Introduction

Timely biological therapy in IBD is associated with reduced disease progression, especially in CD (Berg et al 2019). However, there are no clear UK standards detailing the timescale in which IBD care should be delivered. We evaluated the time between initial consideration of therapy and first dose in a district general hospital and tertiary referral centre in Barts Health NHS Trust.

Aims & Methods

Details of patients receiving biologics for IBD at Newham (NUH) and Royal London Hospital (RLH) (between 2018 – 2022) were obtained from infusion clinics; electronic records were reviewed for the 50 most recent referrals. The following information was collected: demographics, phenotype, drug, first documentation of consideration of biologic, completion of funding application, onset of therapy.

Results

Demographics:
NUH: Age (median(IQR)) = 43.5(30.3 – 50.56) Gender (F:M) = 26:24, CD:UC = 34:16, Biologic: infliximab:vedolizumab:ustekinumab:adalimumab: 29:5:11:5, First biologic: n=34
RLH: Age (median(IQR)) = 31.6 (24.6 – 41.1) Gender (F:M) = 27:23 CD:UC = 23:27, Biologic: infliximab:vedolizumab:ustekinumab:adalimumab: 34:12:3:1, First biologic: n=25
There was substantially longer (median (IQR)) time between initial consideration of therapy and first dose delivered at NUH (94.5 days (44 – 174)) compared with RLH (35.5 days (23.75 – 69), p<0.01). However, time from completion of funding application to first dose did not differ significantly between sites (43.5 days (30.3 – 50.6) vs 31.6 days (24.6 – 41.1), p=0.42). In patients receiving first biologic, there was a trend towards a longer time since diagnosis at NUH (3.2 years (1.0 – 9.1) vs 1.7 years (0.5 – 4.3), p=0.08).

Conclusion

Patients treated in a tertiary referral centre started biologics sooner after consideration, and earlier in disease course. This does not appear due to availability of infusion services, but due to time to complete initial investigations and finalise escalation. This may reflect differences in service set-up; in particular, NUH manages IBD care with a single IBD nurse, and fewer options for fast-track clinic follow up. A clear UK IBD standards framework identifying recommended time frames for establishing biologics is indicated, to ensure equity in care across tertiary and DGH settings.

References

Berg DR et al. The Role of Early Biologic Therapy in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019

Disclosure

HG has received speaker fees from Ferring, Janssen and Abbvie

Introduction

Phase III trials have demonstrated the efficacy of risankizumab (RZB), this being the first humanized monoclonal IgG1 antibody which targets the interleukin 23 p19 subunit, in moderate-to-severe Crohn's disease (CD). However, real-world data with this drug is limited.

Aims & Methods

The aim of our study was to assess the real-world effectiveness of RZB in patients with CD.
Adult CD patients that had received treatment with RZB in the ENEIDA registry —a large prospectively maintained Spanish database promoted by the Spanish Working Group of Crohn’s and Colitis (GETECCU)— were included. Clinical and demographical data including number of previous biologics and advanced therapies were included. The primary endpoints were steroid-free clinical remission after induction period (Harvey-Bradshaw [HB] score <5) and long-term steroid free clinical remission at the end of follow-up. Influence of previous use of ustekinumab (UST) and number of previous advanced therapies in short- and long-term efficacy was also evaluated. Statistical analysis was performed using the Chi-square and the Student-t test as appropriate, and multivariate analysis was performed with logistic regression.

Results

857 CD patients (60% male) were included: median age was 50 (18-84) years, median disease duration 14 years, 27% smokers. 50% were L1, 8% L2, 38% L3, and 4% exclusively L4. B1 phenotype was present in 42%, 37% B2, 21% B3. Perianal disease was present in 28%, 46% had previously undergone CD-related surgery and 39% had extraintestinal manifestations. Only 3% were biological naïve, 50% had been exposed to 1-2 advanced therapies, and 47% to 3 or more biologics or JAK inhibitors. Following induction 56% of the patients achieved steroid-free clinical remission. Remission was more frequent in patients who had not previously been treated with UST (64% vs. 53% in those previously exposed to UST, p<0.01). In the multivariate analysis, a higher number of prior advanced therapies was associated with lower remission rates (p<0.01). Long-term efficacy was evaluated in 652 patients (median follow-up 7 months). At the end of the follow-up 61.2% of patients maintained steroid-free clinical remission. Long-term remission rate in patients non-exposed to UST was 72%, and 55% in patients previously exposed to UST (p<0.01). In the multivariate analysis, younger age was associated with higher long-term remission rates (p<0.01). Eleven percent of patients needed dose optimization or reinduction during follow-up. 68 patients (7.9%) presented adverse events but only 18 (2%) needed to give up the treatment.

Conclusion

This study represents the largest cohort of real-world data on RZB in CD, including highly refractory patients with multiple prior drug failures. RZB induced steroid-free clinical remission in 56% of patients after induction and 61% in the long term. Higher remission rates were observed in patients who had never been exposed to UST. Younger age and fewer previous advanced therapies were associated with better outcomes.

Disclosure

Manuel Barreiro: Speaker, consultant and advisory member for or have received research funding from AbbVie, Janssen, Takeda, Pfizer, Lilly, Alphasigma, Sandoz and Oncostellae

Introduction

Prevalence of inflammatory bowel disease (IBD) is increasing worldwide, while incidence is tending to stabilize. Moreover, the use of biological treatments is increasing, some studies suggest that surgeries and hospitalizations are decreasing instead.

Aims & Methods

A population-based, retrospective cohort study was conducted using data from the Catalan Health Surveillance System (CHSS). All patients diagnosed with IBD were included between 2017-2023. Crude incidence and prevalence rates were calculated for all the Catalan population. Data on pharmacological therapy, surgical procedures, hospitalizations, and mortality were analyzed. Trends in age-sex-adjusted rates were also estimated, and logistic regression was used to calculate the adjusted mortality odds ratio (OR). Data for Crohn’s disease (CD) and ulcerative colitis (UC) were analyzed separately.

Results

The number of prevalent IBD cases rose from 28,752 in 2017 to 41,423 in 2023. Despite incidence rates remained stable (30.8 in 2017 and 29.9 per 100,000 inhabitants in 2023) prevalence rates increased (386.9 and 510.9 per 100,000 inhabitants respectively). The use of biologics significantly increased (from 13.5% in 2017 to 21.0% in 2023), particularly ustekinumab and vedolizumab. In parallel, a decline in the use of immunosuppressants were observed. IBD-related surgeries and hospitalizations decreased during study period, particularly among CD patients. Mortality remained low but was higher among IBD patients compared to the general population.

Conclusion

Incidence of IBD in Catalonia has stabilized, while its prevalence continues rising, suggesting a transition to Stage 3 (compounding prevalence). The use of biological treatments is increasing steadily, whereas rates of surgeries and hospitalizations are consistently decreasing.

Disclosure

None

Clinical Case Summary

Intestinal involvement in systemic lupus erythematosus (SLE) is usually due to vasculitis that predominantly affects the small bowel (1, 2). The coexistence of lupus and inflammatory bowel disease (IBD) is uncommon (1), with a prevalence of 0.4% in ulcerative colitis and even lower in Crohn's disease (2). Drug-induced lupus is more common than lupus associated with IBD itself (2). Moreover, when both conditions coexist, it usually involves systemic lupus rather than oligosymptomatic forms (2).
We present a 20-year-old female patient diagnosed with SLE at age 13 with only joint involvement and well-controlled with methotrexate, hydroxychloroquine and oral prednisone that was referred due to diarrhoea with mucus and blood, diffuse abdominal pain and weight loss. A colonoscopy revealed patchy mucosal involvement with deep, medium-sized ulcers in the cecum, left colon, and especially the rectum. The ileum was lesion-free. Histological analysis showed intense acute and chronic inflammatory processes in the colon mucosa, consistent with IBD (clinically suspected Crohn's disease). Signs of vasculitis were not observed. Treatment with oral Mesalamine 3600 mg/day, rectal Mesalamine suppositories and oral corticosteroids led to improved stools, abdominal pain and normalization of inflammatory markers. However, after three months, she was admitted to our hospital due to increased bloody diarrhoea and diffuse abdominal pain, so we decided to treated with infliximab (5 mg/kg). After six months, the patient was asymptomatic with normal laboratory parameters and no signs of inflammatory activity on follow-up colonoscopy.
This case is interesting due to its low prevalence and association with joint-dominant S.L.E. and colonic involvement. Management is similar to CD patients, with positive results seen with infliximab in corticosteroid non-responders (3). The coexistence of both diseases presents a diagnostic and therapeutic challenge that requires multidisciplinary management.

References

1. Jin X;Wang G;Xu X;Bai Y;An R;Jiang D; (2020) Coexistence of crohn's disease and systemic lupus erythematosus: A case report and literature review, European journal of gastroenterology & hepatology. Available at: https://pubmed.ncbi.nlm.nih.gov/32732809/
2. E.V.;, K.K.P. (2012) Inflammatory bowel disease and lupus: A systematic review of the literature, Journal of Crohn's & colitis. Available at: https://pubmed.ncbi.nlm.nih.gov/22504032/
3. Algassim, A. et al. (2021) Systemic lupus erythematosus with crohn's disease: A rare combination and unusual presentation, European Journal of Case Reports in Internal Medicine. Available at: https://www.ejcrim.com/index.php/EJCRIM/article/view/2678

Introduction

While upper gastrointestinal bleeding (UGIB) risk scores are commonly used to predict mortality, their performance in forecasting alternative clinically meaningful complications during admission, such as rebleeding requiring interventional radiology (IR) or repeat oesophagogastroduodenoscopy (OGD), has not been well explored. This study aimed to validate the predictive accuracy of five UGIB scores for these secondary endpoints.

Aims & Methods

A retrospective cohort analysis was performed on a cohort of 1,003 patients admitted at a UK tertiary centre between January 2025 and August 2023 due to suspected UGIB and investigated via OGD. Each patient’s CHAMPS, ABC, Glasgow-Blatchford (GBS), MAP(ASH), and Japanese scores were calculated using their electronic patient records. The observed outcome was the development of complications, categorised as: (1) re-bleeding, (2) requiring IR, and (3) requiring repeat OGD. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to assess each score’s discriminative ability.

Results

The ABC score had the highest predictive potential for inpatient complications with an AUC of 0.779, followed by the CHAMPS with an AUC of 0.766 and by the MAP(ASH) with an AUC of 0.716. GBS and the Japanese score had lowest prognostic capabilities.

Conclusion

The ABC, CHAMPS, and MAP(ASH) scores show useful discriminative performance for predicting vital non-mortality outcomes in UGIB patients. These results indicate the possibility of these stratification tools being used outside of predicting inpatient mortality, guiding early escalation of care decisions.