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!
For this Y-ECCO Interview Corner we met with Shaji Sebastian, who is known to everyone as Seb, on the Friday of the ECCO Congress. Seb has had a long association with ECCO. He is the outgoing Chair of ClinCom and was elected as Treasurer of ECCO at this year’s General Assembly. He is a consultant in Hull in the North of England, having got there through a somewhat circuitous route, as we will hear...
The SONIC trial yielded seminal findings showing that the combination of infliximab and azathioprine is more effective than either treatment alone for the maintenance of remission in patients with Crohn’s Disease (CD) [1]. In recent years, despite the availability of an increasing number of biologics and small molecules to treat CD, a ceiling of therapeutic efficacy has been reached [2]. Therefore, there has been a resurgence of interest in whether this therapeutic ceiling “effect” can be overcome with new treatment combinations. In the EXPLORER study, the efficacy and safety of triple combination therapy was assessed using two biologics with different modes of action in association with methotrexate for the treatment of CD.
Higher intra-abdominal visceral adipose tissue mass is associated with lower rates of clinical and endoscopic remission in patients with inflammatory bowel diseases initiating biologic therapy: Results of the Constellation Study
Despite an expanding therapeutic arsenal, a considerable proportion of patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) fail to achieve or sustain therapeutic responses [1, 2]. Mechanisms contributing to this failure, particularly with respect to biologic therapy, are only partially understood [3]. Uncovering the mechanisms behind loss of response may help to enhance the efficacy of existing treatment options or to develop alternative options for the future.
Some investigations have noted an association between obesity, high intra-abdominal visceral adipose tissue (IA-VAT) mass and unfavourable outcomes in individuals with Inflammatory Bowel Disease (IBD). However, these observations have been constrained by their methodology and have to date focused only on patients having treatment with anti-tumour necrosis factor alpha (anti-TNF-α) agents [4–6], limiting their scope.
The Constellation Study by Yarur and colleagues aimed to investigate the relationship between IA-VAT in patients with IBD and the response to biologic drugs with multiple different mechanisms of action.
Patients will often ask, “What causes Inflammatory Bowel Disease?” Frustratingly, we remain unable to answer this seemingly simple question, beyond the often-quoted paradigm that unknown environmental factors trigger inflammation in genetically susceptible individuals. Although our understanding of the immune response in IBD has reached phenomenally detailed levels of resolution, the nature and identity of the initial environmental triggers of IBD have continued to remain a mystery. The strong relationship between socioeconomic development and IBD incidence is tantalising evidence of a definable environmental toxin and various substances such as processed food additives have recently been highlighted as potential suspects [1]. However, searching for the causative agent is like looking for a needle in a haystack as the candidate list includes literally every small molecule in existence!
The Y-ECCO Science Workshop celebrated its 10th edition during the recent ECCO Congress in Stockholm. Held on February 21, 2024, the workshop invited young basic scientists to present and discuss their research with peers and senior opinion leaders. This year’s edition proved a tremendous success, inspiring Y-ECCO Members with a friendly yet intellectually stimulating atmosphere and encouraging them to broaden their knowledge and to prepare for more challenging research steps.
Maria Manuela Estevinho
Bram Verstockt
Robin Dart
