Clinical Course of Bio Naive Ulcerative Colitis Patients Five Years After Initiation of Adalimumab in a Nationwide CohortSundararajan, Ramaswamy; Patel, Manthankumar; Bahirwani, Janak; Trivedi, Chinmay; Mahmud, Nadim; Khan, Nabeel
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae046pmid: 39188766
BackgroundThere is limited data on the long-term clinical outcomes of bio-naïve ulcerative colitis (UC) patients who are initiated on adalimumab (ADA). Our study aims to evaluate the clinical course of a nationwide cohort of bio naïve UC patients who were started on ADA, and then followed for 5 years after initiation of the drug.MethodsWe conducted a retrospective cohort study using the US Veteran Affairs Healthcare System (VAHS). Bio naïve UC patients were followed for 5 years after initiation of ADA. The primary outcome was to determine the time to discontinuation of ADA and if patients achieved endoscopic remission by the end of follow-up.ResultsA total of 387 patients were included among whom 193 (49.87%) had pancolitis. The highest rate of ADA discontinuation was within the first year, with the elderly having a higher rate of discontinuation (HR 1.67, 95% CI: 1.14–2.45) and those on concomitant immunomodulators having a lower rate of discontinuation (HR 0.70, 95% CI: 0.48–1.03). In total, 125 (32.30%) patients remained on ADA at the end of their maximum follow-up. 54 (43.90%) achieved endoscopic remission.ConclusionAmong bio-naive UC patients who were started on ADA, a third were still on the drug at the end of 5 years and half had endoscopic remission. The rate of discontinuation was highest within the first year of initiation, but patients continued to stop the drug over the course of follow-up.
Young Adult Patient and Caregiver Perspectives on Transition Readiness in an Inflammatory Bowel Disease ClinicStrobel, Thomas M; Narayani, Nikita A; Nicholson, Maribeth R; Riera, Diana C; Rakos, Tanner G; Fulton, Nisa P; Trotter-Busing, Jordan A; Horst, Sara N; Dalal, Robin L; Pabla, Baldeep S; Scoville, Elizabeth A; Schwartz, David A; Beaulieu, Dawn B
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae044pmid: 39219801
BackgroundWhen it comes to readiness to transition to an adult subspecialty clinic, perspectives between patients with inflammatory bowel disease (IBD) and their caregivers may differ and influence the ability to successfully transition. Patients with IBD have been shown to suffer from poor transfers of care. There is a need to more efficiently and accurately assess transition readiness to improve the transfer process.MethodsPatients transferring to an adult subspecialty clinic and their caregivers were each administered the Transition Readiness Assessment Questionnaire and IBD Self-Efficacy Scale—Adolescent. Differences between patient and caregiver responses and agreement among each dyad were tested.ResultsThere were 29 dyads of patients and caregivers who enrolled. There was no difference between patient and caregiver total scores. The average level of agreement between patients and caregivers was 78%. There was no association between patient response and their age, gender, ethnicity, age at time of transfer, age at diagnosis, or number of emergency room visits in the prior year.ConclusionsPatient-reported readiness to transition to adult care was confirmed by their caregivers using validated readiness assessment tools. As transition clinics must focus on high-yield interventions, a readiness survey of young adult patients without a survey of their caregivers may be adequate. However, as experts in each patient’s journey, caregivers may be utilized when setting goals and priorities for a transition readiness program. The surveys used in this study can be used broadly to aid subspecialty clinics that are trying to improve the transition process.
Successful Preoperative Transjugular Intrahepatic Portosystemic Shunt for Portal Decompression in Patients With Inflammatory Bowel Disease and Cirrhosis Requiring Surgical InterventionKarime, Christian; Vattikonda, Asrita; Hashash, Jana G; Rosser, Barry G; Merchea, Amit; Stocchi, Luca; Farraye, Francis A
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae037pmid: 38966121
BackgroundColorectal surgery in patients with inflammatory bowel disease (IBD) and cirrhosis has increased morbidity, which may preclude surgery. Preoperative transjugular intrahepatic portosystemic shunt (TIPS) is postulated to reduce surgical risk. In this retrospective single-center study, we characterized perioperative outcomes in patients with IBD and cirrhosis who underwent preoperative TIPS.MethodsWe identified patients with IBD and cirrhosis who had undergone preoperative TIPS for portal decompression between 2010 and 2023. All other indications for TIPS led to patient exclusion. Demographic and medical data were collected, including portal pressure measurements. Primary outcome of interest was perioperative outcomes.ResultsTen patients met the inclusion criteria. The most common surgical indications were dysplasia (50%) and refractory IBD (50%). TIPS was performed at a median of 47 days (IQR 34–80) before surgery, with reduction in portal pressures (22.5 vs. 18.5 mmHg, P < .01) and portosystemic gradient (12.5 vs. 5.5 mmHg, P < .01). Perioperative complications occurred in 80% of patients, including surgical site bleeding (30%), wound dehiscence (10%), systemic infection (30%), liver function elevation (50%), and coagulopathy (50%). No patients required re-operation, with median length of stay being 7 days (IQR 5.5–9.3). The 30-day readmission rate was 40%, most commonly for infection (75%), with 2 patients having intra-abdominal abscesses and 1 patient with concern for bowel ischemia. Ninety-day and one-year survival was 100% and 90%, respectively. Patients with primary sclerosing cholangitis (PSC)-cirrhosis were noted to have higher perioperative morbidity and a 30-day readmission rate.ConclusionsIn patients with IBD and cirrhosis, preoperative TIPS facilitated successful surgical intervention despite heightened risk. Nevertheless, significant complications were noted, in particular for patients with PSC-cirrhosis.
Artificial Intelligence- and Physician-Interpreted Stool Image Characteristics Correlate With C-Reactive Protein Among Inpatients With Acute Severe Ulcerative Colitis: A Pilot StudyRotondo-Trivette, Sarah; Castelan, Viankail Cedillo; Mathur, Kushagra; Yasmeh, Pauline; Kraus, Asaf; Lynch, Addison; McGovern, Dermot P B; Melmed, Gil Y
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae043pmid: 39206451
BackgroundStool characteristics are used as a measure of ulcerative colitis (UC) disease activity, but they have not been validated against objective inflammation. We aimed to determine whether stool characteristics measured by trained artificial intelligence (AI) and physicians correlate with inflammation in UC.MethodsPatients hospitalized with acute severe UC (ASUC) were asked to capture images of all bowel movements using a smartphone application (Dieta®). Validated AI was used to measure five stool characteristics including the Bristol stool scale. Additionally, four physicians scored each image for blood amount, mucus amount, and whether stool was in a toilet or commode. AI measurements and mean physician scores were rank-normalized and correlated with rank-normalized CRP values using mixed linear regression models. Mann–Whitney tests were used to compare median CRP values of images with and without mucus and with and without blood.ResultsWe analyzed 151 stool images collected from 5 patients admitted with ASUC (mean age 42 years, 40% male). Overall, Bristol stool scale and fragmentation positively correlated with CRP, while stool consistency negatively correlated with CRP. The median CRP of images with mucus was higher than that of images without mucus.ConclusionsSmartphone application AI measurements of Bristol stool scale, stool consistency, and stool fragmentation significantly correlate with CRP values in hospitalized patients with ASUC. Additionally, median CRPs are higher when mucus is seen. Further training of smartphone-based AI algorithms to validate the association of stool characteristics with objective inflammation may yield a novel, noninvasive tool for UC disease monitoring.
Burden of Bowel Urgency in Patients With Ulcerative Colitis and Crohn’s Disease: A Real-World Global StudyAtreya, Raja; Redondo, Isabel; Streit, Petra; Protic, Marijana; Hartz, Susanne; Gurses, Gamze; Knight, Hannah; Barlow, Sophie; Harvey, Niamh; Hunter Gibble, Theresa
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae047
BackgroundBowel urgency is a highly disruptive and bothersome symptom experienced by patients with inflammatory bowel diseases (IBD), (ulcerative colitis [UC], and Crohn’s disease [CD]). However, the burden of bowel urgency among patients with varying experiences in targeted treatment has not been consistently assessed. This real-world study explored the clinical and health-related quality of life burden of bowel urgency among patients with IBD with differing treatment experiences.MethodsThis cross-sectional survey included gastroenterologists and their patients with IBD across France, Germany, Italy, Spain, the United Kingdom, and the United States treated for over 3 months. Physicians provided patient demographics, clinical characteristics, and treatment history. Patients reported their health-related quality of life and work productivity. Patients with UC and CD were analyzed separately and stratified into 3 groups: Targeted therapy naïve, those receiving their first-line targeted therapy, and targeted therapy experienced.ResultsThis study found that 17%-26% of UC and 13%-17% of CD patients experienced persistent bowel urgency, irrespective of receiving conventional or targeted therapy. Moreover, patients with bowel urgency experienced an increased clinical and health-related quality of life burden compared to patients without bowel urgency, which physicians most commonly regarded as one of the most difficult symptoms to treat, with the burden remaining substantial irrespective of their treatment experience.ConclusionsDespite several current treatment options, new therapeutic strategies are necessary to provide relief from bowel urgency, one of the most challenging symptoms for people living with IBD.
Treatment Pathways in Patients With Crohn’s Disease and Ulcerative Colitis: Understanding the Road to Advanced TherapySiegel, Corey A; Sharma, Dolly; Griffith, Jenny; Doan, Quynhchau; Xuan, Si; Malter, Lisa
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae040pmid: 39211396
BackgroundPatients with Crohn’s disease (CD) or ulcerative colitis (UC) often cycle through conventional therapies (CT) with different mechanisms of action (MOA) before initiating advanced therapy (AT). We describe treatment patterns among patients with CD/UC.MethodsUsing Merative MarketScan Research databases, adult patients with CD/UC were identified from medical/pharmacy claims (2017–2021). Patients had ≥1 hospitalization or ≥2 outpatient visits (≥30 days apart within 1 year) for CD/UC. Two cohorts were established; cohort 1: Newly diagnosed patients (index date is the date of first diagnosis) and cohort 2: Patients initiating AT (index date is the date of first AT). First-line treatment patterns (cohort 1) and CT pathways before AT initiation (cohort 2) by the number of episodes (ie, adding a new therapy, switching to another therapy, or restarting the same therapy after ≥60 days) and MOA are reported.ResultsAmong newly diagnosed patients in cohort 1 (CD: n = 1739; UC: n = 2740), 14.4% (CD) and 5.9% (UC) of patients had any AT use during the follow-up period (mean: 2.3 years; ≥ 77% initiated corticosteroids). Among patients in cohort 2 (CD: n = 2594; UC: n = 2431), the mean number of CT episodes before AT initiation was 4.0 ± 4.3 (CD) and 5.9 ± 5.0 (UC). Among those with ≥1 corticosteroid episode (CD: 82.2%; UC: 91.5%), the mean number of episodes was 4.6 ± 4.3 (CD) and 6.3 ± 5.0 (UC). Overall, 13.3% (CD) and 23.7% (UC) of patients cycled through 3 MOAs before AT initiation.ConclusionsDespite treatment recommendations, few newly diagnosed CD/UC patients initiated AT as their first treatment. Moreover, patients cycled through multiple CTs before initiating AT.
Applying Machine Learning Models Derived From Administrative Claims Data to Predict Medication Nonadherence in Patients Self-Administering Biologic Medications for Inflammatory Bowel DiseaseRhudy, Christian; Perry, Courtney; Wesley, Michael; Fardo, David; Bumgardner, Cody; Hassan, Syed; Barrett, Terrence; Talbert, Jeffery
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae039pmid: 39050112
BackgroundAdherence to self-administered biologic therapies is important to induce remission and prevent adverse clinical outcomes in Inflammatory bowel disease (IBD). This study aimed to use administrative claims data and machine learning methods to predict nonadherence in an academic medical center test population.MethodsA model-training dataset of beneficiaries with IBD and the first unique dispense of a self-administered biologic between June 30, 2016 and June 30, 2019 was extracted from the Commercial Claims and Encounters and Medicare Supplemental Administrative Claims Database. Known correlates of medication nonadherence were identified in the dataset. Nonadherence to biologic therapies was defined as a proportion of days covered ratio <80% at 1 year. A similar dataset was obtained from a tertiary academic medical center's electronic medical record data for use in model testing. A total of 48 machine learning models were trained and assessed utilizing the area under the receiver operating characteristic curve as the primary measure of predictive validity.ResultsThe training dataset included 6998 beneficiaries (n = 2680 nonadherent, 38.3%) while the testing dataset included 285 patients (n = 134 nonadherent, 47.0%). When applied to test data, the highest performing models had an area under the receiver operating characteristic curve of 0.55, indicating poor predictive performance. The majority of models trained had low sensitivity and high specificity.ConclusionsAdministrative claims-trained models were unable to predict biologic medication nonadherence in patients with IBD. Future research may benefit from datasets with enriched demographic and clinical data in training predictive models.
Patient-Related Factors Associated With Long-Term Outcomes After Successful Endoscopic Balloon Dilation For Crohn’s Disease-Associated Ileo-Colic Strictures: A Systematic Review and Meta-analysisMenezes Nascimento Filho, Hiram; Kum, Angelo So Taa; Bestetti, Alexandre Moraes; da Silva, Pedro Henrique Veras Ayres; Gallegos, Megui Marilia Mansilla; Damião, Adérson Omar Mourão Cintra; Navaneethan, Udayakumar; de Moura, Eduardo Guimarães Hourneaux
2024 Crohn s & Colitis 360
doi: 10.1093/crocol/otae041pmid: 39175792
BackgroundSuccessful Crohn’s disease (CD) therapy relies on timely and precise management strategies. Endoscopic balloon dilation (EBD) has been applied as a first-line treatment for symptomatic CD-associated strictures due to its minimally invasive nature and the possibility of preserving intestinal length.ObjectiveThe aim of the present study was to determine patient-related predictive factors associated with the need for surgery for CD-associated ileocolic strictures after technically successful EBD.MethodsAll original studies published before December 2023 that reported the outcomes of patients treated with EBD for ileocolic strictures secondary to CD and described follow-up for at least 1 year were included. The difference in risk of needing surgery was calculated for 8 different patient characteristics (Sex, smoking habit, previous surgery, biologic therapy, steroids, immunosuppressors, nature of the stricture, and endoscopic disease activity).ResultsThere were significant differences in the risk of needing surgery after EBD among patients who underwent surgery and patients without a history of surgery (RD: −0.20 [−0.31, −0.08]), patients with endoscopic mucosal activity and patients in remission at the time of EBD (RD: 0.19 [0.04, 0.34]), patients using biologics at the time of EBD and patients not using biologics (RD: −0.09 [−0.16, −0.03]), and patients using steroids and those not using steroids at the time of EBD (RD: 0.16 [0.07, 0.26]).ConclusionsThe use of biologics and endoscopic disease remission at the time of EBD were protective factors against the need for surgery. No previous surgery or use of steroids at the time of EBD was associated with the need for surgery during follow-up.