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CHANGING THE COURSE OF CROHN’S DISEASE WITH AN EARLY USE OF ADALIMUMAB: THE CURE STUDY FROM THE GETAID

Bénédicte Caron 1, Yoram Bouhnik 2, David Laharie 3, Florian Poullenot 3, Stephane NANCEY 4, Lucine Vuitton 5, pierre Blanc 6, Catherine Reenaers 7, Xavier Roblin 8, Stéphanie Viennot 9, Mathurin Fumery 10, Jerome Filippi 11, Anne Laure Pelletier 12, pauline wils 13, Arnaud Bourreille 14, Jacques Moreau 15, Marion Simon 16, Ludovic Caillo 17, Anthony Buisson 18, Guillaume Bouguen 19, Laurianne Plastaras 20, Alexandre Aubourg 21, Vered Abitbol 22, Médina Boualit 23, Cédric Baumann 1, Laurent Peyrin-Biroulet 1

Affiliations

1 Nancy University Hospital, Vandoeuvre les Nancy, France

2 CHU Beaujon Dept. of IBD and Nutrition, Clichy, France

3 CHU de Bordeaux Hopital Haut-Leveque Dept. de Gastroenterologie, Pessac, France

4 Lyon-Syd Hospital, Pierre Benite, France

5 Besançon University Hospital Gastroenterology, Courbevoie, France

6 University of Montpellier, Montpellier, France

7 CHU Sart Tilman, Lantremange, Belgium

8 University of St. Etienne Dept. de Gastroenterologie, Saint Etienne, France

9 CHRU de Caen HGE 19è étage, Caen, France

10 Amiens University Hospital, Amiens, France

11 Hopital de lAchet Dept. de Gastroenterlogie Dept. de Nutrition Oncologie, Paris, France

12 Hopital Beaujon, Paris, France

13 CHRU Lille, Lille, France

14 Nantes University Hospital, Nantes, France

15 Centre Hospitalier Universitaire de Toulouse, Hopital Rangueil, Toulouse, France

16 Institut Mutualiste Montsouris, Paris, France

17 CHU DE NIMES, Nîmes, France

18 CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France

19 CHU Pontchaillou, Rennes, France

20 Chu Colmar, Colmar, France

21 Cabinet Medical, Chambray Les Tours, France

22 Hopital Cochin Gastroentérologie AP-HP, Paris, France

23 CH Valenciennes, Valenciennes, France

Summary

AI Generated

In a prospective cohort of 201 adults with early Crohn's disease naïve to biologics, 30.6% achieved deep remission after 12 months of adalimumab, and among these patients, 43.5% maintained deep remission one year after treatment discontinuation.

Of 183 evaluable patients with early CD (median disease duration 4 months) treated with 12-month adalimumab, 56 patients (30.6%) achieved deep remission defined as no surgery, clinical flare-up, introduction of CD-related treatment, or adalimumab optimization.
Among 46 patients who achieved deep remission at 12 months and were followed after discontinuation, 20 (43.5%) maintained deep remission at 24 months, with relapse-free survival probability of 44.8%.
Deep remission required clinical remission (CDAI less than 150) and biomarker remission (CRP less than 5 mg/L and fecal calprotectin less than 250) at 6 months, sustained through 12 months.
This multicentre GETAID cohort study enrolled patients between March 2015 and March 2019 to evaluate whether adalimumab can be safely discontinued in patients with early CD after achieving sustained deep remission.

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Abstract

Introduction

Crohn's disease (CD) is a disabling and destructive disease. Early intervention associated with tight monitoring appear to the best way to achieve deep remission and to prevent disease progression. Whether anti-TNF therapy can be interrupted in patients with early CD who have undergone a period of prolonged deep remission is unknown. Relapse is frequent following anti-TNF discontinuation in patients with CD.

Aims & Methods

The primary objective was to evaluate the sustained deep remission rate one year after discontinuation of a 12-month course of adalimumab in adult patients with early CD who achieved deep remission at 12 months and who were already in clinical remission and biomarker remission at 6 months.
We carried out a multicentre prospective GETAID cohort study. All patients were naïve to biologics. The primary study endpoint was the percentage of patients with sustained deep remission at 2 years after a 12-month course of adalimumab in patients who achieved deep remission without therapeutic intervention (i.e. no surgery, no clinical flare-up, no introduction of CD-related treatment, no need for adalimumab optimization) AND who were already in clinical remission (CDAI < 150) and biomarker remission (CRP < 5 mg/L and fecal calprotectin < 250) at 6 months. The time to first relapse in patients who achieved deep remission after 12-month therapy was also evaluated.

Results

A total of 201 subjects were included between March 2015 and March 2019. The median disease duration was 4 months. Overall, 56/183 (30.6%) of patients achieved deep remission at one year. From those who achieved deep remission, not lost to follow-up (n=8) and without protocol violation (n=2), 20/46 (43.48%) maintained their deep remission for one year after their treatment discontinuation (month 24 of the study). Probability of relapse-free survival following adalimumab discontinuation in patients achieving deep remission at 12 months was 44.8%.

Conclusion

Three out of 10 patients with early CD and naïve to biologics achieved deep remission at one year with adalimumab. Among these patients, about half of them maintained deep remission at 2 years. Unraveling factors associated with treatment success will allow identifying CD patients who can stop anti-TNF therapy after achieving deep remission.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

Medical therapy of IBD: Facts and challenges (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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INVESTIGATING THE PROTECTIVE ROLE OF DIETARY MANGANESE INTAKE ON METABOLIC-ASSOCIATED FATTY LIVER DISEASE

Christian Trautwein

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Stephan Vavricka

UEG Presentation

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Measuring and managing abnormal rectal sensory function

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Measuring and managing abnormal rectal sensory function

Walter Chan 1

Affiliations

1 Brigham and Women's Hospital, Boston, United States of America

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Colorectal Education & Training Neurogastroenterology & Motility

Session

ABC of the EAS and the IAS: Why physiology matters when managing faecal incontinence

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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INVESTIGATING THE PROTECTIVE ROLE OF DIETARY MANGANESE INTAKE ON METABOLIC-ASSOCIATED FATTY LIVER DISEASE

Christian Trautwein

Introduction: What’s new in EIM

Stephan Vavricka

UEG Presentation

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Introduction: UEG Journal Session

Haluk Tarik Kani 1, Irene Marafini 2, Anthea Pisani 3

Affiliations

1 Marmara University, School of Medicine, Division of Gastroenterology&Hepatology, Istanbul, Turkey

2 University of Rome Tor Vergata, Rome, Italy

3 Mater Dei Hospital, Mosta, Malta

Summary

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Abstract

Event

UEG Week Vienna 2024

Topics

Digestive Oncology Endoscopy Pancreas

Session

UEG Journal Session

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Christian Trautwein

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Stephan Vavricka

UEG Presentation

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Treatment strategies of itch

Andreas E. Kremer 1

Affiliations

1 University Hospital Zürich, Zürich, Switzerland

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Education & Training Hepatobiliary Neurogastroenterology & Motility Primary Care

Session

How to treat itching?

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Christian Trautwein

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Stephan Vavricka

UEG Presentation

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Psychology

Laurie Keefer 1

Affiliations

1 Icahn School of Medicine, New York, United States of America

Summary

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Abstract

Event

UEG Week Vienna 2024

Topics

Neurogastroenterology & Motility Primary Care

Session

The patient with a challenging functional disorder

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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INVESTIGATING THE PROTECTIVE ROLE OF DIETARY MANGANESE INTAKE ON METABOLIC-ASSOCIATED FATTY LIVER DISEASE

Christian Trautwein

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Stephan Vavricka

UEG Presentation

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INVESTIGATING THE PROTECTIVE ROLE OF DIETARY MANGANESE INTAKE ON METABOLIC-ASSOCIATED FATTY LIVER DISEASE

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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INVESTIGATING THE PROTECTIVE ROLE OF DIETARY MANGANESE INTAKE ON METABOLIC-ASSOCIATED FATTY LIVER DISEASE

Simon Schophaus 1, Kate Townsend Creasy 2, Jan Clusmann 1, Alexander Koch 1, Christian Trautwein 1, Kai Markus Schneider 1, Carolin Schneider 1

Affiliations

1 RWTH Aachen, Aachen, Germany

2 University of Pennsilvania, Philadelphia, United States

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Abstract

Introduction

Metabolic-associated fatty liver disease (MAFLD) is a prevalent condition affecting 20-30% of the general population, characterized by lipid droplet accumulation in hepatocytes. A high-caloric Western-style diet is a well-established risk factor for MAFLD, yet there is limited data on the preventive role of specific nutrients in the general population. This study investigates the association between nutrient intake and MAFLD development in a large-scale cohort.

Aims & Methods

The study population was selected from the UK Biobank dataset (UKB 71300) based on the availability of nutritional assessment data obtained from five questionnaires. Participants with pre-existing liver diseases diagnosed before completing the food questionnaires were excluded. The first nutrient-wide association study, “Nutri-WAS,” was conducted to investigate the association between nutrients calculated from food questionnaires and MAFLD development during an 11-year follow-up (utilizing ICD codes and 39,000 MRI images of the liver). All analyses were adjusted for age, sex, BMI, Townsend index for socioeconomic status, kcal, alcohol, protein intake, fat intake, carbohydrate intake, and multiple testing.

Results

Analysis of data from over 210,000 participants revealed that, among 50 tested nutrients, manganese displayed the strongest protective effect against liver fat accumulation on MRI. Increased dietary manganese intake was associated with a lower prevalence of MAFLD. Each standard deviation (SD) increase in manganese intake reduced the association of MAFLD ICD-10 diagnosis (K76.0) by 14.9% (p<0.0001) and MRI diagnosis of MAFLD by 17.2% (p<0.0001). Furthermore, metabolomics data available for more than 49,000 individuals demonstrated a significant effect of manganese on reduced VLDL secretion.

Conclusion

The present study provides evidence that increased dietary manganese intake may confer protection against the development of MAFLD. Future randomized clinical trials are warranted to confirm the beneficial effects of manganese supplementation for MAFLD prevention.

Event

UEG Week Copenhagen 2023

Topics

Endoscopy Gut Microbiota Hepatobiliary IBD Small Intestine & Nutrition Pancreas

Submission format

Abstract

Session

The various impacts of diet: From IBD to liver

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction: What’s new in EIM

Hannah Gordon 1, Stephan Vavricka 2

Affiliations

1 Royal London Hospital, London, United Kingdom

2 University Hospital Zurich, Zürich, Switzerland

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Education & Training IBD Mechanisms & Personalised Medicine Primary Care

Session

What’s new in extra-intestinal manifestations of IBD?

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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