bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1177 Factors Driving Persistence to First-Line Advanced Therapies in Inflammatory Bowel Disease – A Real-World Study
Authors: Santacroce G , Lenti M V , Lepore F , Mordà F , Lo Bello A , Aronico N , Mengoli C , Delliponti M , Di Sabatino A 
Published: January 2025

Abstract

Background
Advanced therapies, including biologics and small oral molecules, are the mainstay of inflammatory bowel disease (IBD) management. Nonetheless, factors driving drug persistence - defined as the duration from initiation to discontinuation of a therapy- remain unclear. This study aimed to evaluate the persistence of first-line advanced therapies in a real-word IBD cohort and identify factors influencing it.

Methods
Demographic and clinical data from IBD patients who initiated first-line advanced therapies after 2010 at the San Matteo Hospital Foundation were retrospectively collected in September 2024. Persistence and discontinuation, due to failure or other reasons, were recorded. Differences in persistence probability between therapies were analysed using the log-rank test. Univariate (Fisher’s exact test for categorical variables and t-test or Mann-Whitney for continuous variables) and multivariate (logistic regression) analyses were conducted to assess factors influencing persistence versus discontinuation due to failure.

Results
Among the 274 recruited patients (median age 42.5 years; F/M 119/155; 146 with Crohn’s disease (CD) and 128 with ulcerative colitis), 159 (58%) started infliximab, 76 (28%) adalimumab, 26 (9.5%) vedolizumab, 3 (1%) ustekinumab, 3 (1%) Janus-kinase inhibitors and 7 (2.5%) other advanced therapies as first-line treatment. Persistence was observed in 141 patients (51.5%), while 70 (26%) discontinued due to failure, 19 (6.9%) due to allergy/intolerance, 18 (6.6%) due to remission, 2 (0.7%) due to immunogenicity, and 24 (8.8%) for other/unknown reasons. No significant difference in drug persistence was observed between therapies (p=0.11). Univariate analysis identified CD phenotype (p&lt;0.01), disease duration (p=0.01), concomitant mesalamine (p&lt;0.01) or steroids (p&lt;0.01), and therapy optimisation (p&lt;0.01) as factors influencing persistence. A trend toward higher faecal calprotectin levels was observed in the discontinuation group (550 vs 385 mg/kg, p=0.09), while subcutaneous administration showed a slightly higher persistence rate (45% vs 33%, p=0.11). Multivariate analysis confirmed the CD phenotype as factor associated with higher persistence, while therapy optimisation was identified as a risk factor for discontinuation.

Conclusion
While persistence rates were similar across therapies, multiple factors influence persistence or discontinuation, offering potential guidance for optimising IBD management.
P1186 Transperineal ultrasound is accurate in detecting perianal complications in Crohn’s disease: a systematic review and meta-analysis
Authors: Lim C T , Pruijt M , Lim G H , van Etten-Jamaludin F , Teichert C , de Voogd F , Christensen B , D'Haens G , Maconi G , Gecse K 
Published: January 2025

Abstract

Background
Perianal complications such as fistulas and abscesses are common in Crohn’s disease (CD) and contribute to significant morbidity. Transperineal ultrasonography (TPUS) has emerged as a non-invasive and accurate method for perianal CD (PACD). This review evaluates the diagnostic accuracy of TPUS compared with MRI, transrectal ultrasonography (TRUS), and examination under anaesthesia (EUA) for detecting and classifying perianal fistulas and abscesses.

Methods
A comprehensive literature search was conducted across multiple databases from their inception to December 2023 to identify studies evaluating TPUS accuracy in detecting perianal fistula and abscesses using MRI, TRUS, or EUA as reference standards. Meta-analysis was performed to assess TPUS accuracy for fistula detection (FD), fistula classification (FC), internal opening (IO) detection and abscess detection (AD) with a subgroup analysis carried out in CD patients. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the risk of bias.

Results
Of the 994 studies identified, 25 (involving 1435 patients) met the inclusion criteria for the meta-analysis. These included 24 studies on FD, 11 on FC, 21 on AD and 10 on IO detection. Overall, these studies had a moderate risk of bias, with moderate applicability concerns due to high risk of bias in patient selection (non-consecutive enrollment) and reference standard chosen (non-blinding interpretation of scans). Significant heterogeneity was observed across study domains with I2 and X2 values of 98%, 88.0%, 93.0%, and 105.6, 16.0, 27.5 for FD, FC, and AD, respectively (p&lt;0.001).
Pooled sensitivities for FD, FC, IO detection and AD were 97.7%, 99.9%, 91.5% and 94.2% respectively while pooled specificities for FD, IO detection and AD were 77.8%, 73.1% and 78.6% respectively. Diagnostic Odd’s Ratio for FD, IO detection and AD were 148.13, 29.39 and 280.07 respectively. The overall accuracy of TPUS for FD, FC, IO detection and AD was 92.5%, 90.7%, 88.3% and 94.3% respectively (Table 1).
A subgroup analysis focusing on CD patients (from 13 studies) showed pooled sensitivities of 96.6%, 99.9% and 85.5%, with overall accuracies of 85.2%, 86.5% and 83.4% for FD, FC and AD respectively. Stratification by publication date demonstrated improved accuracy in FD and AD in studies published after 2017 (91.6% vs 96.0% and 87.3% vs 96.8%).

Conclusion
TPUS demonstrates high accuracy in detecting perianal fistulas and abscesses in both CD and non-CD patients, supporting its use as a non-invasive, first-line diagnostic tool.
P1189 Rethinking disease clearance in ulcerative colitis: histological activity predicts long-term outcomes in an Argentine reference center cohort
Authors: Marturano M V , Gómez E J , Navar S , Rodriguez Mesias J L , Amante M F , Gonzalez R A 
Published: January 2025

Abstract

Background
Histological normalization in ulcerative colitis (UC) is not yet a formal treatment target, but STRIDE-II consensus recognizes it as a measure of remission depth. Recent studies show histological healing can diminish relapse risk after endoscopic remission, introducing the concept of "disease clearance" (DC) as clinical, biological, endoscopical and histological remission. This study investigates the association between histological activity and long-term outcomes in UC patients to better define this therapeutic goal.

Methods
We conducted a single center retrospective cohort study. Adult patients with a previous diagnosis of UC who underwent colonoscopy from Nov-2020 to Nov-2023 and with at least 1 year of follow-up were included. Data on demography, medications for IBD, measures of activity and follow-up were analyzed. Univariate and multivariate analysis were carried out to identify values of the histopathological Nancy index associated with adverse outcomes. Additionally, Kaplan-Meier survival analysis assessed the association between histological activity and long-term outcomes. The Log-Rank test compared survival curves between groups. A p value &lt;0.05 was considered statistically significant.

Results
We reviewed the medical records of 451 patients with UC, 197 met the inclusion criteria. The mean age was 49 years (range 19–90), 56% were females and median disease duration was 9 years. Fifty patients (25%) were treated with biologics. Sixty six % were in endoscopic remission and 35% were in histological remission or had only chronic inflammatory infiltrate at baseline (Nancy score [NS] 0-1). Median follow-up was 20 months (range 12-46). Patients with significant histological activity at baseline (NS &gt;1) were more likely to experience clinical relapse (30% vs 15%, p= 0.017), endoscopic relapse (22% vs 7%, p= 0.01), corticosteroid use (22% vs 1.5%, p&lt;0.01), therapy intensification (23% vs 6%, p= 0.002) and treatment switch (24% vs 3%, p&lt;0.01) compared to patients in the NS 0-1 group. The Kaplan-Meier curves confirmed that patients with Mayo Endoscopic Score (MES) and NS ≤1 at baseline had a lower risk of both clinical relapse (log-rank p=0.0374) and therapy switch requirement (log-rank p=0.0004). At multivariate analysis, the composite MES 0-1 and NS 0-1 was the only independent variable associated with a lower risk of clinical relapse and change in medical therapy.

Conclusion
Our study found that achieving an endoscopic MES and a NS ≤1 was associated with a lower rate of adverse outcomes during follow-up. We believe this could better define the concept of DC as a target in the treatment of UC. Clinical trials are warranted to demonstrate the benefits of DC versus other outcomes
P1193 Cross-Disease Analysis Unveils CXCL6 as a Shared Immune Mediator in Ulcerative Colitis and Periodontitis: Novel Insights from Bioinformatics
Authors: Gao X 
Published: January 2025

Abstract

Background
Emerging evidence underscores a pathological bidirectional relationship between ulcerative colitis (UC) and periodontitis (PD) through the oral-gut axis, highlighting a complex interplay with significant implications for patient health. However, the shared molecular features underlying this interaction have yet to be explored.

Methods
In this study, we initially established a potential link between periodontitis and ulcerative colitis based on Mendelian randomization. Following this, we analyzed gene expression profiles from the Gene Expression Omnibus (GEO) for both UC and PD, identifying overlapping genes between UC-differentially expressed genes (DEGs) and PD-DEGs.

Results
Functional enrichment analysis revealed associations with various immune pathways, underscoring the immunological relevance of these genes. Intersection with immune-related genes (IRGs) yielded 25 candidate genes, among which CXCL6 emerged as a central hub gene identified through three machine learning methods: LASSO, RF, and SVM-RFE. Subgroup analysis based on CXCL6 expression demonstrated that the CXCL6-high group exhibited increased immune cell infiltration and enhanced immune function. Moreover, our investigation of CXCL6 in relation to biological therapies in UC patients indicated a reduction in CXCL6 levels following treatment, suggesting potential benefits of biological therapies. Finally, we validated the expression of CXCL6 in a rat model of dual diseases.

Conclusion
In summary, CXCL6 is identified as a diagnostic biomarker and potential therapeutic target for UC combined with PD, warranting further investigation into its clinical significance and associated mechanisms.
P1198 Statin Use for Primary Prevention of Cardiovascular Disease and its Association with Risk of Incident Inflammatory Bowel Disease: A Population-Based Cohort Study
Authors: Faye A , Allin K , Juul Poulsen G , Jess T 
Published: January 2025

Abstract

Background
Environmental factors, which play a critical role in the rising incidence of inflammatory bowel disease (IBD), may hold the key for prevention. Statins, known for their cardiovascular benefits, possess anti-inflammatory properties and have been hypothesized to reduce the risk of developing IBD, though prior data have been limited. Thus, to advance what is known, we prospectively assessed the association between statin use and the risk of IBD among individuals eligible for statin therapy.

Methods
Using a prospective new user design within the Danish National Registries, we identified a population-based cohort of individuals ≥ 40 years-old from 2008-2022 who were eligible for statin therapy for the primary prevention of cardiovascular disease. Statin users were matched 1:1 to non-statin users on age, sex, year, and underlying cardiovascular risk factors, with this process repeated one hundred times to ensure an accurate risk estimate. Cox proportional hazards models were then used to obtain adjusted hazard ratios (aHRs) for the development of incident IBD.

Results
In total, 163,563 statin users were matched to 163,563 non-statin users during each iteration. The overall cohort was predominantly male (56.2%), aged between 50-69 years old (63.5%), and primarily met criteria for statin consideration due to the presence of hypertension in the setting of an elevated low-density lipoprotein (51.9%). Overall, statin users did not have a lower risk of developing IBD compared to non-users (aHR 0.88, 95% CI 0.74-1.04), with subgroup analysis demonstrating that this effect held true for both UC (aHR 0.86, 95% CI 0.70-1.05) and CD (aHR 0.95, 95% CI 0.70-1.28; Table 1; Figure 1). Sensitivity analysis where statin users were censored at the time of treatment discontinuation suggested a possible benefit for the development of UC (aHR 0.78, 95%CI 0.61-1.00), though this was not statistically significant.

Conclusion
In the largest and first nationwide new-user designed cohort study, statin use—prescribed in individuals ≥40 years for the primary prevention of cardiovascular disease—was not associated with a reduced risk of developing UC or CD. This contrasts with findings from smaller, previous case-control studies, however our data suggest that ongoing use may possibly be protective for the later development of UC.
P1199 Early life exposures predict childhood-onset IBD in a population-based cohort
Authors: Agrawal M , Hansen A V , Colombel J F , Allin K H , Jess T 
Published: January 2025

Abstract

Background
While many early life exposures have been associated with IBD, prediction of risk based on these variables is not yet available. Therefore, we developed and validated a prediction model for IBD based on early life exposures.

Methods
We conducted a nationwide population-based cohort study leveraging cross-linked Danish registers consisting of all liveborn singleton offspring in the Danish National Birth Cohort with available data on early life exposures based on the first four DNBC interviews (weeks 12 and 30 of pregnancy, 6 months, and 18 months of offspring age), who were alive and residents of Denmark until at least 18 months of age. Follow up was until IBD diagnoses (based on primary and secondary diagnoses codes in the National Patient Register), emigration, death or end of the study period, September 1, 2022. We used elastic net with underlying Cox regression model to predict IBD diagnosis at ≤14 and &gt;14 years of age.

Results
A total of 50,592 offspring were included in the study for a median (IQR) of 21.8 (20.4, 22.9) years. Of these, 310 (0.6%) persons were diagnosed with IBD during follow-up. Early life risk factors were predictive of IBD risk at ≤14 years of age but not later in life [Harrell’s C statistic (SE) 0.72 (0.018) and 0.52 (0.004), respectively]. All of the 74 variable terms considered for inclusion were included in the final model, with the five most important being parental IBD, number of infection episodes age 6-18 months, household mammal pets (protective), number of infection episodes age 0-6 months, and antibiotics exposure age 6-18 months. The cumulative incidence of IBD at age 14 years of age was 0.66% (95% CI 0.49-0.84) among those in the highest 5% for predicted risk, and 0.09 % (95% CI 0.075-0.01) for those in the lowest 95% (Figure).

Conclusion
In a nationwide cohort with long-term follow up data, early life exposures were predictive of childhood-onset IBD, but not later in life. This model warrants validation and could potentially be used to determine IBD risk in children towards prevention strategies.
P1207 Therapy goals and Quality of Life among older patients with Inflammatory Bowel Disease: results of an international EFCCA survey
Authors: Fons A , Girardi P , Savini C , Maljaars J , Haaf I , Avedano L , Asscher V 
Published: January 2025

Abstract

Background
The number of older patients with Inflammatory Bowel Disease (IBD) is rapidly growing, however they are underrepresented in research. To enhance more personalized and patient-centered care, it is important to study the disease burden and therapy goals of this population. Therefore, the aim of this study was to explore prioritized therapy goals, clusters of therapy goals and determinants of quality of life (QoL) in older patients with IBD.

Methods
This was an international, anonymous, online survey in older patients (age ≥ 60 years) with IBD, proposed and conducted by the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA), between May 2023 and November 2023. Patients were asked to select three out of twelve pre-specified therapy goals. A cluster analysis was performed to identify patterns or combinations of therapy goals that were reported together, using a binary distance and an agglomerative clustering algorithm. QoL was assessed by one question about general well-being (five-point Likert scale). We assessed the influence of the therapy goal clusters on QoL by an ordinal regression model adjusting for common confounders.

Results
Of 1997 included respondents from 34 countries, with a median age of 66 years (IQR 63-71), 297 (14.8%) reported poor-terrible QoL. Older patients with IBD most often prioritized therapy goals related to decreasing fatigue (56%), preserving/restoring a good mood (43%) and decrease diarrhea/incontinence (32%). Six clusters of therapy goals were identified and labelled: 1 - Inflammation control, 2 - IBD-symptom control, 3 - Mobility capacity, 4 - Bodily perception, 5 - Mood and energy, 6 - Activity engagement. The proportion of patients with very well QoL was highest in cluster 6 (60%) and the lowest in cluster 2 (17%). Low QoL was independently associated with therapy goal clusters related to Inflammation control (adjusted Odds Ratio (aOR) 1.86 95% confidence interval (95%CI): 1.24-2.77), IBD-symptom control (aOR: 3.19, 95%CI: 2.13-4.79), Mobility capacity (aOR: 2.14, 95%CI: 1.41-3.24) and Mood and energy (aOR: 1.82, 95%CI: 1.19-2.78), compared to the Activity engagement cluster.

Conclusion
Older patients with IBD prioritize therapy goals focused on reducing fatigue, improving mood and decreasing diarrhea/incontinence. Low QoL was significantly associated with therapy goal clusters emphasizing inflammation control, IBD symptoms, mobility, and mood/energy. These results are indicative for the need to evaluate the QoL in older patients with IBD in the context of their therapy goals.
P1212 Effectiveness of Vedolizumab to Reduce Bowel Urgency in a Canadian Real-World Ulcerative Colitis Cohort
Authors: Battat R , Leung Y , Tandon P , Ward R , Wadhwa A , Power S , Weiss J , Moulson R , Pettengell C , Feagan B G 
Published: January 2025

Abstract

Background
Vedolizumab is a gut-selective anti-lymphocyte trafficking drug indicated for the treatment of moderately to severely active ulcerative colitis (UC). Bowel urgency, the immediate or sudden need to have a bowel movement, is a common symptom in UC, that reduces quality of life. We are assessing this emerging and important patient-reported outcome among patients treated with vedolizumab in a real-world cohort.

Methods
This is a retrospective, non-interventional study using data collected as part of the Canadian Takeda Patient Support Program (PSP). Included patients were aged ≥18 years at vedolizumab initiation, consented to secondary use of data and had moderately to severely active UC with an Urgency Numeric Rating Scale (UNRS) score available at baseline. We report the point and percentage reduction from baseline in UNRS 6 weeks following vedolizumab initiation and the association between bowel urgency clinically meaningful improvement (CMI) and clinical remission and response at Week 6, among UC patients with UNRS ≥3 at baseline. Bowel urgency CMI was defined as change from baseline UNRS ≥3 in patients with UNRS ≥3 at treatment baseline. Clinical response was defined as partial Mayo score (pMayo) decrease of ≥2 points and ≥25% from baseline, remission was defined as a score &lt;3. Association between bowel urgency and clinical outcomes was assessed using Fisher’s exact and chi-squared tests with significance specified by a two-sided p-value of &lt;0.05.

Results
87 patients with UC (84% bio-naïve) were eligible. Median age was 44 years (Q1, Q3: 32, 60) and 54% of patients were female. Median baseline UNRS was 7 (Q1, Q3: 3, 8), median pMayo was 7 (Q1, Q3: 6, 8). Disease duration prior to vedolizumab was 5 years (Q1, Q3: 1, 14). Overall, patients with baseline UNRS ≥3 (83% of patients) experienced a median reduction of 3 points from baseline to Week 6 (IQR: 2–8), equating to 60% reduction from baseline (IQR: 20, 100) (Table 1). At 2 and 6 weeks, 39% and 61% of patients experienced bowel urgency CMI, respectively. Notably, there was a significant association between bowel urgency CMI at Week 6 and clinical outcomes (Table 2): patients in bowel urgency CMI were more likely to be in remission when compared to those not in bowel urgency CMI (68% vs. 35%, p=0.009), and more likely to be in response (95% vs. 73%, p=0.023).

Conclusion
Following 6 weeks of vedolizumab induction treatment, bowel urgency decreased from baseline by 60% in patients with moderate to severe UC. Furthermore, bowel urgency CMI was significantly associated with improved clinical outcomes. This study demonstrated the effectiveness of vedolizumab in early reduction of bowel urgency among a real-world cohort of Canadian patients.
P1217 Epidemiology and Temporal Trends of IBD in Central Taiwan
Authors: Chen Y Y , Huang C W , Chou J W , Yen H H 
Published: January 2025

Abstract

Background
Inflammatory Bowel Disease (IBD), as a chronic inflammatory disease of the gastrointestinal tract, encompasses Crohn's disease (CD) and ulcerative colitis (UC). With industrialization and advancements in healthcare, the prevalence of IBD in Taiwan is on the rise.

Methods
This study collected data from 593 IBD patients treated at Changhua Christian Hospital and China Medical University Hospital, analyzing the epidemiology of IBD in central Taiwan.

Results
The cohort included 200 CD and 393 UC patients, with an average age of 40.62 ± 15.08. CD exhibited a higher male proportion than UC (72.50% vs. 62.09%, p = .012). CD patients also had higher rates of appendectomy, bowel resection, and perianal disease surgery before IBD diagnosis, along with increased use of steroids, immunosuppressants, and biologics compared to UC. Over time, Taiwan's UC to CD ratio decreased (≦2005: 2.50; 2006-2015:2.06; 2016-2023:1.76), and CD's L2 location and B3 behavior proportions also declined. The proportion of the UC patients with location E1 was increased.

Conclusion
Taiwan's IBD population mimics patterns observed in high-income countries, with a declining UC to CD ratio. The reduced L2 location and B3 behavior in CD and suggest improved diagnostic awareness and more comprehensive colonoscopy examinations in Taiwan.

References
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