International Magnetic Resonance Imaging Consensus for use in Luminal Crohn's Disease Trials and Clinical Practice.

Background And Aims: Cross sectional imaging is an integral part of evaluating disease activity and complications in Crohn's disease. There remains a need to develop guidance that may be for both clinical trials and clinical practice. This initiative aimed to develop consensus statements for definitions of response and remission, transmural healing, optimal timing for assessing, and evaluation of treatment efficacy in patients with Crohn's disease using magnetic resonance enterography (MRE) in clinical trials and clinical practice.

Longitudinal Profiles of Fecal Calprotectin and C-Reactive Protein in Relation to Outcomes in Crohn's Disease Patients on Infliximab.

Background And Aims: This study explored the relationship between fecal calprotectin (FCAL) and C-reactive protein (CRP) trajectory classes and composite outcomes (COs) in Crohn's Disease (CD) patients under infliximab (IFX). COs reflected disease progression, including surgery, hospitalizations, new fistulas, abscesses, strictures, and treatment escalation.

Methods: The DIRECT study was a multicenter, prospective investigation (2016-2019), including moderate-severe CD patients on IFX.

Treat-to-Target in Inflammatory Bowel Disease: An Updated Survey of Treatment Strategies among Portuguese Gastroenterologists.

Background: In 2018, the authors surveyed the clinical practices among Portuguese gastroenterologists (PGEs) regarding treatment targets in Crohn's disease (CD) and ulcerative colitis (UC). Since then, new evidence has emerged supporting additional targets, such as transmural remission and histological remission. This study provides an updated assessment of treatment practices among PGE with special emphasis on these new targets.

Efficacy and Safety of Upadacitinib Maintenance Therapy in Patients with Moderately to Severely Active Crohn's Disease: 2-Year Results from the U-ENDURE Long-Term Extension Study.

Background And Aims: The long-term efficacy and safety of upadacitinib in patients with moderate to severe Crohn's disease (CD) were evaluated in the U-ENDURE long-term extension (LTE) study. Here we report the results after 2 years of total maintenance treatment.

Methods: U-ENDURE is an ongoing 240-week LTE study conducted at 243 sites across in 43 countries (first patient enrolled in LTE 21 March 2019).

Mirikizumab impact on disease clearance in patients with moderately to severely active ulcerative colitis: analysis of a pre-specified LUCENT trial endpoint.

Background And Aims: Concurrent achievement of symptomatic, endoscopic, and histologic remission, known as disease clearance, has been proposed as a treatment target in ulcerative colitis. Mirikizumab, an anti-interleukin-23 p19 antibody, has demonstrated long-term efficacy and safety, as reported in the LUCENT Phase 3 trials (NCT03518086, NCT03524092, and NCT03519945). The current analysis evaluates the impact of mirikizumab on disease clearance and the association with other clinical and patient-reported outcomes (PROs).

Advancing Precision in IBD Care: Innovations in Diagnosis, Monitoring, and Multidisciplinary Management.

Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a multifactorial disorder involving a dynamic interplay between genetic susceptibility, gut microbiota, nutrition, environmental exposures, immune dysregulation, and psychosocial factors [...

Early Top-Down Treatment With Biologics Improves the Rates of Transmural Remission in Crohn's Disease-A Risk-Adjusted Propensity Score Matched Analysis.

Background: Early top-down treatment with biologics has been associated with higher rates of endoscopic remission compared to step-up treatment in Crohn's disease (CD). The benefits in relation to transmural remission are currently unknown. Better stratification of patients suitable for top-down strategies is needed.

Janus Kinase (JAK) Inhibitor-Induced Acne in Inflammatory Bowel Disease: An International, Multicenter, Retrospective Cohort Study.

Background & Aims: JAK inhibitor-associated acne is a common but poorly understood adverse event. This study aimed to investigate the epidemiology, clinical characteristics, and treatment outcomes of this condition in patients with inflammatory bowel disease (IBD).

Methods: This international, multicenter, retrospective cohort study consecutively enrolled JAK-inhibitor-treated patients with IBD who subsequently developed acne.

The effectiveness of second- and-third-line biologics in perianal Crohn's disease-a multicenter propensity score-matched study.

Background And Aims: Anti-tumor necrosis factor-α inhibitors (anti-TNFs) are the established treatment for perianal Crohn's disease (pCD), but relapse and non-response are common. Data on second- and third-line biologics are limited. We present the first direct comparison of second- and third-line biologics in pCD patients with active perianal disease previously treated with first-line anti-TNFs.

Positioning Guselkumab in The Treatment Algorithm of Patients with Crohn's Disease.

Guselkumab, a selective interleukin-23 (IL-23) inhibitor, has emerged as a promising biologic therapy for the management of patients with moderate-to-severe Crohn's disease (CD) and has been recently approved for its treatment. Unlike conventional therapies, guselkumab offers a different mechanism of action by selectively inhibiting IL-23, a key cytokine implicated in the pathogenesis of CD. IL-23 drives intestinal inflammation through activation of the Th17 cell pathway and other immune processes, positioning IL-23 inhibition as a critical therapeutic approach.

An International Consensus on Appropriate Management of Corticosteroids in Clinical Trials in Inflammatory Bowel Disease.

Background & Aims: Approval of new therapies for inflammatory bowel disease (IBD) requires rigorously designed and well-executed randomized controlled trials (RCTs). Corticosteroids remain a cornerstone of IBD induction therapy, and many patients in trials are enrolled while taking corticosteroids. Despite this, approaches to corticosteroid management in RCTs have been highly heterogeneous, often differing from clinical practice.

Developing IBD Outcome Effect Size Thresholds to Inform Research, Guidelines, and Clinical Decisions.

Background: When designing clinical trials, interpreting trial outcomes for guideline development or sharing decisions with patients in clinical practice, the clinical outcomes used and the implicit choices on what constitutes a clinically significant finding can vary greatly. This can lead to diversity or even inequity in care offered to patients with inflammatory bowel disease (IBD). The GRADE approach to guideline development has proposed a process to address this prospectively to solve these issues, but this has never been used in IBD.

Shaping the future of inflammatory bowel disease: a global research agenda for better management and public health response.

Inflammatory bowel disease (IBD) is a growing global health challenge affecting more than 7 million people worldwide. With increasing prevalence across all age groups, including children and adolescents, IBD places substantial strain on health-care systems and society, resulting in high direct medical costs, lost productivity and reduced quality of life. Despite therapeutic advances, suboptimal disease control and delays in timely diagnosis and adequate treatment persist.

5-Aminosalicylates for non-surgical patients with active or quiescent Crohn's disease: an overview of systematic reviews (umbrella review).

Background: 5-aminosalicylates (5-ASAs) are commonly used in non-surgical patients with Crohn's disease (CD), especially in mild-to-moderate disease, despite current guidelines against their use. Despite this, the evidence regarding their efficacy is mixed, with conflicting findings in systematic reviews (SRs).

Aims: We conducted an overview of reviews (umbrella review) to consolidate existing knowledge from published SRs on using 5-ASAs in patients with active or quiescent CD.

Disease Clearance in Ulcerative Colitis: A Narrative Review.

Ulcerative colitis (UC) is a chronic relapsing disease with significant associated risks such as colectomy, hospitalization, or colorectal cancer. A treat-to-target approach that mitigates disease activity and progression from an early stage is needed. The latest STRIDE II guidelines advocate for clinical and endoscopic remission as the main therapeutic targets in the management of UC; however, histological remission is increasingly being recognized as an important outcome.

Artificial Intelligence for Clinical Trial Facilitation, Lessons for Inflammatory Bowel Disease: A Scoping Review.

Background & Aims: Despite major advances in many fields of science and technology, pharmaceutical research and development continues to be inefficient across multiple diseases. Inflammatory bowel disease (IBD) trials are also subject to high failure rates. The aim of this review was to give an overview of the available literature on the use of artificial intelligence (AI) for clinical trial facilitation across a variety of medical specialties before trying to best position AI in IBD clinical trials.

Higher Life's Essential 8 score is associated with reduced risk of related surgery and all-cause mortality among 3232 individuals with inflammatory bowel disease in a longitudinal cohort study.

Background: Previous studies indicated discrete lifestyle health metrics that benefit cardiovascular health are associated with better prognosis in inflammatory bowel disease (IBD), while evidence regarding the comprehensive impact of cardiovascular health remains limited. This study aimed to investigate the association between the overall cardiovascular health indicator, Life's Essential 8 (LE8), and the adverse outcomes of IBD.

Materials And Methods: We included 3232 IBD participants recruited from the UK Biobank between 2006 and 2010.

Definitions, diagnosis, and management of postoperative recurrence in Crohn's disease patients with permanent ileostomy-a systematic review and meta-analysis.

Background And Aims: Over 10% of patients with Crohn's disease require permanent ileostomy. We aimed to summarize the existing data on diagnosis, definitions of recurrence, and management of Crohn's disease patients with permanent ileostomy.

Methods: MEDLINE, Embase, and CENTRAL databases were searched from inception to February 6, 2024.

Higher dietary glycemic index, but not glycemic load, is associated with increased risk of ulcerative colitis: a prospective cohort study.

Background And Aims: Total carbohydrate intake has been inconsistently associated with inflammatory bowel disease (IBD) risk in previous epidemiological studies. We aimed to evaluate the effects of glycemic index and glycemic load, 2 main indicators for measuring the quality and quantity of carbohydrates, on the risk of IBD subtypes (ie, Crohn's disease [CD] and ulcerative colitis [UC]).

Methods: We included 121 148 UK Biobank participants without IBD at baseline, and collected dietary information from a validated web-based 24-hour dietary recall questionnaire.

TL1A Inhibition in Inflammatory Bowel Disease: A Pipeline Review.

Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), remains challenging to manage, with a substantial proportion of patients not responding to conventional therapies or developing complications. The tumor necrosis factor (TNF) superfamily member TL1A has emerged as an important player in the pathogenesis of IBD, influencing pathways of inflammation and fibrosis. This leading article reviews the role of TL1A in IBD, evaluates the efficacy of anti-TL1A therapies in clinical trials, and discusses future directions for research and treatment.

Understanding the therapeutic toolkit for inflammatory bowel disease.

Inflammatory bowel disease (IBD), encompassing ulcerative colitis and Crohn's disease, is a group of chronic, immune-mediated disorders of the gastrointestinal tract that present substantial clinical challenges owing to their complex pathophysiology and tendency to relapse. A treat-to-target approach is recommended, involving iterative treatment adjustments to achieve clinical response, reduce inflammatory markers and achieve long-term goals such as mucosal healing. Lifelong medication is often necessary to manage the disease, maintain remission and prevent complications.

Inter-Rater Disagreements in Applying the Montreal Classification for Crohn's Disease: The Five-Nations Survey Study.

Background: The Montreal classification has been widely used in Crohn's disease since 2005 to categorize patients by the age of onset (A), disease location (L), behavior (B), and upper gastrointestinal tract and perianal involvement. With evolving management paradigms in Crohn's disease, we aimed to assess the performance of gastroenterologists in applying the Montreal classification.

Methods: An online survey was conducted among participants at an international educational conference on inflammatory bowel diseases.

Association of Gut Microbiome and Dipeptidyl Peptidase 4 in Immune-Mediated Inflammatory Bowel Disease: A Rapid Literature Review.

Immune-mediated inflammatory diseases (IMIDs) are characterized by dysregulated immune responses and chronic tissue inflammation. In the setting of inflammatory bowel disease (IBD), dipeptidyl peptidase 4 (DPP4) and gut microorganisms have been proved to interplay, potentially influenced by dietary factors. This rapid review aimed to study the DPP4-gut microbiome link in IBD.

Clinical Significance of histologic healing in IBD: Evidence from randomized controlled trials (RCT) and real world (RW) data.

Histologic mucosal healing (HMH) has emerged as a crucial target in managing inflammatory bowel disease, complementing the established goal of endoscopic mucosal healing. This review evaluates the significance of HMH in both Crohn's disease (CD) and ulcerative colitis (UC). In UC, strong evidence shows that HMH correlates with improved long-term outcomes, including reduced hospitalization rates, and decreased need for corticosteroids and colectomy.