The incidence and prevalence of IBD varies throughout the world, with the highest incidence seen in industrialised regions of North America and Europe [1]. Within Europe an East–West gradient has been demonstrated, with Western centres showing almost twice the incidence observed in Eastern centres [2].
The general trend in migration is from lower and middle income countries to higher income countries in Western Europe and North America.
IBD manifests with numerous faces. It became clear some time ago that only by joining forces across multiple countries would we perhaps be able to identify and study rare manifestations of IBD and its complications. This was the reason why the CONFER taskforce (COllaborative Network For Exceptionally Rare case reports) was initiated under the auspices of the ClinCom committee.
ECCO is proud of its continuing commitment to support innovative IBD research through its Fellowships, Grants and Travel Awards, including our flagship Pioneer Awards. Our grant programme now extends beyond the borders of Europe with the emergence of our new Global Grant supporting IBD research for low and lower-middle income countries. All of these research efforts continue to improve our understanding of IBD and change outcomes for our patients. None of this would be possible without our community of grant reviewers who provide an invaluable scientific service to the ECCO Family and the broader field of IBD. We owe an enormous debt of gratitude to our growing reviewer network of more than 500 experts, who have reviewed over 750 applications.
In this issue of the ECCO Newsletter we really wanted to highlight two “super reviewers”, Amy Lightner and Hannah Gordon, who have gone above and beyond the call of duty and delivered the highest overall number of reviews. Thank you both! To better understand the peer review process, what motivates reviewers and why potential reviewers in the ECCO Community might want to get involved in the process, I caught up with Amy and Hannah.
This issue's Interview Corner is dedicated to Fernando Magro, the current President-Elect of ECCO. Fernando Magro is a gastroenterologist and head of the Clinical Pharmacology Department at University Hospital São João in Porto, Portugal, where he also serves as a Professor of Pharmacology and Therapeutics. He is a founding member of the Portuguese Inflammatory Bowel Disease Group and an active researcher focusing on the management, treatment and prognosis of IBD. His dedication to ECCO is nothing new, as you'll read below. I took this opportunity to learn more about the academic and clinical journey of the person I'm glad to call my mentor.
Increased versus conventional adalimumab dose intervals for patients with Crohn’s disease in stable remission (LADI): a pragmatic, open-label, non-inferiority, randomised controlled trial
van Linschoten RCA, Jansen FM, Pauwels RWM, et al.
Adalimumab is an effective and safe treatment for Crohn’s Disease (CD). However, both patients and healthcare professionals may wish to mitigate medication exposure due to potential safety and economic concerns in the long term. Since a high relapse rate follows drug discontinuation, treatment de-escalation without actually stopping the medication may allow for decreasing drug exposure while maintaining efficacy. In two observational studies, de-escalation from a 2-week to a 3-week adalimumab dosing interval was successful in most of the patients, though reversal to a 2-week dosing interval was required in about 30% due to insufficient disease control [1, 2]. The Lengthening Adalimumab Dosing Interval (LADI) study is a pragmatic, open-label, multicentre, non-inferiority, parallel, randomised controlled trial conducted in the Netherlands and specifically designed to address this knowledge gap [3].
Withdrawal of immunomodulators or TNF antagonists in patients with inflammatory bowel diseases in remission on combination therapy: A systematic review and meta-analysis
Combination therapy with anti-TNF inhibitors (ATI) and immunomodulator (IMM) therapy remains an efficacious treatment strategy for disease control in moderate to severe Inflammatory Bowel Disease (IBD). This conclusion was largely based on the findings of landmark trials, SONIC and UC SUCCESS, which showed combination therapy to be far superior to monotherapy in achieving durable clinical and endoscopic remission in IBD [1, 2].
However, combination treatment with ATI and IMM can lead to increased risk of infection and malignancy. Whilst withdrawal of combination treatment once the patient is in disease remission can reduce the risk of treatment-related complications as well as the cost to health services, there remains a risk of relapse of previously controlled disease. At present there is no consensus amongst global clinical guidelines as to the appropriate duration of use of combination therapy. Thus, clinicians often find decisions related to withdrawal of treatment quite challenging.
The gut microbiota of patients with Inflammatory Bowel Disease (IBD) may have a role in disease aetiology and course [1]. Patients with IBD often have dysbiotic microbiota, with lower microbial diversity and cell counts, with both absolute and relative abundance of commensal microorganisms [2, 3]. Conversely, during remission following anti-inflammatory therapy, the gut microbiota has been observed to shift to a more eubiosis-like composition [3–6]. Furthermore, lower proportions of taxa with pro-inflammatory properties and mucus-degrading bacteria, as well as higher proportions of short-chain fatty acid-producing bacteria, have been associated with a higher likelihood of favourable outcomes with medical treatment [3, 5, 6]. In this study, Caenepeel and colleagues monitored changes in intestinal microbiota and stool features in order to develop and validate a predictive model to assist clinicians in determining a patient-specific therapeutic strategy.
Can you believe that it’s been only four months since the last ECCO Congress? I bet that many of you are already knee-deep in exciting research for ECCO 2025 in Berlin, so mark your calendars and keep an eye open for the abstract submission deadline. You can’t miss that, as we want to see your top-notch research! Maybe you are the next Y-ECCO Best Abstract awardee!
The last decade has seen a dramatic increase in drugs available for the treatment of IBD. However, each of these novel biologics or small molecules achieves disease remission in only a relatively small proportion of patients [1].To date, implementation in clinical practice of evidence that assists in better evaluating the chance of therapy success in a particular patient for a particular drug is limited. Therefore, when choosing a drug for a patient with IBD who is starting therapy or needs to switch drugs, a trial-and-error approach may be unavoidable.
To address this unmet clinical need, several research groups have now turned their attention to biomarker discovery to allow development of an evidence-based personalised treatment strategy [2]. At this year’s Congress of ECCO in Stockholm, I had the opportunity to provide an update on the field of biomarker discovery from the perspective of a pathologist. In this issue of ECCO News, I want to share with you the most important points from that H-ECCO Masterclass talk.
Caroline Nordenvall has recently joined the S-ECCO Committee. She works at the Karolinska University Hospital as an IBD surgeon and is head of the research group in colorectal surgery. She is an Associate Professor within the University.
Maria Manuela Estevinho
Bram Verstockt
