ECCO News keeps ECCO Members up-to-date on what is going on within the organisation and reports on IBD activities taking place within Europe. Since Spring 2006, ECCO News has maintained the flow of information between Members of the organisation.
ECCO News is an important part of the European Crohn’s and Colitis Organisation’s ambition to create a European standard of IBD care and to promote knowledge and research in the field of IBD. ECCO Members automatically receive this publication four times a year.
Name of group: IBD section of the Finnish Society of Gastroenterology
Number of active members: The Finnish Society of Gastroenterology has 540 members. The IBD section has 30 registered active members.
Number of meetings per year: 2–3
President and Secretary: The Finnish Society of Gastroenterology: Johanna Louhimo (president). The IBD section: Pauliina Molander (president) and Clas-Göran af Björkesten (secretary)
National Representatives: Tuire Ilus and Clas-Göran af Björkesten
Joined ECCO in: 2004
Incidence of IBD in the country: The incidence of IBD in Finland is one of the highest in the world and there has been a significant increase in this incidence during the past 20 years. UC is more common than CD. IBD incidence is 42/100,000 persons per year (UC 31/100,000 and CD 11/100,000).
Britta Siegmund is Medical Director of the Medical Department, Division of Gastroenterology, Infectiology and Rheumatology at the Charité - University Hospital Campus Benjamin Franklin Berlin, Germany. She has recently been accredited with the position of the new President-Elect of ECCO and we were happy to conduct an exclusive interview with her.
For the convenience of our ECCO News readers we recorded the interview and put it in an audio file. We hope you will enjoy listening to interesting facts about our President-Elect.
The BIOCYCLE project has now been ongoing for 5 years. This project, funded by the European Commission under the Horizon 2020 programme, aims to explore different aspects of the question of treatment de-escalation in moderate-severe Crohn’s Disease that first requires combination therapy with anti-TNF and antimetabolites to control the disease. Once the disease has been stabilised, an unsolved question is to whether it is possible to de-escalate therapy. This question is important for several reasons, including safety, tolerance, quality of life and costs, to name the most prominent. BIOCYCLE comprises nine work packages, including a randomised three-arm, controlled clinical trial on 210 patients in seven European countries, several patient and health care provider surveys in Europe and the United States, a biomarker research programme and pharmaco-economic analysis. ECCO is mainly involved in the monitoring of the project (through SciCom and ClinCom) and is the work package leader for dissemination of the results. BIOCYCLE is a 7.5-year project and was launched in April 2015.
Glen Doherty is a consultant gastroenterologist at the Centre for Colorectal Disease at St Vincent's University Hospital and University College Dublin (UCD) as well as Research Director of the Centre for Colorectal Disease. In addition, he serves as an Executive Board member of the Irish Society of Gastroenterology (ISG). He joined GuiCom in 2016 and has been the chair for the last year.
The anti-TNF monoclonal antibody infliximab offers an effective treatment for patients with Inflammatory Bowel Disease (IBD) refractory to conventional immunomodulator therapies. Successful biologic therapy can lead to clinical and endoscopic remission as well as reduced hospitalisation and requirement for surgery .
Unfortunately, as a large protein and chimeric antibody, infliximab is immunogenic and this frequently leads to formation of anti-drug antibodies (ADA), with subsequent secondary loss of response (LOR), drug discontinuation and adverse reactions . Identifying patients at increased risk of developing antibodies prior to treatment may establish which individuals require closer drug level monitoring, concomitant immunomodulator therapy and observation for adverse events.
Previous work by Sazonovs et al. identified the first genetic locus to be robustly associated with immunogenicity to anti-TNF therapies . The HLADQA1*05 allele variant rs2097432, carried by approximately 40% of Europeans, significantly increased the rate of formation of infliximab ADA. In the study reviewed here, Wilson et al. aimed to independently identify whether presence of the variant allele was associated with increased risk of ADA formation, LOR, drug discontinuation and adverse events.
Perianal fistulising Crohn’s Disease is a challenging phenotype affecting more than 20% of patients diagnosed with Crohn’s Disease. It is associated with debilitating symptoms and significant morbidity, with subsequent reduced quality of life and increased disease-related work disability.
Currently treatment remains challenging, incorporating surgical and medical management; the latter is driven largely by biologic agents, specifically anti-tumour necrosis factor (TNF) agents such as adalimumab (ADA) and infliximab (IFX). Whilst ADA and IFX have proven efficacy in inducing and maintaining fistula healing and closure, a significant proportion of patients fail to respond or lose response over time. Increasing evidence suggests that this is in part due to sub-therapeutic drug levels, with or without the presence of antibodies to anti-TNF agents (ATA), with higher target drug levels required for fistula healing compared to mucosal healing in Crohn’s Disease. However, data evaluating the correlation between anti-TNF levels and perianal fistula outcomes, particularly with ADA, remain limited.
The aim of this study was to assess the association between anti-TNF levels and perianal fistula healing and closure with maintenance ADA and IFX therapy.
The growing arsenal of therapies available for Inflammatory Bowel Disease (IBD) is improving IBD physicians’ ability to target remission. However, risk of infectious complications associated with immunosuppression is a reality that weighs in the minds of physicians and patients alike, affecting the acceptability of these treatments . Both treatment- and patient-related risk factors for infection have been identified in observational studies. Systemic steroids and combination anti-tumour necrosis factor (anti-TNF) and immunomodulator therapy are particularly associated with increased risk of infection, while non-modifiable patient factors include older age and non-IBD comorbidities [2–4]. Accordingly, this perceived risk results in reduced use of effective therapies in older people, despite risk of disease progression and a need for surgery similar to that in young people [5,6].
As explained by Kochar et al., however, chronological age does not capture the physiological heterogeneity in older populations, possibly leading to treatment being unnecessarily conservative in some. Furthermore, reliance on chronological age may lead to underappreciation of risk in younger people. Accordingly, more accurate tools for risk stratification of patients in the setting of immunosuppressive therapies are required.
How the world has changed during these last couple of months!
I hope you are all doing well despite the circumstances and are coping with the changes in workload, day-to-day activities and research that the pandemic has forced upon us. Also, many Y-ECCOs will have seen their educational programmes and training placed on hold. In Denmark, we have started opening society again since May and the number of infected persons is decreasing. However, there is still a lot of uncertainty about the consequences for society and the health care system. How are things in your country?
Dietary advice in the management of IBD has evolved in recent years from having gastrointestinal symptom reduction as a goal to a more pathogenesis-focussed approach [1–4]. At present, dietary recommendations in adult Crohn’s Disease (CD) are limited to increasing dietary fibre by means of fruit and vegetables and decreasing processed foods . The nutrition debate has long divided adult and paediatric CD care, from international guidelines all the way through to service provision arrangements, with growth failure being a common feature in paediatric CD and dietetic support being a mainstay of care in many children’s hospitals [5–7].