bluuebunny/crossref_metadata_2025_split huggingface dataset:
P404 Prolonged steroid exposure prior to admission is associated with increased likelihood of rescue therapy and colectomy in acute severe ulcerative colitis
Authors: Barnes A , Spizzo P 
Published: January 2020

Abstract

Background
Steroid exposure has been associated with poorer outcomes following colectomy in acute severe ulcerative colitis. Current treatment algorithms suggest three days of high dose intravenous steroid before the decision to commence rescue therapy. We aimed to look at medium-term outcomes in acute severe ulcerative colitis and their predictors including steroid exposure prior to admission.

Methods
A retrospective case note and electronic record review were conducted at a tertiary inflammatory bowel disease referral centre of admissions for acute severe ulcerative colitis meeting Truelove and Witts criteria from 2013 to 2019. Identified admissions were categorised as: not on steroid prior to admission or on steroid for less than one week prior to admission, on steroid for over one week prior to admission, and on steroid for over one month prior to admission. Data were analysed using Chi-squared test and Fisher’s exact test as appropriate.

Results
In total, 109 admissions were identified for acute severe ulcerative colitis meeting Truelove and Witts criteria over 2013 to 2019. Rescue therapy was significantly more likely in patients with over one week of steroid exposure prior to admission (76.0% vs. 28.5%, p = 0.0001). Prior steroid exposure was not associated with failure of medical rescue therapy (p = 0.42). Patients with steroid exposure for at least one week prior to admission trended towards increased likelihood to undergo colectomy during admission (32.0% vs. 16.6%, p = 0.0.09) and were significantly more likely to undergo colectomy within one year of admission (44.0% vs. 21.4%, p = 0.028).
Excluding patients with a first presentation of inflammatory bowel disease showed that patients with steroid exposure for at least one week prior to admission trended towards significance to undergo colectomy during admission (32.0% vs. 13.2%, p = 0.05) and were significantly more likely to undergo colectomy within one year of admission (44.0% vs. 20.7%, p = 0.036). Readmissions within one year of acute severe ulcerative colitis admission were not significantly different (40.0% vs. 29.7%, p = 0.33).

Conclusion
Prolonged steroid exposure prior to admission was associated with an increased likelihood of rescue therapy but was not predictive of response to medical rescue therapy. Colectomy rates at one year were significantly higher with over one week of steroid exposure prior to admission. Consideration should be given to early commencement of rescue therapy in those with prolonged steroid exposure prior to admission.
P406 Adherence, acceptability and serum trough concentration of adalimumab autoinjector in quiescent patients with inflammatory bowel diseases
Authors: Kato S , Yamaga N , Ishibashi A , Kani K , Nagoshi S 
Published: January 2020

Abstract

Background
Anti-TNF α antibodies have contributed to the good prognosis in patients with inflammatory bowel diseases (IBDs). Adherence of these drugs affects the treatment effects in patients with IBDs. Recently, the use of an adalimumab (ADA) autoinjector (AI) was approved in Japan. However, the effects of the use of this AI in patients with IBDs are not clear. We elucidated whether the use of an AI for ADA administration improves the adherence to and acceptability of ADA therapy compared with the use of syringe (SYR) type.

Methods
This was a single-centre prospective observational study approved by the institutional review board of our hospital. Twenty-six quiescent IBD patients, including ulcerative colitis and Crohn’s disease, treated by administration of ADA 40 mg using SYR every other week for &gt;6 months or naive to ADA were enrolled in this study. The patients administered treatment using SYR were switched to an AI. The AI-naive and AI-switched patients were administered ADA treatment using AI for 6 months. The levels of adherence and acceptability, including pain and satisfaction levels, were measured using the visual analogue scale before and after treatment with ADA administered using AI. Serum ADA trough levels were also examined.

Results
Of the 26 enrolled patients, 1 with selection error, 1 with a rejection of approval and 2 with recurrence were excluded. In total, 24 participants were included in the final analysis. The mean (SD) age of the participants was 12.6 (8.4) years. Of the participants, 54.5% (12/22) were male, 68.2% (15/22) had ulcerative colitis, 27.3% (6/22) used thiopurine and 77.35 (17/22) were administered treatment using SYR. The adherence rate improved after switching to AI. The adherence rate of patients who received maintenance ADA was not significantly different from that of the ADA-naive patients (SYR type: 89.1 ± 12.7 mm, AI-switch: 94.0 ± 8.6 mm, AI-naive: 87.0 ± 21.6 mm, not significant [NS]). According to the acceptability of ADA AI, the pain intensity significantly decreased after switching. It was also significantly lower in the AI-naive group than in the SYR group (SYR: 55.0 ± 24.8 mm, AI-switch*: 87.3 ± 15.4 mm, AI-naive*: 92.2 ± 10.1 mm, *p &lt; 0.01 compared with SYR). The level of satisfaction significantly increased after switching (SYR: 62.6 ± 27.9 mm, AI-switch*: 85.9 ± 12.5 mm, AI-naive: 81.2 ± 20.9 mm; *p &lt; 0.01, compared with SYR). The ADA trough level was not significantly different after switching (SYR: 11.0 ± 9.1 mg/ml, AI-switch: 9.9 ± 5.5 mg/ml, NS).

Conclusion
ADA administration using AI resulted in significantly improved acceptability without changes in serum ADA trough levels.
P407 Is the rapid infliximab infusion a safe and cost-saving strategy in paediatric inflammatory bowel disease?
Authors: Pujol Muncunill G , Martínez-Osorio J , Bossacoma-Busquets F , Álvarez-Carnero L , Arrojo-Juárez J , Vila-Miravet V , Martin De Carpi F J 
Published: January 2020

Abstract

Background
Rapid infliximab (IFX) infusion administered over 60 min is a safe strategy in selected Inflammatory Bowel Disease (IBD) adult patients. Some paediatric studies found similar results among children but data are still scarce. The aim of our study is to evaluate the safety of rapid IFX infusion strategy in our cohort of Paediatric IBD (PIBD) patients and analyze the impact of this strategy on health care resources.

Methods
Paediatric IBD patients under IFX treatment using standard protocol (2-h IFX infusion), and who had received at least 4 previous standard infusions, with no dose change in the last 2 doses, and without infusion reactions were switched to receive a 1-h IFX infusions. Demographic and clinical data were collected from medical records, and patient and family satisfaction was recorded by a telephone survey. The optimisation of health care resources was also analyzed.

Results
A total of 46 PIBD patients were under IFX treatment during the study period (February 2018-February 2019) of whom 26 met inclusion criteria and were switched to rapid IFX infusions (14 Crohn’s disease (CD), 12 ulcerative colitis; 17 males). The mean age at switch was 15.3 years (IQR 5.3–17.9) with a mean time of IFX use of 30 months (IQR: 4–78). Sixteen patients were receiving concomitant immunomodulators. A total of 154 rapid IFX infusions were administered with a mean dose of IFX of 5.4 mg/kg (IQR 4–10) and an average frequency of 6.7 weeks (IQR 4–8). No patient received premedication at any time and no infusion reactions were seen during the study period. Family and patient satisfaction (22/26) was higher in rapid IFX infusion strategy than in standard protocol (9.1/10 vs. 7.6/10). During the study period, 154 h of hospitalisation were saved.

Conclusion
Rapid IFX infusion strategy in selected PIBD patients is safe and well accepted by patients and their families. In addition, it is a cost-saving strategy, minimising the loss of work and teaching hours by the caregivers and patients, and allows optimisation of the hospital resources. These results have led us to establish rapid IFX infusion in selected patients (with stable previous doses and no infusion reactions) as the standard protocol in our centre.
P409 Endoscopic and histological activity is associated with non-response to biologic therapy in ulcerative colitis
Authors: WANN S , Norris R , Williams R , Basnayake C , Lust M , Wright E , Kamm M , Connell W , Thompson A , Ding N 
Published: January 2020

Abstract

Background
Ulcerative colitis (UC) is a chronic inflammatory bowel disease, characterised by a relapsing and remitting course. Biologic therapy in UC has a 30% rate of primary non-response (PNR) and a further 5% loss of response per year. Prognostic indicators of non-response include younger age and longer disease duration. Emerging evidence suggests that endoscopic and histological activity is associated with adverse outcomes such as clinical relapse and colectomy. However, the role of endoscopic or histological disease activity in predicting non-response to biologic therapy is unclear. We aim to investigate the association of endoscopic and histological activity with non-response to biologic therapy in UC.

Methods
Patients with UC treated with biologic therapy between 2014 and 2019 were studied. Baseline endoscopic disease activity was assessed using the Mayo endoscopic subscore from endoscopy performed prior to commencing biologic therapy. Patients who underwent colonoscopy 3–9 months after commencing biologic therapy were selected for histopathological review. Sigmoid biopsies were evaluated by an expert gastrointestinal pathologist. Histological parameters were scored on a 4-point scale, with blinding to clinical and endoscopic outcomes.

Results
Sixty-six patients were followed for a median of 16 months (IQR 6–30), 12 (18%) of whom did not respond to biologic therapy initially and 3 (6%) of whom lost response secondarily. Baseline endoscopic activity was associated with non-response (OR 6.1, 95% confidence interval 1.3 – 29.4, for every 1-point increase in the 4-point Mayo endoscopic subscore). 23 patients were identified for histopathological review. Four (17%) patients exhibited PNR. Baseline crypt atrophy was associated with PNR (p = 0.014) and baseline bifid crypts and crypt atrophy were associated with 52-week clinical relapse (p = 0.482 and p = 0.0497).

Conclusion
For patients with UC, endoscopic disease activity assessed prior to commencing biologic therapy has the potential to predict non-response to biologic therapy. In addition, specific histological parameters relating to crypt inflammation and crypt architecture may also predict non-response. Further prospective studies should be conducted to investigate the clinical utility of assessing endoscopic and histological disease activity prior to commencing biologic therapy.
P413 General impressions about nutrition in patients with inflammatory bowel disease using a nutritional survey
Authors: Ruiz-Ramirez M A , Suarez C , Poza J , Martin-Arranz E , Rueda-Garcia J L , Sanchez-Azofra M , Cuadros M , Mayor P , Garcia-Ramirez L , Martin-Arranz M D 
Published: January 2020

Abstract

Background
Malnutrition is a frequent problem in inflammatory bowel disease (IBD) due to the increase in caloric consumption because of the pathology itself and due to the reduced intake. This low intake is mainly caused by the symptoms and the anorexia associated with the disease, but it is more and more common for patients to adopt elimination diets. Our aim was to investigate the general ideas about nutrition in patients with IBD, as well as to determine whether they consider that health professionals value the nutritional aspect.

Methods
Inclusion of patients with an established diagnosis of IBD followed-up in the unit of the Hospital Universitario La Paz, using an anonymised survey for the researcher and for the attending physician.

Results
A total of 118 patients were included, of which 56% (65 patients) were women. The mean age of the patients was 48.84 years (SD 14.2). All patients had a previous diagnosis of IBD: 51.7% (61 patients) ulcerative colitis (UC), 45% (53 patients) Crohn’s disease (CD) and 3.3% (4 patients) undetermined colitis. 55.6% (64 patients) believed that nutrition influenced the course of their IBD. The patients who answered yes were on average younger (44.5 vs. 53.9 years), these differences being statistically significant (p = 0.0003). Only 22 of the 64 patients (34.4%) believed that it was caused by a specific food or food group and the most frequent answer was food rich in fats, dairy products, alcohol or spices. 52.1% of the sample (61 patients) had eliminated some food from the diet since the diagnosis of IBD. The most noteworthy was the avoiding of dairy products (37%), fibre in 28% (most of them reducing the intake of fruits and vegetables), alcoholic drinks (17%) and carbonated drinks (11.5%). No statistically significant differences were found in the elimination of food from the diet according to age, sex or type of IBD. No differences were observed in the elimination of dairy products, carbonated drinks or alcoholic beverages depending on the type of IBD, being more frequent the elimination of fibre in patients with UC (7/10 patients) than in CD. Regarding the role of their attending physician, 77.5% (86 patients) thought that nutrition was important for their doctor and/or nurse dedicated to IBD, although only 52.6% (61 patients) believed they had received enough information for their pathology.

Conclusion
The health professionals dedicated to IBD should increase our efforts to properly inform patients about nutritional aspects, since in our experience more than a half of patients avoid one or more foods (without scientific evidence to support it). Furthermore, only 52.6% consider that they receive sufficient information regarding this matter.
P423 NF-kB as a prognostic marker of response to biologic therapy in children with IBD
Authors: Radigina T , Illarionov A , Kuptsova D , Potapov A , Petrichuk S , Fisenko A P 
Published: January 2020

Abstract

Background
The transcription factor NF-kB is a regulator of innate and adaptive immunity through the activation of various pro and anti-inflammatory mediators. The aim of this study was to assess the prognostic value of changes in the level of NF-kB translocation in lymphocyte populations in response to infusion of TNF blockers in children with IBD.

Methods
There were examined 44 children with IBD (27-CD, 17-UC) and 20 conditionally healthy children aged 3–18 years. Patient status (exacerbation, remission) was assessed by the PUCAI (UC) and PCDIA (CD) indices. There were determined the percentage of cells with NF-kB translocation in populations CD3+CD4+ (Th), CD3+CD8+(Tc), CD3-CD19+ (B cells), CD3-CD16 / 56+(NK cells), CD3+CD4+CD161+ (Th17), CD3+CD4+CD25highCD127low (Tregs) with NF-kB translocation kit using flow cytometry ImageStreamX MKII (Amnis) before infusion of TNF blockers (infliximab, adalimumab), one day after infusion and after 6 months therapy. Statistical evaluation was performed using a nonparametric Mann–Whitney test. The results are presented as the median per cent of cells with NF-kB translocation (Me [Q 0.25-Q 0.75]).

Results
It was observed an increased level of NF-kB translocation in B-lymphocytes (Me 64 [53–81] – Me 38 [33–45]; p = 6 × 10−5), NK cells (Me 40 [33 -55] – Me 21 [18–26]; p = 4x10-4), Tc (Me 20 [15–24] – Me 16 [13–17]; p = 0.03), Th17 (Me 23 [21–28] – Me 18 [16–19]; p = 0.005) in children with exacerbation compared with remission. The level of NF-kB translocation in populations of lymphocytes during the period of clinical endoscopic remission did not differ from conditionally healthy children. The correlation between the level of NF-kB translocation and the number of cells in the studied lymphocyte populations was not found. In children with IBD after infusion of TNF blockers, a decrease the level of NF-kB translocation in NK cells was observed (Me 27.3 [23.5–39.1] – Me 17.7 [16.5–26.5]; p = 0,03) and an increase in Tregs (Me 18.9 [16.91–20.8] – Me 26.9 [19.4–31.9]; p = 0.0015).

Conclusion
The level of NF-kB translocation reflects the functional activity of major and small populations of lymphocytes. An increase in activity of Tregs in response to the administration of TNF blockers allows predicting a positive outcome from therapy over the next 6 months. If there is no Tregs reaction in response to the administration of TNF blockers, treatment tactics should be reassessed.
P426 In failure of non-optimised adalimumab (ADA) with therapeutic serum levels, a change in biotherapy class is greater than an intensification of ADA dose in IBD patients
Authors: Roblin X , genin C , williet N , veyrard P , boschetti G , berger A E , flourie B , nancey S , Paul S 
Published: January 2020

Abstract

Background
Nearly 40% of patients who failed on ADA have therapeutic residual trough levels (pharmacodynamic failure). It is then recommended to change the therapeutic class to a non-anti-TNF biological. In this situation, however, a quarter of patients respond to an ADA dose optimisation. The purpose of this work was to compare these two strategies and identify predictors of response for each strategy.

Methods
This is a bi-centre, retrospective study based on a clinical and biological database that included patients followed from 2015 to 2016 with an IBD in maintenance treatment with ADA as monotherapy (40 mg/sc/14 days) and in loss of response (CDAI &gt; 220 with faecal calprotectin &gt; 250 µg/g stool for CD and Mayo score &gt; 6 with endoscopic sub-score &gt; 1 for UC). All patients included had residual trough ADA levels &gt; 5 µg/ml. Relapsed patients were treated either with dose optimisation (ADA: 40 mg/sc/7 days) or other biotherapy (ustekinumab or vedolizumab, according to classic regimens and dosages). The primary endpoint was the relapse-free survival rate (defined as clinical and biological or endoscopic activity requiring therapeutic change). The survival curve analysis was performed using the Kaplan–Meier method and the log-rank test.

Results
In total, 125 patients (mean age: 38 years, 75% CD, sex ratio M/F = 57%, previous infliximab = 42%) were included and 50 were treated with another biological (Vedolizumab: 30 patients, Ustekinumab: 20 patients). The characteristics of the two groups were comparable except for significantly higher levels of CRP and faecal calprotectin at inclusion in the biological change arm. The duration without relapse was significantly longer after the class change (p = 0.0005; HR = 0.39[0.23–0.68]). The relapse-free survival rates at 54 weeks were 35% for the optimised arm and 66% for a class change (p = 0.04). In multivariate analysis, the only long-term response predictor was biotherapy class change vs. ADA dose optimisation (p = 0.042; HR = 0.3[0.02–0.95]). Previous use of IFX or type of IBD were not associated with relapse. For the dose optimisation strategy, in multivariate analysis, only age &lt; 40 years was associated with a progression without relapse (p = 0.007; HR = 0.09[0.01–0.52]). Residual ADA levels were not predictive of response to optimisation (p = 0.73) and no ADA quartile was significantly associated with a more favourable clinical response. For the class change strategy, no relapse predictors were isolated in univariate analysis.

Conclusion
In patients on ADA who are losing response despite therapeutic rates, the change of class to non-anti-TNF biotherapy allows a significantly greater lasting response than a dose optimisation strategy for ADA.
P436 Evaluation of targeted vitamin D supplementation regimen in postoperative patients with Crohn’s disease
Authors: LI Y , Zheng L , Yao D , Zhou Z , Liu B , Huang Y , Duan Y 
Published: January 2020

Abstract

Background
Vitamin D with a serum 25(OH)D concentration above 100 nmol/l was associated with disease remission in patients with IBD and suggested that targeted administration may be an anti-inflammatory drug. This study was designed to assess the effectiveness, safety, and predictive measures of a vitamin D regimen in postoperative patients with Crohn’s disease to achieve the above goals.

Methods
In a prospective study, patients with Crohn’s disease and serum 25(OH)D concentrations &lt;75 nmol / L were prescribed an oral vitamin D supplement at a dose of one year, and adjusted 4-weekly to aim for a serum 25(OH)D level of 100–125 nmol/l.

Results
Thirty-two postoperative patients with Crohn’s colitis had an average 25(OH)D concentration of 51.5 (range 25–74 nmol / L). 25 patients reached the target level and six patients reached 90–94 nmol / L. Because of the reoperation, one patient withdrew in 6 months. Patients with BMI &lt;30 kg / m2 could reach the target dose (p = 0.006), and the total dose was negatively correlated with the initial serum 25(OH)D (Spearman r = 0.86, p = 0.002). One patient developed a high level (146 nmol/L) at 2 months and the other had new hypercalciuria. There are no serious adverse events attributable to treatment. Clinical disease activity continued to decline (p = 0.015), but faecal calprotectin (p = 0.264), inflammatory cycle markers (p = 0.513) and Rutgeerts score (p = 0.428) did not decrease.

Conclusion
Specific oral vitamin D regimens can successfully and safely reach or approach target levels, improve symptom-based activity scores, but do not alter objective indicators of intestinal or systemic inflammation. A modified version of this dose-escalation protocol is suitable for randomised placebo-controlled trials, and the further randomised controlled trial was needed.