bluuebunny/crossref_metadata_2025_split huggingface dataset:
P549 Changing Lanes: Switching Therapies in Inflammatory Bowel Disease, An Observational Study
Authors: Mc Gettigan N , Leung E , Harhen A , Anderson E , McMahon S , Walshe M , Keohane J , Sengupta S 
Published: May 2021

Abstract

Background
Switching between therapies in inflammatory bowel disease (IBD) is common and a paucity of data exists regarding the optimal switching strategy. A number of new drug therapies have recently emerged for the treatment of IBD. Failure of biologic and small molecule therapies occur regularly, prompting the need for a treatment switch. Our aim is to review trends amongst our patients who switched biologic/small molecule therapy to identify high risk characteristics and to look for predictor variables which may reduce the need to switch in the future.

Methods
This is a 4 year retrospective observational study of IBD patients who underwent a therapy switch. Patients were identified from a prospectively maintained IBD database of 141 patients. Patient demographics, treatment history, disease history, biomarkers (within 3 months of switch) and endoscopy results were reviewed. Minitab17 was used for statistical analysis.

Results
Switching of biologic therapy was observed in 39 patients (28%); 21 (54%) were male; mean age was 42.8Y. Of these, 21 (53.9%) had Crohn’s disease (CD), 17 (44%) had ulcerative colitis (UC) and 1 patient had indeterminate colitis. Mean disease duration at time of switch was 78 months. 82% (n=14/17) of UC patients had pancolitis. 43% (n=9/21) of CD patients had a previous intestinal resection. The most common initial therapy was Adalimumab 46% (n=18) (Fig1) with the most common switch to IFX 36% (n=14) (Fig2). Primary LOR occurred in 28% (n=11) and secondary LOR in 44% (n=17), the remainder switched due to infusion reaction/adverse effects (n=10) and clinical remission (n=1). Mean CRP was 13.68 (95% CI: 7.28, 20.09), mean FCP was 874 (95% CI: 418, 1329), mean mayo score was 1.88 (95% CI: 1.37, 2.39), mean SES CD score was 5.79 (95% CI: 3.24, 8.33). Median IFX level was 0.8ug/ml (IQR 0.4, 9.7), 37.5% (n=6/16) of the patients on IFX developed ADAs to IFX. Median Adalimumab level was 5.2ug/ml (IQR 1.4, 13.5) and 11% (n=2/18) developed ADAs to Adalimumab. A significant negative correlation was found between FCP and IFX level using Spearman rank correlation -0.822, p = 0.01. 39% (n=15) were on an immunomodulator, no significant association was found between immunomodulator therapy and primary/secondary LOR, p= 0.67 and p= 0.63. 28% (n=11) were admitted with an IBD flare in the 1st year post switch and 13% (n=5) underwent intestinal resection. 8 (21%) subsequently switched to a 3rd biologic agent.

Conclusion
The most common therapy switch was within Anti-TNF drug class, mean CRP and FCP were raised at the time of switch and a significant number of patients were admitted in the year post switch with an IBD flare. Pancolitis in UC and previous intestinal surgery in CD were common characteristics of those who switched.
P553 Factors related to steroid consumption in IBD patients: Evidence from a multicenter Study
Authors: Barkan R , Shpoker L , Abboud R , Nafrin S , Ganon M , Ilsar T , Volf T , Markovitch L , Saban M , Kagan I 
Published: May 2021

Abstract

Background
Steroids are frequently used to induce remission in inflammatory bowel disease (IBD) but should not be used as maintenance treatment. Understanding the factors related to steroid consumption is essential in order to avoid over prescription of these drugs.

Methods
A cross-sectional study was conducted between 2019 and 2020 in six medical centers in Israel. Data was collected using a structured self-administered tool containing the following: socio demographic and clinical characteristics, knowledge of side effects and complications of steroid treatment, self-care and compliance with medical instructions, Steroid Assessment Tool (SAT) and objective physiological measures.

Results
The study included 402 IBD patients; 262 patients with Crohn’s disease (CD) (66%) and 135 patients with ulcerative colitis (UC) (34%). Most of the patients reported being monitored in the IBD unit in the medical centers (87.7%). A quarter of the patients (n=88) had been prescribed systemic steroids over the previous year, and 20 (23%) received 3 or more prescriptions for systemic steroids over the preceding year. Likewise, over 20% of patients were on systemic steroid therapy for over 4 months in the preceding year. Those patients were mostly men and ultra-orthodox. Patients with UC were prescribed steroids more often than CD patients. Knowledge levels regarding appropriate steroid consumption were significantly higher among women (F=40.24, p&lt;.001) and lower among ultra-orthodox patients (X2=6.43, p&lt;.05). Although most of the patients (85.9%) were routinely treated by gastroenterologist, the majority (80%) choose to visit the general practitioner when their disease had flared up.

Conclusion
Several factors were found to be related to inappropriateness use of steroids in IBD patients. Thus, tailored intervention for specific population should be developed to ensure that steroids are used correctly and that their side effects are minimized. Also, infrastructure and alignment of an integrated health care delivery system, with multidisciplinary team may provide the optimal environment for care coordination, especially during disease flare.
P569 Online education significantly improved gastroenterologists’ knowledge of management strategies and treatment options for ulcerative colitis
Authors: Bell E , Calle M 
Published: May 2021

Abstract

Background
Ulcerative colitis (UC) is a challenging condition for gastroenterologists to manage. With the rapid evolution of the treatment landscape and more stringent goals for therapy, many physicians may struggle to stay abreast of current best practice in UC management.
We assessed whether online continuous medical education (CME) can improve gastroenterologists’ knowledge of management strategies and treatment options for UC.

Methods
Gastroenterologists participated in an online CME activity entitled ‘Key Considerations for Treatment Success in Patients With UC’. This was a 45-minute segmented video activity with accompanying slides. Questions were developed to address each of the educational objectives for the activity. Educational effect was assessed using a repeated-pair design, pre-/post-assessment. A Chi-square test of independence determined if a statistically significant improvement (5% significance level, P&lt;.05) existed in the number of correct responses between the pre-test and post-test scores. Cramer’s V estimated the effect size of the education (&lt;.06, modest impact; .06-.15, noticeable impact; .16-.26, considerable impact; &gt;.26, extensive impact). The activity launched on 16 May 2019 with data collection through 11 September 2019.

Results
A total of 1173 gastroenterologists participated in the activity. Of those, 171 completed both pre- and post-questions, providing a set of linked learner data for analysis.
The results showed:
• Significant improvement in average percentage of correct responses, rising from 47% at baseline to 77% post-activity (P&lt;.001) and extensive educational impact (Cramer’s V=.260)
• The percentage of gastroenterologists (n=171) answering all 3 questions correctly more than tripled, from 13% pre-activity to 41% post-activity
• Significant improvements in knowledge of UC pathogenesis, treatment targets according to STRIDE recommendations, and which drug targets IL-12 and IL-23 (P&lt;.001 for all 3 questions)
• 38% of gastroenterologists reported increased confidence in selecting an appropriate therapy for a patient with UC

Conclusion
Online education significantly improved gastroenterologists’ knowledge of management strategies and treatment options in UC which should support them in achieving successful outcomes for their patients. However, there remains a notable gap in knowledge of the STRIDE recommendations and in confidence regarding treatment selection. These results suggest that gastroenterologists would benefit from additional education to reinforce their knowledge of UC management strategies and improve their confidence in translating these principles into clinical practice.
P636 The natural history of COVID-19 in patients with IBD: A nationwide study by the Hellenic Society for the Study of IBD
Authors: Bamias G , Kokkotis G , Christodoulou D , Delis V , Gatopoulou A , Giouleme O , Kalantzis C , Kapsoritakis A , Karatzas P , Karmiris K , Katsanos K , Kevrekidou P , Mathou N , Michalopoulos G , Michopoulos S , Papaconstantinou I , Polymeros D , Potamianos S , Poulopoulos G , Protopappas A , Soufleris K , Theodoropoulou A , Triantafillidis J K , Triantafyllou K , Tsiolakidou G , Tsironi E , Tzouvala M , Viazis N , Zacharopoulou E , Zampeli E , Papatheodoridis G , Mantzaris G J 
Published: May 2021

Abstract

Background
COVID-19 has evolved into a global health crisis, variably affecting the management of patients with chronic illnesses. Patients with inflammatory bowel disease (IBD) may represent a vulnerable population due to the frequent administration of immune-modifying treatments.

Methods
We aimed to depict the natural history of COVID-19 infection in Greek patients with IBD at a nationwide level via the unbiased reporting of all cases that were registered during the first and second waves of the pandemic. Following a national call from the Hellenic Society for the study of IBD, we enrolled all IBD patients with established diagnosis of COVID-19. Clinical and epidemiological data, including COVID-19 modifying factors and IBD-associated therapies were analysed against adverse outcomes (hospitalization, ICU admission, and death).

Results
We identified 80 patients with IBD who were diagnosed with COVID-19 during the study period (male:65%; median age=44 [IQR=26] years; CD:62.5%). Adverse outcomes were reported in 16 patients (20%), including 3 ICU admissions (3.75%) and 2 deaths (2.5%). Negative prognostic factors for adverse outcomes included age, Body Mass Index, and hypertension, as well as dyspnoea, fatigue and abdominal pain at presentation. In contrast, treatment with biologics, in particular anti-TNF agents, exerted a protective effect against an unfavorable course COVID-19. Patients on subcutaneous biologics were more likely to halt treatment due to the infection as compared to those on intravenous medications.

Conclusion
Patients with IBD who developed COVID-19 had a benign course with adverse outcomes being scarce. Treatment with biologics had a beneficial effect, supporting the continuation of therapy during the pandemic.
P649 Ulcerative Colitis Narrative Japanese survey: Identifying gaps between patient and healthcare professional perspectives on communication and disease management to optimise patient care
Authors: Watanabe K , Gardiner S , Arai S 
Published: May 2021

Abstract

Background
The Ulcerative Colitis (UC) Narrative is a global initiative examining perspectives on multiple aspects of UC via 2 related surveys (1 patient [pt]-based and 1 healthcare professional [HCP]-based), with the aim of improving understanding of the impact of UC and identifying gaps in optimal care. We present survey responses from pts and HCPs in Japan, a subanalysis of the global UC Narrative.

Methods
Surveys were conducted by The Harris Poll between Nov 2017 and Jan 2018. Pts (≥18 years of age) met the following criteria: had a diagnosis of UC (confirmed by endoscopy), had not had a colectomy, had taken prescription UC medication beyond 5-aminosalicylates, and had visited a gastroenterologist/internist in the previous year. HCPs were required to see ≥5 pts with UC per month, and ≥10% of their current pts had to be taking a biologic for their UC. Self-reported treatment history was used as a proxy for disease severity, and &gt;80% of pt respondents were required to have moderate to severe UC.

Results
210 pts and 151 HCPs in Japan responded. The mean age of pts with UC was 44.3 (standard deviation 11.6; median 44) years, and 73% were male. Most (85%) pts were satisfied with their communication with their HCP. HCPs slightly underestimated pt satisfaction, believing that, on average, 71% of their pts were satisfied. However, most pts (65%) and HCPs (82%) wished for more discussion about goals for managing or treating UC. Most (83%) pts said they were honest with their HCP when discussing their experiences with UC, although almost half (45%) said they regretted not telling their HCP more; most (75%) HCPs felt that their pts were being honest with them. Over half (55%) of pts said they were hesitant to tell their HCP if they did not take their medication exactly as prescribed; however, most (79%) HCPs believed that &gt;50% of their pts adhered to treatment. HCPs underestimated the importance of toileting accidents to pts (28% vs 54%), and overestimated the importance of mucosal healing (59% vs 29%) (Figure 1). Some pts had misconceptions about treatment: only 69% knew that it was not OK to stop taking UC medications once they felt better, only 76% knew that it was not OK to keep using steroids as a long-term maintenance medication, and only 60% knew that it was possible for their body to stop responding to biologics (Figure 2). Most (71%) HCPs believed that pt advocacy organisations are important, but only recommended them to 26% of pts; only 38% of pts had interacted with one.

Conclusion
There was a high level of concordance in responses between pts in Japan and their HCPs; however, this survey revealed several gaps between pt and HCP perspectives. Consequently, the importance of pt-HCP communication in treat-to-target strategies remains.
P653 Rheumatic extraintestinal manifestations in ulcerative colitis : Prevalence and predictive factors
Authors: Mtir M , Cherif D , Kchir H , Hassine H , Maamouri N 
Published: May 2021

Abstract

Background
Ulcerative colitis (UC) are an inflammatory condition affecting the gastrointestinal tract. They are considered as chronic disease with complex genetic, immune and environmental components. UC are not exclusive to the gastrointestinal system as they have been identified to be associated with extraintestinal manifestations (EIM) that encompass every other organ in the human body including musculoskeletal system.
The aim of this study was to evaluate the prevalence and predictive factors of rheumatic EIM among patients with UC.

Methods
We carried out a retrospective study from January 2000 to December 2018 including all patients with UC. A complete rheumatologic examination, osteodensitometry,lumbosacral and sacroiliac X-rays were performed.The variables retrospectively analyzed were: gender, age,habits, location and extension of the disease, biochemical markers, other EIM, and previous immunosuppressive therapy. We investigated associations between rheumatic manifestations and clinical and biological criteria.

Results
Seventy eight patients were included in our study with an average age of 47,56 years [24–85 years]. Sex ratio M/F 0,85.
Rheumatic manifestations of any type were present in 42,3%(33 of 78). Peripheral arthritis were observed in 3,8%. Axial involvement including sacroiliitis (SI), with or without spondylitis was noticed in 8,97%. Bone mineral loss was present in 25,6% with 13 cases of osteopenia and 7 cases of osteoporosis. Three patients (3,8%) had an association of SI and osteoporosis. No cases of enthesopathy have been reported.
Otherwise, univariate and multivariate logistic regression methods testing for each predictor and their possible association with rheumatic manifestations among UC had shown a decreased risk for rheumatic manifestations with an age over 40 years (p=0,018), an hepatobiliary disorders such as the presence of hepatic cytolysis (p=0,034) and cholestasis (p=0,017) , the coexistence of dermatologic EIM (p=0,048).
Forms complicated with an acute severe ulcerative colitis are likely to be correlated with rheumatologic manifestations (p=0,039) but location and extension of the disease had not shown any significant association.
And finally, patients who underwent systemic corticosteroid treatment were highly associated with a decreased risk for rheumatic manifestations (p=0,044).

Conclusion
Predictive factors involved in the occurrence of rheumatic manifestations are: an advanced age, presence of other EIM, severe forms and the use of steroid. Regular screening for EIM and early use of biological therapies may prevent the development of musculoskeletal involvement . Medical care for patients with UC should be multidisciplinary involving the coordination between rheumatologists and gastroenterologists .
P665 Cardiovascular risk profile in chronic auto-inflammatory diseases: a cross-sectional single center study
Authors: Sleutjes J A M , Roeters van Lennep J E , Verploegh P J P , van Doorn M B A , Vis M , van der Woude C J , de Vries A C 
Published: May 2021

Abstract

Background
Chronic auto-inflammatory diseases are associated with an increased risk of arterial and venous cardiovascular diseases (CVD). Pathogenesis may be related to chronic inflammation and/or traditional CVD risk factors. We aimed to assess the prevalence of CVD and cardiovascular risk profile in inflammatory bowel disease (IBD), psoriasis (PSO) and spondylarthropathies (SpA).

Methods
This is a single center cross-sectional study at the depts. of Gastroenterology, Dermatology and Rheumatology. Patients ≥18 years underwent body measurements (blood pressure (BP), BMI, waist and hip circumference), laboratory analysis (plasma glucose, lipid spectrum) and completed a cardiovascular questionnaire (e.g. history of CVD, medication use). Multivariate linear and logistic regression models corrected for age and sex were applied to identify differences between groups.. Sensitivity analyses were performed excluding patients taking statins or anti hypertensive drugs. Within groups, association between lipid levels and clinical disease activity was assessed by stratification, and with CRP levels by Pearson correlation test.

Results
A total of 668 patients were included (335 males (50%), median age 47 years: 459 IBD (69%), 106 PSO (16%) and 103 SpA patients (15%). (Table 1) The prevalence of venous thromboembolisms was 6%, heart failure 3% and arterial CVD 8%. IBD patients had lower BMI, systolic BP, TC and LDL-c levels, and lower odds ratio of having diabetes, overweight and hypercholesterolemia, as compared to PSO and SpA, but a higher odds ratio of having VTE. (Table 2) These results were independent of statin of anti hypertensive drug use. All groups showed a trend towards higher levels of TC, HDL-c and LDL-c during disease remission as compared to active disease (Figure 1) Overall, TC and LDL-c levels were inversely correlated with CRP (R -.145, p=.002 and R -.111, p=.016); within groups a significant association was only observed in IBD. (Table 3, Figure 2)

Conclusion
IBD patients have a more favorable cardiovascular risk profile, as compared to PSO and SpA. Screening and early intervention for CVD risk factors requires different strategies for each population.
Role of pharmacogenomics in T-cell hypersensitivity drug reactions
Authors: Hertzman Rebecca J. , Deshpande Pooja , Gibson Andrew , Phillips Elizabeth J. 
Published: May 2021

Purpose of review
An update of the pharmacogenetic risk factors associated with T-cell-mediated delayed hypersensitivity reactions.

Recent findings
Recent HLA associations relevant to our understanding of immunopathogenesis and clinical practice include HLA-B∗13:01 with co-trimoxazole-induced SCAR, and HLA-A∗32:01 with vancomycin-DRESS, for which an extended HLA class II haplotype is implicated in glycopeptide antibiotic cross-reactivity. Hypoactive variants of ERAP1, an enzyme-trimming peptide prior to HLA loading, are now associated with protection from abacavir-hypersensitivity in HLA-B∗57:01+ patients, and single-cell sequencing has defined the skin-restricted expansion of a single, public and drug-reactive dominant TCR across patients with HLA-B∗15:02-restricted carbamazepine-induced SJS/TEN. More recent strategies for the use of HLA and other risk factors may include risk-stratification, early diagnosis, and diagnosis in addition to screening.

Summary
HLA is necessary but insufficient as a risk factor for the development of most T-cell-mediated reactions. Newly emerged genetic and ecological risk factors, combined with HLA-restricted response, align with underlying immunopathogenesis and drive towards enhanced strategies to improve positive-predictive and negative-predictive values. With large population-matched cohorts, genetic studies typically focus on populations that have been readily accessible to research studies, but it is now imperative to address similar risk in globally relevant and understudied populations.
Recent advances in understanding the adaptive evolution of metabolic genes and traits
Authors: Yang Shuang , Ye Kaixiong 
Published: May 2021

Purpose of review
This review summarizes the recent advances in understanding the adaptive evolution of metabolic genes and traits, providing insights into gene-diet interactions in human evolution and health.

Recent findings
The rapid accumulation of ancient DNA across time and geography illuminates unprecedented details of some well-established examples of genetic adaptation to diet, such as the LCT and FADS genes. Novel cases of thrifty genes were identified, especially a microRNA at the LCT locus that controls energy expenditure and glucose homeostasis, connecting the historical adaptation to present-day metabolic disorders. A new example of gene–diet–microbiota interactions was established among the AMY1 copy number, starchy diets, and resistant-starch-digesting Ruminococcus. The explosion of genome-wide association studies in large cohorts unravels the present-day health implications of historically adaptive genetic variants. It also enables studies into the polygenic adaptation of metabolic traits, revealing intriguing adaptive signals for increased bone mineral density, blood pressure, and risk of type 2 diabetes, but decreased body mass index and HbA1c.

Summary
The rapid accumulation of ancient and modern DNA has fueled the characterization of novel and existing cases of genetic adaptation. However, transferring these evolutionary insights into genome-informed precision nutrition requires extensive mechanistic studies and genotype-aware clinical trials.