Laurent Beaugerie © ECCO

This year’s 4^th School for Clinical Trialists, organised by the ECCO Clinical Research Committee (ClinCom), offered an excellent opportunity to review all the key points of the balance between expected efficacy and potential risks of IBD drugs, in the contexts of both clinical trials and routine care.

JAK-STAT-driven immunometabolism as a novel principle in the pathophysiology of Ulcerative Colitis

Janus kinase (JAK) inhibition is a novel therapeutic approach in the management of Ulcerative Colitis (UC). However, the role of JAK inhibition with respect to cell-specific immunometabolic properties is not known.

The overall aim of this multi-year research proposal is to generate deeper understanding of the interplay of JAK inhibition and immunometabolic properties in the intestinal mucosa at a cellular level and thereby to open up new avenues in biomarker development and novel targeted interventions in UC. This aim is being pursued by (i) identifying immunometabolomic signatures of JAK inhibition in UC patients using multi-omics analysis of longitudinal therapy response cohorts and (ii) modelling the impact of two metabolic principles, namely amino acide (e.g. tryptophan) and short-chain fatty acids (e.g. butyrate), on the efficacy of JAK inhibition in ex vivo organisms.

Yves Panis © ECCO

Precision medicine in IBD 

The ninth edition of the SciCom Workshop, held during the 16^th Congress of ECCO, was dedicated to recent advances in "Precision medicine in IBD", covering different aspects from disease prevention to prediction of disease course and therapeutic responses and potential strategies for disease cure.

Charlotte Hedin © ECCO

Dr. Rupa Banerjee is a senior consultant gastroenterologist in the Department of Gastroenterology and Director of the Inflammatory Bowel Diseases (IBD) Centre at the Asian Institute of Gastroenterology, Hyderabad, India. She is also Director of IBD Research with the Asian Healthcare Foundation, Hyderabad. 

Dr. Rupa established the first dedicated IBD centre of excellence in India in 2004. She has designed and maintains a 6500-patient database and biorepository for the centre detailing the demographics, type and course of disease and response to treatment in the Indian subpopulation.

Her primary focus has been optimal and affordable multidisciplinary care of IBD. The outpatient clinics run from early morning to late evening, and many of the patients are from middle- or low-income strata. The centre has adopted a large cluster of villages for screening for IBD, including blood and endoscopic evaluations free of cost to enable early diagnosis and with house-to-house surveys on the incidence and prevalence of IBD in the region.

Dr. Rupa is actively involved in research on IBD in the Asian region, focussing on the epidemiology, microbiota and genetic profile of this population for the purposes of optimisation and individualisation of the management of IBD. 

Dr. Rupa has initiated the IBD-ENC (IBD – Emerging Nations Consortium), comprising more than 20 countries in South Asia, Middle East and Africa, to promote collaborative work on IBD in these parts of the world. She has been the key person in the design of the interactive web platform for the IBD-ENC (www.ibdenc.org), which presents IBD news and the latest publications, discusses challenging cases and offers members the unique opportunity to create their own patient IBD registry.

Dr. Rupa has received support from the Helmsley Charitable Trust, USA for the Rural programme for early diagnosis of Crohn’s Disease.

DEEP REMISSION AT 1 YEAR PREVENTS PROGRESSION OF EARLY CROHN’S DISEASE

Ungaro RC, Yzet C, Bossuyt P, et al.

Gastroenterology 2020;159:139–47.

Omer Serhan Omer © Omer Serhan Omer

Introduction

Despite recent advances in medical therapy, patients with Crohn’s Disease may still suffer disease progression requiring surgery and hospitalisation. It is increasingly recognised that early effective therapy is associated with improved patient outcomes and there is growing emphasis on early intervention, treat to target and tight control (TC) approaches [1]. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) programme highlighted the importance of targetting deep remission, defined as resolution of symptoms and objective resolution of inflammation on endoscopy [2]. The Effect of Tight Control Management on CD (CALM) study recently demonstrated that a TC approach in which therapy is escalated based on objective markers of inflammation [faecal calprotectin and C-reactive protein (CRP)], in addition to symptoms, is an effective strategy to achieve endoscopic and deep remission [3]. 

DRUG SURVIVAL OF ANTI-TNF AGENTS COMPARED WITH VEDOLIZUMAB AS A SECOND-LINE BIOLOGICAL TREATMENT IN INFLAMMATORY BOWEL DISEASE: RESULTS FROM NATIONWIDE SWEDISH REGISTERS

Sara Rundquist, Michael C Sachs, Carl Eriksson, Ola Olén, Scott Montgomery, Jonas Halfvarson, SWIBREG Study Group

Aliment Pharmacol Ther 2021;53:471–83. doi: 10.1111/apt.16193.

Samuel Lim © Samuel Lim

Introduction

The advent of monoclonal antibody therapy has propelled the management of Inflammatory Bowel Disease firmly into the biologic era, with numerous biologic therapies now licensed or in various stages of development.

Anti-tumour necrosis factor (TNF) agents such as infliximab [1, 2], adalimumab [3, 4] and golimumab [5] were the first biologics to be developed and have the greatest body of evidence for their effectiveness and safety in the treatment of Crohn’s Disease (CD) and Ulcerative Colitis (UC). The arrival of biosimilars has brought down costs and made treatment with anti-TNF more widespread, such that they are the most important first-line treatment option for moderate to severe IBD.

Johan Burisch © ECCO

Dear Y-ECCO Friends,

I hope that you are all doing fine and that you managed to submit your abstract to the virtual ECCO Congress before the deadline. As always, we will select the best abstracts submitted by Y-ECCO Members for the Y-ECCO Award 2021. We are really excited to read about your research and, of course, hear all about it at the Congress.

Pamela Baldin © ECCO

Paediatric-onset Inflammatory Bowel Diseases (IBDs) represent about 25%–30% of all IBDs. As in adult patients, cases are classified as Ulcerative Colitis (UC) or Crohn’s Disease (CD). In addition, a third diagnostic category, unclassified-IBD (U-IBD), can be used when a definite differential diagnosis between UC and CD is not possible.

Paediatric-onset IBDs, by definition, are those IBDs which are diagnosed in children and adolescents under the age of 17 years. They are further categorised as very early onset IBD (VEO-IBD) when the disease is diagnosed before 6 years of age, infantile IBD when the diagnosis is made before 2 years of age and neonatal-onset IBD when the patient is 28 days old or less. 

Anti-tumor necrosis factor alpha (TNFα) therapy is frequently used in the treatment of Crohn’s Disease (CD) and Ulcerative Colitis (UC) in both adult and paediatric patients. Nevertheless, primary or secondary treatment failure of anti-TNFα treatment is not uncommon [1]. Both primary and secondary treatment failures are attributed either to pharmacokinetic, pharmacodynamic and immunogenic factors or to adverse events in response to the specific agent [2]. In recent years, loss of response (LOR) during anti-TNFα treatment has commonly been approached through the use of therapeutic drug monitoring involving measurement of infliximab or adalimumab trough concentrations (TC) and anti-drug antibodies (ADAs). Therapeutic drug monitoring of anti-TNFα agents enables proper stratification of LOR into a specific type of LOR, with corresponding adjustment of treatment. In children, in line with findings in adults, it has consistently been shown that higher drug TC is associated with higher efficacy [3] and that LOR is most commonly attributable to either low TC or the development of anti-drug antibodies [4].

“One cannot think well, love well, sleep well, if one has not dined well.” ― Virginia Woolf

Unfortunately for many of our patients, dining well is often not an option since their disease symptoms give rise to wariness about the foods they eat. Patients are forced to consider how they may feel after a meal and to take into account their requirement for toilet facilities and ability to cope with pain. They often forego social eating to manage these aspects. This can negatively impact their social interactions, daily activities and food-related quality of life [1]. Coupled with this, patients with IBD have higher rates of depression and anxiety [2] and a higher incidence of behavioural, psychological and eating disorders [3]. Self-directed food exclusions can trigger these disorders and lead to higher nutritional risk. We need to be mindful of this when addressing diet and nutrition with our patients. It is important that we consider the implications of asking patients to modify their diets for disease or symptom management while taking into account their desire to use diet as a tool to manage their disease.