bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOP61 Development and validation of novel models in prediction of intravenous corticosteroids resistance in patients with Acute Severe Ulcerative Colitis
Authors: Yu S , Li H , Li Y , Xu H , Tan B , Tian B , Dai Y , Tian F , Qian J 
Published: January 2022

Abstract

Background
Early prediction of intravenous corticosteroid (IVCS) resistance in Acute severe ulcerative colitis (ASUC) patients could reduce costs and delay in rescue therapy. However, most prediction models for ASUC were at high risk of bias with a lack of external validation. This study aims to construct and validate a model that accurately predicts IVCS resistance using various statistical methods.

Methods
A retrospective cohort of patients who were diagnosed with ASUC and had undergone IVCS treatment between March 2012 to January 2020 was established. Predictors evaluated included age, gender, race, medications before admission, infections, and laboratory data at baseline and during IVCS treatment, and endoscopic outcomes relied on blinded centralized endoscopy reading. The LASSO regression was used in feature selection for multivariate logistic regression model. Models based on machine learning methods (decision tree and random forest [RF]) were also constructed. Internal validity was confirmed and model performances were compared. External validation was conducted using data using an independent cohort from a tertiary referral centre.

Results
A total of 129 patients were included in the derivation cohort. During index hospitalization, 102 (79.1%) responded to IVCS, and 27 (20.9%) failed; 16 patients underwent colectomy, 6 received cyclosporin, and 5 succeeded with IFX as rescue therapy. Ulcerative Colitis Endoscopic Index of Severity (UCEIS; odds ratio [OR] 5.39, 95% confidence interval [CI] 2.52–14.0, p&lt;0.001) and C-reactive protein (CRP) level on the third day (OR 1.05, 95% CI 1.03–1.08, p&lt;0.001) were selected by LASSO regression and identified as the only two independent predictors of IVCS resistance in logistic regression. The decision tree model identified a UCEIS higher than 6.5 points and CRP level at day 3 higher than 33.57 mg/dL as the proxy for IVCS resistance. UCEIS and CRP level at day 3 were also the most important predictors in the RF model. Areas under the curve receiver operating characteristic (AUC) of logistic model, decision tree model, and RF model were 0.64 (95% CI 0.49–0.80), 0.81 (95% CI 0.71–0.90), and 0.88 (95% CI 0.82–0.95), respectively. A validation cohort of 65 ASUC patients were established, and the AUC of the models in external validation were 0.57 (95% CI 0.45–0.70), 0.70 (95% CI 0.61–0.80), and 0.71 (95% CI 0.48–0.94), respectively.

Conclusion
In patients with ASUC, UCEIS and CRP level at day 3 of IVCS treatment appeared to allow the prompt prediction of likely IVCS nonresponders. Machine learning-based models outperformed the traditional statistical model in the prediction. The models may aid therapeutic decision-making in ASUC patients.
DOP62 Efficacy of biologic drugs in short-duration versus long-duration Inflammatory Bowel Disease: A systematic review and an individual-patient data meta-analysis of randomized controlled trials
Authors: Ben-Horin S , Novack L , Mao R , Guo J , Zhao Y , Sergienko R , Zhang J , Kobayashi K , Hibi T , Chowers Y , Peyrin-Biroulet L , Colombel J F C , Kaplan G G K , Chen M H 
Published: January 2022

Abstract

Background
Starting biologic treatment early in the course of inflammatory bowel disease (IBD) may associate with higher efficacy, especially in Crohn’s disease (CD).

Methods
A systematic review and individual-patient-data meta-analysis of all placebo-controlled trials of biologics approved for IBD at study inception (Oct 2015), using Vivli data-sharing platform. The primary outcome was the proportional biologic/placebo treatment effect on induction-of-remission in patients with short-duration (≤18months) versus long-duration disease (&gt;18months) analyzed separately for CD and ulcerative colitis (UC). We used meta-regression to examine the impact of patients’ characteristics on the primary outcome. Study PROSPERO registration: CRD42018041961.

Results
We obtained data from five biologics drug manufacturers and included 25 trials, testing infliximab, adalimumab, certolizumab, golimumab, natalizumab or vedolizumab (6,168 CD, 3,227 UC patients). In CD, induction-of-remission rates were higher in pooled placebo and active arms’ patients with short-disease duration≤18 months (41.4%, 244/589) compared with disease-duration&gt;18months (29.8%, 852/2857, meta-analytically estimated OR=1.33, 95%CI:1.09–1.64). The primary outcome, proportional biologic/placebo treatment effect on induction-of-remission, was not different in short-duration disease ≤18 months (n= 589, OR 1.47, 95%CI:1.01–2.15) compared with longer disease-duration (n=2857, OR 1.43, 95%CI:1.19–1.72). In UC trials, both the proportional biologic/placebo remission-induction effect and the pooled biologic-placebo effect were stable regardless of disease duration. Primary outcome results remained unchanged when tested using alternative temporal cut-offs and when modelled for individual-patients’ co-variates, including prior anti-TNFs exposure. In exploratory post-hoc analysis comparing patients with colonic-CD (L2) versus small-bowel L1 CD (and excluding ileo-colonic L3 disease) the OR for induction-of-remission in long-duration disease&gt;18months compared with short-duration disease was 0.62 for small-bowel CD (95%CI: 0.42; 0.91) but was not significant in pooled colonic CD population (OR=0.94, 95%CI: 0.66; 1.34)

Conclusion
This Individual patient level meta-analysis of clinical trials of multiple biologics found there are higher rates of induction-of-remission in early CD for both biologics and placebo, resulting in a treatment-to-placebo effect ratio which is similar across different disease durations. No such relationships between disease-duration and outcomes is found in UC
DOP63 Real World Effectiveness, Safety and Pharmacokinetics of Switching Intravenous Vedolizumab Maintenance treatment to Subcutaneous Vedolizumab Therapy for Inflammatory Bowel Disease
Authors: Volkers A , Straatmijer T , Duijvestein M , Sales A , Levran A , van Schaik F , Jeroen M , Gecse K , Ponsioen C , Grootjans J , Hanzel J , Tack G , Jansen J , Hoentjen F , de Boer N , van der Marel S , Dijkstra G , Oldenburg B , Löwenberg M , van der meulen A , D’Haens G 
Published: January 2022

Abstract

Background
Subcutaneous (SC) formulation of vedolizumab (VDZ) is available for Crohn’s disease (CD) and ulcerative colitis (UC). We assessed the efficacy, safety, and pharmacokinetic (PK) profiles of patients with inflammatory bowel diseases (IBD) who switched from intravenous (IV) to SC VDZ treatment in two prospective, real world cohorts.

Methods
The primary cohort is an ongoing open-label, real life, prospective single centre cohort study. As a validation cohort, we used the Initiative on Crohn and Colitis (ICC) registry, a prospective, observational, nationwide registry including patients switching from IV to SC VDZ. In both cohorts, patients receiving IV VDZ maintenance for &gt;4 months were offered to switch treatment to SC VDZ, 108 mg every 2 weeks. In the primary cohort, assessment of clinical, biochemical and PK parameters took place at baseline, at approximately 10 weeks following the switch and at the physician’s discretion thereafter. In the ICC cohort, follow up visits were at week 12 and 24. The primary endpoint was the proportion of patients discontinuing SC VDZ at week 24.

Results
In total, 78 (50 CD (64%) and 28 UC (36%)) and 54 patients (29 CD (54%) and 25 UC (46%)) were included in the primary and ICC cohort respectively (table 1). During follow up, 8 (10.3%) of the primary cohort and 6 (11.1%) patients of the ICC cohort stopped VDZ SC during follow-up time till week 24, after a median treatment duration of 18 (IQR=5–19) and 10 (IQR=7–15) weeks, respectively. Treatment withdrawal was most often caused by adverse events (AE), in total for 8 out of 132 patients (6%) (table 2). Four patients had loss of response to SC VDZ. Three of these patients had biochemical disease activity at initiation of SC therapy. Reported AEs included headache and injection related reactions. The median VDZ concentration increased from 11 ug/mL (IQR=9.4–20) to 28 ug/mL (IQR=24.3–31.2, p&lt;0.0001) and from 20 ug/mL (14.3–26.3) to 34.6 ug/mL (26.8–42.9) (p&lt;0.01), between baseline and visit 1 in the primary and validation cohort, respectively (figure 1).

Conclusion
The present abstract reports real world experience of switching IV to SC VDZ maintenance treatment in IBD patients in two observational Dutch cohorts. VDZ concentrations were significantly higher after the switch to SC VDZ. A switch from IV to SC VDZ appears to be effective and safe. However, a proportion of patients switched back to IV VDZ due to injection related AEs.
DOP72 The association of anti-tumor necrosis factor and thiopurine therapy with the risk of lymphoma among Inflammatory Bowel Disease patients: A nation-wide study from the epi-IIRN
Authors: Waterman M , Lavi I , Harel S , Focht G , Loewenberg Weisband J , Greenfeld S , Kariv R , Ledderman N , Matz E , Keinan-Boker L , Eizenstein S , Dotan I , Turner D , Levi Z 
Published: January 2022

Abstract

Background
To clarify the risk of lymphoma in patients with inflammatory bowel diseases (IBD) exposed to anti-tumor necrosis factor (anti-TNF) and/or thiopurines we aimed to evaluate the Israeli IBD population.

Methods
A nested case-control study on the epidemiology cohort of the Israeli IBD Research Nucleus (epi-IIRN) including all 4 Health Maintenance Organizations in Israel linked to the Israeli Cancer Registry. Patients diagnosed since 1.1.2005 until 31.12.2015 (42,954 patients) were included and followed until 31.12.2017. Each lymphoma case was matched to 30 non-lymphoma IBD patients by age, gender, IBD subtype, and date of earliest evidence of IBD in the database. Patients with other risk factors for lymphoma, or lymphoma diagnosis prior to IBD diagnosis were excluded (figure 1). Conditional logistic regression was used to compute the association of drug exposure (anti-TNF, thiopurines and combination) with diagnosis of lymphoma. Patients without exposure to anti-TNF and/or thiopurines in each group served as reference within each group. Additionally, sub-group analyses by gender, age group at inclusion (≤48, 49–64, ≥65), time from last drug exposure (≤90 days, 91–365 days, &gt;365 days) were done.

Results
The final nested cohort included 5556 IBD patients (185 lymphoma cases matched to 5,371 without lymphoma). Mean follow-up (F/U): 5.5±3.5 years, 50% with Crohn’s disease, mean age at database entry 52.6±17.80 years. Anti-TNF-only exposure was documented in 4.3% (8/185) of lymphoma cases vs. 2.6% (145/5,371) of controls OR 1.97, CI 0.93–4.16, p=0.07; in males the ORs were 2.84 (CI 1.17–6.92 p=0.04) and increased to OR 3.48 (CI 1.55–7.88, p=0.002) for males &lt;48 years and OR 2.87 (CI 1.53–5.37, p=0.001) for patients with last exposure ≤90 days (figure 2). Exposure to combination anti-TNF+thiopurines occurred in 8.6% (16/185) of lymphoma cases vs. 5.3% (282/5,371) of controls OR 2.09 (CI 1.17–3.73, p=0.013). Males on anti-TNF-thiopurine combination had OR of 3.42 (CI 1.37–8.52, p=0.003) and in sequential (non-overlapping exposure to both thiopurines and anti-TNFs during F/U) combination an OR of 2.74 (CI 1.02–7.35 p=0.02). Thiopurine-only exposure occurred in 15.1% (28/185) of lymphoma cases vs. 13.5% (726/5,371) of controls, OR 1.32 (CI 0.86–2.03, p=0.20). Males on thiopurines had an OR of 1.75 (CI 1.02–2.99, p=0.05). The risk increased further in males &lt;48 years OR 2.17 (CI 1.01–4.66, p=0.047) and in males aged≥65 OR 3.50 (CI 1.55–7.82, p=0.002). Females were not at risk for lymphoma (figure 3).

Conclusion
This nationwide study suggests that exposure to anti-TNF therapy alone or in combination with thiopurines may be associated with an increased risk of lymphoma, but only in males, especially when last exposure occurred within 90 days.
DOP82 Achievement of steroid-free remission in patients with moderately to severely active Crohn’s Disease during treatment with risankizumab
Authors: Schreiber S W , Cross R , Panaccione R , D’Haens G , Bossuyt P , Colombel J F , Louis E , Dubinsky M , Kligys K , Neimark E , Song A , Zambrano J , Cheng E , Ferrante M 
Published: January 2022

Abstract

Background
The efficacy and safety of risankizumab (RZB) as induction and maintenance therapy for patients with moderately to severely active Crohn’s disease (CD) has been documented. Steroid-free clinical remission is an important additional treatment goal in CD. The efficacy of RZB by baseline steroid use during induction and steroid-free outcomes during maintenance was examined.

Methods
In ADVANCE (NCT03105128) and MOTIVATE (NCT03104413), patients with moderately to severely active CD received intravenous (IV) RZB induction therapy or placebo (PBO) for 12 weeks. Patients with clinical response to RZB were re-randomised in a 52-week maintenance study (FORTIFY; NCT03105102) to subcutaneous (SC) RZB or PBO (ie, withdrawal). Patients receiving steroids (maximum prednisone or equivalent ≤ 20 mg/day; budesonide ≤ 9 mg/day) at baseline of the induction studies maintained stable doses for the 12-week study duration. A mandatory steroid taper per protocol was initiated at the beginning of maintenance for patients receiving steroids during induction. Patients losing clinical response (per investigator assessment) after initiation of taper could have their steroid dose increased up to the induction baseline dose. This analysis included patients who received RZB 600 mg IV in ADVANCE or MOTIVATE and patients who received RZB 360 mg SC in FORTIFY. Endpoints reported included clinical remission (defined by CD Activity Index [CDAI] or stool frequency/abdominal pain score [SF/APS] criteria) at week 12 of induction by baseline steroid use, steroid-free clinical remission (CDAI or SF/APS), steroid-free endoscopic response, and steroid-free endoscopic remission at week 52 of maintenance. Steroid discontinuation rates over 52 weeks of maintenance were also assessed.

Results
Induction of clinical remission at week 12 with RZB 600 mg IV in ADVANCE or MOTIVATE was independent from baseline steroid use (Figure 1).Clinical remission rates (CDAI or SF/APS) at week 12 were similar for patients using steroids vs those who were not (33.8%–42.0% vs 34.9%–46.6%; Figure 1). Steroid use decreased over time in FORTIFY, with a greater proportion of patients receiving RZB 360 mg SC discontinuing steroids at week 52 vs withdrawal (PBO SC; Figure 2A). Rates of steroid-free clinical remission (P ≤ .012), steroid-free endoscopic response (P &lt; .001), and steroid-free endoscopic remission (P &lt; .001) were significantly higher with RZB 360 mg SC vs withdrawal (PBO SC) at week 52 of maintenance (Figure 2B–2C).

Conclusion
Efficacy of RZB induction therapy was independent of baseline steroid use. RZB maintenance promotes high rates of steroid-free clinical and endoscopic outcomes, demonstrating a benefit of RZB treatment in CD.
DOP86 Mirikizumab-induced upregulation of colonic transcripts correlates with improvements in stool frequency in a phase 2 study of patients with moderately to severely active Ulcerative Colitis
Authors: Steere B , Powell N , Higgs R , Wang Y C , Milch C , Sandborn W J , Sands B E , Reinisch W , D’Haens G , Krishnan G 
Published: January 2022

Abstract

Background
We have previously shown that treatment with mirikizumab (miri), a p19-directed IL-23 antibody, significantly downregulates inflammatory genes associated with disease activity and upregulates genes expressing epithelial transporter proteins in colonic tissue in patients with ulcerative colitis (UC). Here we explored the correlation between the expression of colonic mucosa genes and stool frequency (SF), a symptom reflective of disease activity, during the 12-week induction period of a Phase 2 study of patients with moderately to severely active UC (NCT02589665).

Methods
Patients were randomised 1:1:1:1 to receive intravenous placebo (PBO), miri 50mg or 200mg with possibility of exposure-based dose increases, or fixed miri 600mg every 4 weeks for 12 weeks. SF was reported daily by patients and transformed on a 4-level ordinal scale [0–3] representing increased SF above their normal or healthy baseline (BL). Patient colonic biopsies (PBO N=58, miri 50mg N=52, 200mg N=51, 600mg N=54) were collected at BL and Week (W)12, and gene expression measured using an Affymetrix HTA2.0 microarray workflow. BL and W12 gene expression or SF values were pooled and associations identified based on non-parametric Kendall’s tau. Pathway analysis (Hallmark and Reactome) of correlated genes was performed using over-representation analysis. p values of enrichment were determined by hypergeometric distribution test and adjusted for multi-testing with Benjamini-Hochberg procedure. Differential gene expression after miri treatment was determined by paired t-test comparing expression levels at BL and at W12 using data from the 200mg treatment group.

Results
A total of 267 genes were correlated with SF (|tau| &gt;0.3 and qval &lt;0.001). Of these, 212 were positively correlated (high expression associated with high SF) and 55 were negatively correlated (high expression associated with low SF). The 212 transcripts that were positively correlated with SF were uniformly and consistently downregulated with miri treatment, while the 55 transcripts that negatively correlated with SF, were consistently upregulated with miri treatment (Table 1). Biological pathways significantly associated with the miri-responsive transcripts that correlated with SF included inflammatory response, extracellular matrix dysregulation, neutrophil degranulation and cytokine signaling pathways, especially TNF and IL6 pathways (Table 2).

Conclusion
This is the first study to identify colon-based transcripts that correlate with a clinical disease activity measure, stool frequency, and it demonstrates that treatment with miri may upregulate genes associated with normalization of SF and down regulate genes associated with inflammation in colonic tissue samples of patients with UC.
DOP88 Long-term real-world data of ustekinumab in Crohn’s Disease – the Stockholm ustekinumab study – STOCUSTE
Authors: Bello F , Lördal M , Johansson F , Sabhan H , Muhsen S , Borin A , Forsberg O , Wennerström C , Söderman C , Almer S 
Published: January 2022

Abstract

Background
Ustekinumab (UST), an anti-interleukin-12/23 antibody, has successfully been introduced in the treatment of IBD, mainly in patients failing anti-TNF-agents. The STOCUSTE study includes IBD patients treated with UST at four teaching hospitals in Stockholm to provide long-term follow-up data. Here, we report the outcome in Crohn’s disease over the first 12 months.

Methods
This retrospective study includes patients diagnosed with Crohn’s disease and treated with UST who were followed until withdrawal of treatment for any reason, or until end of study, July 31, 2021. Disease activity (Harvey-Bradshaw Index (HBI); Physician Global Assessment (PGA), laboratory parameters and drug persistence were assessed. The primary outcome was remission (HBI ≤4; PGA = 0) and response (decrease HBI ≥3; PGA ≥1 from baseline) at 3 and 12 months, respectively.

Results
120 patients, 61 women (51%), with a median age of 27 (IQR 27) at start of UST were included. All patients had luminal disease and 19 (16%) also fistulizing disease. 109 (91%) had failed ≥1 and 59 (49%) ≥2 anti-TNF drugs. In addition, 50 patients (42%) failed vedolizumab. At inclusion, 106 (88%) had active disease; 40 (33%) were on corticosteroid treatment and 22 (18%) on thiopurines.
The persistence on UST was high, 93% at 3 months and 56% at 12 months. Of patients on UST at 3 months, 38% were in remission, and, at 12 months, 53%. An additional 26% were in response at 12 months. Of the 40 patients initially on corticosteroids, 17 (43%) and 28 (70%) had stopped steroids at 3 and 12 months, respectively. The median faecal calprotectin level declined from 272 (90–1763) at baseline to 75 (49–99) µg/g at 3 months (p&lt;0.01). There was a slight decrease in CRP over 12 months, from 3 (2–12) to 1 (1–2) mg/l, together with increases in haemoglobin and serum albumin (n.s).
Withdrawal from treatment during the first 12 months was 44% (53/120), mainly due to persisting disease activity. Four patients were withdrawn due to adverse events, three needed bowel surgery, two had malignancy and one patient suffered from systemic infection.

Conclusion
In this group of difficult-to-treat patients with Crohn’s disease, UST was shown to be effective in the majority, with high drug persistence at 12 months in combination with a favorable safety profile.
P005 The solute carrier LC22A4/Organic Cation Transporter (OCTN)-1 as a novel Inflammatory Bowel Disease determinant at the microbe-host interface
Authors: Masi L , Petito V , Fidaleo M , Palucci I , Del Chierico F , Ivagnes V , Mercuri A , Graziani C , Lopetuso L R , Armuzzi A , Gasbarrini A , Pani G , Scaldaferri F 
Published: January 2022

Abstract

Background
The putative Ergothioneine Transporter, SLC22A4/OCTN1, is expressed in the intestine and monocytes/macrophages, and its widely represented missense variant L503F (0.4 Minor Allele Frequency in Caucasians) has been found to be associated with Crohn’s disease, sporadic colorectal cancer in early age and ulcerative colitis (UC) patients. The leucine-to-phenylalanine substitution at amino acid 503 affects OCTN1 capacity to transport ergothioneine, acetylcholine and likely other substrates of endogenous or microbial origin; however, whether this defect contributes to inflammatory bowel disease (IBD) pathogenesis, and the mechanistic underpinnings, remain elusive.

Methods
In order to gain mechanistic insight on the role of SLC22A4 in IBD, we first analyzed primary monocytes from healthy donors and UC patients of varying OCTN1 genotypes. Then we stably knocked down or overexpressed OCTN1 and its disease-associated variant in the monocytic cell line THP-1. Finally, we compared wild-type and OCTN1 knockout C57BL/6 mice in a chemical colitis paradigm in vivo.

Results
Primary adherent monocytes from healthy donors homozygous for the IBD-associated allele (TT) displayed a significant enhancement of interleukin 1 beta (IL-1β) response to peptidoglycan (PGN) compared to the other genotypes. Likewise, cells from UC patients bearing the 503F variant released more IL-1β in response to live bacteria and displayed reduced expression of autophagy markers (e.g. p62, LC3), compared to patients negative for the variant.
In agreement with these findings, OCTN1-deficient THP-1 macrophages secreted reduced amounts of IL-1β when challenged in vitro with PGN or live bacteria. Most relevant, THP1 cells engineered to overexpress the 503F variant of OCTN1 displayed a much stronger IL-1β response to muramyl dipeptide and PGN challenge, compared to cells transduced with the “wild type” transporter. Also consistent with a role for OCTN1 variants in inflammatory cascades relevant to IBD, in vivo studies revealed milder DSS-induced colitis in OCTN1 knockout mice compared to wild-type animals, both at the peak of disease severity and at the end of the recovery period.

Conclusion
Collectively our initial evidence supports the view that OCTN1 may have a causative role in IBD via deranged bacterial sensing and cytokine production, with 503F likely behaving as a gain-of-function variant. Thus, targeting OCTN1 variant may provide unprecedented opportunities for the personalized treatment of IBD patients and a better understanding of disease pathogenesis.