Introduction

Ulcerative colitis (UC) is a chronic, gastroenterological disease, heterogenic in presentation¹. Little is known regarding where specific clinical characteristic heterogeneity lies in the context of age groups.

Aims & Methods

We aimed to investigate whether naturally occurring age groups existed among adult patients with UC based on symptomatology and health-related quality of life (HRQoL) and to assess differences in the symptomatology and flaring status of these age groups. Data were drawn from the Adelphi Disease Specific Programme™ for UC, a cross-sectional survey of gastroenterologists (GIs) and UC patients in France, Germany, Italy, Spain, the United Kingdom (UK), the United States (US) and Japan from Jan 2020–Mar 2021. GIs reported data for their next seven consulting patients, including demographics, clinical characteristics, and components of the Mayo score, allowing full Mayo scores to be calculated for all patients. Patients voluntarily reported on HRQoL via the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). 10-fold cross-validation was used to identify age groupings by adjusting knot placement in linear splines of age in regression models with outcomes of patients’ Mayo scores and SIBDQ scores. Patients’ clinical characteristics across the age groups were compared using bivariate analysis.

Results

Overall, 3052 patients with UC were included (55.8% male, mean [standard deviation; SD] BMI 24.1 [3.9], mean [SD] disease duration 5.1 [5.9] yrs), of which 960 had known SIBDQ scores (52.1% male, mean [SD] BMI 23.5 [3.5], mean [SD] disease duration 3.1 [6.2] yrs).
Age groupings based on Mayo scores were 18-28 yrs (n=651), 29-60 yrs (n=2114), 61+ yrs (n=287). Current flaring status was significantly different across groups with 19.2% of patients in the 18-28 yrs group flaring (p<0.01). Of symptoms with the greatest difference in prevalence between age groups, prevalence of rectal bleeding, abdominal pain, bloody diarrhoea, bowel movement urgency, and anaemia differed, although the results were not always significant.
Age groupings based on SIBDQ scores were 18-37 yrs (n=506), 38-40 yrs (n=83), 41-50 yrs (n=173), and 50+ yrs (n=198). Flaring differed significantly across age groups. Among symptoms with the greatest difference in prevalence between age groups, prevalence of flatulence, fatigue/tiredness, abdominal pain, abdominal distension, and anaemia differed, although not always significantly.

Conclusion

Naturally occurring age groups were identified by exploring disease activity measures and HRQoL outcomes. Further analyses found differences in flaring status and symptomatology across age groups. This highlights that age should be considered when treating patients with UC as patients of different ages are likely to present and respond differently. While further research is warranted, aspects of treatments in clinical trials, such as safety and efficacy, should be tested within different age cohorts, and publicising individual age data would aid in enabling the analysis of drug disposition and safety in patients with UC.

References

1. Guan Q. A Comprehensive Review and Update on the Pathogenesis of Inflammatory Bowel Disease. Journal of Immunology Research. 2019;2019:7247238.

Introduction

Inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), are difficult to diagnose due to a broad symptoms spectrum.1,2 If symptoms remain uncontrolled with conventional therapy (CT), patients are transitioned to biologics. Little is understood about which CD and UC patients will respond to CT and which patients may have a more aggressive disease progression, and therefore should be treated with biologic therapies sooner.

Aims & Methods

We aimed to develop and evaluate machine learning (ML) models to identify non-responders to CT based on patients’ demographic characteristics and on data available before their treatment with CT. The study cohort included all Finnish patients ≥18 years of age, with a diagnosis for CD or UC between 1.1.2000–31.12.2019. Data were collected from electronic health records and national healthcare and prescription registers. CT drugs included corticosteroids (CS), immunomodulators and 5-aminosalicylic acids. CT failure outcomes are defined in Table 1. A set of 6,782 predictive features including demographic and clinical characteristics, comorbidities, healthcare visits, procedures, laboratory measurements, and medication were created for three different baseline periods. A Lasso model was run both separately and in combination for each period, splitting the data into training and testing subcorpora ten different times to estimate the error bounds.

Results

After applying specific attrition criteria, the final analysis cohort included 12,818 CD and 30,178 UC patients. In total, 64.2% of CD and 61.1% of UC patients experienced CT failure (Table 1). For CD, CS at baseline and young age (0–18 and 18–30 years) were the highest predictors of CT failure. For UC, the model selected 78 predictive features, the strongest being: baseline CS use, age (0–18, 18–30, and 65+ years), gastrointestinal and schizoaffective disorders, and secondary care visits to rheumatology, general medicine, and emergency. The key findings of the Lasso model were: 1) The performance of CD-models was slightly better than the UC-models (median test accuracy was 0.65 [CD] and 0.62 [UC]); 2) a slight discrepancy between test and training statistics suggested overfitting, and 3) most features appeared in all ten splits indicating their relevance.

Table 1. CT failure outcomes (within one year from CT initiation) for CD, UC, and combined cohorts.

Conclusion

Data quality is critical to build high-performance models. Even though Finnish registries provide access to comprehensive longitudinal data allowing the generation of relatively large analysis cohorts, our ML model demonstrated a weak predictive potential, with low AUCs and accuracies (0.6 range), in line with previous findings.3 Due to scarcity of information on additional clinical variables available in the Finnish IBD registry, their use did not improve prediction of CT failure. Additional prediction difficulty is introduced by non-standardized data recording practices. Confounding factors and random chance affect complicated outcomes, such as CT failure, making them especially difficult to predict.

References

1. Wang, R., Li, Z., Liu, S. & Zhang, D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open 13, e065186 (2023).
2. Yantiss, R. K. & Odze, R. D. Diagnostic difficulties in inflammatory bowel disease pathology. Histopathology 48, 116–132 (2006).
3. Chen, I. et al. PGI27 Applying Machine Learning to Large Databases to Predict Nonresponse to Conventional Treatment in Patients with Ulcerative Colitis. Value Health 24, S99 (2021).

Disclosure

This study was sponsored by Takeda Oy. TK, JM, and HL are employees by MedEngine Oy. TY is the CEO and founder of MedEngine Oy. KE and PK are employed by Takeda and hold Takeda stocks/stock options. Mónica Ferreira (PhD) from MedEngine Oy is acknowledged for medical writing support.

Introduction

Aims & Methods

Results

Conclusion

References

Introduction

Histologic activity has emerged as an aspirational therapeutic goal in IBD management. It is not yet a formal treatment-target in either CD or UC. However, it could be used as an adjunct to mucosal healing to represent a deeper level of healing. Recent studies show that histologic healing is associated with decreased risk of clinical relapse, medication escalation and corticosteroid use, both in ulcerative colitis and Crohn's disease [1,2]. We investigated histologic remission (HR) rates and potential predictors of achieving histologic remission in an IBD cohort.

Aims & Methods

We conducted a retrospective subgroup analysis of data collected from IBD patients enrolled in an ongoing prospective cohort study. Clinical, biological, endoscopic data (including the Mayo endoscopic subscore and SES-CD score) and histopathology results were available at multiple time-points for the enrolled patients (annual visits). Mucosal healing was defined as SES-CD <3 or Mayo endoscopic score=0[3]. Histologic healing was defined as microscopic normalization of mucosal biopsies.

Results

219 patients (88 CD, 131 UC) were enrolled in our study and were prospectively followed for a median length of 2 years (range 0-5 years), totaling 452 study visits. Mucosal healing was recorded for 51 (27 UC, 24 CD, 23,2%) patients at 76(16%) different study visits. Overall, only 35(15%) patients achieved histologic healing. In the mucosal healing subgroup, histologic remission was achieved in 30(58%) patients. After logistic regression analysis, none of the investigated factors was associated with histologic remission.

Conclusion

Mucosal healing and endoscopic remission rates are low in real-life settings. Frequently used patient and disease related factors, including mucosal healing are not reliable predictors for histologic remission.

References

[1] Christensen B, Erlich J, Gibson PR, Turner JR, Hart J, Rubin DT. Histologic Healing Is More Strongly Associated with Clinical Outcomes in Ileal Crohn's Disease than Endoscopic Healing. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2518-2525.e1. doi: 10.1016/j.cgh.2019.11.056. Epub 2019 Dec 5.
[2]Battat R, Duijvestein M, Guizzetti L, Choudhary D, Boland BS, Dulai PS, Parker CE, Nguyen TM, Singh S, Vande Casteele N, Pai RK, Feagan BG, Sandborn WJ, Jairath V. Histologic Healing Rates of Medical Therapies for Ulcerative Colitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Gastroenterol. 2019 May;114(5):733-745. doi: 10.14309/ajg.0000000000000111.
[3] Turner D, Ricciuto A, Lewis A, D'Amico F, Dhaliwal J, Griffiths AM, Bettenworth D, Sandborn WJ, Sands BE, Reinisch W, Schölmerich J, Bemelman W, Danese S, Mary JY, Rubin D, Colombel JF, Peyrin-Biroulet L, Dotan I, Abreu MT, Dignass A; International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570-1583. doi: 10.1053/j.gastro.2020.12.031. Epub 2021 Feb 19. PMID: 33359090.

Introduction

Shared decision-making is defended as an ideal model in the management of patients with chronic pathology, namely inflammatory bowel disease (IBD). The objective of this study was to identify knowledge gaps in IBD population, as well as correlate with patient demographic and sociocultural factors, to implement strategies aimed at improving care provision and patient empowerment.

Aims & Methods

Application of a survey to patients with IBD under biological therapy in a Day Hospital, from March 4^th to 22^nd 2024, and subsequent descriptive analysis.

Results

Out of the 102 patients with IBD (65% Crohn's Disease, 31% Ulcerative Colitis), 53% were men and 47% women, the majority of whom are Portuguese up to 50 years of age, with at least secondary education. The majority obtains information through health professionals and the Internet. The self-assessment of knowledge was higher than the demonstrated knowledge (90% consider themselves to be informed). The majority prefers to obtain oral information from health professionals or information leaflets (although only 50% had received information leaflets prior to starting biologics). The population over 50 years old, with a lower level of education and diagnosed more than 2 years ago, tends to have important knowledge gaps. 46% are unaware what medication can worsen the disease and 24% are unaware of the impact of tobacco. 56% of patients believe that a restrictive diet should be preferred, with 59% never being evaluated by a nutritionist, although 63% have already discussed this topic with their doctor. 85% of women are unaware of the implications of IBD on fertility, pregnancy and breastfeeding, particularly the population under 30 years of age and with a lower level of education.

Conclusion

The application of a survey across IBD population under biological therapy allowed to detect important gaps in the transmission of information adapted to each patient and identify key points to be optimized during the medical appointment or in dedicated Nursing and Nutrition appointments.

References

1. Xu D, Zhang H, Chen Y. Patients' views of shared decision making in inflammatory bowel disease: a survey in China. BMC Med Inform Decis Mak. 2021 Dec 6;21(1):340. doi: 10.1186/s12911-021-01702-8. PMID: 34872536; PMCID: PMC8650369.
2. Al Khoury, A., Balram, B., Bessissow, T. et al. Patient Perspectives and Expectations in Inflammatory Bowel Disease: A Systematic Review. Dig Dis Sci, 1956–1974 (2022). https://doi.org/10.1007/s10620-021-07025-y
3. A.F.A. Neto, P.M.N. Figueiredo, C. Correia. Patient Empowerment in Inflammatory Bowel Disease– Regarding Shared Decision-Making in the Treatment of IBD. Revista Portuguesa de Coloproctologia. Maio/Agosto 2022.
4. Song K, Wu D. Shared decision-making in the management of patients with inflammatory bowel disease. World J Gastroenterol. 2022 Jul 14;28(26):3092-3100. doi: 10.3748/wjg.v28.i26.3092. PMID: 36051346; PMCID: PMC9331519.

Introduction

Biologic therapies are associated with an increased risk for adverse events such as infections and malignancies. This is of particular importance in elderly patients with inflammatory bowel disease (IBD).

Aims & Methods

The aim of this study was to compare the efficacy and safety of different biologic therapies between IBD patients aged over 60 years and younger patients.All adult patients with IBD treated with biologic agents from 2010 to 2022 in the sole tertiary referral center for inflammatory bowel disease in central Greece were screened for eligibility and their electronic medical records were retrospectively reviewed. Data collected included the socio-demographic and clinical characteristics of the study population, endoscopy reports as well as information regarding treatment compliance and drug sustainability. Adverse events (AEs) and serious AEs were also recorded. Patients with incomplete information were excluded from the analysis.

Results

267 IBD patients were screened for eligibility and 187 were included. The majority (65%) of the patients had Crohn's disease. Of all patients, 47.8% received infliximab, 18% adalimumab, 18% vedolizumab, and 16% ustekinumab. The median duration of biologic treatments was 10 years. Parallel steroid therapy was required in 70% at baseline, 35% at 3 months, 18 % at 6 months, and 5% at 12 months from treatment onset. The efficacy of biologic therapies did not differ significantly between patients aged > 60 years and younger patients. Kaplan-Meyer analysis did not show statistical differences or trends in drug sustainability (P > 0.05), time to an adverse event (P >0.05), and infection rates (P >0.05) among the different classes of biologic agents compared. The most common AEs leading to drug discontinuation were loss of response and local injection site reactions. After adjusting for differences in baseline characteristics between the two age groups, no significant differences in drug sustainability and the need for treatment optimization were found between elderly and younger patients (p >0.05).

Conclusion

Available biologic therapies were characterized by comparable efficacy, sustainability, and safety among elder and younger patients, hardening the preferential selection among the available biologic agents for the elderly. More real-world evidence is required to make treatment recommendations.

References

1. de Silva S, Devlin S, Panaccione R. Optimizing the safety of biologic therapy for IBD. Nat Rev Gastroenterol Hepatol. 2010 Feb;7(2):93-101. doi: 10.1038/nrgastro.2009.221. PMID: 20134491.
2. Lasa JS, Olivera PA, Danese S, Peyrin-Biroulet L. Efficacy and safety of biologics and small molecule drugs for patients with moderate-to-severe ulcerative colitis: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2022 Feb;7(2):161-170. doi: 10.1016/S2468-1253(21)00377-0. Epub 2021 Nov 29. PMID: 34856198.

Introduction

Inflammatory bowel disease (IBD) and atopic diseases, namely asthma, atopic dermatitis (AD), and atopic rhinoconjunctivitis (AR) show a rising prevalence worldwide and share some genetic and epidemiological risk factors. Consequently, observational studies have explored the potential association between IBD and atopic diseases, with some conflicting data.

Aims & Methods

The objective of this study was to systematically review and summarize the current evidence on the co-occurrence of IBD and these atopic diseases.
We searched Medline, Embase, Web of Science and CENTRAL (from inception to August 14, 2022) to identify observational studies on the incidence or prevalence of IBD in atopic diseases (asthma, AD; AR) and vice versa.

Results

We included 23 observational studies (17 cohort, 4 case-control, 2 cross-sectional) on the association between IBD and asthma, comprising approximately 2 million patients; 17 of them showed a positive association and only one study showed a negative association. Nineteen studies (12 cohort, case-controls, 4 cross-sectional) on the association between IBD and AD were included, with approximately 2,6 million patients; 16 showed a positive association and 3 showed no association. We included 4 cohort studies on the association between IBD and AR, covering approximately 2,2 million patients which all showed a positive statistically significant association.

Conclusion

Published literature supports that IBD is associated with asthma, AD and AR, and vice versa. These results may increase gastroenterologists’ awareness for these diagnoses so that timely management can be initiated. Additional research is needed to determine if one disease influences the risk of developing the other or if the frequent co-occurrence of these diseases results from shared genetic, environmental and microbial factors. As far as the author’s know, this is the first systematic review that reports the association between IBD and the three main atopic diseases.