了循环中的 eNAMPT 水平是否与生物制剂(英夫利昔单抗、阿达木单抗、乌斯特库单抗、维妥珠单抗)的临床反应相关。临床反应的定义是:HBI(CD)和pMAYO(UC)比基线降低>2个点。第三,我们开发了一种单克隆抗 eNAMPT 抗体,并在急性和慢性 IBD 临床前模型中评估了其临床前疗效。结果 我们测定了三组接受英夫利西单抗(IFX,第一组和第三组)或阿达木单抗(ADA,第二组)治疗但未被DMARDs控制的患者的循环中ENAMPT水平。值得注意的是,我们证实各组群之间存在明显的差异,其中一组患者的ENADMPT血清水平与健康成人相当,另一组患者的ENADMPT水平升高。通过 ROC 曲线分析,可以推断出 4.5 纳克/毫升的临界值可以区分这两类人群。值得注意的是,ENAMPT水平低于4.5纳克/毫升的患者100%对英夫利西单抗/阿达木单抗有反应。相比之下,一些循环中ENAMPT水平较高的患者的抗肿瘤坏死因子治疗在14周或22周时均告失败,这表明全身ENAMPT水平较高可能与抗肿瘤坏死因子治疗耐药风险增加有关。值得注意的是,我们还发现,与健康人相比,IBD 患者粪便中的 eNAMPT 水平升高。随后,我们开发并验证了一种候选单克隆抗体(名为 C269),该抗体能与 eNAMPT 结合,阻断 eNAMPT 的细胞因子活性,减轻 DSS 和 DNBS 模型中的 IBD 症状、免疫浸润和纤维化。结论 我们的数据表明,ENAMPT 血清水平与抗肿瘤坏死因子疗法的临床反应相关,这表明ENAMPT 并不是一个简单的 IBD 副标志物,局部和血清ENAMPT 可定义为生物标志物,以确定对生物制剂的反应性。值得注意的是,中和 eNAMPT 可能是一种值得研究的药物策略。
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引用次数: 0
P960 Comparison of clinical outcomes by induction therapy response status in patients with Inflammatory Bowel Disease (IBD) treated with subcutaneous (SC) versus intravenous (IV) infliximab (IFX): Post hoc analysis of a pivotal, randomised controlled trial P960 炎症性肠病(IBD)患者皮下注射英夫利西单抗(IFX)与静脉注射英夫利西单抗(IFX)诱导治疗反应状态的临床疗效比较:关键性随机对照试验的事后分析
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1090
L Vuitton, N Mathieu, B D Ye, D H Kim, A L Jeong, Y N Lee, S Schreiber
Background Clinical associations between initial response and long-term outcome are well established for IV IFX in IBD.1,2 In 2020, SC IFX was approved in Europe for treating moderate-to-severe Crohn’s disease (CD) or ulcerative colitis (UC), based on a pivotal randomised trial (NCT02883452) comparing SC and IV IFX.3 This post hoc analysis investigated clinical outcomes in patients (pts) treated with SC or IV IFX, by response to IV IFX induction. Methods In the pivotal trial, adults with active CD or UC received IV IFX induction (5 mg/kg; Week [W] 0 and W2), before randomisation to SC (n=66) or IV (n=65) arms. W6 clinical response (≥70-point decrease in Crohn’s Disease Activity Index [CDAI] score [CD]; ≥2-point decrease in partial Mayo score with ≥1-point decrease in rectal bleeding subscore or an absolute rectal bleeding subscore of 0 or 1 [UC]) was a stratification factor. The SC arm received SC IFX (120/240 mg for pts weighing <80/≥80 kg) every 2 weeks from W6–54; the IV arm received IV IFX 5 mg/kg every 8 weeks (W6–22), then switched to SC IFX (W30–54). Rates of clinical remission (CDAI score <150 [CD]; partial Mayo score ≤1 [UC]) and trough IFX concentrations (Ctrough) were assessed at W6, W30 and W54. Analyses were descriptive. Results There were 101 induction responders (IRs) to IV IFX, who were randomised to the SC arm (n=49, 74.2%; SC-IR subset) or the IV arm (n=52, 80.0%; IV-IR subset). Correspondingly, there were 17 (25.8%) and 13 (20.0%) induction non-responders (INRs; SC-INR and IV-INR subsets, respectively). In both study arms, IRs had higher clinical remission rates than INRs at both W30 and W54 (Figure A). Comparing by formulation, the SC-INR subset had nearly twice the W30 clinical remission rate of the IV-INR subset (58.8% vs. 30.8%; p=0.159 [Fisher exact test]). In addition, IV-INR subset clinical remission rates numerically increased after pts switched to SC IFX (W30: 30.8% vs. W54: 46.2%; p=0.476 [McNemar test]). These observations were generally consistent with Ctrough findings (Figure B); median Ctrough in the IV-INR subset increased from 1.5 to 18.3 µg/mL (p=0.005 [Wilcoxon signe-drank test]) after switching to SC IFX. Conclusion Findings suggested associations between initial response to IFX induction therapy and positive long-term outcomes for both SC and IV IFX, and supported potential benefits with SC IFX maintenance therapy for INRs, compared with the option of IV IFX maintenance. Given the post hoc nature of the analysis and the small analysis population (thus statistical inconclusiveness), investigation in larger studies is warranted. 1Murthy SK et al. Inflamm Bowel Dis 2015;21:2090–6. 2Wong ECL et al. J Crohns Colitis 2021;15:1114–9. 3Schreiber S et al. Gastroenterology 2021;160:2340–53.
背景IBD患者静脉注射IFX的初始反应与长期疗效之间的临床关联已得到确立1,2。2020年,欧洲批准了SC IFX用于治疗中重度克罗恩病(CD)或溃疡性结肠炎(UC),该试验是基于一项比较SC和IV IFX的关键性随机试验(NCT02883452)3 。方法 在关键试验中,患有活动性 CD 或 UC 的成人接受了静脉注射 IFX 诱导治疗(5 毫克/千克;第 [W] 0 周和第 W2 周),然后随机分配到静脉注射组(66 人)或静脉注射组(65 人)。W6临床反应(克罗恩病活动指数[CDAI]评分[CD]下降≥70分;部分梅奥评分下降≥2分,直肠出血评分下降≥1分或直肠出血评分绝对值为0或1[UC])是分层因素。在W6-54期间,SC组每2周接受一次SC IFX(体重<80/≥80 kg的患者为120/240 mg)治疗;IV组每8周(W6-22)接受一次5 mg/kg的IV IFX治疗,然后转为SC IFX治疗(W30-54)。临床缓解率(CDAI评分<150[CD];部分梅奥评分≤1[UC])和IFX谷浓度(Ctrough)在W6、W30和W54时进行评估。分析为描述性分析。结果 有101名IFX诱导应答者(IR)被随机分配到SC治疗组(49人,74.2%;SC-IR亚组)或IV治疗组(52人,80.0%;IV-IR亚组)。相应地,诱导无应答者(INRs;SC-INR 子集和 IV-INR 子集)分别为 17 人(25.8%)和 13 人(20.0%)。在两个研究臂中,IR 在 W30 和 W54 时的临床缓解率均高于 INR(图 A)。按剂型比较,SC-INR 亚组的 W30 临床缓解率几乎是 IV-INR 亚组的两倍(58.8% 对 30.8%;P=0.159 [费舍尔精确检验])。此外,IV-INR亚组临床缓解率在受试者转用SC IFX后在数量上有所增加(W30:30.8% vs. W54:46.2%;P=0.476 [McNemar检验])。这些观察结果与Ctrough结果基本一致(图B);转用SC IFX后,IV-INR亚组的中位Ctrough从1.5微克/毫升升至18.3微克/毫升(P=0.005 [Wilcoxon符号秩检验])。结论 研究结果表明,IFX诱导疗法的初始反应与SC和IV IFX的长期疗效之间存在关联,并支持与IV IFX维持疗法相比,SC IFX维持疗法对INRs的潜在益处。考虑到该分析的事后分析性质以及分析人群较少(因此统计结果不确定),有必要在更大规模的研究中进行调查。1Murthy SK et al. Inflamm Bowel Dis 2015;21:2090-6。2Wong ECL et al. J Crohns Colitis 2021;15:1114-9.3Schreiber S et al. Gastroenterology 2021;160:2340-53.
{"title":"P960 Comparison of clinical outcomes by induction therapy response status in patients with Inflammatory Bowel Disease (IBD) treated with subcutaneous (SC) versus intravenous (IV) infliximab (IFX): Post hoc analysis of a pivotal, randomised controlled trial","authors":"L Vuitton, N Mathieu, B D Ye, D H Kim, A L Jeong, Y N Lee, S Schreiber","doi":"10.1093/ecco-jcc/jjad212.1090","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1090","url":null,"abstract":"Background Clinical associations between initial response and long-term outcome are well established for IV IFX in IBD.1,2 In 2020, SC IFX was approved in Europe for treating moderate-to-severe Crohn’s disease (CD) or ulcerative colitis (UC), based on a pivotal randomised trial (NCT02883452) comparing SC and IV IFX.3 This post hoc analysis investigated clinical outcomes in patients (pts) treated with SC or IV IFX, by response to IV IFX induction. Methods In the pivotal trial, adults with active CD or UC received IV IFX induction (5 mg/kg; Week [W] 0 and W2), before randomisation to SC (n=66) or IV (n=65) arms. W6 clinical response (≥70-point decrease in Crohn’s Disease Activity Index [CDAI] score [CD]; ≥2-point decrease in partial Mayo score with ≥1-point decrease in rectal bleeding subscore or an absolute rectal bleeding subscore of 0 or 1 [UC]) was a stratification factor. The SC arm received SC IFX (120/240 mg for pts weighing <80/≥80 kg) every 2 weeks from W6–54; the IV arm received IV IFX 5 mg/kg every 8 weeks (W6–22), then switched to SC IFX (W30–54). Rates of clinical remission (CDAI score <150 [CD]; partial Mayo score ≤1 [UC]) and trough IFX concentrations (Ctrough) were assessed at W6, W30 and W54. Analyses were descriptive. Results There were 101 induction responders (IRs) to IV IFX, who were randomised to the SC arm (n=49, 74.2%; SC-IR subset) or the IV arm (n=52, 80.0%; IV-IR subset). Correspondingly, there were 17 (25.8%) and 13 (20.0%) induction non-responders (INRs; SC-INR and IV-INR subsets, respectively). In both study arms, IRs had higher clinical remission rates than INRs at both W30 and W54 (Figure A). Comparing by formulation, the SC-INR subset had nearly twice the W30 clinical remission rate of the IV-INR subset (58.8% vs. 30.8%; p=0.159 [Fisher exact test]). In addition, IV-INR subset clinical remission rates numerically increased after pts switched to SC IFX (W30: 30.8% vs. W54: 46.2%; p=0.476 [McNemar test]). These observations were generally consistent with Ctrough findings (Figure B); median Ctrough in the IV-INR subset increased from 1.5 to 18.3 µg/mL (p=0.005 [Wilcoxon signe-drank test]) after switching to SC IFX. Conclusion Findings suggested associations between initial response to IFX induction therapy and positive long-term outcomes for both SC and IV IFX, and supported potential benefits with SC IFX maintenance therapy for INRs, compared with the option of IV IFX maintenance. Given the post hoc nature of the analysis and the small analysis population (thus statistical inconclusiveness), investigation in larger studies is warranted. 1Murthy SK et al. Inflamm Bowel Dis 2015;21:2090–6. 2Wong ECL et al. J Crohns Colitis 2021;15:1114–9. 3Schreiber S et al. Gastroenterology 2021;160:2340–53.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
P465 Upadacitinib is effective and safe for the treatment of ulcerative colitis and Crohn’s disease: 1-year prospective real-world experience P465 Upadacitinib 用于治疗溃疡性结肠炎和克罗恩病既有效又安全:为期1年的前瞻性真实世界经验
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0595
N Krugliak Cleveland, N K Choi, J A Klein, E N Fear, Z D Fine, N M Garcia, E A Picker, S R Friedberg, R D Cohen, S R Dalal, J Pekow, D Choi, D T Rubin
Background Upadacitinib (UPA) is a novel selective Janus kinase 1 inhibitor that has shown efficacy and received approval for the treatment of moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). We previously reported a large real-world experience of UPA induction in UC and CD (Friedberg, CGH. 2023). Here we report our 1-year real-world experience. Methods This is a prospectively collected study of clinical outcomes of UPA treatment in patients with UC and CD using predetermined intervals at weeks 0, 2, 4, 8, then every 3 months until week 52 as part of a formalized treatment protocol at our institution. We used the Simple Clinical Colitis Activity Index and the Harvey-Bradshaw index, as well as C-reactive protein and faecal calprotectin to assess efficacy, and also recorded treatment-related adverse events and serious adverse events. Results 110 patients were initiated on UPA and followed for a one-year period (CD=57, UC=44, IBDU=5, pouchitis=4). 109/110 (99%) were biologic exposed and 31/110 (28.2 %) were tofacitinib exposed. 99/110 (90%) were initiated on UPA for luminal disease (Table 1). 54 patients remained on UPA therapy at 1 year. In UC: week 8 clinical response and remission was 24/47 (51.1%), 39/47 (83%), respectively; week 26 clinical response and remission was 20/34 (58.8%), 24/34 (70.6%), respectively; 52 week clinical response and remission was 17/30 (56.7%), 29/30 (96.7%), respectively. In CD: week 8 clinical response and remission was 14/32 (43.8%), 25/32 (78.1%%), respectively; week 26 clinical response and remission was 9/22 (40.9%), 15/22 (68.2%), respectively; 52 week clinical response and remission was 10/17 (58.8%), 13/17 (76.5%), respectively. 56 patients discontinued UPA prior to the 1 year follow-up, 13 were due to adverse events[DR1] . The most commonly experienced AEs leading to discontinuation was dermatological side effects (CD=2, UC=2). One instance of shingles occurred leading to discontinuation. No other serious infections or serious adverse events including VTE, MACE, or malignancies occurred. Conclusion In this large 1-year real-world experience in medically resistant patients with UC or CD, we report that UPA is both effective and safe, including in those who had prior exposure to tofacitinib.
背景 乌达替尼(UPA)是一种新型选择性 Janus 激酶 1 抑制剂,已显示出治疗中重度溃疡性结肠炎(UC)和克罗恩病(CD)的疗效并获得批准。我们曾报道过 UPA 诱导治疗 UC 和 CD 的大量实际经验(Friedberg, CGH. 2023)。在此,我们报告了我们 1 年的实际经验。方法 这是一项前瞻性研究,研究 UPA 治疗 UC 和 CD 患者的临床疗效,在第 0、2、4、8 周进行预定时间间隔检测,然后每 3 个月检测一次,直到第 52 周,这是我们机构正式治疗方案的一部分。我们使用简易临床结肠炎活动指数、哈维-布拉德肖指数以及 C 反应蛋白和粪便钙蛋白来评估疗效,同时还记录了与治疗相关的不良事件和严重不良事件。结果 110 名患者开始接受 UPA 治疗,并随访一年(CD=57 人,UC=44 人,IBDU=5 人,小袋炎=4 人)。109/110(99%)例患者接触过生物制剂,31/110(28.2%)例患者接触过托法替尼。99/110(90%)例患者因腔隙性疾病开始接受 UPA 治疗(表 1)。54 名患者在 1 年后仍在接受 UPA 治疗。UC:第8周临床应答和缓解率分别为24/47(51.1%)、39/47(83%);第26周临床应答和缓解率分别为20/34(58.8%)、24/34(70.6%);第52周临床应答和缓解率分别为17/30(56.7%)、29/30(96.7%)。CD患者:第8周的临床应答和缓解率分别为14/32(43.8%)、25/32(78.1%);第26周的临床应答和缓解率分别为9/22(40.9%)、15/22(68.2%);第52周的临床应答和缓解率分别为10/17(58.8%)、13/17(76.5%)。56例患者在1年随访前停用了UPA,其中13例是由于不良反应[DR1]。导致停药的最常见不良反应是皮肤病副作用(CD=2,UC=2)。有 1 例带状疱疹导致停药。没有发生其他严重感染或严重不良事件,包括 VTE、MACE 或恶性肿瘤。结论 在这项针对UC或CD耐药患者的为期1年的大型真实世界经验中,我们报告称UPA既有效又安全,包括那些曾接触过法替尼的患者。
{"title":"P465 Upadacitinib is effective and safe for the treatment of ulcerative colitis and Crohn’s disease: 1-year prospective real-world experience","authors":"N Krugliak Cleveland, N K Choi, J A Klein, E N Fear, Z D Fine, N M Garcia, E A Picker, S R Friedberg, R D Cohen, S R Dalal, J Pekow, D Choi, D T Rubin","doi":"10.1093/ecco-jcc/jjad212.0595","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0595","url":null,"abstract":"Background Upadacitinib (UPA) is a novel selective Janus kinase 1 inhibitor that has shown efficacy and received approval for the treatment of moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). We previously reported a large real-world experience of UPA induction in UC and CD (Friedberg, CGH. 2023). Here we report our 1-year real-world experience. Methods This is a prospectively collected study of clinical outcomes of UPA treatment in patients with UC and CD using predetermined intervals at weeks 0, 2, 4, 8, then every 3 months until week 52 as part of a formalized treatment protocol at our institution. We used the Simple Clinical Colitis Activity Index and the Harvey-Bradshaw index, as well as C-reactive protein and faecal calprotectin to assess efficacy, and also recorded treatment-related adverse events and serious adverse events. Results 110 patients were initiated on UPA and followed for a one-year period (CD=57, UC=44, IBDU=5, pouchitis=4). 109/110 (99%) were biologic exposed and 31/110 (28.2 %) were tofacitinib exposed. 99/110 (90%) were initiated on UPA for luminal disease (Table 1). 54 patients remained on UPA therapy at 1 year. In UC: week 8 clinical response and remission was 24/47 (51.1%), 39/47 (83%), respectively; week 26 clinical response and remission was 20/34 (58.8%), 24/34 (70.6%), respectively; 52 week clinical response and remission was 17/30 (56.7%), 29/30 (96.7%), respectively. In CD: week 8 clinical response and remission was 14/32 (43.8%), 25/32 (78.1%%), respectively; week 26 clinical response and remission was 9/22 (40.9%), 15/22 (68.2%), respectively; 52 week clinical response and remission was 10/17 (58.8%), 13/17 (76.5%), respectively. 56 patients discontinued UPA prior to the 1 year follow-up, 13 were due to adverse events[DR1] . The most commonly experienced AEs leading to discontinuation was dermatological side effects (CD=2, UC=2). One instance of shingles occurred leading to discontinuation. No other serious infections or serious adverse events including VTE, MACE, or malignancies occurred. Conclusion In this large 1-year real-world experience in medically resistant patients with UC or CD, we report that UPA is both effective and safe, including in those who had prior exposure to tofacitinib.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
P433 Short-term outcomes of surgical treatment in primary ileocecal Crohn’s disease patients. Results of Crohn’s(urg) study, multicenter, retrospective, comparative analysis between indications for luminal and complicated phenotype P433 原发性回盲部克罗恩病患者手术治疗的短期疗效。克罗恩病(urg)多中心、回顾性、管腔型和复杂表型适应症比较分析研究结果
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0563
N L Avellaneda, G Pellino, A Maroli, A Tottrup, G Bislenghi, J Colpaert, A D'Hoore, L Giorgi, P Juachon, S Harsløf, A de Buck Van Overstraeten, P Olivera, J Gomez, S Holubar, E Lincango Naranjo, S Steele, A Merchea, A Shacker, M Marti Gallostra, M Kraft, P G Kotze, B Yuki Maruyana, S Wexner, Z Garoufalia, C Zhihui, D Hahnloser, D Rrupa, C Buskens, A Haanappel, J Warusavitarne, K Williams, P Christensen, A Spinelli
Background Recent evidence challenges the current standard of offering surgery to patients with ileocecal Crohn’s disease only when they present complications of the disease. Methods A retrospective, multicenter comparative analysis was performed including patients operated for primary ileocecal CD at 12 referral centers. Patients were divided in 2 groups, according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. Patients operated on for primary isolated ileocaecal CD (last 50 cm of the terminal ileum and cecum), either for predominantly inflammatory phenotype or for complications of the disease (stricturing or fistulizing pattern), between January 2012 - December 2021 were considered eligible to participate in this study. Patients with previous abdominal procedures for CD, and patients who had activity of the disease in other intestinal segments other than the ileocaecal region at the time of surgery, were excluded from the study. Results 2013 patients were included, 291 (14.5%) in the ICD group. No differences were found between groups in time from diagnosis to surgery or in the levels of exposure to biologic drugs before indication of surgery. CCD patients had higher rates of low BMI, anemia (40.9 vs. 27%, p: < 0.001), and low albumin (11.3 vs. 2.6%, p: < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3 vs. 93.1%, p: 0.001), and higher conversion rates (9.3 vs. 1.9%, p: < 0.001). CCD had longer hospital stay and higher postoperative complication rates (26.1 vs. 21.3%, p: 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1 vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgeries (OR: 3.44, p: 0.001) and requirements of multiple intraoperative procedures (OR: 8.39, p: 0.030). Conclusion Indication of surgery in patients who present an inflammatory phenotype of CD was associated with better outcomes when compared to patients operated on for complications of the disease, without a difference between groups in time from diagnosis to surgery.
背景 最近有证据表明,回盲部克罗恩病患者只有在出现疾病并发症时才接受手术治疗的现行标准受到了质疑。方法 对 12 个转诊中心接受原发性回盲部克罗恩病手术的患者进行了回顾性多中心对比分析。根据炎症(ICD)或复杂(CCD)表型的手术指征,将患者分为两组。对短期结果进行了比较。2012年1月至2021年12月期间,因原发性孤立回盲部CD(回肠末端和盲肠最后50厘米)而接受手术治疗的患者,无论是炎症表型为主,还是因疾病并发症(狭窄或瘘管化模式)而接受手术治疗,均被视为符合参与本研究的资格。曾因 CD 而进行腹部手术的患者以及手术时除回盲部外其他肠段有疾病活动的患者不在研究范围内。结果 共纳入 2013 例患者,其中 291 例(14.5%)为 ICD 组。两组患者从确诊到手术的时间或手术指征前接触生物药物的水平均无差异。CCD患者的低体重指数、贫血率(40.9% 对 27%,P:< 0.001)和低白蛋白率(11.3% 对 2.6%,P:< 0.001)较高。CCD患者的手术时间更长,腹腔镜手术率更低(84.3% 对 93.1%,p:0.001),转阴率更高(9.3% 对 1.9%,p:< 0.001)。CCD 的住院时间更长,术后并发症发生率更高(26.1% 对 21.3%,P:0.083)。该组吻合口漏和再次手术的发生率也更高。CCD 组中需要扩大肠切除范围的患者更多(14.1% 对 8.3%,P:0.017)。在多变量分析中,CCD 与手术时间延长(OR:3.44,P:0.001)和需要多次术中操作(OR:8.39,P:0.030)有关。结论 与因疾病并发症而接受手术的患者相比,出现 CD 炎症表型的患者接受手术治疗的预后更好,但各组患者从诊断到手术的时间并无差异。
{"title":"P433 Short-term outcomes of surgical treatment in primary ileocecal Crohn’s disease patients. Results of Crohn’s(urg) study, multicenter, retrospective, comparative analysis between indications for luminal and complicated phenotype","authors":"N L Avellaneda, G Pellino, A Maroli, A Tottrup, G Bislenghi, J Colpaert, A D'Hoore, L Giorgi, P Juachon, S Harsløf, A de Buck Van Overstraeten, P Olivera, J Gomez, S Holubar, E Lincango Naranjo, S Steele, A Merchea, A Shacker, M Marti Gallostra, M Kraft, P G Kotze, B Yuki Maruyana, S Wexner, Z Garoufalia, C Zhihui, D Hahnloser, D Rrupa, C Buskens, A Haanappel, J Warusavitarne, K Williams, P Christensen, A Spinelli","doi":"10.1093/ecco-jcc/jjad212.0563","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0563","url":null,"abstract":"Background Recent evidence challenges the current standard of offering surgery to patients with ileocecal Crohn’s disease only when they present complications of the disease. Methods A retrospective, multicenter comparative analysis was performed including patients operated for primary ileocecal CD at 12 referral centers. Patients were divided in 2 groups, according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. Patients operated on for primary isolated ileocaecal CD (last 50 cm of the terminal ileum and cecum), either for predominantly inflammatory phenotype or for complications of the disease (stricturing or fistulizing pattern), between January 2012 - December 2021 were considered eligible to participate in this study. Patients with previous abdominal procedures for CD, and patients who had activity of the disease in other intestinal segments other than the ileocaecal region at the time of surgery, were excluded from the study. Results 2013 patients were included, 291 (14.5%) in the ICD group. No differences were found between groups in time from diagnosis to surgery or in the levels of exposure to biologic drugs before indication of surgery. CCD patients had higher rates of low BMI, anemia (40.9 vs. 27%, p: < 0.001), and low albumin (11.3 vs. 2.6%, p: < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3 vs. 93.1%, p: 0.001), and higher conversion rates (9.3 vs. 1.9%, p: < 0.001). CCD had longer hospital stay and higher postoperative complication rates (26.1 vs. 21.3%, p: 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1 vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgeries (OR: 3.44, p: 0.001) and requirements of multiple intraoperative procedures (OR: 8.39, p: 0.030). Conclusion Indication of surgery in patients who present an inflammatory phenotype of CD was associated with better outcomes when compared to patients operated on for complications of the disease, without a difference between groups in time from diagnosis to surgery.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
P281 The role of transabdominal ultrasound in evaluating Ulcerative Colitis disease activity and predicting treatment response P281 经腹超声在评估溃疡性结肠炎疾病活动性和预测治疗反应中的作用
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0411
M Peng, T Pu, Y Zhao
Background As a non-invasive, accurate, and feasible examination, transabdominal ultrasound(TAUS) is of great value in disease monitoring of ulcerative colitis. The cut-off for disease activity of 3.0 or 4.0 mm is often debated, and studies lacked assessment of treatment response. This study aimed to assess the diagnostic accuracy of TAUS in detecting disease activity in adult patients with UC using endoscopy as the reference standard and evaluate TAUS for treatment response in a longitudinal cohort. Methods This study prospectively consecutive adult patients with an established diagnosis of UC in the First Affiliated Hospital of Zhengzhou University between June 2022 and September 2023. The patients with moderate-to-severe disease activity at baseline should have follow-up endoscopic assessment after induction, with available corresponding TAUS. The primary outcome of this study was the difference in BWT in the descending colon(DC) or sigmoid colon(SC) for patients with and without segmental endoscopic response after treatment. Endoscopic remission was defined as MES=0-1 or UCEIS=0-1, and Endoscopic response as a decrease of MES ≥1 or a reduction of UCEIS ≥2. Results A total of 315 colon segments in 80 patients were included. 171 (54.3%) colorectal segments had endoscopic remission and 144(45.7%) were in endoscopic activity. The TAUS parameters correlated with the Mayo endoscopic sub-score with significant differences between patients in endoscopic remission and patients in endoscopic activity. And we found 3.45mm(AUROC 0.833;95%CI 0.789-0.878, P<0.001) to be the cutoff for endoscopic remission with 78% sensitivity and 75% specificity. The multivariable analysis identified BWT, the Colour Doppler Signal(CDS), and the wall layer stratification as independent predictors for endoscopic activity( P<0.001、=0.004、=0.001). BWT in the DC or SC was significantly lower in patients with endoscopic response than those without after treatment. A 28% decrease in BWT from baseline predicted endoscopic response [AUROC 0.743;95%CI 0.589-0.896, P=0.015] with 58% sensitivity and 93% specificity. Multivariable analysis among all the ultrasound parameters considered normal wall layer stratification at baseline as the only independent predictor of endoscopic response at reassessment (odds ratio [OR]23.334, 95% CI 2.257-241.219; p = 0.008). Conclusion TAUS, importantly BWT, CDS, and wall layer stratification as the crucial parameters, is highly accurate in detecting disease activity and treatment response when evaluated against endoscopic outcomes. Normal intestinal wall stratification at baseline predicts long-term endoscopic response.
背景 经腹超声(TAUS)是一种无创、准确、可行的检查方法,在溃疡性结肠炎的疾病监测中具有重要价值。在溃疡性结肠炎的疾病监测中具有重要价值。关于疾病活动度为 3.0 或 4.0 mm 的临界值常有争议,且研究缺乏对治疗反应的评估。本研究旨在以内镜检查为参考标准,评估TAUS检测成年溃疡性结肠炎患者疾病活动性的诊断准确性,并在纵向队列中评估TAUS的治疗反应。方法 本研究于2022年6月至2023年9月期间在郑州大学第一附属医院连续对确诊为UC的成年患者进行前瞻性研究。基线时有中重度疾病活动的患者应在诱导治疗后进行随访内镜评估,并提供相应的TAUS。本研究的主要结果是治疗后有和无节段性内镜反应患者的降结肠(DC)或乙状结肠(SC)BWT差异。MES=0-1或UCEIS=0-1为内镜缓解,MES下降≥1或UCEIS下降≥2为内镜反应。结果 共纳入了 80 名患者的 315 个结肠节段。171个(54.3%)结直肠节段在内镜下缓解,144个(45.7%)在内镜下活动。TAUS 参数与梅奥内镜次级评分相关,内镜缓解患者与内镜活动患者之间存在显著差异。我们发现 3.45mm(AUROC 0.833;95%CI 0.789-0.878,P<0.001)是内镜缓解的临界值,敏感性为 78%,特异性为 75%。多变量分析发现,BWT、彩色多普勒信号(CDS)和壁层分层是内镜活动的独立预测因子(P<0.001、=0.004、=0.001)。治疗后,有内镜反应的患者 DC 或 SC 的 BWT 明显低于无内镜反应的患者。BWT比基线下降28%可预测内镜反应[AUROC 0.743;95%CI 0.589-0.896,P=0.015],敏感性为58%,特异性为93%。对所有超声参数进行的多变量分析表明,基线时正常壁层分层是再次评估时内镜反应的唯一独立预测因素(比值比 [OR]23.334, 95%CI 2.257-241.219;P = 0.008)。结论 TAUS 以 BWT、CDS 和肠壁分层为重要参数,在根据内镜结果进行评估时,能高度准确地检测出疾病活动性和治疗反应。基线肠壁分层正常可预测长期内镜反应。
{"title":"P281 The role of transabdominal ultrasound in evaluating Ulcerative Colitis disease activity and predicting treatment response","authors":"M Peng, T Pu, Y Zhao","doi":"10.1093/ecco-jcc/jjad212.0411","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0411","url":null,"abstract":"Background As a non-invasive, accurate, and feasible examination, transabdominal ultrasound(TAUS) is of great value in disease monitoring of ulcerative colitis. The cut-off for disease activity of 3.0 or 4.0 mm is often debated, and studies lacked assessment of treatment response. This study aimed to assess the diagnostic accuracy of TAUS in detecting disease activity in adult patients with UC using endoscopy as the reference standard and evaluate TAUS for treatment response in a longitudinal cohort. Methods This study prospectively consecutive adult patients with an established diagnosis of UC in the First Affiliated Hospital of Zhengzhou University between June 2022 and September 2023. The patients with moderate-to-severe disease activity at baseline should have follow-up endoscopic assessment after induction, with available corresponding TAUS. The primary outcome of this study was the difference in BWT in the descending colon(DC) or sigmoid colon(SC) for patients with and without segmental endoscopic response after treatment. Endoscopic remission was defined as MES=0-1 or UCEIS=0-1, and Endoscopic response as a decrease of MES ≥1 or a reduction of UCEIS ≥2. Results A total of 315 colon segments in 80 patients were included. 171 (54.3%) colorectal segments had endoscopic remission and 144(45.7%) were in endoscopic activity. The TAUS parameters correlated with the Mayo endoscopic sub-score with significant differences between patients in endoscopic remission and patients in endoscopic activity. And we found 3.45mm(AUROC 0.833;95%CI 0.789-0.878, P<0.001) to be the cutoff for endoscopic remission with 78% sensitivity and 75% specificity. The multivariable analysis identified BWT, the Colour Doppler Signal(CDS), and the wall layer stratification as independent predictors for endoscopic activity( P<0.001、=0.004、=0.001). BWT in the DC or SC was significantly lower in patients with endoscopic response than those without after treatment. A 28% decrease in BWT from baseline predicted endoscopic response [AUROC 0.743;95%CI 0.589-0.896, P=0.015] with 58% sensitivity and 93% specificity. Multivariable analysis among all the ultrasound parameters considered normal wall layer stratification at baseline as the only independent predictor of endoscopic response at reassessment (odds ratio [OR]23.334, 95% CI 2.257-241.219; p = 0.008). Conclusion TAUS, importantly BWT, CDS, and wall layer stratification as the crucial parameters, is highly accurate in detecting disease activity and treatment response when evaluated against endoscopic outcomes. Normal intestinal wall stratification at baseline predicts long-term endoscopic response.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
P1229 The Role and Niche-Specific Adaptation of Malassezia in patients with Ulcerative colitis P1229 马拉色菌在溃疡性结肠炎患者中的作用和特定环境适应性
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1359
S Shin Shin, Y J Cho, J Yang, H K Kim, P Rintarhat, M Park, K Lagree, D M Underhill, C S Yang, J M Moon, J Seo, K Kim, W H Jung, C H Choi
Background Accumulating evidence has underscored the role of gut fungal microbiota (mycobiota) in the development of inflammatory bowel disease. We aimed to isolate a Malassezia strain directly from the human intestine mucosal surface from the patients with ulcerative colitis (UC) and investigated its genome and virulence in comparison with the same fungal species isolated from the human skin. Methods Mucosal lavage samples were collected separately from colonic areas with and without inflammation in patients with UC. Samples from healthy individuals (HT) were obtained in the same manner as from patients with UC at sigmoid or descending colon. Skin samples were taken from HT in our previous work. DNA was extracted from these lavage samples, and fungal isolation was conducted using PCR amplification with ITS4 and ITS5 primers. Comprehensive analysis and comparison of the genomes, transcriptomes, and virulence between M. globosa gut isolates and those of M. globosa strains isolated from the skin were performed. To determine the contribution of M. globosa gut isolates to exacerbating inflammation, 1107 fungal cells were orally gavaged to DSS-induced colitis mouse model for three days. Results Total 56 and 11 intestinal water-lavage samples from 29 UC patients and 11 HT were obtained respectively. The α- and b-diversities of mycobiota showed no significant differences between the groups, patients with UC vs. HT or the sites with inflammation vs. non-inflammation of the patient with UC. Malassezia was the fifth most frequently found fungal genus throughout the samples, and live fungal strains belong to 28 and 7 different species were isolated from the patients with UC and HT, respectively. The patients with UC tend to have higher frequency of M. globosa and M. restricta than HT in their gut mucosal surface with inflammation. Whole genome sequencing showed no specific genomic characteristics between gut-isolated M. globosa and skin-isolated M. globosa. However, gut-isolated M. globosa were suffered more from the higher oxygen levels than the skin isolates in different oxygen concentrations. In a mouse model, gut-isolated M. globosa exhibited a more pronounced exacerbation of DSS-induced colitis and elevated production of inflammatory cytokines, including TNF-a, IL-6, IL-12p40, IL-1b, and IL-18, while the skin isolates showed no difference compared to the negative control (Figure). Conclusion Our data shed new light on the pivotal role of M. globosa in the pathogenesis of UC, highlighting the potential influence of niche-specific adaptations on the virulence of this fungus. These findings provide critical insights into the complex interplay between the member of the gut mycobiota and host health.
背景 越来越多的证据表明,肠道真菌微生物群(mycobiota)在炎症性肠病的发病过程中发挥着重要作用。我们的目的是直接从溃疡性结肠炎(UC)患者的肠道粘膜表面分离出马拉色菌菌株,并将其基因组和毒力与从人体皮肤中分离出的同种真菌进行比较研究。方法 分别从溃疡性结肠炎患者有炎症和无炎症的结肠部位采集粘膜灌洗样本。健康人(HT)的样本采集方式与 UC 患者的乙状结肠或降结肠样本相同。在我们之前的工作中,我们从 HT 身上采集了皮肤样本。从这些灌洗样本中提取 DNA,并使用 ITS4 和 ITS5 引物进行 PCR 扩增,分离真菌。我们对肠道分离出的球孢霉和从皮肤分离出的球孢霉菌株的基因组、转录组和毒力进行了综合分析和比较。为了确定球孢霉肠道分离株对加剧炎症的作用,对DSS诱导的结肠炎小鼠模型进行了为期三天的口服灌胃,共灌胃1107个真菌细胞。结果 从 29 名 UC 患者和 11 名 HT 患者中分别获得了 56 份和 11 份肠道水-粪便样本。在 UC 患者与 HT 患者、UC 患者的炎症部位与非炎症部位之间,霉菌生物群的 α 和 b 多样性无显著差异。马拉色菌是所有样本中第五个最常发现的真菌属,从 UC 和 HT 患者身上分离出的活真菌菌株分别属于 28 个和 7 个不同的菌种。在有炎症的肠道粘膜表面,UC 患者的球孢子菌和限制型球孢子菌的频率往往高于 HT 患者。全基因组测序显示,肠道分离的球孢子菌和皮肤分离的球孢子菌没有特定的基因组特征。然而,在不同的氧气浓度下,肠道分离的球孢霉菌比皮肤分离的球孢霉菌更容易受到高浓度氧气的影响。在小鼠模型中,肠道分离的球孢霉菌表现出更明显的DSS诱导的结肠炎恶化和炎性细胞因子(包括TNF-a、IL-6、IL-12p40、IL-1b和IL-18)产生的升高,而皮肤分离的球孢霉菌与阴性对照相比没有差异(图)。结论 我们的数据揭示了球孢霉菌在 UC 发病机制中的关键作用,强调了生态位特异性适应对该真菌毒力的潜在影响。这些发现为了解肠道真菌生物群成员与宿主健康之间复杂的相互作用提供了重要见解。
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引用次数: 0
N09 Transition Success Score as a valid quantitative measure to evaluate the effect of transitional care in IBD patients N09 作为评估 IBD 患者过渡护理效果的有效量化指标的 "成功过渡评分
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1381
M van Gaalen, M van Pieterson, L de Ridder, L Derikx, J Escher
Background Transition programs are designed to prepare adolescent patients with inflammatory bowel disease (IBD) for their new role in adult care. The outcome of these programs is often assessed in a qualitative way (patient satisfaction, quality of life, disease burden). However, there is no quantitative measure to evaluate the effect of a transition program. The aim of this study was to develop and validate a Transition Success Score (TSS) by the identified key components of successful transition. Methods The TSS was developed through an international Delphi consensus study, with the expert panel of pediatric and adult healthcare providers and patients. The top 10 key outcome items associated with success of transition were collated into one questionnaire. In every round, the minimum response rate required was 80%, and a consensus of more than 80% was necessary for each item. After four rounds of discussion, a consensus was reached on the initial version of the TSS. This score included seven items for adult healthcare providers to evaluate the patient's disease management behavior, including shared decision making, therapy adherence, and appointment attendance. Additionally, two items concern patient and parent experience concerning the transition period. The TSS was subsequently employed and validated in a prospective multicenter cohort of young adult IBD patients, who made the transfer 9-15 months ago, in the Netherlands. Results In seven hospitals, 160 IBD patients (median age 19.05, male 48.8%, Crohn's disease 56%, median age at diagnose 13.97) completed the TSS, at 9-15 months after transfer to adult care. Hypothesis testing for construct validation revealed significant association of characteristics related to transition care such as knowledge (RTT), independence (TRAQ), and quality of life (IBDQ) (p=<0.005). In addition, Rasch analysis for structural validation showed that the TSS was discriminating at lower levels of transition success (Figure 1). Internal consistency, as measured by Cronbach alpha, was acceptable at 0.64. TSS was significantly lower in patients with high disease burden, exacerbation within the first year after transfer and parental dependency. Also, TSS was lower in certain patient profile types, characterized as either "laid back, nonchalant" or "worried and uncertain". Conclusion The Transition Success Score (TSS) can serve as a quantitative measure to help identify IBD patients who did not have successful transition to adult care. TSS can be utilized for identifying factors that impact successful transition and for measuring the effect of various transition programs in IBD.
背景 过渡计划旨在帮助患有炎症性肠病(IBD)的青少年患者为在成人护理中扮演新角色做好准备。这些计划的结果通常以定性的方式进行评估(患者满意度、生活质量、疾病负担)。然而,目前还没有定量的方法来评估过渡计划的效果。本研究的目的是根据已确定的成功过渡的关键要素,开发并验证过渡成功评分(TSS)。方法 TSS 是由儿科和成人医疗保健提供者及患者组成的专家小组通过一项国际德尔菲共识研究制定的。与成功转归相关的前 10 个关键结果项目被整理成一份问卷。在每一轮讨论中,最低回复率要求为 80%,每个项目的共识率必须超过 80%。经过四轮讨论后,大家就最初版本的 TSS 达成了共识。该评分包括七个项目,供成人医疗服务提供者评估患者的疾病管理行为,包括共同决策、坚持治疗和预约出诊。此外,还有两个项目涉及患者和家长对过渡期的体验。随后,在荷兰对 9-15 个月前转院的年轻成年 IBD 患者进行了前瞻性多中心队列研究,并对 TSS 进行了验证。结果 七家医院的 160 名 IBD 患者(中位年龄 19.05 岁,男性占 48.8%,克罗恩病占 56%,诊断时中位年龄 13.97 岁)在转入成人医疗机构 9-15 个月后完成了 TSS。结构验证假设检验显示,知识(RTT)、独立性(TRAQ)和生活质量(IBDQ)等与过渡护理相关的特征存在显著关联(p=<0.005)。此外,用于结构验证的 Rasch 分析表明,TSS 对较低水平的过渡成功具有区分作用(图 1)。用 Cronbach alpha 测量的内部一致性为 0.64,可以接受。在疾病负担重、转院后第一年内病情加重和依赖父母的患者中,TSS 明显较低。此外,某些患者的 TSS 值也较低,这些患者的特征要么是 "悠闲、淡定",要么是 "担忧、不确定"。结论 成功转院评分(TSS)可作为一种量化指标,帮助识别未能成功转入成人护理的 IBD 患者。TSS 可用于确定影响成功过渡的因素,以及衡量各种 IBD 过渡计划的效果。
{"title":"N09 Transition Success Score as a valid quantitative measure to evaluate the effect of transitional care in IBD patients","authors":"M van Gaalen, M van Pieterson, L de Ridder, L Derikx, J Escher","doi":"10.1093/ecco-jcc/jjad212.1381","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1381","url":null,"abstract":"Background Transition programs are designed to prepare adolescent patients with inflammatory bowel disease (IBD) for their new role in adult care. The outcome of these programs is often assessed in a qualitative way (patient satisfaction, quality of life, disease burden). However, there is no quantitative measure to evaluate the effect of a transition program. The aim of this study was to develop and validate a Transition Success Score (TSS) by the identified key components of successful transition. Methods The TSS was developed through an international Delphi consensus study, with the expert panel of pediatric and adult healthcare providers and patients. The top 10 key outcome items associated with success of transition were collated into one questionnaire. In every round, the minimum response rate required was 80%, and a consensus of more than 80% was necessary for each item. After four rounds of discussion, a consensus was reached on the initial version of the TSS. This score included seven items for adult healthcare providers to evaluate the patient's disease management behavior, including shared decision making, therapy adherence, and appointment attendance. Additionally, two items concern patient and parent experience concerning the transition period. The TSS was subsequently employed and validated in a prospective multicenter cohort of young adult IBD patients, who made the transfer 9-15 months ago, in the Netherlands. Results In seven hospitals, 160 IBD patients (median age 19.05, male 48.8%, Crohn's disease 56%, median age at diagnose 13.97) completed the TSS, at 9-15 months after transfer to adult care. Hypothesis testing for construct validation revealed significant association of characteristics related to transition care such as knowledge (RTT), independence (TRAQ), and quality of life (IBDQ) (p=<0.005). In addition, Rasch analysis for structural validation showed that the TSS was discriminating at lower levels of transition success (Figure 1). Internal consistency, as measured by Cronbach alpha, was acceptable at 0.64. TSS was significantly lower in patients with high disease burden, exacerbation within the first year after transfer and parental dependency. Also, TSS was lower in certain patient profile types, characterized as either \"laid back, nonchalant\" or \"worried and uncertain\". Conclusion The Transition Success Score (TSS) can serve as a quantitative measure to help identify IBD patients who did not have successful transition to adult care. TSS can be utilized for identifying factors that impact successful transition and for measuring the effect of various transition programs in IBD.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Crohn's and Colitis
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