Christian Maaser  © ECCO

At ECCO 2020 two ultrasound workshops were held. The 2^nd ECCO-ESGAR Basic Imaging Workshop was devoted to the basics of intestinal ultrasound (IUS) and MRI. In this workshop, gastroenterologists from ECCO who are experts in intestinal ultrasonography and radiologists from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) who are experts in IBD jointly provided delegates with a full immersion in imaging in IBD. 

Sophie Restellini © ECCO

Julien Kirchgesner © ECCO

The Epidemiological Committee (EpiCom) organised the 5^th EpiCom Workshop at the ECCO’20 Congress in Vienna. The delegates were welcomed by Marieke Pierik, who introduced the concept of patient-reported outcomes (PRO) with the aid of a clinical case. The discussion continued by examining discrepancies between what a treating physician defines and sees as a response to therapy and the perceptions of the treated patient. Physician and patient may hold different views on the effectiveness of a treatment, particularly if the physician bases the evaluation of treatment success solely on improvements in clinical, biochemical and endoscopic measurements, without considering the patient’s quality of life and wellbeing. Integration of PROs into the evaluation can play a pivotal role in overcoming this issue.

Shaji Sebastian © ECCO

The mission of ClinCom is to promote investigator-initiated studies among ECCO Members. The Committee welcomes submissions from investigators and national study groups and evaluates and critically appraises the quality, feasibility and practicality of each study proposal. The 5^th IBD National Study Group Meeting, held on February 12 during the ECCO 2020 Congress, featured presentations from five investigators on proposals for high-quality collaborative studies which will be suitable for running across national study groups.

Uri Kopylov  © ECCO

This year’s 7^th ClinCom Workshop focussed on two main topics. The first session was devoted to sequencing and combination of different IBD treatments for IBD. The speakers addressed the possible biological implications of drug sequencing and the mechanistic changes in the inflammatory pathways.

Krisztina Gecse © ECCO

Peter Bossuyt © ECCO

The ECCO Congress offers an ideal opportunity to learn, share and interact. This was also the main purpose of the 5^th Basic ECCO: EduCational COurse for Industry, held on Wednesday, February 12, 2020.  The course aimed to provide corporate and non-corporate members who have recently entered the field of IBD with an introduction to IBD, focussing on the clinical essentials and ‘need-to-knows’. 104 participants from 23 countries attended the course.

Sebastian Zeissig  © ECCO

One of the main goals of ECCO is to promote IBD-related basic and clinical research as well as to foster interaction and productive collaboration among European research groups working in the IBD field. To achieve this goal, ECCO supports numerous funding schemes with different scopes including ECCO Fellowships, Grants, and Travel Awards.

Efficacy and safety of mirikizumab in a randomized phase 2 study of patients with Ulcerative Colitis

Sandborn WJ, Ferrante M, Bhandari BR, Berliba E, Feagan BG, Hibi T, Tuttle JL, Klekotka P, Friedrich S, Durante M, Morgan-Cox M, Laskowski J, Schmitz J, D'Haens GR

Gastroenterology. 2019;doi: https://doi.org/10.1053/j.gastro.2019.08.043. [Epub ahead of print]

Introduction

Hajir Ibraheim © Hajir Ibraheim

Interleukin-23 (IL23) contributes to the pathogenesis of chronic inflammatory diseases, including Ulcerative Colitis (UC), by maintaining and amplifying T helper 17 cells and stimulating many innate immune cells. IL-23 is a heterodimeric cytokine composed of a p40 subunit (shared by IL12) and a p19 subunit (IL-23p19). Ustekinumab, a monoclonal antibody targeting the shared p40 subunit, is effective for treatment of Crohn’s Disease (CD) and psoriasis [1–3]. However, studies in patients with psoriasis have suggested that selective targeting of the IL23 pathway by blocking IL-23p19 is more effective than ustekinumab [4, 5]. Whilst promising phase 2 results have been observed in CD patients following treatment targeting IL-23p19 [6, 7], the role of this therapeutic strategy in UC is unknown. Mirikizumab (LY3074828) is a humanised immunoglobulin G4 (IgG4)-variant monoclonal antibody that binds to the IL-23p19 subunit. The current study evaluated the efficacy and safety of mirikizumab for the treatment of patients with moderate-to-severely active UC. 

Tight control for Crohn’s Disease with adalimumab-based treatment is cost-effective: An economic assessment of the CALM trial

Panaccione R, Colombel J-F, Travis SPL, Bossuyt P, Baert F, Vaňásek T, Danalıoğlu A, Novacek G, Armuzzi A, Reinisch W, Johnson S, Buessing M, Neimark E, Petersson J, Lee W-J, D’Haens GR GR

Gut 2019 Jul 8. doi: 10.1136/gut-jnl-2019-318256 [Epub ahead of print].

Introduction

Jennie Clough © Jennie Clough

It is widely accepted that a ‘treat-to-target’ (T2T) approach of continual assessment against established biomarkers and early treatment optimisation is important in preventing progression in Crohn’s Disease (CD) [1], and in 2015 the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) programme was initiated to define a T2T approach for CD [2].

CALM was an open-label, multicentre, randomised controlled phase 3 study comparing the outcome of a ‘tight control’ (TC) adalimumab-based treatment strategy against standard clinical symptom-based management (CM) for patients with early CD [3]. Treatment of patients in the TC arm was escalated in a stepwise manner in response to elevated C reactive protein (CRP) or faecal calprotectin, even in the absence of symptoms. A significantly higher proportion of patients in the TC group achieved the primary endpoint of mucosal healing (CDEIS<4) at 48 weeks compared to the CM group (46% vs 30%).

Perhaps unsurprisingly, a TC approach led to higher rates of adalimumab usage than a conventional approach [3]. Biologics constitute a significant cost in managing Inflammatory Bowel Disease, with other major cost drivers being hospital admission and surgical management [4]. As rates of surgery and hospitalisation have decreased with the advent of biologics [5, 6], costs have shifted to outpatient care, drug acquisition and infusion unit management [7].

This study sought to model the costs of a TC versus a conventional approach, to determine whether the increased biologic costs could be offset by a reduction in hospital attendance and need for surgery, and enhanced economic outputs associated with increased wellbeing.  

Infliximab induction regimens in steroid‐refractory acute severe colitis: A multicentre retrospective cohort study with propensity score analysis

Sebastian S, Myers S, Argyriou K, Martin G, Los L, Fiske J, Ranjan R, Cooper B, Goodoory V, Ching HL, Jayasooriya N, Brooks J, Dhar A, Shenoy AH, Limdi JK, Butterworth J, Allen PB, Samuel S, Moran GW, Shenderey R, Parkes G, Lobo A, Kennedy NA, Subramanian S, Raine T

Aliment Pharmacol Ther. 2019;50:675–683. doi: 10.1111/apt.15456..

Introduction

Joshua McGuire © Joshua McGuire

Acute Severe Ulcerative Colitis (ASUC) is a medical emergency which necessitates a colectomy in up to 30% of cases on index presentation [1]. The first-line treatment is with intravenous corticosteroids but up to 40% of patients will fail to respond [2]. Ciclosporin and infliximab are then well-recognised options for rescue therapy to avert the need for a colectomy and, whilst there appear to be no difference in response rates between these two choices [3], many experts favour infliximab owing to convenience and familiarity [4]. Up to 55% of patients do not respond to the standard dosing regimen of infliximab extrapolated from the outpatient setting [5]. The exaggerated clearance of infliximab in ASUC is increasingly better characterised [6]; this has led to the concept of accelerated dosing regimens although the efficacy of such regimens has yet to be evaluated by randomised controlled trials. A recent meta-analysis [7] of the available cohort studies showed no benefit of accelerated induction in reducing colectomy rates in steroid‐refractory disease; however, provider bias represents a significant barrier to answering this question. Propensity score matching seeks to address this provider bias.

Dominik Bettenworth © ECCO

Dear Y-ECCO Friends,

I hope this Members’ Address finds you well.

Those who want to succeed in academia have to lead and love the life of an academic athlete. This lifestyle, together with its (daily?) exercises and training tools, has been masterfully illustrated by Eric Benchimol and Richard Keijzer in a recent article for the Mentoring, Education, and Training corner in Gastroenterology (Gastroenterology 2018;154:8–14). Indeed, the advent of technological applications has created powerful tools to improve organisation and productivity. Furthermore, social media provides valuable platforms that have substantially decreased barriers between different centres, experts from other disciplines and even colleagues from other continents, making it possible to connect in real time.