bluuebunny/crossref_metadata_2025_split huggingface dataset:
P716 Efficacy and safety of upadacitinib during induction in Crohn’s disease: Real-world experience
Authors: Jairath R , Zoughlami A , Pilote N , Afif W , Bitton A , Wild G , Narula N , Lakatos P L , Bessissow T 
Published: January 2024

Abstract

Background
Upadacitinib is a selective JAK1 inhibitor that has recently been approved for treatment of moderate-severe Crohn’s disease, with Phase III clinical trials showing positive efficacy and safety profiles. Our aim was to evaluate the real-world experience of upadacitinib in a refractory cohort of Canadian patients with Crohn’s disease.

Methods
This was a two-centre retrospective study looking at 12-week induction data for patients with active Crohn’s disease from McGill University Health Centre and Hamilton Health Sciences. The primary outcome was clinical remission at 12 weeks, with secondary outcomes including clinical response, biochemical remission, and biochemical response. Clinical remission was defined as a Harvey-Bradshaw index (HBI) &lt; 5. Clinical response was defined as an HBI reduction of ≥ 3. Biochemical remission was defined as a c-reactive protein (CRP) &lt; 5 mg/L and/or fecal calprotectin (FCP) &lt; 250 μg/g. Biochemical response was defined as a reduction of CRP or fecal calprotectin by 50% from baseline. These parameters were all evaluated at 8 and 12 weeks. Adverse events were summarized for patients who had follow up data available and included in the efficacy analysis.

Results
There were 28 patients who were treated in total, all of which had multiple biologic treatment failures. Baseline median age was 37, median HBI was 9, median CRP was 9.41 mg/L, and median FCP was 580 μg/g. The median disease duration was 13.5 years. Four patients discontinued upadacitinib due to no response or side effects. For all available data including patients who discontinued upadacitinib, clinical remission was achieved at 12 weeks in eight patients (8/11, 72.7%). Clinical response was achieved in eight patients (8/11, 72.7%), biochemical remission was achieved in four patients (4/11, 36.4%), and biochemical response was achieved in six patients (6/11, 54.6%). Of those that were initially on steroids (n=5), four patients (4/5, 80.0%) were able to wean off steroids and achieved a steroid-free clinical or biochemical response at 12 weeks. Of those who had previously been on off-label tofacitinib (n=5), clinical follow-up data was available for three patients at the end of the 12-week induction period. Two patients achieved clinical remission (2/3, 66.7%) and three patients had a clinical response (3/3, 100%). Among 13 patients with follow-up data, adverse events were observed in three patients (3/13, 23.1%), with two having non-serious infections (2/13, 15.4%) and one having fevers of unknown origin (1/13, 7.69%).

Conclusion
This real-world multicentre Canadian induction study shows favourable efficacy and tolerability of upadacitinib in refractory active Crohn’s disease.
P721 Dutch Crohn’s disease patients’ (pediatric and adult) perspectives of CDED diet and Modulife program
Authors: Wijers F , van Zundert S , Verburgt C , van der Kruk N , van Limbergen J , Wierdsma N 
Published: January 2024

Abstract

Background
The Crohn’s Disease Exclusion Diet (CDED) with partial enteral nutrition can induce remission in patients with mild-to-moderate Crohn’s disease. As adherence is the key of (possibly) success of a medical therapy and CDED might be a complicated diet to perform, we aimed to investigate patients’ experience with CDED and the available tools (Modulife programme) to improve patientcare.

Methods
All mild-to-moderate active Crohn’s disease (CD) (adult and pediatric) patients treated with CDED as nutritional therapy as part of their medical treatment at Amsterdam UMC between 2019-2022 were approached for this retrospective qualitative study. A structured telephone interview was conducted by a dedicated dietician/doctor with the patients and/or parent/guardian in case of children. Questions about CDED-experience and Modulife program were either measured with the NET Promotor Score (NPS -100 - +100), as yes/no answer options or with 5-point likert scales (1=strongly agree/always to 5=strongly disagree/never). Lastly, patients were asked to evaluate the effectiveness of CDED on complaints and experience on a scale from 0-10.

Results
44 patients (33 pediatric/11 adults; 26 women) participated in the interviews. The majority (61%) of the pediatric patients started CDED at diagnosis. The remaining 39% started 1-11 years (median 3[IQR 2-5]) after diagnosis at an age of 7-17 years (median 15[IQR 12-16]). 91% of the adult patients started CDED 3-37 years (median 11[IQR 4-28]) after diagnosis and only 1 immediately after diagnosis at an median age of 48 [IQR 33-60] (range: 19-69). The majority of the pediatric participants would recommend CDED to others (77%) and consider to start the diet again (55%). All of the adults would recommend CDED to others and consider to start CDED again. The NPS scores on CDED experiences are shown in figure 1. The median score for the effect of the diet on complaints was 8[IQR 5-9] (range 0-10) and 7[IQR 6-7](range 2-8.5) for experience. The majority of the patients (75%) used the Modulife program always or often during therapy and did (strongly) agree that the Modulife program was helpful. A NPS of 31 was given for recommending the app to others. The recipes-feature was the most used and most esteemed part of the app and was assessed with a good NPS of 27 for recommendation to others.

Conclusion
The majority of the pediatric and all of the adult participants would recommend CDED to others and would reconsider starting the diet again. CDED is better assessed by adults (positive NPS) then children and/or their parents (negative NPS). Most of the patients, assess the Modulife programme very positively and the majority would rate this as helpful in performing the diet.
P723 Upadacitinib in Crohn’s disease: Real world experience from an early access program in Greece
Authors: Papathanasiou E , Leonidakis G , Michalopoulos G , Manolakopoulos S , Siakavellas S , Theodoropoulou A , Tasovasili A , Giouleme O , Tzouvala M , Tsironi E , Viazis N , Michopoulos S , Zampeli E 
Published: January 2024

Abstract

Background
Upadacitinib is a novel selective Janus kinase 1 inhibitor, recently approved for the management of Crohn’s disease (CD) by Food and Drug Administration. In Greece, upadacitinib is available through an early access program for refractory patients who have exhausted their therapeutic options. Our goal was to describe our real practice experience.

Methods
This is a multicenter retrospective cohort study of adult patients with moderate to severe CD, who received upadacitinib. The primary endpoint was clinical response, defined by a reduction ≥3 in Harvey-Bradshaw index (HBI). Clinical remission was defined as HBI ≤4. Secondary endpoints included endoscopic and biochemical improvement based on physician’s assessment and CRP measurement, respectively. Outcomes were assessed at 12 weeks and at patient’s latest follow up. All patients received 45mg upadacitinib for 3 months and then 30mg for another 3 months, whereas the maintenance dose (30mg or 15mg) was based on the patient’s response. We also evaluated short -term safety.

Results
A total of 22 CD patients (12 female) received upadacitinib and were included in the analysis. Mean age 42.2 years (24-63). Five patients were active smokers. Mean treatment duration was 5.4 months (1-20). Two patients have not yet reached 12 weeks of treatment and were excluded from the efficacy analysis. Ten patients (45.4%) had ileocolonic Crohn’s, seven (31.8%) ileal disease and five (22.7%) Crohn’s colitis. Four patients had perianal disease and seven patients Crohn’s related surgery (5 ileocecal resection, 2 seton placement). Four patients had active extraintestinal manifestations: Three inflammatory arthritis and one atopic dermatitis. The majority of patients (15/20) had failed ≥ 3 biologics. All of them failed treatment with anti-TNF and 15 (75%) with ustekinumab. Six patients have just completed the induction period of 12 weeks, ten are on 30mg upadacitinib and four on 15mg. At 12 weeks, 18 patients achieved clinical response (90%). CRP was normal for 15/20 (75%) patients at 12 weeks. At last follow-up (mean 5.9 months, 3-20), all patients were in clinical remission. Endoscopy was available for six patients and improvement was documented for all of them. Adverse events occurred in 3 patients (15.7%): An episode of abdominal pain, a skin infection and a case of neutropenia. All adverse events resolved without discontinuing treatment.

Conclusion
In a small cohort of medically resistant Crohn’s patients, the short- term clinical efficacy of upadacitinib was high. No serious safety issues were recorded.
P729 Prospective observational study evaluating the effects of GLP1-RA on Inflammatory Bowel Disease (IBD) in patients with Type 2 Diabetes Mellitus (TDM2)
Authors: Piumatti A , Beccuti G , Armandi A , Bugianesi E , Broglio F , Ribaldone D G 
Published: January 2024

Abstract

Background
GLP-1 RA are antidiabetic drugs approved for treatment of TDM2 as second-choice therapy for long-term treatment in patients with TMD2 without previous cardiovascular events or as first-choice therapy in patients with previous cardiovascular events and without heart failure (SID/AMD guidelines).
Their beneficial effect is not only associated with glycol-metabolic control, but also with a systemic anti-inflammatory action. In view of this anti-inflammatory action, we wanted to assess whether GLP1-RA could have a possible beneficial effect on IBD in terms of laboratory and clinical parameters. Moreover, these drugs have proven to improve liver function and histology, therefore, liver wellbeing may also be included as a cross-sectional element of evaluation in the possible benefits of these therapies.

Methods
Through the evaluation of 981 medical records of IBD patients followed in the gastroenterology department of the Hospital San Giovanni Antica Sede (SGAS), 71 TDM2 patients were identified. Among these, 21 were recruited for the study. The recruited patients were scheduled for a diabetological examination: GLP-1 RA treatment could then be introduced where indicated. At a 3-month follow-up interval, both the GLP-1 RA treatment group and the subjects that did not have any changes in therapy (control group) underwent re-evaluation of the parameters of interest. All patients in the study were offered the possibility to receive a FibroScan to measure liver stiffness at the start of the study and at the 3-months follow-up.

Results
A prevalence in the IBD population of TDM2 was found to be 7.2% (vs. Piedmont population prevalence 6.2%, p = 0.31). Out of the 21 patients recruited, 6 received GLP-1 RA treatment. At 3 months, an analysis of the results through the Wilcoxon test showed that the GLP-1 RA treated patients had a reduction in faecal calprotectin levels, an improvement in disease scores, an improvement in glycemic balance and a reduction in CAP and FIB4 when compared to the control group; these results did not reach statistical significance. In contrast, the reduction in BMI reached statistical significance. A comparison of the deltas for the variables under analysis between the two groups was also carried out using the Mann-Whitney test. Concordant and positive trends were observed in the GLP-1 RA-treated group: in this case the reduction in HbA1c reached statistical significance.

Conclusion
Treatment with GLP-1 RA in patients with TDM2 and IBD appears safe and seems to show benefits from an intestinal, metabolic and hepatic viewpoint. Studies with a larger number of subjects are certainly needed to effectively confirm the benefit of GLP-1 RA in this specific category of patients.
P754 Inadequate Pregnancy Specific Knowledge among Patients with Inflammatory Bowel Disease: A Multi-Center Survey in China
Authors: Li R , Wu T , Li X , Zhou H , Shi Y , Wang F , Liang J 
Published: January 2024

Abstract

Background
Perceptions and attitudes of inflammatory bowel disease patients on pregnancy may influence their fertility planning and disease progression. There was data published about knowledge as well as the impact of education in relation to inflammatory bowel disease and pregnancy. However, it is unknown in China. Facing the sharp decline in birth rate, we need to understand the pregnancy-specific knowledge of Chinese gastroenterologists and patients with inflammatory bowel disease and the significance of education.

Methods
A cross-sectional questionnaire, regarding pregnancy-specific knowledge, was carried out among China's 63 inflammatory bowel disease centers. 794 questionnaires were obtained, including 185 from physicians and 609 from patients. Our center then led the educational intervention.

Results
Compared to physicians, patients' knowledge levels of fertility (39.1% vs. 70.8%, p &lt; 0.001), imaging examinations (22.8% vs. 72.4%, p &lt; 0.001), and endoscopy performed during pregnancy (19.9% vs. 71.4%, p &lt; 0.001) and vaccination (16.6% vs. 46.5%, p &lt; 0.001) were significantly lower. There was a lack of knowledge among gastroenterologists regarding the delivery mode (36.8%), medications (36.8%), and emergency surgery (26.5%) during pregnancy in patients with inflammatory bowel disease. The following six aspects were significantly improved after education, including the medication (26.7% vs. 51.7%, p=0.005), fertility (45% vs. 63.3%, p=0.044), heritability (40% vs. 58.3%, p=0.045), indications for emergency surgery (15% vs. 53.3%, p&lt;0.001), imaging examinations during pregnancy (20% vs. 40%, p=0.017) and vaccinations (26.7% vs. 45%, p=0.036).

Conclusion
Pregnancy-specific inflammatory bowel disease knowledge was lacking among certain gastroenterologists and inflammatory bowel disease patients in China. Educational interventions can partially improve the knowledge levels of patients in this area.
P755 Long-term need for restart of biologics after withdrawal in patients with Inflammatory Bowel Disease in mucosal healing
Authors: Ruz Zafra P , Luque Carmona A M , Nuñez Ortiz A , Trigo Salado C , Leo Carnerero E 
Published: January 2024

Abstract

Background
In patients with inflammatory bowel disease (IBD) on biologic therapy, once remission has been achieved, withdrawal is a frequent issue in clinical practice that generates uncertainty in aspects such as the reduction of adverse effects and costs, but also the risk of recurrence of activity and the need to restart treatment. The aim of this study was to determine the rate of long-term reintroduction of biologics after withdrawal due to mucosal healing (MH) in IBD, the response to reintroduction and the associated factors.

Methods
Observational, descriptive, single-centre, retrospective, descriptive study of 178 cases in 164 patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) who were withdrawn from anti-tumor necrosis factor (anti- TNF) therapy once MH had been demonstrated, between July 2009 and February 2022. Demographic and phenotypic characteristics of IBD, characteristics of biologic and immunosuppressive therapy, analytical and endoscopic/histological variables at the time of withdrawal were collected. We analysed the risk of restarting biologics due to clinical relapse and response to reintroduction of treatment. We evaluated possible factors related to the risk of restarting treatment and response to treatment.

Results
We included 178 cases. 123 CD and 55 UC. Most had received infliximab (62.9%) and the main indication was corticodependence (68%). Median follow-up was 78 months (IQR 59-95). Clinical relapse occurred in 69% of cases and 61.2% required reintroduction of biologics, with the probability of retreatment at 1, 3, 5 and 7 years being 19.4%, 50%, 60% and 63.4%, respectively (Figure 1). The response to reintroduction was 86.2%. Only 1.68% required surgery during follow-up. Univariate analysis showed higher risk of re-introduction at younger age at diagnosis (23 vs 30 vs 30, p 0.022) and at withdrawal (32 vs 40, p 0.019) and longer follow-up time after withdrawal (82 vs 71, p 0.026). Multivariate analysis also identified the indication for corticodependence (p 0.046).

Conclusion
The risk of relapse and re-starting treatment is high in the long term after withdrawal of biologic therapy for MH in IBD. Younger age at diagnosis and withdrawal, indication for corticodependence and long-term follow-up are risk factors for poor outcome. Reintroduction of treatment is very effective with low complication rates.
P757 Patient attitudes, perceptions, and beliefs on the role of diet and nutrition in inflammatory bowel diseases. A scoping review
Authors: Magkiosi A , Strongylou D E , Gkikas K , Gerasimidis K , Androutsos O , Svolos V 
Published: January 2024

Abstract

Background
Despite substantial evidence implicating diet in the development and management of inflammatory bowel disease (IBD), we still lack widely agreeable recommendations for dietary therapy. As a result, patients often self-manage their disease symptoms following a range of dietary regimes, including elimination diets and specific nutrient supplementation. The aim of this in-depth scoping review is to characterise the perception of patients in the role of diet in IBD.

Methods
An extensive literature search was undertaken on PubMed (inception to August ‘23), including MeSH terms ("Inflammatory Bowel Disease" OR IBD OR Crohn's OR Colitis) AND (belief OR perception OR opinion OR views OR attitude) AND (diet OR food OR nutrition). Eligible studies included primary research exploring attitudes, perceptions, or beliefs of adults and children with IBD and/or their carers towards the role of diet in IBD onset, progression or management. We excluded animal, in vitro and non-English articles (Table 1).

Results
1,649 records were identified. After full-text review of 162, 42 papers fulfilled eligibility criteria. Another 6 papers were identified after cross-checking reference lists from included papers, resulting in final inclusion of 48 articles. All articles described that diet perceptions relate with behaviour. In 17 studies a significant percentage of participants considered diet an initiating factor for their IBD diagnosis (Median,IQR: 32%,28%-45%). In 39 studies, patients listed foods they perceived to trigger or benefit their symptoms or inflammation. Most of these studies listed foods affecting the disease for IBD in general (n=29), while fewer studies described trigger and beneficial foods for Crohn’s disease (n=13) and ulcerative colitis (n=16), separately. Spicy food, dairy, alcohol, and coffee were the most perceived as disease-trigger foods, whereas rice, chicken, gluten free products and fish were perceived as beneficial (Fig 1A). Interestingly, 23 studies described patients’ most frequent sources of diet and nutrition information for IBD management (Fig 1B). The top-ranked being patient’s own experience with diet(82%), gastroenterologists(40%), other physicians(35%) and internet(35%). Only 25% of participants reported dietitians as their source of information.

Conclusion
There is a strong belief among patients with IBD that diet is important in disease development and management. It is possible that such beliefs translate to disease management practices, hence increasing restrictive eating, diminish quality or life, including food related quality of life. Until further evidence is produced to pinpoint the exact role of diet in IBD management, it is imperative that HCPs initiate such discussions and advise their patients accordingly.
P759 Understanding how patients with moderate-to-severe Crohn’s disease describe the spectrum of bowel urgency definitions: Results from qualitative research
Authors: Dubinsky M C , Hunter Gibble T , Stassek L , Harding G , Stefan M , Fikre T , Potts Bleakman A , Moses R 
Published: January 2024

Abstract

Background
The objective of this study was to understand how adult patients with moderately-to-severely active Crohn’s disease (CD) describe bowel urgency (BU) remission and “no or minimal” BU.

Methods
Qualitative phone interviews were conducted with adults with HCP-confirmed moderately-to-severely active CD. The interview included open-ended questions that elicited participant (pt) perceptions of BU remission, “no or minimal” and “normal” BU. Pts indicated which score on the 11-point Urgency Numeric Rating Scale (Urgency NRS; 0 [no urgency] to 10 [worst possible urgency] (24hour recall period)) they would use to describe “no or minimal” and “normal” BU. Pts were recruited from 6 clinical sites based in the US. ATLAS.ti was used to organize the data. Descriptive statistics were used for sociodemographic and clinical characteristics.

Results
21 pts with moderately-to-severely active CD participated in this study. Pts had a mean age of 45.4 years, 71% were female, 91% were white, and 48% were employed full-time. All pts had experienced BU and 86% (n=18/21) confirmed they had experienced a BU-related accident in the past. The majority of CD pts (n=18/21; 86%) defined BU remission as a state of normalcy, where there are normal or fewer bowel movements and BU is either gone or less frequent (Table 1). The impact of BU remission included the ability to partake in social/leisure activities and feeling less anxious overall.
Pts selected scores from 0 to 6 on the Urgency NRS to describe “no or minimal” level. The highest proportion of pts (n=7/21; 33%) selected “0 to 2,” with “0 to 3” (n=5/21; 24%) and “0 to 1” (n=5/21; 24%) also being commonly chosen ranges. The majority of pts (n=17/21; 81%) described “no or minimal” BU as having no impact on their life—thus allowing them to feel close to “normal,” and offering them the ability to live an improved life free of worry or panic. Pts were also asked to indicate the highest score on the Urgency NRS at which they could still consider their BU to be “normal” and 29% of pts (n=6/21) selected 4 or 3 (n=5/21; 24%) as the highest score that they would still consider as “normal.”

Conclusion
These interviews provided evidence that among pts with moderately-to-severely active CD, BU can still be considered “no or minimal”, “normal” or in “remission” even when some amount of BU is present. In general, responses of “0” to “6” on the Urgency NRS were considered to correlate to “no or minimal” or “normal” BU.