Articles tagged with: e-Library

25March2021

Y-ECCO Literature Review: Eathar Shakweh

Eathar Shakweh

Randomised clinical trial: high‐dose oral thiamine versus placebo for chronic fatigue in patients with quiescent inflammatory bowel disease (TARIF study)

Bager P, Hvas CL, Rud CL1Dahlerup JF

Aliment Pharmacol Ther 2021;53(1):79–86.


Eathar Shakweh
© Eathar Shakweh

Introduction

Fatigue is a common yet poorly understood manifestation of Inflammatory Bowel Disease (IBD) and can occur independently of disease activity. A prospective cohort study of 326 IBD patients initiating biologic therapy (with infliximab, vedolizumab or ustekinumab) demonstrated fatigue was prevalent at baseline (63%)1. Whilst fewer patients reported fatigue with treatment (70% at week 14, 61% at week 30 and 61% at week 54), a third continued to experience fatigue despite achieving clinical remission. This is supported by other studies, where fatigue prevalence in quiescent disease was as high as 36% in Ulcerative Colitis (UC) and 41% in Crohn’s disease (CD)2.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 1, Y-ECCO

25March2021

Y-ECCO Literature Review: Rajan N Patel

Rajan N Patel

AN ANTI-MIGRATION SELF-EXPANDABLE AND REMOVABLE METAL STENT FOR CROHN’S DISEASE STRICTURES: A NATIONWIDE STUDY FROM GETAID AND SFED

Attar A, Branche J, Coron E et al.

J Crohns Colitis 2020 Oct 27. doi: 10.1093/ecco-jcc/jjaa208. Online ahead of print.


Rajan N Patel
© Rajan N Patel

Introduction

Crohn’s Disease is complicated by strictures in up to 30% of cases. Medical management with biologics is often suboptimal and surgical treatment is associated with postoperative complications and disease recurrence. Targeted therapy with endoscopic balloon dilatation (EBD) of strictures less than 5 cm has high rates of technical success (passage of endoscope through the stricture) but variable clinical success (relief of obstructive symptoms), with up to 25% of patients requiring surgery at one-year follow-up [1]. Removable fully covered metal stents are safe for the treatment of refractory strictures but the risk of stent migration is high [2].

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 1, Y-ECCO

29April2021

Y-ECCO Literature Review: Samuel Lim

Samuel Lim

DRUG SURVIVAL OF ANTI-TNF AGENTS COMPARED WITH VEDOLIZUMAB AS A SECOND-LINE BIOLOGICAL TREATMENT IN INFLAMMATORY BOWEL DISEASE: RESULTS FROM NATIONWIDE SWEDISH REGISTERS

Sara Rundquist, Michael C Sachs, Carl Eriksson, Ola Olén, Scott Montgomery, Jonas Halfvarson, SWIBREG Study Group

Aliment Pharmacol Ther 2021;53:471–83. doi: 10.1111/apt.16193.


Samuel Lim
© Samuel Lim

Introduction

The advent of monoclonal antibody therapy has propelled the management of Inflammatory Bowel Disease firmly into the biologic era, with numerous biologic therapies now licensed or in various stages of development.

Anti-tumour necrosis factor (TNF) agents such as infliximab [1, 2], adalimumab [3, 4] and golimumab [5] were the first biologics to be developed and have the greatest body of evidence for their effectiveness and safety in the treatment of Crohn’s Disease (CD) and Ulcerative Colitis (UC). The arrival of biosimilars has brought down costs and made treatment with anti-TNF more widespread, such that they are the most important first-line treatment option for moderate to severe IBD.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 2, Y-ECCO

29April2021

Y-ECCO Literature Review: Omer Serhan Omer

Omer Serhan Omer

DEEP REMISSION AT 1 YEAR PREVENTS PROGRESSION OF EARLY CROHN’S DISEASE

Ungaro RC, Yzet C, Bossuyt P, et al.

Gastroenterology 2020;159:139–47.


Omer Serhan Omer
© Omer Serhan Omer

Introduction

Despite recent advances in medical therapy, patients with Crohn’s Disease may still suffer disease progression requiring surgery and hospitalisation. It is increasingly recognised that early effective therapy is associated with improved patient outcomes and there is growing emphasis on early intervention, treat to target and tight control (TC) approaches [1]. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) programme highlighted the importance of targetting deep remission, defined as resolution of symptoms and objective resolution of inflammation on endoscopy [2]. The Effect of Tight Control Management on CD (CALM) study recently demonstrated that a TC approach in which therapy is escalated based on objective markers of inflammation [faecal calprotectin and C-reactive protein (CRP)], in addition to symptoms, is an effective strategy to achieve endoscopic and deep remission [3]. 

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 2, Y-ECCO

17September2021

Y-ECCO Literature Review: Homira Ayubi

Homira Ayubi

Randomised clinical trial: exclusive enteral nutrition versus standard of care for acute severe ulcerative colitis

Sahu P, Kedia S, Vuyyuru SK et al.

Aliment Pharmacol Ther. 2021;53:568–76.


Homira Ayubi
© Homira Ayubi

Introduction

Acute Severe Ulcerative Colitis (ASUC) is a medical emergency which affects about 25% of UC patients at least once in their lifetime [1]. Corticosteroids are the mainstay of treatment for ASUC; however, 30%–40% of patients do not respond and eventually need medical rescue therapy or surgery [2].Medical rescue therapy (in the form of ciclosporin or infliximab) can be costly and its use can be limited by side effects. Therefore, there is a need for safe and low-cost therapy which can augment the effect of corticosteroids to induce and maintain remission.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 3, Y-ECCO

17September2021

Y-ECCO Literature Review: Jennifer Murray

Jennifer Murray

Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab

Kennedy NA, Goodhand JR, Bewshea C, et al., Contributors to the CLARITY IBD study

Gut 2021;70:865–875


Jennifer Murray
© Jennifer Murray

Introduction

Infection with the novel coronavirus SARS-CoV-2 leading to coronavirus disease-2019 (COVID-19) has a broad spectrum of clinical presentations and disease severity. A number of host and viral factors contribute to this heterogeneity in presentation and severity, including the host immune response [1]. Given that immune-mediated inflammatory diseases (IMIDs) including Inflammatory Bowel Disease (IBD), are characterised by immune dysregulation and use of biologic or immunosuppressive therapies, COVID-19 presents a particular challenge.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 3, Y-ECCO

17September2021

Y-ECCO Literature Review: Omer F. Ahmad

Omer F. Ahmad

Central reading of ulcerative colitis clinical trial videos using neural networks

Gottlieb K, Requa J, Karnes W, et al.

Gastroenterology 2021;160:710–9.e2

Omer F. Ahmad
© Omer F. Ahmad

Introduction

Endoscopic grading of the severity of Ulcerative Colitis (UC) is a critical component of disease assessment and particularly important for guiding therapy. Despite the availability of numerous scoring systems, such as the Mayo Endoscopic Score (eMS) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), widespread use in routine clinical practice is often limited, primarily due to inter-observer variability and lack of training for standardised use [1,2].

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 3, Y-ECCO

16December2021

Y-ECCO Literature Review: Aamir Saifuddin

Aamir Saifuddin

Tofacitinib as salvage therapy for 55 patients hospitalised with refractory severe ulcerative colitis: A GETAID cohort

Uzzan, M, Bresteau, C, Laharie, D, et al.

Aliment Pharmacol Ther. 2021;54:312– 9.


Aamir Saifuddin
© Aamir Saifuddin

Introduction

Approximately 25% of patients with Ulcerative Colitis (UC) require admission to hospital for acute severe (ASUC) or refractory disease, with one-third suffering from multiple episodes [1]. The mainstay of initial anti-inflammatory treatment remains corticosteroids, following the seminal report from Truelove and Witts in the BMJ in 1955 [2, 3]. Here, 210 patients were randomised to standard care with oral cortisone or placebo. Significant benefit was demonstrated in the cortisone group, particularly in those at index presentation and those who had mild UC. At follow-up to 2 years, 21.5% had undergone surgery.

It is interesting that acute colectomy rates remain approximately 20% despite improvements in overall care and infliximab or ciclosporin ‘rescue’ therapy [1, 3]. The CONSTRUCT trial, reported in 2016, demonstrated no significant difference in the frequency of colectomy between these rescue medications, with surgery required in roughly 40% of steroid-refractory patients within one year.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 4, Y-ECCO

16December2021

Y-ECCO Literature Review: Rawen Kader

Rawen Kader

Discontinuation of infliximab in patients with ulcerative colitis in remission (HAYABUSA): a multicentre, open-label, randomised controlled trial

Kobayashi T, Motoya S, Nakamura N, et al.

Lancet Gastroenterol Hepatol 2021;6:429–7. doi: 10.1016/S2468-1253(21)00062-5.


Rawen Kader
© Rawen Kader

Introduction

The anti-tumour necrosis factor monoclonal antibody infliximab is one of the most widely used therapies for corticosteroid-refractory Ulcerative Colitis (UC). Long-term use of infliximab is associated with an increased risk of adverse events such as malignancies and infections, which is particularly concerning for those on concurrent immunosuppressive medications such as corticosteroids, thiopurines or calcineurin inhibitors [1–3]. With the number of patients with UC on long-term infliximab therapy continuing to rise, an important clinical question to address is whether these patients remain in remission upon discontinuing infliximab. Prospective studies have evaluated discontinuation of infliximab in patients with Crohn’s Disease, with deep (i.e. clinical, biological and endoscopic) remission thought to have a lower risk of relapse, but the evidence for patients with UC is limited to retrospective studies [4–6]. The HAYABUSA study aimed to address this issue with a randomised controlled trial (RCT) to evaluate discontinuing infliximab in patients with UC in remission.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 16, Issue 4, Y-ECCO

28April2022

Y-ECCO Literature Review: Patrick Dawson

Patrick Dawson

Intensive drug therapy versus standard drug therapy for symptomatic intestinal Crohn's disease strictures (STRIDENT): an open-label, single-centre, randomised controlled trial

Schulberg JD, Wright EK, Holt BA, et al.

Lancet Gastroenterol Hepatol. 2022;7:318–31. doi: 10.1016/S2468-1253(21)00393-9.


Patrick Dawson
© Patrick Dawson

Introduction

Crohn’s Disease (CD) is a chronic gastrointestinal inflammatory condition [1] that commonly causes strictures, with more than 50% of patients developing at least one stricture in the first decade after diagnosis [2]. Management options include biologics, endoscopic dilatation and surgery. Dilatation requires that the stricture be endoscopically accessible and medical therapy has limited benefit in fibrostenosing disease; therefore, surgery often remains the initial treatment of choice [3]. MRI and ultrasound can provide detailed assessment but cannot always definitively quantify active inflammation [4, 5].

This open label, randomised control trial was carried out at a specialist IBD unit in Australia with the aim of establishing whether medical therapy is an effective treatment of stricturing CD and, if so, whether intensive medical therapy is more effective than standard therapy. The primary end point was an improvement in the 14-day obstructive symptom score by one or more points compared to baseline at 12 months. Secondary outcomes included: improvement in the Crohn’s Disease Activity Index (CDAI), C-reactive protein (CRP), faecal calprotectin (FCP), stricture morphology on MRI, small bowel ultrasound (SBUS) or endoscopy, and correlation of serum adalimumab concentration with any improvement.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Volume 17, Issue 1, Y-ECCO

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