Australian gastroenterologists made numerous presentations of research findings at the European Crohn’s and Colitis Organisation (ECCO) annual scientific meeting in Vienna from 12-15 February. Here are the limbic’s top 5 highlights:
Virtual Clinic model for anti-TNF dose escalation
A ‘virtual clinic’ model of IBD care may be more effective than the traditional outpatient model for implementing treat-to-target anti-TNF dose intensification in Crohn’s Disease, according to clincians from Melbourne. At ECCO 2020 they presented results from a cohort of 69 patients undergoing dose escalation with either infliximab or adalimumab dose intensification via a virtual clinic to address secondary loss of response. When compared to a cohort of 80 patients undergoing dose escalation via a standard outpatient care, the virtual clinic patients had higher rates of appropriate dose intensification (82.6 vs 40%, p<0.01) after an average of 1.5 years of follow up. The virtual clinic model was also associated with higher proportions of anti-TNF escalation success (60.9 v 35%, p<0.01), biomarker remission (CRP <5mg/L and faecal calprotectin <150 ug/ml) and tight disease monitoring (84.1 vs 28.8%, p<0.01). Higher rates of de-escalation of intensified therapy (21.3 vs 10%, p=0.03) were also achieved by the virtual clinic cohort following dose-intensification. The study was led by Dr Ashish Srinivashan of Austin Health.
How to predict corticosteroid therapy failure
Queensland gastroenterologists have developed a risk assessment tool that allows personalised prediction of the likelihood of success of a course of IV corticosteroid therapy in moderate-severe ulcerative colitis. The risk score was derived from factors associated with corticosteroid therapy failure in a cohort of 349 patients with UC at the Royal Brisbane and Women’s Hospital. It included variables such as oral corticosteroid therapy failure, bowel frequency and serum albumin concentration as well as the Mayo endoscopic subscore (MES).When the threshold positive predictive value of the score for correctly predicting corticosteroid therapy failure was set at 85%, the risk tool identified 105/275 (38%) of presentations as high risk for therapy failure. The tool therefore offers a practical way for clinicians to identify individuals at high risk of treatment failure who may be suitable for consideration of early treatment escalation or screening for appropriate clinical trials, concluded Dr Anthony Croft of the Department of Gastroenterology, Royal Brisbane and Women’s Hospital.
TDM for adalimumab
Although the evidence for therapeutic drug monitoring with adalimumab in Crohn’s disease is not as strong as for infliximab, performing TDM subsequent to dose escalation has a role in predicting outcomes, according to Dr Adrian Swaine and colleagues from the Alfred Hospital, Melbourne. In a retrospective study involving 133 patients with Crohn’s disease they found that adalimumab levels at loss of response did not discriminate between responder and non-responders. However the measurements of adalimumab levels at 6 and 12 months showed that higher levels (with a target threshold between 7.7-10.9μg/mL) were associated with favourable outcomes for clinical and objective remission.
Favourable outcomes with ustekinumab in real world study
A single centre ‘real world’ study conducted at the Gold Coast University Hospital found that ustekinumab was efficacious and safe in 76 patients with moderate to severe Crohn’s disease. The retrospective study found that after 12 weeks 48 (63%) of patients achieved steroid free clinical remission or response. The response rates were 73% in the anti-TNF naive patients and 59% in anti-TNF exposed patients At one year, 68% of patients achieved the endoscopic endpoint, 67.5% achieved the radiological, endpoint and 56% and 69% achieved the biochemical and clinical endpoints respectively. Patients who achieve steroid free clinical remission or response at 12 weeks are more likely to be in clinical remission or response at 24 and 52 weeks.
Bone density screening needed in IBD patients
Patients with IBD have high rates of osteopenia but are often not screened for bone mineral density, researchers from the ANU Medical School, Canberra, have found. A study of 553 IBD patients attending the Canberra Hospital found that 41% had osteopenia, and 6.5% had osteoporosis The significant risk factors for low BMD were older age (≥50 years) and BMI <25.5. Only 44% of the patients had an initial DXA scan and only one third of those had a follow-up DXA scan. Local guidelines on screening for low bone mineral density are warranted, concluded the study authors led by Dr Kavitha Subramaniam.