Marta Maia Bosca-Watts

Erratum to: Effectiveness of adalimumab for the treatment of ulcerative colitis in clinical practice: comparison between anti-tumour necrosis factor-naïve and non-naïve patients

Background Ulcerative colitis (UC) treatment is focused to achieve mucosal healing, avoiding disease progression. The study aimed to evaluate the real-world effectiveness of adalimumab (ADA) in UC and to identify predictors of remission to ADA.

Short-term effectiveness of golimumab for ulcerative colitis: Observational multicenter study

AIM To evaluate the real-world effectiveness of golimumab in ulcerative colitis (UC) and to identify predictors of response. METHODS We conducted an observational, prospective and multi-center study in UC patients treated with golimumab, from September 2014 to September 2015. Clinical activity was assessed at week 0 and 14 with the physician’s global clinical assessment (PGA) and the partial Mayo score. Colonoscopies and blood tests were performed, following daily-practice clinical criteria, and the results were recorded in an SPSS database. RESULTS Thirty-three consecutive patients with moderately to severely active UC were included. Among them, 54.5% were female and 42 years was the average age. Thirty percent had left-sided UC (E2) and 70% had extensive UC (E3). All patients had an endoscopic Mayo score of 2 or 3 at baseline. Twenty-seven point three percent were anti-tumor necrosis factor (TNF) treatment naïve, whereas 72.7% had previously received infliximab and/or adalimumab. Sixty-nine point seven percent showed clinical response and were steroid-free at week 14 (a decrease from baseline in the partial Mayo score of at least 3 points). Based on PGA, the clinical remission and clinical response rates were 24% and 55% respectively. Withdrawal of corticosteroids was observed in 70.8% of steroid-dependent patients at the end of the study. Three out of 10 clinical non-responders needed a colectomy. Mean fecal calprotectin value at baseline was 300 μg/g, and 170.5 μg/g at week 14. Being anti-TNF treatment naïve was a protection factor, which was related to better chances of reaching clinical remission. Twenty-seven point three percent of the patients required treatment intensification at 14 wk of follow-up. Only three adverse effects (AEs) were observed during the study; all were mild and golimumab was not interrupted. CONCLUSION This real-life practice study endorses golimumab’s promising results, demonstrating its short-term effectiveness and confirming it as a safe drug during the induction phase.

HLA-DQ: Celiac disease vs inflammatory bowel disease

AIM To determine the genetic predisposition to celiac disease (CeD) in inflammatory bowel disease (IBD) patients by quantifying the frequency of CeD-related human leucocyte antigen (HLA) (HLA-CeD: HLA-DQ2 and -DQ8) in IBD patients globally, by type of IBD and gender, and by calculating the protective/risk contribution of these haplotypes in the development of the IBD disease. METHODS We conducted a prospective study with IBD patients from our Unit. Clinical information was gathered and blood was tested for HLA-CeD. The control group was made up of unrelated Valencian organ donors. RESULTS 1034 subjects were analyzed: 457 IBD [207 ulcerative coliti (UC) and 250 Crohn’s disease (CD)] patients and 577 healthy controls. 39% of the controls and 34% of the patients had HLA-CeD (P = 0.0852). HLA-DQ2 was less frequent in UC patients (P = 0.0287), and HLA-DQ8 in CD (P = 0.0217). In women with UC, the frequency of DQ2.5cis (DQB1*02:01-DQA1*05:01) was reduced ≥ 50% [P = 0.0344; preventive fraction (PF) = 13%]. PFs (7%-14%) were obtained with all HLA-CeD haplotypes. HLA DQB1*02:02-DQA1*02:01 (HLA-DQ2.2) was more frequent in CD patients with respect to controls (P = 0.001) and UC patients (etiological fraction = 15%). CONCLUSION HLA-CeD is not more frequent in IBD patients, with an even lower frequency of HLA-DQ2 and -DQ8 in UC and CD respectively. HLA-DQ2.5 confers protection from the development of UC, especially in women, and HLA-DQ8 does so for the appearance of CD. HLA-DQ2.2 is present in 34% of the CD patients and may constitute a genetic risk factor for CD development.

Inflammatory bowel disease in patients over the age of 70 y. Does the disease duration influence its behavior

Abstract Introduction: The fastest growing segment of our population is that of people above 70 years of age. Elderly patients with IBD exhibit several specific problems. Our objective was to evaluate the clinical course, the side effects of the treatments and the need for surgery of elderly patients, regardless of the age of onset. Materials and Methods: This was a cross-sectional study wherein retrospective data were collected from multiple centers from seven hospitals within the Valencia metropolitan area. Data were collected on patients older than 70 y with inflammatory bowel disease. Results: We identified a total of 331 patients older than 70 years of age (5.3% of patients monitored at our centers). The mean age at the time of the study was 77.34 y (±5.39). Mesalamine were the most frequently used medications. Corticosteroids were used in 66% of the patients. However, the use of corticosteroids and biologics was less probable in older patients (OR 0.96, p = .06). The longer the disease progressed, the more immunosuppressive medications were used (OR 1.3, p = .052). Neoplasms appeared in 41 patients (13%). Of the 36 patients with tumors that appeared after the onset of the disease, 20 patients had not been treated with immunomodulators or biologics. Conclusions: Mesalamine was the most frequently used medication. There is no increased risk of tumors regarding the medications used. The use of immunosuppressive medications is more prevalent with longer disease progression times, although with a high rate of adverse events.

The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

Treatment paradigms for Crohn′s disease with perianal fistulae (CD‐pAF) are evolving.

Sa1170 Inflammatory Bowel Disease in the Late Elderly: Clinical Aspects, Immunosupression and Surgery

presence and number of EIMs and young age at onset (p=0.03 OR: 1.77, 95%CI: 1.003.08), disease extent (pextensive=0.003 OR: 3.58, 95%CI: 1.37-9.30) and female gender (p= 0.07, OR: 1.57 95%CI: 0.90-2.77), but not with smoking and colectomy. Presence of EIMs was associated with need for steroids (p<0.001, OR: 3.1, 95%CI: 1.74-5.51) and azathioprine (p=0.004, OR: 2.57, 95%CI: 1.35-4.89) in both univariate and logistic regression analysis. In Kaplan-Meier analysis there was an association between the presence of EIMs and time to first IBD-related hospitalization (p=0.002). Conclusions: Presence of EIMs in UC was associated with the treatment steps and need for hospitalization.

Su1189 There Is a Different Tissue Transglutaminase (tTG) Distribution in Celiac Disease (CD) and Inflammatory Bowel Disease (IBD) Duodenal Mucosa

central review of endoscopic images on patient selection and trial outcomes. Methods: We utilized data from a placebo-controlled randomized trial of Asacol®, an 800mg formulation of mesalamine, conducted in patients with mildly-to-moderately active UC (NCT01059344). Eligible patients had a UC-DAI total score of 4 10 and an endoscopy sub-score 2. Patients were randomized 1:1 to Asacol® 4.8 g/day or placebo for 10 weeks. Outcomes were assessed at weeks 6 and 10. Post-hoc exploratory analyses compared week 6 clinical and endoscopic outcomes in site investigator (SI)and central reader (CR)-defined endoscopically eligible populations, as well as outcomes in CReligible patients using SI versus CR scoring. Results: A total of 281 patients comprised the SI population. Of these, 194 (69%) were considered eligible by the CR and were included in CR-based analyses. The effect size (percent difference Asacol® minus placebo) was consistently greater for all outcomes in the CR-versus SI-defined population (see Table 1). Placebo rates were uniformly greater in the SI population due to inclusion of patients with low endoscopic disease activity as judged by the CR. No difference in effect size was observed between CRand SI-based outcomes at week 6 in the CR-defined population.