BackgroundThere is limited real-word data comparing efficacy of low dose upadacitinib (UPA) to high dose UPA as maintenance therapy for ulcerative colitis (UC).MethodsThis was a retrospective cohort study utilizing the U.S. Collaborative Network in adults ≥18 years old with UC who initiated UPA 15 mg compared to 30 mg for maintenance therapy between April 2022 and December 2023. The primary outcome was a composite of intravenous steroid use, oral steroid use, or colectomy from 12 to 60 weeks from the index UPA prescription. Propensity score matching (PSM) was performed for demographics, co-morbid conditions, laboratory, and IBD medication history. Cox proportional hazard model was used to identify predictors of failure.ResultsAmong 1110 patients on UPA maintenance therapy, 361 (32.5%) were on 15 mg and 749 (67.5%) were on 30 mg. After PSM, there was no difference in the composite outcome of steroid use or colectomy between the 15-mg UPA cohort versus 30 mg cohort (35.3% vs 35.6%; aHR 0.95, 0.71-1.24, P = .8). There was no difference in IV steroid use, oral steroid use or change in therapy between the two cohorts. There was no difference in the proportion of patients who achieved a fecal calprotectin of <250 μg/g (55.8% vs 63.5%, P = .33). Recent oral or IV steroid use and rheumatoid arthritis were associated with failure of both 15 mg and 30 mg UPA.ConclusionOur study indicates that 15 mg UPA shows similar efficacy as 30 mg UPA for maintenance treatment in a subset of patients with UC.

BackgroundInflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). While several studies have explored patients’ general knowledge of IBD, less is known about their awareness of CRC risk and its management. This systematic review aimed to synthesize the available evidence on IBD patients’ awareness of CRC risk and its related management strategies.MethodsMedline, EMBASE, and PubMed databases were searched from inception to November 2023. All study designs and publication types were considered. Non–English studies and those assessing only general IBD knowledge were excluded. The appraisal tool for cross-sectional studies (AXIS) was used to assess the quality of studies.ResultsTwenty-three studies (17 papers and 6 conference abstracts), including 4674 participants (2481 with ulcerative colitis, 53.5% females) were included. Overall, 18 studies assessed CRC risk knowledge, 7 reported attitudes toward cancer screening, and 8 explored knowledge or attitude regarding colectomy for dysplasia. Patients demonstrated moderate awareness of CRC risk, limited knowledge of risk factors, and moderate levels of fear regarding this complication. Awareness of the diagnostic role of colonoscopy was high, but attitudes toward the procedure were mixed, largely due to concerns about complications. Awareness of appropriate screening initiation and willingness to undergo colectomy for dysplasia, regardless of the risk level, were generally low.ConclusionsEvidence on IBD patients’ awareness of CRC risk and its management remains limited, restricting firm conclusion about the extent of knowledge and educational needs. Further research is required to better characterize patients’ understanding and to inform targeted education strategies.

BackgroundThis post hoc analysis of a 60-week post-marketing surveillance (PMS) study in Japan assessed tofacitinib safety and effectiveness in patients with ulcerative colitis (UC), stratified by prior biologic exposure.MethodsThe PMS study registered all patients with UC receiving tofacitinib in Japan (May 2018-June 2021). Outcomes included the proportion of patients with clinically important adverse events (AEs), incidence rates (IR; unique patients with events/100 patient-years of exposure) of clinically important AEs, reasons for discontinuation, and effectiveness (partial Mayo score remission). Patients were stratified by prior biologic exposure (biologic-experienced/biologic-naïve). Prior biologics included infliximab, adalimumab, golimumab, and others (eg, ustekinumab/vedolizumab).ResultsOverall, 1367 biologic-experienced and 615 biologic-naïve patients were included. More biologic-naïve versus biologic-experienced patients (30.6% vs. 16.9%) had disease duration <2 years. Proportions of AEs were similar between groups, although IRs (95% confidence intervals) were numerically higher in biologic-experienced versus biologic-naïve patients for herpes zoster (HZ; 6.77 [5.30, 8.53] vs. 4.10 [2.50, 6.33]) and serious infections (SI; 1.92 [1.19, 2.94] vs. 0.60 [0.12, 1.77]). Insufficient clinical response (biologic-experienced: 53.3%; biologic-naïve: 38.9%) was the primary reason for discontinuation. At week 60, remission rates were 63.07% for biologic-naïve patients and 56.37% for biologic-experienced patients.ConclusionsSafety was generally similar between biologic-experienced and biologic-naïve patients, although HZ and SI IRs were numerically higher in biologic-experienced patients. Remission rates were numerically higher in biologic-naïve versus biologic-experienced patients, although differences were small. Discontinuation was mostly due to insufficient clinical response. Missing concomitant corticosteroid/tofacitinib dose data and endoscopic assessment might limit the analysis.ClinicalTrials.govNCT03643211.

BackgroundCrohn’s perianal fistula (CPF) is a debilitating disease that significantly affects patients’ quality of life. Prior research revealed substantial knowledge gaps among individuals with CPF in accessing evidence-based educational resources. We evaluated the reach and engagement of two validated CPF educational videos and a companion website (HealMyFistula.org) that was disseminated through Facebook and Instagram.MethodsA six-month social media campaign was conducted to promote the CPF educational videos and website using targeted advertising strategies to maximize reach. Primary outcomes were the proportion of users who viewed at least 50% of a video and the outbound click rate to the website. Results were stratified by age, sex, and social media platform.ResultsThe CPF Overview video reached 3.1 million users and had a ≥ 50% view rate of 3.31% (n = 103 463), while the CPF Treatment video reached 1.8 million users with a 1.40% view rate (n = 25 606). Older age groups showed significantly higher engagement, while females demonstrated higher view and click rates to HealMyFistula.org than males (P < .05). Facebook outperformed Instagram for the CPF Overview video, while Instagram slightly outperformed Facebook for the CPF Treatment video.ConclusionsTargeted social media campaigns can be effective in disseminating educational content. Engagement varied by video type, age, sex, and platform, showing the importance of demographically informed dissemination strategies. These findings suggest that health educational campaigns may benefit from tailoring content and dissemination strategies based on demographic engagement patterns.

Prior research has estimated the rates of avoidant/restrictive food intake disorder (ARFID) to be between 10% and 54% in patients with inflammatory bowel disease (IBD). However, recently published studies have questioned the ability of providers to differentiate the presence of ARFID in patients with gastrointestinal (GI) symptoms and highlighted the relationship between ARFID and food literacy, which may reflect poor cognitive or psychological flexibility to navigate dietary restriction. We suggest the discourse around ARFID has neglected the neurological basis of fear conditioning as to how and why patients develop fear around eating in the setting of severe postprandial symptoms. In this review, we discuss the role of the amygdala in post-ingestive learning and how this needs to shape the approach to dietary liberalization for the highest likelihood of success. We provide specific strategies for practice when working with patients who experience significant fear of eating, including the framework for and development of appropriate exposure hierarchies to guide the reintroduction process. We encourage collaboration with dietitians and psychologists trained in gastroenterology when possible.

In this nationwide study, we aimed to explore healthcare services utilization, medical management, and disease outcomes of inflammatory bowel diseases (IBD) across the 2 major ethnic groups in Israel. We utilized a cohort including all patients diagnosed with IBD in Israel since 2005. The primary outcome was steroid dependency, with secondary outcomes including use of biologics, time to surgery, and hospitalizations. Outcomes were controlled for possible inherent differences in disease course and phenotype. Of the 32 491 included patients, 18 252 (56%) had Crohn's disease (CD) and 14 239 (44%) had ulcerative colitis (UC); 10% were Arabs and 90% were Jews. Jewish ethnicity was associated with lower rates of steroid dependency compared to Arab ethnicity in both CD (HR = 0.7 [95% CI, 0.6-0.8]) and UC (HR = 0.7 [95% CI, 0.6-0.8]). The risk of IBD-related surgery in CD was higher in the Arab group at both 3 and 5 years (13% vs. 10%, 16% vs 14%, respectively, P = .005). Arabs had more frequent IBD-related hospitalizations than Jews at 5 years (28% vs. 19% with at least 2 hospitalizations, P < .001). In contrast, Jewish ethnicity was associated with more frequent use of biologics during the first year from diagnosis in patients with CD (HR = 1.3 [95% CI, 1.1-1.6]) but not with UC. Arab ethnicity is associated with higher rates of hospitalizations, steroid dependency, and surgeries, and, on the other side, with lower utilization of biologics. Healthcare practitioners and policymakers should address potential cultural and systemic barriers in healthcare delivery in order to improve care across all populations.

Despite advancements in the therapeutic armamentarium for Crohn's disease (CD), biologic and small molecule monotherapies are associated with sub-optimal response and remission rates. Utilizing dual biologic therapy (DBT) holds the potential to increase efficacy in the treatment of refractory or partially responsive CD. Evidence pertaining to this strategy remains limited. We retrospectively examined refractory CD patients treated with a combination of ustekinumab and vedolizumab. Outcomes to DBT at week (wk) 52 were compared to monotherapy. The primary outcome constituted corticosteroid-free remission. Secondary outcomes included adverse events, infections, hospitalizations, surgeries, treatment persistence, and disease clearance. Sixteen of 21 active refractory CD patients (76%) on DBT achieved disease remission at wk 52. Mucosal healing was observed in 38% (n = 6), biochemical remission in 25% (n = 4), and both clinical and biochemical remission in 38% (n = 6). Of these patients, 50% (n = 8) achieved corticosteroid-free remission. Three patients (37.5%) with corticosteroid-free remission achieved complete disease clearance. Paired median fecal calprotectin decreased from 508 to 118 µg/g (P < .0001). Paired C-reactive protein median decreased from 1.04 to 0.50mg/dL (P < .0001). Median Harvey Bradshaw Index score reduced from 7 to 2 (P = .003). Endoscopic healing was achieved with a paired simple endoscopic score for CD decrease from 6 to 3 (P = .013). Corticosteroid dependency reduced from 17 to 8 patients discontinuing altogether. Patients still requiring corticosteroids experienced a decrease in average daily dose from 9 to 6mg (P = .045). At wk 52, 5 patients (24%) did not meet the criteria for remission with 4 requiring CD-related surgical intervention. Mean CD-related hospitalizations reduced from 2.95 ± 2.33 to 0.52 ± 1.12 (P < .001) and surgeries from 1.76 ± 1.3 to 0.14 ± 0.4 (P < .001). Three infections with 1 requiring hospitalization and 1 report of headache were noted. Two patients discontinued DBT. Dual biologic therapy with ustekinumab and vedolizumab is a safe and effective strategy to induce disease remission in refractory CD. Large-scale studies are necessary to validate findings in a prospective setting.

Despite a wide range of available treatments, there is limited evidence as to why significant numbers of Crohn's disease (CD) patients do not achieve disease remission or continue to have residual symptom burden. We aimed to quantify the impact of this suboptimal treatment on patient symptom incidence and severity, quality of life (QoL), and work impairment. Data were derived from the Adelphi Real World CD Disease Specific Programme, a cross-sectional survey of CD patients and their treating physicians in France, Germany, Italy, Spain, the United Kingdom, and the United States between January 2020 and March 2021. Physicians reported on patients' clinical history, disease status, symptom load, and treatment. Patients reported their QoL and activity impairment using the EQ-5D-5L and Work Productivity and Activity Impairment measures. Patients were divided into remitters, partial remitters, and non-remitters. Multivariate regression models were used to assess the impact of remission status on clinical and QoL outcomes. Of 1786 patients, 24.1% were remitters, 53.2% were partial remitters, and 22.7% were non-remitters. Partial remitters and non-remitters had a significantly higher symptom load than remitters (P < .05), and non-remitters were up to 15 times more likely to experience key symptoms than remitters. Both non-remitters and partial remitters were also significantly more likely to have increased symptom severity (P < .05). Non-remitters were more likely to have switched treatment and received more treatment lines, as well as having significantly worse QoL, than remitters. Suboptimal treatment response was associated with increased symptoms and QoL burden. Despite the increased burden experienced, partial remitters were not more likely to switch or receive more treatment lines than remitters, demonstrating the need to initiate effective therapy.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), often results in significant morbidity among patients with moderate to severe forms. While biologics and small molecules are effective in inducing remission, many patients experience refractory disease or extraintestinal manifestations. This study assesses the safety and efficacy of dual-targeted therapy in IBD patients treated at the Inflammatory Bowel Disease Center. This retrospective cohort study examined 79 patients with UC or CD who received dual-targeted therapy at the University from October 2018 to August 2023. Data collected included demographics, disease characteristics, previous treatments, and clinical outcomes. Primary outcomes were endoscopic, radiographic, and patient-reported clinical improvements, with secondary outcomes focusing on safety profiles. Among the 79 patients (42 UC, 37 CD), 97 dual-targeted therapy cases were analyzed, primarily involving a biologic combined with a JAK inhibitor (90.7%). The median therapy duration was 39.1 weeks. Endoscopic improvement occurred in 69% of matched samples, with significant differences between pre- and postdual-targeted therapy Mayo scores for UC (P = .002) and Simple Endoscopic Score for CD (SES-CD) scores for CD (P = .018). The median pre- and postdual-targeted therapy Mayo scores across matched samples were 3 (range 1-3) and 1 (range 0-3), respectively, and for SES-CD scores were 12 (range 0-36) and 4 (range 0-20), respectively. Clinical improvement was reported by 73.2% of patients, with notable reductions in ESR (median 19 [range 2-124] mm/h to 9 [range 0-116] mm/h, P = .006), CRP (median 8.0 [range 0.2-78.5] mg/L to 3.0 [range 0.2-68.2] mg/L, P < .001), and albumin levels (4.0 [range 2.2-4.9] mg/dL to 4.2 [range 3.4-5.2], P < .001). Non-obesity was associated with both more endoscopic improvement (P = .002) and clinical improvement (P = .007). Adverse events occurred in 37 cases, predominantly upper respiratory tract infections and dermatologic issues, with no thromboembolic events reported. Dual-targeted therapy demonstrated efficacy in improving clinical and endoscopic outcomes in patients with severe, refractory IBD and exhibited an acceptable safety profile. Despite the promising results, further research is needed to confirm these findings and determine optimal therapy combinations.