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P524 Etrasimod shows low risk of adverse events following concomitant use with opioids or antidepressants in patients with ulcerative colitis P524 在溃疡性结肠炎患者中同时使用阿片类药物或抗抑郁药后,Etrasimod 发生不良事件的风险较低
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0654
A Afzali, M Regueiro, A J Yarur, Y Zabana, S C Ng, S S Menon, A McDonnell, K Lazin, M Keating, A Bhattacharjee, D Branquinho, E Bananis, L Peyrin-Biroulet
Background Etrasimod is an oral, once-daily (QD), selective sphingosine 1-phosphate (S1P)1,4,5 receptor modulator for the treatment of moderately to severely active ulcerative colitis (UC). Unlike the other S1P receptor modulator approved for UC, etrasimod and its metabolites do not have a molecular structure to inhibit monoamine oxidase (MAO).1 Coadministration of drugs that inhibit MAO with opioids and antidepressants may increase the risk of adverse events (AEs), including hypertension.2 This post hoc analysis evaluated the incidence of AEs potentially related to serotonin syndrome in patients taking etrasimod and concomitant opioids or antidepressants in the phase 3 ELEVATE UC 52 (NCT03945188) and ELEVATE UC 12 (NCT03996369) trials. Methods Safety data pooled from both trials were analysed in patients receiving etrasimod 2 mg QD (up to 52 weeks of exposure) with/without concomitant opioids or antidepressants. We report the proportions of patients who had ≥1 concurrent AE potentially related to serotonin syndrome, consisting of one standardised MedDRA Query, one query based on the Hunter Criteria and supplemental preferred terms (pyrexia, tachycardia and hypertension-related AEs).3 Results Among 527 patients receiving etrasimod, 77 (14.6%) and 35 (6.6%) patients were taking concomitant opioids or antidepressants, respectively. Most patients on concomitant opioids or antidepressants were White (80.0–88.3%); male (50.6–51.4%); their median age was 35.0 (18.0–70.0) and 41.0 (19.0–74.0) years, respectively. More patients with vs without concomitant opioids or antidepressants, respectively, consumed alcohol (40.3% vs 24.7% and 48.6% vs 25.4%) and used tobacco (40.3% vs 20.9% and 34.3% vs 23.0%). The incidence of other AEs potentially related to serotonin syndrome was low and generally comparable in all subgroups; reported rates of pyrexia and tachycardia were similar in patients with/without concomitant opioids or antidepressants (Table). Hypertension-related AEs were infrequent and generally balanced. No AEs per the Hunter Criteria were reported in patients on concomitant opioids or antidepressants (Table). No reported AEs were serious or led to treatment discontinuation among patients taking these concomitant medications. Conclusion The incidence of AEs was low and comparable in patients receiving etrasimod with or without concomitant opioids or antidepressants. This analysis supports the low likelihood of clinically relevant drug–drug interactions between etrasimod and medications commonly prescribed to patients with UC, such as opioids or antidepressants. References 1. Lee CA et al. Clin Pharmacol Drug Dev 2023; 12: 553–571. 2. Sands BE et al. J Crohns Colitis 2023; online ahead of print. 3. Dunkley EJC et al. QJM 2003; 96: 635–642.
背景 Etrasimod 是一种口服、每日一次(QD)的选择性 1-磷酸鞘磷脂(S1P)1,4,5 受体调节剂,用于治疗中度至重度活动性溃疡性结肠炎(UC)。与其他获批用于治疗 UC 的 S1P 受体调节剂不同,依曲莫德及其代谢物不具有抑制单胺氧化酶(MAO)的分子结构1 。这项事后分析评估了ELEVATE UC 52(NCT03945188)和ELEVATE UC 12(NCT03996369)三期试验中服用依曲莫德和同时服用阿片类药物或抗抑郁药的患者中可能与血清素综合征有关的AEs的发生率。方法 我们分析了这两项试验中汇集的安全性数据,对象是接受依曲西莫德 2 毫克 QD(最多暴露 52 周)治疗,同时服用/不同时服用阿片类药物或抗抑郁药的患者。我们报告了并发≥1种可能与血清素综合征有关的AE的患者比例,包括1种标准化MedDRA查询、1种基于亨特标准的查询和补充首选术语(发热、心动过速和高血压相关AE)3 结果 在接受依曲莫德治疗的527例患者中,分别有77例(14.6%)和35例(6.6%)患者同时服用阿片类药物或抗抑郁药物。大多数同时服用阿片类药物或抗抑郁药物的患者为白人(80.0-88.3%);男性(50.6-51.4%);年龄中位数分别为 35.0(18.0-70.0)岁和 41.0(19.0-74.0)岁。同时服用阿片类药物或抗抑郁药物与未同时服用阿片类药物或抗抑郁药物的患者中,饮酒(40.3% 对 24.7%,48.6% 对 25.4%)和吸烟(40.3% 对 20.9%,34.3% 对 23.0%)的人数分别较多。可能与血清素综合征有关的其他 AEs 发生率较低,在所有亚组中大致相当;报告的热病和心动过速发生率在同时服用/未同时服用阿片类药物或抗抑郁药的患者中相似(表)。与高血压相关的 AEs 并不常见,总体上比较均衡。在同时服用阿片类药物或抗抑郁药物的患者中,未出现符合亨特标准的 AEs(见表)。在同时服用这些药物的患者中,没有报告严重的不良反应或导致治疗中断的不良反应。结论 在接受依曲西莫德治疗的患者中,无论是否同时服用阿片类药物或抗抑郁药物,AEs 的发生率都很低,且具有可比性。该分析表明,依曲莫德与 UC 患者常用药物(如阿片类药物或抗抑郁药)之间发生临床相关药物相互作用的可能性较低。参考文献 1.Lee CA et al. Clin Pharmacol Drug Dev 2023; 12: 553-571.2.Sands BE et al. J Crohns Colitis 2023; online ahead of print.3.Dunkley EJC et al.QJM 2003; 96: 635-642.
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引用次数: 0
P459 The prevalence and characteristics of inflammatory bowel disease-related ocular involvement in children P459 儿童炎症性肠病相关眼部受累的发病率和特征
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0589
A Ben-Tov, T Achler, T Patalon, S Gazit, H Yanai, S Shulman, A Assa
Background Ocular manifestations (OM) in patients with inflammatory bowel disease (IBD) are uncommon, particularly in children. We aimed to explore the prevalence, characteristics and risk factors of IBD associated OM in a large epidemiologic cohort-based study. Methods A cross-sectional study was performed using the Maccabi Healthcare Services (MHS) database. The eligible population included all patients diagnosed with IBD as children (<18 years) between January 2005 and July 2023. An additional analysis was conducted on patients diagnosed with ocular disease during childhood (<18 years) and IBD during childhood or adulthood. Results Out of 2,567 children with IBD (males 55%, Crohn’s disease 64%), 78 (3%) were diagnosed with OM at any time during disease course. In 54 patients (69%), the OM occurred after IBD diagnosis with a median time of 2.6 (0.47-7) years between the two events, whereas in 24 patients (31%) OM preceded IBD diagnosis with a median time of 2.1 (0.6-5.7) years. OM was significantly associated with Crohn’s disease, compared with ulcerative colitis (78.2% vs. 63.6% in the entire cohort; p=0.03). The presence of OM was associated with increased usage of systemic corticosteroids (p<0.001), biologic agents (p=0.04) and longer duration since IBD diagnosis (p=0.04). There were 55 patients with OM during childhood who were ever diagnosed with IBD. In this population OM was also associated with increased usage of systemic corticosteroids (p<0.001) and increased hospitalization rate per year (p=0.048). The annual prevalence of OM increased gradually from 10/1000 patients in 2005 to 22/1000 patients in 2022 (p=0.55). Conclusion Ocular involvement in children with IBD is rare and more common in patients with Crohn’s disease with a stable prevalence rate. It is associated with a longer duration of disease, greater usage of systemic corticosteroids and biologic agents and with a higher rate of hospitalizations, potentially representing a more severe disease course.
背景 炎症性肠病(IBD)患者的眼部表现(OM)并不常见,尤其是在儿童中。我们的目的是在一项大型流行病学队列研究中探讨与 IBD 相关的 OM 的患病率、特征和风险因素。方法 我们利用马卡比医疗保健服务(MHS)数据库进行了一项横断面研究。符合条件的人群包括 2005 年 1 月至 2023 年 7 月期间所有被诊断为 IBD 的儿童患者(<18 岁)。此外,还对在儿童期(18 岁)被诊断患有眼部疾病以及在儿童期或成年期被诊断患有 IBD 的患者进行了分析。结果 在 2567 名患有 IBD 的儿童中(男性占 55%,克罗恩病占 64%),有 78 人(3%)在病程中的任何时候被诊断出患有眼底病。有 54 名患者(69%)在确诊 IBD 后出现 OM,两事件之间的中位时间为 2.6(0.47-7)年,而有 24 名患者(31%)在确诊 IBD 前出现 OM,中位时间为 2.1(0.6-5.7)年。与溃疡性结肠炎相比,OM 明显与克罗恩病相关(整个队列中 78.2% 与 63.6%;P=0.03)。OM的存在与全身使用皮质类固醇激素(p<0.001)、生物制剂(p=0.04)和IBD诊断后持续时间较长(p=0.04)有关。有 55 名儿童期 OM 患者曾被诊断为 IBD。在这一人群中,OM 还与全身使用皮质类固醇增多(p<0.001)和每年住院率增加(p=0.048)有关。OM 的年发病率从 2005 年的 10/1000 例逐渐增加到 2022 年的 22/1000 例(p=0.55)。结论 IBD 儿童眼部受累很少见,在克罗恩病患者中更为常见,患病率稳定。眼部受累与病程较长、使用全身性皮质类固醇激素和生物制剂较多、住院率较高有关,可能代表了更严重的病程。
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引用次数: 0
P1123 Social isolation, loneliness, and incident inflammatory bowel disease: results from a large prospective cohorts and Mendelian randomization P1123 社会隔离、孤独感与炎症性肠病的发生:大型前瞻性队列和孟德尔随机分析的结果
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1253
J Zhao, M Zhang, J Ye, X Li
Background Background Social isolation and loneliness pose significant public health challenges globally. The objective of this study is to investigate the association between social isolation, loneliness, and the risk of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD). Methods Methods 275,157 UK adults from the UK Biobank (UKB) was analyzed. The exposures of interest were social isolation and loneliness. Social isolation was measured by the frequency of meeting family/friends, leisure and social activity, and communal/solitary living. Loneliness was evaluated by the subjective feeling of loneliness and the willingness to confide in others. The primary endpoint was incident IBD, including UC and CD. The twosample Mendelian randomization (MR) analysis was based on the genome-wide association studies of UKB and the a nonoverlapping European ancestry GWAS study. Results Results The UKB cohort study documented 1,565 IBD (1063 UC and 492 CD) cases during a mean follow-up of 13.49 years. Social isolation and loneliness showed significant associations with an elevated risk of IBD in UKB (social isolation [moderate vs least]: aHR 1.13, 95% CI 1.02-1.26; social isolation [most vs least]: aHR 1.31, 95% CI 1.01-1.70; loneliness [yes vs no]: aHR 1.29, 95% CI 1.04-1.60). These associations were evident among moderate genetic susceptibility to IBD. Social isolation and loneliness jointly increase the risk of IBD onset, with an aHR of 1.60 (95% CI 1.21-2.12). Two-sample MR analyses determined that engaging in fewer leisure/social activities (OR 3.42, 95% CI 1.55-7.58; 3.32, 95% CI 1.29-8.55; 3.09, 95% CI 1.35-7.07) were associated with increased IBD, UC and CD risk, whereas more activities-sports club or gym (OR 0.37, 95% CI 0.15-0.88) was associated with reduced IBD risk. Conclusion Conclusion Social isolation and loneliness are each associated with an elevated risk of IBD especially for individuals with a moderate genetic risk for IBD, with MR analyses suggesting potential causal links. The findings highlight the importance of promoting initiatives to address social isolation and loneliness as part of IBD prevention strategies.
背景 社会隔离和孤独是全球面临的重大公共卫生挑战。本研究旨在调查社会隔离、孤独与炎症性肠病(IBD)、溃疡性结肠炎(UC)和克罗恩病(CD)风险之间的关联。方法 对英国生物库(UKB)中的 275,157 名英国成年人进行了分析。研究对象为社会隔离和孤独感。社会隔离通过与家人/朋友会面的频率、休闲和社交活动以及集体/独居生活来衡量。孤独感通过主观孤独感和向他人倾诉的意愿来评估。主要终点是IBD事件,包括UC和CD。双样本孟德尔随机化(MR)分析基于UKB的全基因组关联研究和一项非重叠的欧洲血统GWAS研究。结果 UKB队列研究记录了1565例IBD病例(1063例UC和492例CD),平均随访时间为13.49年。在 UKB 中,社会隔离和孤独与 IBD 风险升高有显著关联(社会隔离[中度 vs 最小]:aHR 1.13,95% CI 1.02-1.26;社会隔离[最大 vs 最小]:aHR 1.31,95% CI 1.01-1.70;孤独[有 vs 无]:aHR 1.29,95% CI 1.04-1.60)。这些关联在中度遗传性 IBD 易感人群中非常明显。社会隔离和孤独感共同增加了 IBD 的发病风险,aHR 为 1.60(95% CI 1.21-2.12)。双样本 MR 分析表明,参与较少的休闲/社交活动(OR 3.42,95% CI 1.55-7.58;3.32,95% CI 1.29-8.55;3.09,95% CI 1.35-7.07)与 IBD、UC 和 CD 风险增加有关,而参与较多的活动--体育俱乐部或健身房(OR 0.37,95% CI 0.15-0.88)则与 IBD 风险降低有关。结论 社会隔离和孤独都与 IBD 风险的升高有关,特别是对于具有中度 IBD 遗传风险的个体,MR 分析表明两者之间存在潜在的因果关系。研究结果突出表明,作为 IBD 预防策略的一部分,推动解决社会隔离和孤独问题的措施非常重要。
{"title":"P1123 Social isolation, loneliness, and incident inflammatory bowel disease: results from a large prospective cohorts and Mendelian randomization","authors":"J Zhao, M Zhang, J Ye, X Li","doi":"10.1093/ecco-jcc/jjad212.1253","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1253","url":null,"abstract":"Background Background Social isolation and loneliness pose significant public health challenges globally. The objective of this study is to investigate the association between social isolation, loneliness, and the risk of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD). Methods Methods 275,157 UK adults from the UK Biobank (UKB) was analyzed. The exposures of interest were social isolation and loneliness. Social isolation was measured by the frequency of meeting family/friends, leisure and social activity, and communal/solitary living. Loneliness was evaluated by the subjective feeling of loneliness and the willingness to confide in others. The primary endpoint was incident IBD, including UC and CD. The twosample Mendelian randomization (MR) analysis was based on the genome-wide association studies of UKB and the a nonoverlapping European ancestry GWAS study. Results Results The UKB cohort study documented 1,565 IBD (1063 UC and 492 CD) cases during a mean follow-up of 13.49 years. Social isolation and loneliness showed significant associations with an elevated risk of IBD in UKB (social isolation [moderate vs least]: aHR 1.13, 95% CI 1.02-1.26; social isolation [most vs least]: aHR 1.31, 95% CI 1.01-1.70; loneliness [yes vs no]: aHR 1.29, 95% CI 1.04-1.60). These associations were evident among moderate genetic susceptibility to IBD. Social isolation and loneliness jointly increase the risk of IBD onset, with an aHR of 1.60 (95% CI 1.21-2.12). Two-sample MR analyses determined that engaging in fewer leisure/social activities (OR 3.42, 95% CI 1.55-7.58; 3.32, 95% CI 1.29-8.55; 3.09, 95% CI 1.35-7.07) were associated with increased IBD, UC and CD risk, whereas more activities-sports club or gym (OR 0.37, 95% CI 0.15-0.88) was associated with reduced IBD risk. Conclusion Conclusion Social isolation and loneliness are each associated with an elevated risk of IBD especially for individuals with a moderate genetic risk for IBD, with MR analyses suggesting potential causal links. The findings highlight the importance of promoting initiatives to address social isolation and loneliness as part of IBD prevention strategies.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"233 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559210","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
P1101 Patient-reported physical activity of IBD patients is of concern when weighed with the international physical activity questionnaire regardless of disease activity and IBD phenotype: barriers and facilitators emerged from the extended "BE-FIT-IBD" cross-sectional study P1101 无论疾病活动和 IBD 表型如何,用国际体力活动调查问卷权衡患者报告的 IBD 患者体力活动情况时,都会出现问题:"BE-FIT-IBD "横断面扩展研究中出现的障碍和促进因素
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1231
A G Gravina, R Pellegrino, G Palladino, G Imperio, R D'Onofrio, G Arboretto, M Romeo, P Ciamarra, M Dallio, A Federico
Background As the World Health Organization recommends, regular physical activity (PA) determines quality of life. The qualitative/quantitative characteristics of ideal PA to be suggested for inflammatory bowel diseases (IBD) nor the relationship with disease activity are not yet well defined. This study aimed to weigh PA levels and barriers/facilitators to PA in a cross-sectional group of patients with IBD. Methods Consecutive Italian non-severe IBD patients (assessed with partial Mayo score for and Harvey-Bradshaw index) received an anonymous online questionnaire to assess PA levels using the International Physical Activity Questionnaire (IPAQ), disease activity as Patient-Reported Outcomes 2 (PRO-2), and finally habits, beliefs, and barriers in conducting regular PA. Clinical, anthropometric, and demographic data were also collected. PA was processed as continuous units of resting metabolic rate in minutes/week (Met min/wk). Three PA groups were identified: inactive (< 700 Met min/wk), sufficiently active (700-2500 Met min/wk) and Health Enhancing PA (i.e., HEPA active, > 2500 Met min/wk) patients. Results The 219 patients enrolled exhibited overall PA levels of 834.5 Met min/wk, with a large proportion (94, 42.9%) classified as inactive. Only a minority (9, 4.1%) resulted as health-enhancing PA. Patients with a non-dyslipidaemia metabolic profile (p < 0.0001) or on biologics therapy (p=0.022) showed better IPAQ scores in moderate activities. PRO-2 correlated negatively with IPAQ intense activities scores (τ= -0.156, p=0.038) in ulcerative colitis patients. PRO-2 did not show notable sensitivity/specificity in predicting IPAQ inactivity (AUC < 0.6). IPAQ showed no notable differences when related to disease activity categories according to PRO-2 (p > 0.05). Physically active patients were more willing to discuss their PA with their IBDologists. Several barriers (e.g., diagnosis of IBD and fear of flare-ups after PA) are firmly rooted in physically inactive patients. Evacuation urgency (rectal syndrome) is the IBD-related barrier most physically inactive patients reported. Some fears about PA were worse felt in the absence of a stable partner (i.e., fear of worsening or recurrence of IBD, p < 0.05). Conclusion Many Italian IBD patients show a worrying rate of physical inactivity, depriving themselves of the multidimensional benefits that regular PA can bring. There is a need for IBDologists to act by removing barriers to PA and engaging in a regular discussion on the importance of PA with IBD patients. IPAQ has shown good feasibility and patient acceptance in this setting.
背景 正如世界卫生组织所建议的那样,经常进行体育锻炼(PA)可提高生活质量。炎症性肠病(IBD)理想的体力活动的定性/定量特征以及与疾病活动的关系尚未明确。本研究旨在权衡 IBD 患者的 PA 水平和 PA 的障碍/促进因素。方法 连续的意大利非重度 IBD 患者(以部分梅奥评分和哈维-布拉德肖指数进行评估)接受匿名在线问卷调查,使用国际体育锻炼问卷 (IPAQ) 评估体育锻炼水平,以患者报告结果 2 (PRO-2) 评估疾病活动情况,并最终评估定期进行体育锻炼的习惯、信念和障碍。此外,还收集了临床、人体测量和人口统计学数据。运动量以静息代谢率的连续单位进行处理,单位为分钟/周(Met min/wk)。研究确定了三组热能锻炼人群:不活跃人群(< 700 Met min/wk)、充分活跃人群(700-2500 Met min/wk)和健康增强型热能锻炼人群(即 HEPA 活跃人群,> 2500 Met min/wk)。结果 219 名入选患者的总体活动量为 834.5 Met min/wk,其中很大一部分(94 人,42.9%)被归类为不活动。只有少数患者(9 人,占 4.1%)的活动量达到了增进健康的水平。患有非血脂异常代谢病(p< 0.0001)或接受生物制剂治疗(p=0.022)的患者在中度活动中的 IPAQ 得分更高。PRO-2与溃疡性结肠炎患者的IPAQ剧烈活动评分呈负相关(τ= -0.156,p=0.038)。PRO-2在预测IPAQ活动不足方面没有显示出明显的敏感性/特异性(AUC < 0.6)。IPAQ与根据PRO-2划分的疾病活动类别没有明显差异(p> 0.05)。身体活跃的患者更愿意与他们的 IBD 专家讨论他们的 PA。一些障碍(如 IBD 诊断和对 PA 后复发的恐惧)在身体不活跃的患者中根深蒂固。排便紧迫感(直肠综合征)是大多数不运动患者报告的与 IBD 相关的障碍。在没有稳定伴侣的情况下,对 PA 的某些恐惧感会更加强烈(即担心 IBD 恶化或复发,p < 0.05)。结论 许多意大利 IBD 患者缺乏体育锻炼的比例令人担忧,他们无法享受定期体育锻炼带来的多方面益处。因此,IBD 患者需要定期与 IBD 专家讨论 PA 的重要性,消除 PA 的障碍。在这种情况下,IPAQ 已显示出良好的可行性和患者接受度。
{"title":"P1101 Patient-reported physical activity of IBD patients is of concern when weighed with the international physical activity questionnaire regardless of disease activity and IBD phenotype: barriers and facilitators emerged from the extended \"BE-FIT-IBD\" cross-sectional study","authors":"A G Gravina, R Pellegrino, G Palladino, G Imperio, R D'Onofrio, G Arboretto, M Romeo, P Ciamarra, M Dallio, A Federico","doi":"10.1093/ecco-jcc/jjad212.1231","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1231","url":null,"abstract":"Background As the World Health Organization recommends, regular physical activity (PA) determines quality of life. The qualitative/quantitative characteristics of ideal PA to be suggested for inflammatory bowel diseases (IBD) nor the relationship with disease activity are not yet well defined. This study aimed to weigh PA levels and barriers/facilitators to PA in a cross-sectional group of patients with IBD. Methods Consecutive Italian non-severe IBD patients (assessed with partial Mayo score for and Harvey-Bradshaw index) received an anonymous online questionnaire to assess PA levels using the International Physical Activity Questionnaire (IPAQ), disease activity as Patient-Reported Outcomes 2 (PRO-2), and finally habits, beliefs, and barriers in conducting regular PA. Clinical, anthropometric, and demographic data were also collected. PA was processed as continuous units of resting metabolic rate in minutes/week (Met min/wk). Three PA groups were identified: inactive (< 700 Met min/wk), sufficiently active (700-2500 Met min/wk) and Health Enhancing PA (i.e., HEPA active, > 2500 Met min/wk) patients. Results The 219 patients enrolled exhibited overall PA levels of 834.5 Met min/wk, with a large proportion (94, 42.9%) classified as inactive. Only a minority (9, 4.1%) resulted as health-enhancing PA. Patients with a non-dyslipidaemia metabolic profile (p < 0.0001) or on biologics therapy (p=0.022) showed better IPAQ scores in moderate activities. PRO-2 correlated negatively with IPAQ intense activities scores (τ= -0.156, p=0.038) in ulcerative colitis patients. PRO-2 did not show notable sensitivity/specificity in predicting IPAQ inactivity (AUC < 0.6). IPAQ showed no notable differences when related to disease activity categories according to PRO-2 (p > 0.05). Physically active patients were more willing to discuss their PA with their IBDologists. Several barriers (e.g., diagnosis of IBD and fear of flare-ups after PA) are firmly rooted in physically inactive patients. Evacuation urgency (rectal syndrome) is the IBD-related barrier most physically inactive patients reported. Some fears about PA were worse felt in the absence of a stable partner (i.e., fear of worsening or recurrence of IBD, p < 0.05). Conclusion Many Italian IBD patients show a worrying rate of physical inactivity, depriving themselves of the multidimensional benefits that regular PA can bring. There is a need for IBDologists to act by removing barriers to PA and engaging in a regular discussion on the importance of PA with IBD patients. IPAQ has shown good feasibility and patient acceptance in this setting.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"163 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559379","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
P310 Intestinal ultrasound as a tool to assess treatment response in patients with Inflammatory Bowel Diseases P310 肠道超声作为评估炎症性肠病患者治疗反应的工具
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0440
M Katsaros, A Katsoula, M Kalogirou, P Paschos, P Papagiannakis, T Tsionis, O Giouleme
Background The assessment of treatment response in patients with Inflammatory Bowel Disease (IBD) is often based on clinical indices [Harvey Bradshaw index (HBI), Partial Mayo score (PMS)] and biomarkers [C - reactive protein (CRP)]. Intestinal ultrasound (IUS) has been proposed as a modality capable of objectively evaluating therapeutic response. We investigated the utility of the IUS as a tool to assess treatment response, as well as its association with HBI, PMS and CRP. Methods We included patients with an established diagnosis of IBD who initiated biologic agent (infliximab, adalimumab, ustekinumab, vedolizumab) or tofacitinib. Active disease on IUS was defined as an increase in bowel wall thickness (BWT) >3 mm in the most affected bowel segment, while the presence of a Doppler signal (CDS) in the bowel wall was also assessed. Treatment response on IUS was defined according to the International Bowel Ultrasound Group (IBUS) criteria: reduction in bowel wall thickness (in continuous measurements) >25% or >2.0 mm or >1.0 mm with concomitant reduction in CDS by 1 unit at week 14 ± 2 from the initiation of treatment. Results A total of 19 patients (11 men, 11 with Crohn's disease) underwent IUS at week 0 and week 14 ± 2, while CRP, HBI and PMS were calculated at the same time points. We included bio-naïve as well bio experienced patients (table 1). At week 0, 84.2% of patients exhibited clinical activity (HBI ≥5, PMS ≥2), median CRP was 24.7 mg /L (IQR 18.6-42.8) and median BWT was 7.1mm (IQR 6.5-7.6). At week 14 ± 2, 42.1% of patients remained clinically active, median CRP was 6.8 mg/L (IQR 4.6-20.7) and median BWT was 5.2 mm (IQR 4.6- 6.4). Overall 10/19 patients fulfilled the criteria of treatment response on IUS at week 14 ± 2. Clinical remission was observed in 8/10 patients who demonstrated therapeutic response on IUS and 3/9 patients who did not (p=0.07). Normalization of CRP value (<6mg/L) was observed in 8/10 patients who exhibited treatment response on IUS and in none of the patients who did not (p<0.001). Among the IUS parameters at baseline, a statistically significant difference was found only in the presence of fat wrapping between treatment responders and treatment non-responders (table 2). Finally, median CRP was 4.9 mg/L (IQR 2.6-6.2) in IUS treatment responders and 20.7 mg/L (IQR 10.5-28.5) in IUS treatment non-responders. (p<0.001), with median BWT being 4.7mm (IQR 3.3-5.1) and 6.4mm (IQR 6.1-6.9) respectively (p<0.001). Conclusion IUS represents an objective tool for evaluating treatment response in patients with IBD, which demonstrates a significant correlation with CRP but not with clinical indices of activity.
背景 炎症性肠病(IBD)患者治疗反应的评估通常基于临床指标[哈维-布拉德肖指数(HBI)、部分梅奥评分(PMS)]和生物标志物[C反应蛋白(CRP)]。肠道超声(IUS)被认为是一种能够客观评估治疗反应的方法。我们研究了 IUS 作为治疗反应评估工具的实用性及其与 HBI、PMS 和 CRP 的关联。方法 我们纳入了已确诊并开始使用生物制剂(英夫利昔单抗、阿达木单抗、乌斯特库单抗、维妥珠单抗)或托法替尼的 IBD 患者。IUS上的活动性疾病定义为受影响最严重的肠段肠壁厚度(BWT)增加>3毫米,同时还要评估肠壁是否出现多普勒信号(CDS)。根据国际肠道超声组织(IBUS)的标准,IUS治疗反应的定义是:自开始治疗起第14±2周时,肠壁厚度(连续测量值)减少>25%或>2.0毫米或>1.0毫米,同时CDS减少1个单位。结果 共有 19 名患者(11 名男性,11 名克罗恩病患者)在第 0 周和第 14±2 周接受了 IUS 治疗,并在同一时间点计算了 CRP、HBI 和 PMS。我们的研究对象既包括生物免疫缺陷患者,也包括生物免疫缺陷经验丰富的患者(表 1)。在第 0 周,84.2% 的患者表现出临床活性(HBI ≥5,PMS ≥2),CRP 中位数为 24.7 毫克/升(IQR 18.6-42.8),BWT 中位数为 7.1 毫米(IQR 6.5-7.6)。在第 14±2 周,42.1% 的患者保持临床活动,CRP 中位数为 6.8 mg/L(IQR 4.6-20.7),BWT 中位数为 5.2 mm(IQR 4.6-6.4)。总体而言,10/19 名患者在第 14 周(±2)时达到了 IUS 治疗反应标准。8/10 名患者在 IUS 治疗反应中出现临床缓解,3/9 名患者未出现临床缓解(P=0.07)。8/10名IUS治疗反应患者的CRP值(<6mg/L)趋于正常,而没有治疗反应的患者的CRP值趋于正常(p<0.001)。在基线 IUS 参数中,治疗应答者和治疗无应答者之间只有脂肪包裹存在统计学差异(表 2)。最后,IUS 治疗应答者的 CRP 中位数为 4.9 毫克/升(IQR 2.6-6.2),IUS 治疗无应答者的 CRP 中位数为 20.7 毫克/升(IQR 10.5-28.5)。(p<0.001),BWT 中位数分别为 4.7 毫米(IQR 3.3-5.1)和 6.4 毫米(IQR 6.1-6.9)(p<0.001)。结论 IUS 是评估 IBD 患者治疗反应的客观工具,它与 CRP 有显著相关性,但与临床活动指数无关。
{"title":"P310 Intestinal ultrasound as a tool to assess treatment response in patients with Inflammatory Bowel Diseases","authors":"M Katsaros, A Katsoula, M Kalogirou, P Paschos, P Papagiannakis, T Tsionis, O Giouleme","doi":"10.1093/ecco-jcc/jjad212.0440","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0440","url":null,"abstract":"Background The assessment of treatment response in patients with Inflammatory Bowel Disease (IBD) is often based on clinical indices [Harvey Bradshaw index (HBI), Partial Mayo score (PMS)] and biomarkers [C - reactive protein (CRP)]. Intestinal ultrasound (IUS) has been proposed as a modality capable of objectively evaluating therapeutic response. We investigated the utility of the IUS as a tool to assess treatment response, as well as its association with HBI, PMS and CRP. Methods We included patients with an established diagnosis of IBD who initiated biologic agent (infliximab, adalimumab, ustekinumab, vedolizumab) or tofacitinib. Active disease on IUS was defined as an increase in bowel wall thickness (BWT) >3 mm in the most affected bowel segment, while the presence of a Doppler signal (CDS) in the bowel wall was also assessed. Treatment response on IUS was defined according to the International Bowel Ultrasound Group (IBUS) criteria: reduction in bowel wall thickness (in continuous measurements) >25% or >2.0 mm or >1.0 mm with concomitant reduction in CDS by 1 unit at week 14 ± 2 from the initiation of treatment. Results A total of 19 patients (11 men, 11 with Crohn's disease) underwent IUS at week 0 and week 14 ± 2, while CRP, HBI and PMS were calculated at the same time points. We included bio-naïve as well bio experienced patients (table 1). At week 0, 84.2% of patients exhibited clinical activity (HBI ≥5, PMS ≥2), median CRP was 24.7 mg /L (IQR 18.6-42.8) and median BWT was 7.1mm (IQR 6.5-7.6). At week 14 ± 2, 42.1% of patients remained clinically active, median CRP was 6.8 mg/L (IQR 4.6-20.7) and median BWT was 5.2 mm (IQR 4.6- 6.4). Overall 10/19 patients fulfilled the criteria of treatment response on IUS at week 14 ± 2. Clinical remission was observed in 8/10 patients who demonstrated therapeutic response on IUS and 3/9 patients who did not (p=0.07). Normalization of CRP value (<6mg/L) was observed in 8/10 patients who exhibited treatment response on IUS and in none of the patients who did not (p<0.001). Among the IUS parameters at baseline, a statistically significant difference was found only in the presence of fat wrapping between treatment responders and treatment non-responders (table 2). Finally, median CRP was 4.9 mg/L (IQR 2.6-6.2) in IUS treatment responders and 20.7 mg/L (IQR 10.5-28.5) in IUS treatment non-responders. (p<0.001), with median BWT being 4.7mm (IQR 3.3-5.1) and 6.4mm (IQR 6.1-6.9) respectively (p<0.001). Conclusion IUS represents an objective tool for evaluating treatment response in patients with IBD, which demonstrates a significant correlation with CRP but not with clinical indices of activity.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"155 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559385","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
P1069 One-year clinical outcomes of switching to subcutaneous infliximab in patients with inflammatory bowel disease on maintenance of intravenous infliximab therapy with or without remission: A multicentre cohort study P1069 炎症性肠病患者改用皮下注射英夫利西单抗后一年的临床疗效:一项多中心队列研究
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1199
J H Bae, J B Park, J E Baek, Y J Lee, K O Kim, E S Kim, H H Jo, S W Hong, S H Park, D H Yang, B D Ye, J S Byeon, S J Myung, S K Yang, E Y Kim, S W Hwang
Background An elective switching to the subcutaneous (SC) formulation of infliximab (IFX) has shown effectiveness and safety in patients with inflammatory bowel disease (IBD) on intravenous (IV) IFX maintenance therapy. However, data on long-term outcomes in patients not in clinical remission during maintenance therapy is limited. This study aims to evaluate the long-term outcomes of SC switching in patients who were in clinical remission and not in remission during IV IFX maintenance therapy. Methods This retrospective multicentre study was conducted from January 2021 to October 2023. Clinical remission was defined as Crohn’s Disease Activity Index (CDAI) <150 for Crohn’s disease (CD) and partial Mayo score <2 for ulcerative colitis. Biological remission was defined as faecal calprotectin (FC) <250 µg/g and C-reactive protein (CRP) <0.5 mg/dL. The primary outcome measure was 1-year treatment persistence of SC IFX. Results Among 127 patients included in the study, 80 (62.9%) had CD, and 47 (37.1%) had UC. At the time of switching, 90 patients (70.9 %) were in clinical remission; whereas, 37 (29.1 %) were in a non-remission state. The treatment persistence rate at 1 year was high at 92.9%. Treatment persistence rates between the clinical remission and non-remission groups did not differ significantly (94.4% vs. 89.2%, p=0.287). In both groups, IFX pharmacokinetics and biomarkers between baseline and 12 months (p<0.01) significantly improved. The median infliximab levels increased from a baseline of 3.3 µg/mL (interquartile range [IQR] 1.3–5.1) to 14.4 µg/mL (IQR 9.4–23.0, p<0.001) at 12 months. Disease activity index was stable in the remission group, and decreased in the non-remission group (partial Mayo score, p<0.001; CDAI, p=0.063). At the one-year follow-up, clinical remission and biological remission were achieved in 86.6% and 60.6%, respectively, an increase from baseline (70.9% and 48.0%, respectively). Biologics exposure before IFX was the only significant variable associated with treatment persistence (odds ratio 5.138, 95% confidence interval 1.150–22.951, p=0.032). The concomitant use of immunomodulators was not associated. The incidence of IFX-related adverse events was 14.2%, with only three patients discontinuing treatment. Conclusion Switching to SC IFX from IV IFX maintenance therapy demonstrated high treatment persistence and favourable safety profiles, irrespective of remission status at the time of switching. Patients in both remission or non-remission states showed significant improvement in pharmacokinetics and biomarkers, and/or stable disease activity indices.
背景 在接受静脉注射 IFX 维持治疗的炎症性肠病(IBD)患者中,选择性转用英夫利昔单抗(IFX)皮下注射制剂已显示出有效性和安全性。然而,有关在维持治疗期间未达到临床缓解的患者的长期疗效的数据却很有限。本研究旨在评估静脉注射 IFX 维持治疗期间临床缓解和非缓解患者转用 SC 后的长期疗效。方法 该回顾性多中心研究于 2021 年 1 月至 2023 年 10 月进行。克罗恩病(CD)的临床缓解定义为克罗恩病活动指数(CDAI)<150,溃疡性结肠炎的部分梅奥评分<2。生物缓解的定义是粪便钙蛋白(FC)<250 µg/g和C反应蛋白(CRP)<0.5 mg/dL。主要结果指标是 SC IFX 1 年治疗的持续性。结果 在纳入研究的 127 名患者中,80 人(62.9%)患有 CD,47 人(37.1%)患有 UC。换药时,90 名患者(70.9%)处于临床缓解状态,37 名患者(29.1%)处于非缓解状态。1 年后的治疗持续率高达 92.9%。临床缓解组和非缓解组的治疗持续率差异不大(94.4% 对 89.2%,P=0.287)。两组患者的 IFX 药代动力学和生物标志物在基线和 12 个月之间(p<0.01)均有显著改善。英夫利西单抗的中位水平从基线的3.3 µg/mL(四分位距[IQR] 1.3-5.1)升至12个月时的14.4 µg/mL(IQR 9.4-23.0,p<0.001)。缓解组的疾病活动指数保持稳定,未缓解组的疾病活动指数有所下降(部分梅奥评分,p<0.001;CDAI,p=0.063)。在一年的随访中,分别有 86.6% 和 60.6% 的患者实现了临床缓解和生物缓解,比基线(分别为 70.9% 和 48.0%)有所提高。IFX 前的生物制剂暴露是与治疗持续性相关的唯一显著变量(几率比 5.138,95% 置信区间 1.150-22.951,P=0.032)。同时使用免疫调节剂与此无关。IFX相关不良事件的发生率为14.2%,只有3名患者中断了治疗。结论 从静脉注射IFX维持治疗转为SC IFX治疗,无论转药时病情是否缓解,均显示出较高的治疗持续性和良好的安全性。处于缓解或非缓解状态的患者的药代动力学和生物标志物均有显著改善,疾病活动指数也趋于稳定。
{"title":"P1069 One-year clinical outcomes of switching to subcutaneous infliximab in patients with inflammatory bowel disease on maintenance of intravenous infliximab therapy with or without remission: A multicentre cohort study","authors":"J H Bae, J B Park, J E Baek, Y J Lee, K O Kim, E S Kim, H H Jo, S W Hong, S H Park, D H Yang, B D Ye, J S Byeon, S J Myung, S K Yang, E Y Kim, S W Hwang","doi":"10.1093/ecco-jcc/jjad212.1199","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.1199","url":null,"abstract":"Background An elective switching to the subcutaneous (SC) formulation of infliximab (IFX) has shown effectiveness and safety in patients with inflammatory bowel disease (IBD) on intravenous (IV) IFX maintenance therapy. However, data on long-term outcomes in patients not in clinical remission during maintenance therapy is limited. This study aims to evaluate the long-term outcomes of SC switching in patients who were in clinical remission and not in remission during IV IFX maintenance therapy. Methods This retrospective multicentre study was conducted from January 2021 to October 2023. Clinical remission was defined as Crohn’s Disease Activity Index (CDAI) <150 for Crohn’s disease (CD) and partial Mayo score <2 for ulcerative colitis. Biological remission was defined as faecal calprotectin (FC) <250 µg/g and C-reactive protein (CRP) <0.5 mg/dL. The primary outcome measure was 1-year treatment persistence of SC IFX. Results Among 127 patients included in the study, 80 (62.9%) had CD, and 47 (37.1%) had UC. At the time of switching, 90 patients (70.9 %) were in clinical remission; whereas, 37 (29.1 %) were in a non-remission state. The treatment persistence rate at 1 year was high at 92.9%. Treatment persistence rates between the clinical remission and non-remission groups did not differ significantly (94.4% vs. 89.2%, p=0.287). In both groups, IFX pharmacokinetics and biomarkers between baseline and 12 months (p<0.01) significantly improved. The median infliximab levels increased from a baseline of 3.3 µg/mL (interquartile range [IQR] 1.3–5.1) to 14.4 µg/mL (IQR 9.4–23.0, p<0.001) at 12 months. Disease activity index was stable in the remission group, and decreased in the non-remission group (partial Mayo score, p<0.001; CDAI, p=0.063). At the one-year follow-up, clinical remission and biological remission were achieved in 86.6% and 60.6%, respectively, an increase from baseline (70.9% and 48.0%, respectively). Biologics exposure before IFX was the only significant variable associated with treatment persistence (odds ratio 5.138, 95% confidence interval 1.150–22.951, p=0.032). The concomitant use of immunomodulators was not associated. The incidence of IFX-related adverse events was 14.2%, with only three patients discontinuing treatment. Conclusion Switching to SC IFX from IV IFX maintenance therapy demonstrated high treatment persistence and favourable safety profiles, irrespective of remission status at the time of switching. Patients in both remission or non-remission states showed significant improvement in pharmacokinetics and biomarkers, and/or stable disease activity indices.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"23 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559423","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
P696 Initiation of Vedolizumab did not provoke new-onset spondylarthritis in patients with inflammatory bowel disease: A Prospective Study Including Rheumatological and Blinded Imaging Assessments P696 炎症性肠病患者开始使用维多珠单抗不会引发新发脊柱关节炎:一项包括风湿病学和盲法成像评估的前瞻性研究
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0826
S Rohekar, T Boyd, R Lambert, M Beaton, N Chande, J Gregor, H Lennox, K McIntosh, T Ponich, A Rahman, T Sharma, M Sey, M Tauqir, V Jairath
Background Prior case series indicated a temporal relationship between use of vedolizumab and new-onset spondyloarthritis. Methods We aimed to evaluate the relationship between initiation of vedolizumab and development of new-onset spondyloarthritis in patients with inflammatory bowel disease, through serial clinical evaluation and magnetic resonance imaging. A single-centre prospective observational study of 24 patients with inflammatory bowel disease. Patients were eligible if they had active ulcerative colitis or Crohn’s disease and initiating vedolizumab, had no prior history of arthritis or spondyloarthritis and suitable for undergoing serial magnetic resonance imaging. Clinical evaluation was performed by a rheumatologist prior to first dose of vedolizumab and at weeks 8 and 24 weeks after administration. Axial magnetic resonance imaging was performed at baseline, weeks 8 and 24 and evaluated by a blinded central reader. Results Nine tumour necrosis factor inhibitor-naïve patients (4 male; mean age 53.2 yrs; 6 ulcerative colitis; 3 Crohn’s disease) and eight tumour necrosis factor inhibitor-experienced patients (7 male; mean age 48 yrs; 3 ulcerative colitis; 5 Crohn’s disease) completed all assessments. No patients developed new features of axial arthritis either on clinical or blinded radiological assessment at weeks 8 or 24, nor any features of peripheral spondyloarthritis including inflammatory oligoarthritis, enthesitis, dactylitis, or psoriasis (nail, body, or scalp). Both the tumour necrosis factor inhibitor-naive and tumour necrosis factor inhibitor-experienced patients demonstrated good intestinal response to vedolizumab. Conclusion Initiation of vedolizumab did not induce new features of axial or peripheral spondyloarthritis in tumour necrosis factor inhibitor-experienced or tumour necrosis factor inhibitor-naive patients with inflammatory bowel disease.
背景 之前的系列病例表明,使用维多珠单抗与新发脊柱关节炎之间存在时间关系。方法 我们旨在通过系列临床评估和磁共振成像,评估炎症性肠病患者开始使用维多珠单抗与新发脊柱关节炎之间的关系。这是一项针对 24 名炎症性肠病患者的单中心前瞻性观察研究。如果患者患有活动性溃疡性结肠炎或克罗恩病并开始使用维多珠单抗,既往无关节炎或脊柱关节炎病史,且适合接受序列磁共振成像检查,则符合研究条件。在首次服用维多珠单抗之前以及用药后第 8 周和第 24 周,由风湿免疫科医生进行临床评估。在基线、第8周和第24周进行轴向磁共振成像,并由盲人中心阅读器进行评估。结果 9 名肿瘤坏死因子抑制剂无效患者(4 名男性;平均年龄 53.2 岁;6 名溃疡性结肠炎患者;3 名克罗恩病患者)和 8 名肿瘤坏死因子抑制剂有效患者(7 名男性;平均年龄 48 岁;3 名溃疡性结肠炎患者;5 名克罗恩病患者)完成了所有评估。在第 8 周或第 24 周的临床或盲法放射学评估中,没有患者出现新的轴关节炎特征,也没有出现任何外周脊柱关节炎特征,包括炎性少关节炎、腱鞘炎、趾关节炎或银屑病(指甲、身体或头皮)。对肿瘤坏死因子抑制剂无免疫反应的患者和对肿瘤坏死因子抑制剂有免疫反应的患者均对韦多珠单抗表现出良好的肠道反应。结论 有肿瘤坏死因子抑制剂治疗经验的炎症性肠病患者和无肿瘤坏死因子抑制剂治疗经验的炎症性肠病患者开始使用维多珠单抗不会诱发轴性或周围脊柱关节炎的新特征。
{"title":"P696 Initiation of Vedolizumab did not provoke new-onset spondylarthritis in patients with inflammatory bowel disease: A Prospective Study Including Rheumatological and Blinded Imaging Assessments","authors":"S Rohekar, T Boyd, R Lambert, M Beaton, N Chande, J Gregor, H Lennox, K McIntosh, T Ponich, A Rahman, T Sharma, M Sey, M Tauqir, V Jairath","doi":"10.1093/ecco-jcc/jjad212.0826","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0826","url":null,"abstract":"Background Prior case series indicated a temporal relationship between use of vedolizumab and new-onset spondyloarthritis. Methods We aimed to evaluate the relationship between initiation of vedolizumab and development of new-onset spondyloarthritis in patients with inflammatory bowel disease, through serial clinical evaluation and magnetic resonance imaging. A single-centre prospective observational study of 24 patients with inflammatory bowel disease. Patients were eligible if they had active ulcerative colitis or Crohn’s disease and initiating vedolizumab, had no prior history of arthritis or spondyloarthritis and suitable for undergoing serial magnetic resonance imaging. Clinical evaluation was performed by a rheumatologist prior to first dose of vedolizumab and at weeks 8 and 24 weeks after administration. Axial magnetic resonance imaging was performed at baseline, weeks 8 and 24 and evaluated by a blinded central reader. Results Nine tumour necrosis factor inhibitor-naïve patients (4 male; mean age 53.2 yrs; 6 ulcerative colitis; 3 Crohn’s disease) and eight tumour necrosis factor inhibitor-experienced patients (7 male; mean age 48 yrs; 3 ulcerative colitis; 5 Crohn’s disease) completed all assessments. No patients developed new features of axial arthritis either on clinical or blinded radiological assessment at weeks 8 or 24, nor any features of peripheral spondyloarthritis including inflammatory oligoarthritis, enthesitis, dactylitis, or psoriasis (nail, body, or scalp). Both the tumour necrosis factor inhibitor-naive and tumour necrosis factor inhibitor-experienced patients demonstrated good intestinal response to vedolizumab. Conclusion Initiation of vedolizumab did not induce new features of axial or peripheral spondyloarthritis in tumour necrosis factor inhibitor-experienced or tumour necrosis factor inhibitor-naive patients with inflammatory bowel disease.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"163 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559435","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
DOP63 Mortality in Pediatric-onset Immune-Mediated Inflammatory Disease – A Nationwide Study 小儿免疫性炎症疾病的 DOP63 死亡率 - 一项全国性研究
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.0103
M Malham, S Jansson, H A S Ingels, M H Jørgensen, N Roed, A V Wewer, M P Fox
Background Patients with pediatric-onset immune-mediated inflammatory diseases (pIMID) show more aggressive phenotypes compared to patients diagnosed as adults. Despite this, data on mortality is extrapolated from patients diagnosed in adulthood, which might underestimate the actual risk. We aim to estimate the effect of pIMID compared to reference individuals from the general population on the long-term risk of all-cause mortality. Methods A population-based cohort study using the nationwide Danish health care registers. We included all patients diagnosed with pIMID in Denmark from 1980 to 2018 and matched them to up to ten reference individuals from the general population (with no recorded IMID) based on sex, age at diagnosis, and area of residence. Exposure was pIMID, defined as ICD codes indicative of autoimmune hepatitis, primary sclerosing cholangitis, Crohn’s disease, ulcerative colitis, juvenile idiopathic arthritis, system lupus erythematosus, or vasculitis registered before age 18. The primary outcome was all-cause mortality. The secondary outcome was cause-specific mortality. Cox survival analysis was used to estimate hazard ratios (HR) and Aalen survival analysis to estimate rate differences with corresponding 95% confidence intervals (CI) adjusted for the year of diagnosis and family income. Denmark has universal free health care, and health care data can be accessed through the nationwide health registers, continuously updated since 1980. Results We included 11,581 individuals diagnosed with pIMID, and 99,665 matched reference individuals, accounting for 1,371,994 person-years of follow-up. Median age at pIMID diagnosis was 12.6 years (IQR: 7.9 – 15.9). During follow-up, 152 pIMID patients and 316 reference individuals died, resulting in an all-cause mortality adjusted HR (aHR) of 3.8 (95% confidence interval [CI]: 3.1-4.7) compared to reference individuals without pIMID. This corresponded to 7.8 (95%CI: 6.1-9.5) additional deaths per 10,000 person-years. The strongest associations were found for gastrointestinal disorders (aHR 22.8 [95%CI: 9.6-64.1]), gastrointestinal cancers (aHR 19.2 [95%CI: 5.0-74.2]), and lymphoproliferative diseases (aHR 6.8 [95%CI: 2.8-16.8]). The aHR of suicide was 2.9 (95%CI: 1.6-5.0). Conclusion Patients diagnosed with pIMID have a four-fold increased risk of mortality when followed into adulthood. This underlines the severe disease course of pIMID and highlights the need for lifelong multidisciplinary care.
背景 儿科发病的免疫介导的炎症性疾病(pIMID)患者与成年诊断的患者相比,表现出更具侵袭性的表型。尽管如此,有关死亡率的数据仍是从成年期诊断的患者中推断出来的,这可能低估了实际风险。我们旨在估算与普通人群中的参照个体相比,pIMID 对全因死亡率长期风险的影响。方法 通过丹麦全国范围内的医疗登记进行一项基于人群的队列研究。我们纳入了 1980 年至 2018 年期间在丹麦确诊为 pIMID 的所有患者,并根据性别、确诊时的年龄和居住地区,将他们与普通人群中最多 10 个参照个体(无 IMID 记录)进行匹配。暴露为pIMID,定义为18岁之前登记的表明自身免疫性肝炎、原发性硬化性胆管炎、克罗恩病、溃疡性结肠炎、幼年特发性关节炎、系统性红斑狼疮或血管炎的ICD代码。主要结果是全因死亡率。次要结果为病因特异性死亡率。采用 Cox 生存分析法估算危险比 (HR),采用 Aalen 生存分析法估算死亡率差异,并根据诊断年份和家庭收入调整相应的 95% 置信区间 (CI)。丹麦实行全民免费医疗,医疗数据可通过自 1980 年以来持续更新的全国健康登记册获取。结果 我们纳入了 11,581 名确诊为 pIMID 的患者和 99,665 名匹配的参照患者,随访时间为 1,371,994 人年。确诊 pIMID 时的中位年龄为 12.6 岁(IQR:7.9 - 15.9)。在随访期间,152 名 pIMID 患者和 316 名参照个体死亡,与没有 pIMID 的参照个体相比,全因死亡率调整 HR (aHR) 为 3.8(95% 置信区间 [CI]:3.1-4.7)。这相当于每 10,000 人年增加 7.8 例死亡(95% 置信区间:6.1-9.5)。胃肠道疾病(aHR 22.8 [95%CI: 9.6-64.1])、胃肠道癌症(aHR 19.2 [95%CI: 5.0-74.2])和淋巴组织增生性疾病(aHR 6.8 [95%CI: 2.8-16.8])的相关性最强。自杀的 aHR 为 2.9(95%CI:1.6-5.0)。结论 被诊断为 pIMID 的患者成年后的死亡风险增加了四倍。这凸显了 pIMID 的严重病程,并强调了终生多学科护理的必要性。
{"title":"DOP63 Mortality in Pediatric-onset Immune-Mediated Inflammatory Disease – A Nationwide Study","authors":"M Malham, S Jansson, H A S Ingels, M H Jørgensen, N Roed, A V Wewer, M P Fox","doi":"10.1093/ecco-jcc/jjad212.0103","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjad212.0103","url":null,"abstract":"Background Patients with pediatric-onset immune-mediated inflammatory diseases (pIMID) show more aggressive phenotypes compared to patients diagnosed as adults. Despite this, data on mortality is extrapolated from patients diagnosed in adulthood, which might underestimate the actual risk. We aim to estimate the effect of pIMID compared to reference individuals from the general population on the long-term risk of all-cause mortality. Methods A population-based cohort study using the nationwide Danish health care registers. We included all patients diagnosed with pIMID in Denmark from 1980 to 2018 and matched them to up to ten reference individuals from the general population (with no recorded IMID) based on sex, age at diagnosis, and area of residence. Exposure was pIMID, defined as ICD codes indicative of autoimmune hepatitis, primary sclerosing cholangitis, Crohn’s disease, ulcerative colitis, juvenile idiopathic arthritis, system lupus erythematosus, or vasculitis registered before age 18. The primary outcome was all-cause mortality. The secondary outcome was cause-specific mortality. Cox survival analysis was used to estimate hazard ratios (HR) and Aalen survival analysis to estimate rate differences with corresponding 95% confidence intervals (CI) adjusted for the year of diagnosis and family income. Denmark has universal free health care, and health care data can be accessed through the nationwide health registers, continuously updated since 1980. Results We included 11,581 individuals diagnosed with pIMID, and 99,665 matched reference individuals, accounting for 1,371,994 person-years of follow-up. Median age at pIMID diagnosis was 12.6 years (IQR: 7.9 – 15.9). During follow-up, 152 pIMID patients and 316 reference individuals died, resulting in an all-cause mortality adjusted HR (aHR) of 3.8 (95% confidence interval [CI]: 3.1-4.7) compared to reference individuals without pIMID. This corresponded to 7.8 (95%CI: 6.1-9.5) additional deaths per 10,000 person-years. The strongest associations were found for gastrointestinal disorders (aHR 22.8 [95%CI: 9.6-64.1]), gastrointestinal cancers (aHR 19.2 [95%CI: 5.0-74.2]), and lymphoproliferative diseases (aHR 6.8 [95%CI: 2.8-16.8]). The aHR of suicide was 2.9 (95%CI: 1.6-5.0). Conclusion Patients diagnosed with pIMID have a four-fold increased risk of mortality when followed into adulthood. This underlines the severe disease course of pIMID and highlights the need for lifelong multidisciplinary care.","PeriodicalId":15453,"journal":{"name":"Journal of Crohn's and Colitis","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559644","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
P886 Ustekinumab concentrations in induction are associated with mid-term endoscopic outcomes in patients with inflammatory bowel disease P886 Ustekinumab在诱导过程中的浓度与炎症性肠病患者的中期内镜检查结果有关
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1016
X Serra-Ruiz, E Céspedes Martínez, L Mayorga Ayala, C Herrera de-Guise, V Robles Alonso, Z Pérez Martínez, E Oller, N Borruel Sainz
Background It is unclear whether ustekinumab (UST) concentrations can predict the clinical course of inflammatory bowel disease (IBD) and guide treatment algorithms during the induction phase. The aim of our study was to assess the association between serum UST concentrations during the induction phase and clinical outcomes at week 24 and to determine the validity of a UST threshold for guiding intensification strategies. Methods We conducted a retrospective study including Crohn's disease (CD) and ulcerative colitis (UC) patients who started UST treatment between June 2022 and February 2023. Intensification strategies were determined according to standard clinical practice. UST concentrations were collected at weeks 8, 16, and 24. Quartile analysis and logistic regression were performed to evaluate the association between UST concentrations and treatment targets. Definitions are clinical steroid-free remission as a Harvey-Bradshaw index <5 and a partial Mayo score <2; endoscopic remission as a simple endoscopic score (SES-CD) ≤2 and Mayo endoscopic score (EMS) ≤1; and endoscopic response as a ≥50% reduction in SES-CD and ≥1 point in EMS. Results We included 42 patients (CD: 24). At week 24, clinical remission rates of 67% and endoscopic response and remission rates of 57% and 28%, respectively, were achieved. At week 24, the majority of patients continued intensified treatment: 90 mg subcutaneously every 4 weeks in 55% and 130 mg intravenously every 4 weeks in 36%. Patients who achieved an endoscopic response at week 24 had higher UST levels at week 8 (4.1 vs. 2.9 µg/ml, p=0.029). No significant differences between endoscopic remission rates and UST levels at any week were observed. The differences observed in the quartile analysis between the UST concentrations at week 8 and the endoscopic response were not statistically significant (p=0.451). The area under the ROC curve value for UST levels at week 8 to predict endoscopic response was 0.734 (p=0.012). Logistic regression analysis identified prior exposure to vedolizumab and absence of perianal disease as predictors of endoscopic response and remission at week 24 in univariate analysis, but not in multivariate analysis. No association was observed between UST levels and drug persistence rates. Conclusion In this real-world cohort, higher UST concentrations at week 8 were associated with higher rates of endoscopic response at week 24. A reliable concentration threshold for predicting endoscopic response and treatment intensification could not be determined, probably due to the insufficient number of patients included in the study and the relatively poor performance of the ROC curve. Prospective, randomized studies are needed to validate these results.
背景 目前尚不清楚乌司替单抗(UST)浓度能否预测炎症性肠病(IBD)的临床过程并指导诱导期的治疗算法。我们的研究旨在评估诱导期血清 UST 浓度与第 24 周临床结果之间的关联,并确定 UST 阈值对指导强化策略的有效性。方法 我们进行了一项回顾性研究,研究对象包括在 2022 年 6 月至 2023 年 2 月期间开始 UST 治疗的克罗恩病(CD)和溃疡性结肠炎(UC)患者。根据标准临床实践确定了强化策略。在第 8、16 和 24 周收集 UST 浓度。采用四分位分析和逻辑回归评估 UST 浓度与治疗目标之间的关联。定义为临床无类固醇缓解为哈维-布拉德肖指数(Harvey-Bradshaw index)<5,部分梅奥评分(Mayo score)<2;内镜缓解为单纯内镜评分(SES-CD)≤2,梅奥内镜评分(EMS)≤1;内镜反应为 SES-CD 降低≥50%,EMS 降低≥1 分。结果 我们共纳入 42 例患者(CD:24 例)。第24周时,临床缓解率为67%,内镜反应和缓解率分别为57%和28%。第24周时,大多数患者继续加强治疗:55%的患者每4周皮下注射90毫克,36%的患者每4周静脉注射130毫克。在第24周获得内镜反应的患者在第8周时的UST水平较高(4.1 vs. 2.9 µg/ml,p=0.029)。内镜缓解率与任何一周的 UST 水平之间均无明显差异。在第 8 周 UST 浓度与内镜反应之间的四分位分析中观察到的差异无统计学意义(p=0.451)。第 8 周 UST 浓度预测内镜反应的 ROC 曲线下面积值为 0.734(p=0.012)。逻辑回归分析表明,在单变量分析中,曾接触过维多利珠单抗和无肛周疾病是第24周内镜反应和缓解的预测因素,但在多变量分析中却不是。未观察到 UST 水平与药物持续率之间存在关联。结论 在这个真实世界队列中,第 8 周 UST 浓度越高,第 24 周的内镜反应率越高。预测内镜反应和加强治疗的可靠浓度阈值无法确定,这可能是由于研究中纳入的患者人数不足,以及 ROC 曲线的表现相对较差。需要进行前瞻性的随机研究来验证这些结果。
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引用次数: 0
N03 Flexibility & Accessibility, e-Literacy, Resourcing and The Human Factor: Early Lessons from EIBD, a UK Qualitative Interview Study N03 灵活性和无障碍性、电子扫盲、资源配置和人为因素:英国定性访谈研究:EIBD 的早期经验教训
Pub Date : 2024-01-24 DOI: 10.1093/ecco-jcc/jjad212.1375
P Avery, K Kemp, L Dibley, S Green
Background Since the COVID-19 pandemic, the use of health tools (video/phone consultations, patient portals, and digital applications) has increased in the clinical management of patients with Inflammatory Bowel Disease (PIBD). We aimed to evidence the acceptability of eHealth tools by investigating the shared experience of PIBD and healthcare professionals (HCPs) in using eHealth to carry out follow-up appointments and support self-management. Methods An exploratory qualitative method was used. Participants were recruited via professional networks, social media platforms, Crohn's and Colitis UK website and newsletters. Semi-structured interviews were conducted remotely in April/May 2023 using MS Teams or Zoom. Transcripts were analysed using a thematic analysis. Results Fifteen HCPs (13 female) participated: IBD specialist nurses (n=9); gastroenterologists (n=2), pharmacists (n=2) and Dieticians (n=2). The 16 PIBD (10 female) participants were living with Crohn’s Disease (n=9), Ulcerative Colitis (n=6), and Inflammatory Bowel Disease Unclassified (n=1); age was reported in ranges 18 -24 (n=3), 24-34 (n=1), 35-54 (n=8), and 55-65 (n=2) and 75-85 (n=1). Time since IBD diagnosis ranged from < 6 months - 43 years (mean time 18.7 years). Some participants had pre-diagnosis symptoms for at least one year (81%) to over five years (25%). Four themes emerged: • Flexibility and Accessibility: PIBD appreciated the ease of virtual appointments and access to test results and information but wanted flexibility and a personal approach to their care; eHealth connected them to their IBD team more easily. • Resource: HCPs wanted better digital training since remote assessment skills differ from in-person assessment skills. They also identified the need for admin support when planning to implement eHealth tools. HCPs and PIBD wondered whether eHealth was primarily a cost-savings exercise, whilst the need for resource efficiencies across the health service was recognised. • e-Literacy: HCPs were concerned that some older PIBD might be excluded from accessing eHealth due to e-literacy and capability issues, perceiving that eHealth is for the younger generation. • The Human Factor: PIBD and HCPs wanted to have already met in person anyone they engaged with later virtually. For PIBD, in-person consultations meant they felt seen or understood, and they described the importance of hands-on abdominal examinations in reassuring them about their health status. Conclusion There is an acceptability of eHealth to support the care of PIBD, but HCPs and PIBD still value the Human factor. Concerns over Resourcing, Flexibility and Accessibility and e-Literacy may need addressing to avoid these becoming barriers to the benefits of virtual healthcare in supporting PIBD.
背景 自从 COVID-19 大流行以来,在炎症性肠病(PIBD)患者的临床管理中,健康工具(视频/电话咨询、患者门户网站和数字应用程序)的使用有所增加。我们的目的是通过调查炎性肠病患者和医疗保健专业人员(HCPs)在使用电子健康工具进行随访预约和支持自我管理方面的共同经验,证明电子健康工具的可接受性。方法 采用探索性定性方法。研究人员通过专业网络、社交媒体平台、英国克罗恩病与结肠炎协会网站和通讯招募参与者。2023 年 4 月/5 月,使用 MS Teams 或 Zoom 进行了半结构化远程访谈。访谈记录采用主题分析法进行分析。结果 15 名 HCP(13 名女性)参加了访谈:IBD专科护士(9人)、胃肠病学家(2人)、药剂师(2人)和营养师(2人)。16 名 PIBD 患者(10 名女性)分别患有克罗恩病(9 名)、溃疡性结肠炎(6 名)和未分类的炎症性肠病(1 名);年龄范围为 18-24 岁(3 名)、24-34 岁(1 名)、35-54 岁(8 名)、55-65 岁(2 名)和 75-85 岁(1 名)。确诊 IBD 的时间从 6 个月到 43 年不等(平均时间为 18.7 年)。一些参与者的诊断前症状持续了至少一年(81%)至五年以上(25%)。出现了四个主题:- 灵活性和可及性:IBD 患者对虚拟预约、获取检查结果和信息的便捷性表示赞赏,但他们也希望获得灵活、个性化的护理方式;电子健康系统能更方便地将他们与 IBD 团队联系起来。- 资源:初级保健人员希望获得更好的数字化培训,因为远程评估技能不同于现场评估技能。他们还指出,在计划实施电子健康工具时需要行政支持。保健医生和 PIBD 怀疑电子保健是否主要是为了节约成本,同时也认识到整个医疗服务需要提高资源效率。- 电子扫盲:保健医生担心,由于电子扫盲和能力问题,一些年长的太平洋岛屿族裔人士可能会被排除在电子医疗之外,他们认为电子医疗是为年轻一代准备的。- 人为因素:患者和保健服务提供者希望与他们后来通过虚拟方式接触的任何人都已经见过面。对于 PIBD 来说,面对面咨询意味着他们感觉自己被看见或被理解,他们描述了亲身腹部检查在让他们对自己的健康状况放心方面的重要性。结论 人们可以接受电子医疗来支持对肺结核患者的护理,但保健医生和肺结核患者仍然重视人的因素。对资源配置、灵活性和可及性以及电子扫盲的担忧可能需要解决,以避免这些问题成为虚拟医疗在支持肺结核患者方面获益的障碍。
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引用次数: 0
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Journal of Crohn's and Colitis
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