Introduction

Anaemia and iron deficiency (IDA) in inflammatory bowel disease (IBD) usually suggests an underlying inflammatory activity at some degree. In case of inflammation, oral iron supplementation is mostly ineffective, or even it could worse symptoms. In contrast, ferric-carboxymaltose appears to be effective and safe independently from underlying disease activity so far.

Aims & Methods

Our aim was to prospectively investigate the short- and long term efficacy of ferric carboxymaltose regarding to disease activity and whether dose optimisation of IBD treatment (as a T2T approach) is necessary with iv iron supplementation in case of IDA observed in patients with remission. We included patients in our prospective study based on the IDA criteria defined by the ECCO guideline. Patients were divided into two groups according to the disease status (active/remission). Active disease was defined by CRP ≥10 mg/l or by clinical activity scores CDAI ≥150 in Crohn’s disease and pMayo ≥2 in ulcerative colitis. Patients in the active group (A) received iv. iron with therapy modification. Patients in the remission group were further divided into two subgroups: patients in group R1 received iron supplementation alone, while patients in the R2 group had therapy optimisation in addition to iron supplementation. Ferric-carboxymaltose was administered at the first visit according the body weight and haemoglobin level. From that time, laboratory parameters and clinical activities were measured in every two month throughout the 6 months’ follow-up period. Primary outcome was defined as the normalisation of haemoglobin levels or an increase of at least 20 g/l.

Results

In total, 73 patients were involved (mean age 40.4 years; male/female ratio 51/19; CD/UC 46/16), 27 patients in group A, and 23-23 in groups R1 and R2, respectively. Primary outcomes achieved at week 8, 16 and 24 did not differ between groups. Haemoglobin level increased significantly in all groups (p<0.001), in addition, no difference was observed between patients in the active and remission groups. Increase in haemoglobin levels did not differed in R1 and R2 subgroups. Ferritin and serum iron levels and transferrin saturation increased in all groups (p<0.05), without any difference observed between the groups. No adverse event was observed.

Conclusion

Based on our results, ferric-carboximaltose is an effective and safe therapeutic method in the treatment of IDA. Our results suggest, that iv. ferric-carboxymaltose is equally effective in active and inactive IBD. Based on our results, iv. iron supplementation is efficient in remission without treatment modification, however, due to the pathomechanism of IDA, treatment modification should be considered in every case.

Disclosure

Tamás Molnár has received speaker's honoraria from Swixx BioPharma.

Introduction

Anaemia develops through several pathomechanisms (e.g., occult bleeding, mucosal inflammation, medications) in inflammatory bowel disease (IBD). In true iron deficiency anaemia (IDA) biochemical markers are not elevated, however, due to the pathomechanism, activity at some degree is presumed.

Aims & Methods

Our aim was to compare the one-year disease course of IBD patients with IDA compared to non-anaemic patients. This was a retrospective, double centre, cohort study, including a tertiary referral IBD centre and a secondary IBD centre. The study was carried out between June 2020 and November 2022. IDA was defined as CRP >10 μg/ml, ferritin <30 μg/ml and transferrin saturation <20 % with the presence of anaemia. Biochemical activity was defined as CRP >10mg/l, and severe anaemia as haemoglobin <100 g/l. Baseline laboratory data was obtained. Outcomes were all complications during the one-year follow-up period, including introduction of new treatment, treatment escalation, corticosteroid treatment and major complications (hospitalization and abdominal surgery).

Results

In total, 713 consecutive patients (median age 43 years [IQR: 33 - 57]; male/female ratio 335/378; CD/UC ratio 402/311) were involved in our study, 195 patients (27.3 %) from the secondary and 518 patients (72.7 %) from the tertiary referral centre. Median follow-up period was 1.06 [IQR: 0.98 – 1.13] years. IDA (OR: 2.745; p<0.001) increased the risk of all complications, including major complications (OR: 2.606; p=0.002), except abdominal surgery. The anaemia increased the risk of all outcomes, and the severity of anaemia increased the prevalence of major complications (p<0.001). CRP level was associated with the severity of anaemia (p<0.001).

Conclusion

IDA was a predictor of worse one-year outcomes, including introduction of new therapeutic agent, treatment escalation, corticosteroid admission and major complications despite the absence of inflammation. In conclusion, IDA should be involved in the treat to-target approach, and should be monitored tightly. Furthermore, due to the worse one-year outcomes, we suggest therapeutic intervention, in addition to the iron therapy. In addition, the severity of anaemia correlates with the prevalence of major complications.

Introduction

Iron deficiency anaemia (IDA) is a common comorbidity in inflammatory bowel diseases (IBD). Previous studies have already showed the predictive value of anaemia on hospitalization and mortality rates, however, these studies did not focus on the effect of IDA on patients with clinical and biochemical remission, however, due to the ethiopathology, certain effects are hypothesized.

Aims & Methods

This was a multicenter retrospective real-life cohort study assessing the effect of IDA on clinically and biochemically inactive IBD patients. We included patients from the outpatient setting who has been followed-up for a year. Patients with need of blood transfusion at baseline were excluded. IDA was defined as no clinical and biochemical activity, ferritin <30 μg/mL and transferrin saturation <20% with the presence of anemia. Primary outcome was disease aggravation, defined as need of change in the current treatment/hospitalization/abdominal surgery. Secondary outcome was proportion of major complications, defined as need of hospitalization/abdominal surgery. Pearson’s chi squared sample size calculation (n=720) was performed on our pilot results based on 200 IBD patients.

Results

In total, 711 patients (median age: 43.1 years [IQR: 32.3 - 49.6]; male/female ratio: 332/379; CD: 397, UC: 311; IDA/non-IDA 85/623) were enrolled. Mean follow-up period was 1.1±0.28 years. The presence of IDA increased the risk of disease aggravation (OR: 1.7) and major complications (OR: 2.8). Furthermore, male sex (OR: 0.6) and older age (OR: 0.8) were protective, and ileocoecal resection (OR: 2.0) and higher C-reactive protein levels (OR: 1.5) increased the disease aggravation.

Conclusion

IDA predicts the risk of relapse at some degree in patients with clinical and biochemical remission in the outpatient setting. IDA may help to identify underlying disease activity in patients with clinical and biochemical remission in time, therefore, we recommend to be implemented in the treat-to-target approach.

Introduction

Data suggest that patients' knowledge about their chronic disease is associated with treatment adherence, and education may help improve disease outcomes. The effectiveness of educational activities depends on the source of the information.

Aims & Methods

Our study aimed to compare the effectiveness of targeted educational activities in written and podcast formats for patients with inflammatory bowel disease (IBD). In this nationwide randomized controlled trial, IBD patients were enrolled between December 2023 and May 2024. At baseline, enrolled patients completed an online questionnaire assessing general knowledge of their disease (Inflammatory Bowel Disease Knowledge [IBD-KNOW]) and health-related quality of life (Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and Patient Health Questionnaire-9 [PHQ-9]). Patients were randomized (1:1) into a control and an intervention group and the latter received targeted telemedical educational material, either in podcast format or as a written version, covering topics on anatomy, medical and surgical therapy, quality of life, epidemiology, diet/lifestyle, reproduction, and vaccination. This content was developed by IBD experts. Two months after the educational material was distributed, intervention group was re-tested, and satisfaction was measured. Descriptive statistics, Welch’s test, and Fisher’s exact test were used to compare groups, with p-values <0.05 considered significant.

Results

A total of 221 patients were recruited, among whom 129 (58%) had Crohn’s disease (median age was 42 years [IQR 34-49], and median disease duration was 10 years [IQR 4-19]). Baseline characteristics and overall IBD-KNOW scores did not differ significantly between groups, except for a clinically irrelevant age discrepancy. In total cohort, higher IBD-KNOW scores were associated with longer disease duration (B = 0.277), and younger age (B = -0.16), while results were not coupled with biological treatment use, IBD nurse participation, and SIBDQ or PHQ-9 scores. Of the 221 patients, 95 were randomized into the intervention group to receive educational content, with 46/95 receiving the written version and 49/95 the podcast. The intervention resulted in higher overall scores (before 23.8 ± 5.3 vs. after 26.7 ± 4.9; p < 0.001), while the intervention group had higher overall IBD-KNOW scores compared to the control group (26.65 ± 4.9 vs. 23.66 ± 6.5; p < 0.001), while the format of the educational activity or quality of life had no significant impact on scores. Patient satisfaction was high (mean score of 8 ± 1.98) and was not influenced by the format of the educational content.

Conclusion

Telemedical education may enhance disease knowledge among IBD patients, with both forms of educational materials proving equally effective. Although no clear predictors of educational efficacy were identified, disease duration and younger age was associated with higher baseline knowledge.

Introduction

Usability of subcutaneous vedolizumab (SC VDZ) in inflammatory bowel diseases (IBD, ulcerative colitis [UC], Crohn’s disease [CD]) have proved via clinical trials, while real-world data collection is ongoing. Experiences of Central-European population and assessment of patient’s perspectives are lacking.

Aims & Methods

Our study aimed to evaluate the real-world efficacy, safety and patient’s preferences of SC VDZ maintenance treatment after switching from intravenous (IV) formulation in a Hungarian IBD cohort. In this prospective, multicenter cohort study, IBD patients on maintenance IV VDZ treatment were enrolled, who switched to SC administration. Baseline was the day of the switch, while 52-week follow-up was set. Clinical and demographic data were collected, while serum VDZ level and CRP was measured at baseline and at w52. A non-validated questionary was filled by patients who were on drug at w12 recording patient’ satisfaction. Primary outcome was the drug survival rate at one year, while secondary outcomes were change in corticosteroid-free clinical (CSFR, based on physicians’ global assessment score PGA<1), and biochemical remission (BR, 5 mg/l³CRP) rates to w52, safety issues and patients’ preferences and change in serum drug levels.

Results

In total, 37 IBD patients were followed (15 CD and 22 UC, male/female ratio 45.9 %, median age 42.0 [IQR 34-49] years). In CD group, 66.7% were in CSFR and 60 % in BR, while in UC group 63.6% were in CSFR and 68.2 % in BR (p=0.55 and p=0.61). Overall, 29.7 % of patients ceased SC VDZ treatment after a median of 20 (IQR 6-26) weeks. Cessation was due to secondary response losing in 3/6 and 4/5 patients in CD and UC group. In case of 2 and one patients, SC treatment was terminated due to local reactions. One patient was fear of needle. Severe adverse event did not occur. Factors associated with discontinuation did not identify. The mean serum VDZ level has higher at w52 compared to baseline in CD and UC patients (CD: 8.9 ±6.9 to 30.6 ±17.8 ug/mL, p = 0.047; UC: 13.6±13.8 to 33.6±17.6 ug/mL, p = 0.001), while disease activity was stable. 84 % of the patients who filled the questionnaire were satisfied with injection, while only one patient found it difficult to inject.

Conclusion

Transition from IV to SC maintenance VDZ treatment is effective at one year, the overall survival rate is high presumably due to the elevated serum drug levels. Severe safety issue did not raise. Satisfaction of switched patients is high, which may improve treatment adherence and save resources.

Disclosure

K.F. has received speaker’s honoraria from AbbVie, Janssen, Ferring, Takeda, and Goodwill Pharma. T.M. has received speaker’s honoraria from MSD, AbbVie, Egis, Goodwill Pharma, Takeda, Pfizer, Janssen, Sandoz, MundiPharma, Phytotec, Roche, Fresenius, and Teva. ​Remaining authors have no conflict of interest to declare.

Introduction

High-quality endoscopy in IBD is associated with better clinical outcomes, while quality measurement supports effective quality control. The European Society of Gastrointestinal Endoscopy recommends using nine performance measures, depending on the indication for endoscopic examination in IBD.

Aims & Methods

Our study aimed to compare colonoscopy quality between tertiary and secondary referral centers for IBD patients, based on endoscopic reports. In this cross-sectional study, colonoscopy reports of IBD patients were analyzed. At our tertiary center, we consecutively enrolled patients over 18 years old with established IBD between July and October 2024, using their available colonoscopy reports. The secondary care group included patients referred to our tertiary center, with the last existing report from secondary care used for analysis, while the tertiary care group consisted of our patients whose most recent report was similarly used. Nine key performance measures (indication, bowel preparation, photo documentation, ileal intubation, biopsy, endoscopic activity score, high-definition and chromoendoscopy use, and neoplasia detection) were evaluated based on colonoscopy reports. Patients were stratified by procedure indication (diagnostic, activity assessment, or surveillance) as well. Descriptive statistics, Welch’s, and Fisher’s exact tests were used to compare groups, with p-values <0.05 considered significant.

Results

Overall, 207 colonoscopy reports were assessed, of which 68/207 were performed at secondary care level. A total of 78/207 patients were diagnosed with Crohn’s disease, while unclassified diagnoses were noted only at secondary centers. Activity control (88% vs. 38%, p<0.001) and surveillance (8% vs. 0%, p=0.02) examinations were more common at the tertiary level. Bowel preparation was better at tertiary centers (Boston Bowel Preparation Scale [BBPS] 8.3±2.3 vs. 7.2±1.2; p=0.003), and use of BBPS was more frequent at higher levels of care (p<0.001). Disease activity scores were more commonly used at the tertiary level during activity control examinations (51.2% vs. 19.2%, p=0.004), while ileal intubation was also more frequent at the tertiary level (53% vs. 28%; p<0.001). Procedure and withdrawal times did not differ between levels in diagnostic or activity control examinations. Neoplasia detection was low, and biopsy rates were similar.

Conclusion

Quality indicator targets were met in neither secondary nor tertiary centers; however, wider investigation is needed to verify these results. Broad education can help to improve the quality of colonoscopy in IBD care.

Introduction

Crohn’s disease (CD) complicated with intra-abdominal abscess often requires surgical intervention. Image guided percutaneous drainage (PD) can help to avoid surgical interventions, however there is limited evidence on the optimal management after PD.

Aims & Methods

Our study aimed to analyze the long-term outcomes of CD complicated with intra-abdominal abscess after intervention. In this multicenter, interational retrospective trial penetrating CD patients with simplex intra-abdominal abscess were enrolled and followed until 12-24 months. Baseline was the day of the first detection of abdominal abscess. Patients with urgent resection were excluded. Patients were grouped based on elective surgical need during follow-up after a successful PD, while the control group consisted of patients who underwent resection without PD. Primary outcome was the abscess recurrence, while stoma rate, post procedural complications rate (<30 days), need for re-drainage and postoperative luminal recurrence were analyzed as secondary outcomes.

Results

A total of 151 CD patients from 9 countries were recruited and 86/151 patients had PD due to simplex abdominal abscess (Table 1.). Abscess recurrence rates were similar (12.8% vs. 7.7%, p=0.231). Need for re-drainage was more common amongst PD patients (OR=0.088, 95% CI=0.011-0.682), while hospital admission need was more frequent in control patients (OR=2.56, 95% CI=1.22-5.37). Postoperative luminal recurrence, new stoma, and biological treatment escalation needs were similar between groups based on PD. Surgical complications were coupled with increased odds in patients without prior PD (OR=3.3, 95% CI=1.09-10.0), septic complications, perforation and new fistula formation were reported the most, while PD associated complication did not occur. Higher baseline diameter of the abscess increased the odds for postoperative recurrence (OR=1.05, 95% CI=1.02-1.08) and new biological treatment initiation (OR=0.98, 95% CI=0.96-0.98). Elective resection was delayed after PD compared to control (24 vs 10 week, p=0.003). Time until resection increased the odds for redrainage (OR=1.03, 95% CI 1.01-1.05), and outcome was worse exceeding 17 weeks.

Conclusion

The size of the abscess determines the outcomes, while surgical treatment alone may be associated with post-procedural complications. PD may delay resection; however, this delay can necessitate re-drainage.