The American College of Gastroenterology held its 2019 Annual Scientific Meeting in San Antonio, Texas. Here are some of the presentations that grabbed our attention:

JAK inhibitor off the hook for DVT?

A post-hoc analysis of trials of tofacitinib in patients with ulcerative colitis has provided some reassuring evidence that rates of DVT or PE are not increased with the 10 mg dose.

The study, presented by Professor William Sandborn from the University of California, San Diego, was in response to safety concerns raised in a trial of the JAK inhibitor in patients with rheumatoid arthritis.

The RA trials showed higher rates of DVT or PE with the 10 mg dose compared to the 5 mg dose, which resulted in safety warnings from regulatory authorities including the TGA.

Professor Sandborn’s study looked at DVT and PE events in four randomised controlled trials, one maintenance trial, and an ongoing, open-label, long-term extension trial collectively comprising 1,157 patients with 2,404 patient years of tofacitinib exposure and up to 6.1 years of treatment.

It found all five patients who developed DVT and PE in the placebo-controlled trials were receiving placebo however in the long-term extension trial, five patients who developed DVT and PE were all receiving tofacitinib 10 mg bid.

He said this equates to a rate of less than 0.2/100 patient years.

“This is a low rate and consistent with the rates of DVT and PE seen in patients with ulcerative colitis who are not taking tofacitinib,” said Professor Sandborn.

Oral budesonide effective in EoE

A novel oral suspension of budesonide is effective in adolescents and adults with eosinophilic esophagitis (EoE) and dysphagia.

A phase 3 trial randomised 322 patients to either 2 mg budesonide or placebo twice daily for 12 weeks.

The study found significantly more histologic (53.1% v 1.0%, p< 0.001) and symptom responders (52.6% v 39.1%, p=0.024) in the budesonide-treated than the control group.

Improvements in mean EoE endoscopic reference scores (EREFS) were also significantly greater with budesonide than placebo (−4.0 v −2.2; p< 0.001).

Few patients had severe or serious treatment-emergent adverse events.

The findings, presented by Professor Ikuo Hirano from Northwestern University Feinberg School of Medicine in Chicago, extend the evidence from the recently published phase 2 study.

Most other trials in EoE have used corticosteroid formulations intended for asthma rather than a product developed specifically for eosophageal delivery.

A maintenance study is still ongoing.

Normal body weight safer in CRC

According to Vita Jaspan, #obese patients have worse #ColonCancer outcomes compared to normal weight patients. This is an important finding since obesity increases the risk of colorectal cancer. We need to investigate why. #ACG2019 @AmCollegeGastro @PopovVioleta pic.twitter.com/tnPCLlNwpe

— Mark B. Pochapin, MD (@MarkPochapin) October 30, 2019

Both obesity and being underweight are associated with poor long-term outcomes in colorectal cancer.

A systematic review and meta-analysis comprised 17 studies representing 251,347 patients with stage 1 to 3 nonmetastatic CRC who were followed for up to 16 years.

The study, presented by Vita Jaspan from the New York University School of Medicine, found obesity was associated with a 30% increase in CRC mortality and a 20% increase in overall mortality compared to patients with normal weight.

And these odds were similar in underweight patients, who typically represent a subset with cachexia and more advanced disease.

She said clinicians now have additional evidence to support advice regarding patient goals of a healthy weight and waist circumference.

Statins reduce liver cancer risk

My oh my, the discussions of #statins and liver disease has certainly evolved over the last 15 years!

Large meta-analysis of statins associated with over 40% risk reduction in Hepatocellular Cancer in certain populations (USA & Hep B highest possible correlation).#ACG2019 pic.twitter.com/fWo44CvtfX

— Dawn Sears, MD (@GutGirlMD) October 28, 2019

A meta-analysis of 20 studies comprising more than 2.6 million patients has shown a significant reduction in risk of developing HCC among statin users compared to non-users (OR = 0.57).

In studies performed in Asia, Europe and the US, statin use was associated with 48%, 29% and 46% risk reductions, respectively.

The study, presented by Dr Muhammad Talal Sarmini from the Cleveland Clinic Foundation, suggests statins should be considered in patients at high risk for HCC such as people with cirrhosis, HBV and HCV.

Statins are known to have pro-apoptotic, anti-angiogenic, anti-proliferative and immunomodulatory effects and this is the largest meta-analysis conducted on the association with HCC to date.

However further prospective randomised research is needed to confirm this association, the meeting was told.