Withdrawal of infliximab or concomitant immunosuppressant therapy in patients with Crohn’s disease on combination therapy (SPARE): a multicentre, open-label, randomised controlled trial

Louis E, Resche-Rigon M, Laharie D, et al; GETAID and the SPARE-Biocycle research group

Lancet Gastroenterol Hepatol 2023;8:215–27.

Introduction

Therapeutic strategies for Crohn’s Disease have evolved over the past decade, with mounting evidence that achieving deep remission (defined as clinical, biochemical and endoscopic remission) is associated with better long-term outcomes [1, 2]. Combination therapy with infliximab and azathioprine has been shown to be superior to either infliximab or azathioprine monotherapy in achieving clinical remission and endoscopic healing in azathioprine-naive patients, thus supporting the paradigm of early disease management and the use of treatment combinations to increase treatment success [3]. Concerns regarding the implications of long-term combination therapy, such as infections and lymphoproliferative disorders, have provided the rationale for a formal clinical trial of treatment de-escalation.

The aim of this trial was to compare the relapse rate and the time spent in remission over 2 years between patients continuing combination therapy and those stopping infliximab or immunosuppressant therapy.

After two consecutive virtual events, the Y-ECCO Basic Science Workshop was back with a face-to-face meeting, reaching its 9^th edition on March 1, 2023, in Copenhagen.

This Workshop aims to involve young fellows in a fully comprehensive manner, giving them the opportunity to present relevant data that were submitted for the scientific programme and discuss their views with successful key opinion leaders in the field of Inflammatory Bowel Diseases (IBD), with special focus on basic and translational research. All sessions open with a hot topic presented by an invited senior specialist, followed by excellent presentations by selected young researchers. The secret of the constant success of this initiative is the friendly atmosphere, which allows participating Y-ECCO Members to increase their knowledge while also preparing for more challenging stages.

Dear Y-ECCO Friends,

I do hope you all enjoyed the ECCO Congress in Copenhagen and made the most of the opportunity to “get physical” again for the first time in too long! I’m sure many will agree that, although virtual conferencing has its positives, much of what makes ECCO such a special organisation to be part of can only be fully realised in person. The fact that this year’s meeting was the first in-person ECCO Congress since before the pandemic only added to the sense of excitement, and the meeting’s content did not disappoint. As is often the case, contributions from Y-ECCO Members made up a sizeable proportion of the original research presented: 58 oral presentations were selected to be presented by Y-ECCO Members and a total of ten Y-ECCO Members were awarded prizes. This again underscores the essential role played by Y-ECCO within ECCO, as a new generation of IBD experts are ushered in. 

After two years of virtual meetings, the main goal of the 18^th ECCO Congress, held in Copenhagen (March 1–4, 2023), was “Let’s get physical”. During this conference we enjoyed the face-to-face interaction, which provided a positive boost to the 8^th H-ECCO Masterclass. The aim of our meeting was not only to discuss the histopathological aspects of Inflammatory Bowel Disease but also to demonstrate the interaction between the different specialisms, which reflects the multidisciplinary collaboration in our daily practice.

Pär Myrelid © ECCO

The 18th ECCO Congress and 12^th S-ECCO IBD Masterclass provided many of us with the opportunity finally to meet in real life and delivered much new knowledge and numerous new insights. This year’s Masterclass was opened by Christianne Buskens, who in a very distinct manner showed us what kind of effect the pandemic and all virtual meetings have had on us by showing a picture from last year’s virtual meeting (we all looked terribly concerned and sad). This can be compared with a picture from this year’s meeting, where good old friends reunited to discuss IBD.

Chen Sarbagili Shabat  © ECCO

After a long hiatus, the 18^th ECCO Congress finally took place in person and face-to-face, which was very exciting. The 8^th D-ECCO Workshop was full, with attendees including not only dietitians but also a great mix of specialists from all around the world. There were three Workshop sessions, on “Food science: there is more than EEN for Crohn’s Disease”, “Practical and clinical advice for the IBD dietitian” and “Psychological aspects of dietary management in IBD”. Apart from these sessions, great discussions were hosted and participated in by D-ECCO Committee Members and external speakers, and the D-ECCO Grant and Travel Awards were handed out.

Miriam Ganon © ECCO

The N-ECCO School ran for the first time in 2010. Its aim is to deliver knowledge on basic aspects of IBD in a clear and precise manner in order to enable nurses and those with an interest in the subject to provide better support to IBD patients throughout Europe and beyond. In addition, the N-ECCO School has come to serve as a great networking opportunity for both nurses and dietitians, allowing them to share experiences and plans for furtherance of their careers and demonstrating the importance of the MDT approach to IBD care.

Tim Raine  © ECCO

In stepping down as the Chair of GuiCom, it is my absolute pleasure to welcome and introduce our newest member of the committee, Henit Yanai. Henit is the director of the IBD centre at the Rabin Medicine Centre in Petach Tikva, Israel and is also a faculty member at the Department of Gastroenterology and Liver Disease, Tel Aviv University. But in addition to her long and distinguished list of accomplishments, I’ve also had the pleasure of getting to know Henit through ECCO as a friend. Most recently, Henit was the Chair of the ECCO Educational Committee, which she led through the challenges and disruptions of the COVID-19 pandemic. She has also previously served as the National Representative to ECCO for Israel. She has organised the ECCO Advanced Course, where generations of the brightest and best of new IBD talent have benefited from her dynamic leadership and teaching.

The 3^rd ECCO Postgraduate Course in IBD, entitled "It's getting more complicated!", was successfully held on-site during the 18^th ECCO Congress in Copenhagen in March 2023. The course was split into two sessions, with the first session focusing on common complications in IBD practice, which were presented by renowned speakers who are key opinion leaders in the field. The second session was an interactive discussion with expert panelists, who discussed two vignettes that looked at practical assessment and decision making in the context of complicated Crohn’s Disease and Ulcerative Colitis.

Mariangela Allocca  © ECCO

Finally, after a hiatus of two years owing to the global COVID-19 pandemic, the 10^th ECCO Ultrasound Workshop – Advanced in collaboration with ESGAR & IBUS took place physically at ECCO’23 in Copenhagen.