Clinics and research in hepatology and gastroenterology最新文献

{"title":"Treatment modalities for metabolic dysfunction-associated steatotic liver disease (MASLD) in children and adolescent: A systematic review and meta-analysis of randomized controlled trials","authors":"Syed Muhammad Mehdi Zaidi ,&nbsp;Qunoot Irfan ,&nbsp;Rahmah Javed ,&nbsp;Zulekha Khalid ,&nbsp;Hamna Khan ,&nbsp;Muhammad Hasan Ashraf ,&nbsp;Mustafa Hassan Alvi ,&nbsp;Faiq Wahid ,&nbsp;Sana Zehra ,&nbsp;Zainab Abbas","doi":"10.1016/j.clinre.2025.102685","DOIUrl":"10.1016/j.clinre.2025.102685","url":null,"abstract":"<div><h3>Introduction</h3><div>Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is prevalent amongst children and adolescents. Despite higher incidence, effective treatment options for this population are controversial. This Meta-analysis aims to evaluate the effects of all non-invasive treatment modalities available for MASLD.</div></div><div><h3>Methods</h3><div>This study includes PubMed, Cochrane Library, and Embase searches (January 2010 to July 2025) for Randomised Controlled Trials (RCTs), evaluating different treatment modalities of MASLD in pediatrics and adolescent population. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Primary outcomes were Aspartate Aminotransferase (AST), Triglycerides (TGs) and Low-Density Lipoproteins (LDL). Secondary outcomes were Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), High-Density Lipoprotein (HDL) and adverse effects. Data were analyzed using Revman 5.3. Continuous values were pooled using the standard mean difference (SMD). Sensitivity analysis was performed to reduce heterogeneity. This study was registered with PROSPERO, CRD42024596682.</div></div><div><h3>Results</h3><div>We included 31 RCTs, having 1722 participants. Multiple treatment modalities were identified and categorized into dietary intervention, supplementation, drug intervention and exercise. We further categorized dietary intervention into low-sugar diet, low-fat diet and mediterranean diet and compared against different controls. The low-sugar diet showed significant improvement in TG levels against placebo/usual diet [-2.44,95 %CI:3.61,-1.27] and in AST levels against low-fat diet [-1.02, 95 %CI –1.88, -0.16]. LDL levels showed significant change when probiotics were administered against placebo [-0.33, 95 % CI:0.65,0.00].</div></div><div><h3>Conclusion</h3><div>Supplements and Dietary intervention have shown improvement in liver enzymes and lipid profile. However, more research is required to evaluate the dosage and adverse effects associated with these interventions.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102685"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of histological healing on ulcerative colitis disease course among patients with endoscopic healing: results of a prospective study","authors":"Clara Yzet ,&nbsp;Camille Robert ,&nbsp;Franck Brazier ,&nbsp;Erica Meudjo ,&nbsp;Capucine Moreau ,&nbsp;Denis Chatelain ,&nbsp;Mathurin Fumery","doi":"10.1016/j.clinre.2025.102700","DOIUrl":"10.1016/j.clinre.2025.102700","url":null,"abstract":"<div><h3>Background</h3><div>The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved.</div></div><div><h3>Methods</h3><div>We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading).</div></div><div><h3>Results</h3><div>A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5–19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively <em>p</em> = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively <em>p</em> = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, <em>p</em> = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], <em>p</em> = 0.0118).</div></div><div><h3>Conclusion</h3><div>In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102700"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut-liver axis: An emerging target for exercise in obesity management","authors":"Laura Alexia Ramos-da-Silva ,&nbsp;Henrique Souza-Tavares ,&nbsp;Gabriela Rodrigues Medeiros ,&nbsp;Nathan Soares Dantas-Miranda ,&nbsp;Gabrielle Lima-de-Figueiredo ,&nbsp;Daiana Araujo Santana-Oliveira ,&nbsp;Flavia Maria Silva-Veiga ,&nbsp;Fabiane Ferreira Martins ,&nbsp;Vanessa Souza-Mello","doi":"10.1016/j.clinre.2025.102687","DOIUrl":"10.1016/j.clinre.2025.102687","url":null,"abstract":"<div><div>Gut dysbiosis emerged as a potential metabolic dysfunction-associated steatotic liver disease (MASLD) trigger due to leaky gut and LPS leakage (endotoxemia). MASLD attracts attention from the scientific community due to the non-existence of a specific treatment, the intimate connection to obesity, and its multiple triggers. In this context, physical exercise is a relevant non-pharmacological strategy. However, different intensities and periodicities can produce divergent results, and their impact on the gut-liver axis remains unraveled. Therefore, this comprehensive review outlines the contribution of exercise (MICT or HIIT) to modulating the gut-liver axis in experimental obesity models, with a focus on the intestinal barrier and hepatic mitochondrial and endoplasmic reticulum (ER) homeostasis. The effects of both exercise protocols are likely related to restoring tight junctions and improving gut permeability. Ceased endotoxemia alleviates MASLD by targeting the endoplasmic reticulum (ER) and mitochondria, countering disturbances caused by glucolipotoxicity and inflammation, like ER stress and mitochondrial dyshomeostasis. Although HIIT is superior to MICT in enhancing gut structure and microbiota diversity and possibly mitigating MASLD due to reduced adiposity and improved insulin sensitivity, regular exercise should be encouraged to counter the obesity pandemic by modulating the gut-liver axis.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102687"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of occult Hepatitis B infection among the blood donors in Pune, India","authors":"Anuradha S Tripathy ,&nbsp;Meenal Sharma ,&nbsp;Neeta Thorat ,&nbsp;Prasad Babar ,&nbsp;Nalini Kadgi ,&nbsp;Leena Nakate","doi":"10.1016/j.clinre.2025.102694","DOIUrl":"10.1016/j.clinre.2025.102694","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102694"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of dynamic changes in multiple serum tumor markers during neoadjuvant therapy on clinical outcome in gastrointestinal cancer","authors":"Fengchun Wang ,&nbsp;Xiande Feng ,&nbsp;Jianxiang Sun ,&nbsp;Xiaoxin Fan ,&nbsp;Jian Geng ,&nbsp;Yu Leng ,&nbsp;Hechao Tang","doi":"10.1016/j.clinre.2025.102692","DOIUrl":"10.1016/j.clinre.2025.102692","url":null,"abstract":"<div><h3>Background</h3><div>Dynamic shifts in serum tumor markers during neoadjuvant therapy could refine prognostication in gastrointestinal (GI) cancers, but supporting evidence is limited.</div></div><div><h3>Methods</h3><div>We prospectively followed 200 patients with gastric (55 %) or colorectal (45 %) cancer who received neoadjuvant chemotherapy ± radiotherapy and curative-intent surgery (2016–2025). Carcinoembryonic antigen (CEA), CA19–9, CA72–4 and CA125 were assayed at baseline and pre-surgery. Three-year disease-free survival (DFS) and overall survival (OS) were primary endpoints. Multivariable Cox models assessed associations between marker dynamics and outcomes.</div></div><div><h3>Results</h3><div>Baseline positivity rates were 40 % for CEA and 30 % for CA19–9; 31 % of patients had ≥ 2 markers elevated. Therapy converted 45 % of CEA-positive and 53 % of CA19–9-positive cases to negative. Major pathological response (Tumor Regression Grade 0–1) occurred in 30 % overall and was higher in marker converters than non-converters (45 % vs 18 %, <em>p</em> &lt; 0.001). Persistent positivity correlated with lower R0 resection (78 % vs 91 %, <em>p</em> = 0.04), more complications (26 % vs 12 %, <em>p</em> = 0.03) and poorer 3-year DFS (42 % vs 69 %). On multivariable analysis, persistence of ≥ 2 positive markers independently predicted shorter DFS (HR 1.9, 95 % CI 1.2–3.0) and OS (HR 2.1, 95 % CI 1.3–3.3). Sensitivity analyses using alternative cut-offs, multiple imputation and exclusion of borderline metastatic cases yielded consistent results.</div></div><div><h3>Conclusion</h3><div>Failure of serum tumor markers to normalize after neoadjuvant therapy signals inferior pathological response and survival. Serial marker assessment can enhance perioperative risk stratification and guide surgical decisions in GI cancers.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102692"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual follicular dendritic cell sarcoma with liver metastasis","authors":"Jiuliang Jiang ,&nbsp;Pingping Yang ,&nbsp;Guimin Hou","doi":"10.1016/j.clinre.2025.102707","DOIUrl":"10.1016/j.clinre.2025.102707","url":null,"abstract":"<div><div>We present the case of a patient with abdominal follicular dendritic cell sarcoma (FDCS) with liver metastasis, a tumor with an extremely low prevalence. The preoperative diagnosis of FDCS remains challenging due to the rarity of this disease. Despite the complete surgical removal of the lesion, the risk of local recurrence after surgery for FDCS remains high. Furthermore, adjuvant radiotherapy and chemotherapy have been demonstrated to have no significant impact on the overall survival of the patient. A pan-cancer panoramic gene test was conducted on pathological specimens from patients, and the results indicated the presence of a class II variant, namely a reduction in the copy number of the CDKN2A gene. Piperacillin may prove to be a targeted drug with the potential to influence patient prognosis. During the three-month follow-up period following asymptomatic discharge, the patient's condition remained stable. The genetic testing of surgical resection specimens to determine subsequent treatment plans may represent a future treatment strategy.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102707"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protecting the fetus during hepatic surgery in pregnancy: the role of cavo-caval bypass","authors":"Arthur Marichez ,&nbsp;Nour Aldajani ,&nbsp;Catherine Fleureau ,&nbsp;Jean-Philippe Adam ,&nbsp;Brigitte Le Bail ,&nbsp;Hugo Madar ,&nbsp;Loïc Sentilhes ,&nbsp;Laurence Chiche","doi":"10.1016/j.clinre.2025.102701","DOIUrl":"10.1016/j.clinre.2025.102701","url":null,"abstract":"<div><h3>Background</h3><div>The discovery of a liver mass during pregnancy requires careful etiological assessment.A 29-year-old woman was diagnosed with a 17-cm inflammatory hepatocellular adenoma at 24-weeks of gestation. Given the high risk of spontaneous rupture and bleeding,a multidisciplinary team opted for a right hepatectomy at 26-weeks. To maintain stable maternal hemodynamics and avoid fetal hypoperfusion, a veno-venous cavo-caval bypass was established, allowing liver resection under total vascular exclusion without blood pressure fluctuations. The procedure was uneventful and a healthy child was delivered at term. The use of cavo-caval bypass offers a protective strategy to stabilize maternal circulation and preserve fetal well-being during major hepatectomy.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102701"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of osteoporosis in adult patients with beta-thalassemia major and its relation to serum sclerostin level","authors":"Ahmed Abd El Fattah El Bamby ,&nbsp;Tamer Abd El Hamid El bedawi ,&nbsp;Mohammed Adel Eltomi ,&nbsp;Sara Mamdouh Shoeeb ,&nbsp;Enji Abd El Wahab Ibrahim","doi":"10.1016/j.clinre.2025.102709","DOIUrl":"10.1016/j.clinre.2025.102709","url":null,"abstract":"<div><h3>Background</h3><div>Beta-thalassemia major (β-TM) is a chronic hemoglobinopathy in which improved survival has shifted focus toward long-term complications, notably osteoporosis. The pathogenesis is multifactorial, involving iron overload, bone marrow expansion, endocrine dysfunction, and impaired osteoblast activity. While histomorphometric data highlight reduced bone formation, clinical evidence demonstrates broader and more severe skeletal abnormalities.</div></div><div><h3>Purpose of study</h3><div>To evaluate osteoporosis in β-TM patients and examine its relationship with serum sclerostin levels.</div></div><div><h3>Methods</h3><div>This study employed a cross-sectional case-control design. Enrolled 80 individuals diagnosed with β-TM. Participants were equally assigned to two groups: Group I, consisting of β-TM patients, and Group II, composed of healthy controls matched for age and sex.</div></div><div><h3>Results</h3><div>Serum sclerostin significantly predict osteoporosis among the tested patients (P &lt; 0.001 and AUC = 0.868) at cut-off&gt;0.61 with 80 %sensitivity, 80 %specificity. T score exhibited significantly lower value in beta TM (group I) when compared to control (group II) (P &lt; 0.001). The poorly chelated group exhibited significantly higher T-scores and serum sclerostin levels. In univariate regression, (hemoglobin, transferrin saturation, serum iron, serum ferritin, total iron binding capacity and serum sclerostin) were independent predictors of osteoporosis β TM patients (P &lt; 0.05). In Multivariate regression, serum sclerostin was independent predictor of osteoporosis in β- TM patients (P = 0.02) while weight, height, BMI, WBCs, Platelets, transferrin saturation, serum iron, ferritin were not.</div></div><div><h3>Conclusions</h3><div>Patients with β-TM exhibit a greater prevalence of osteoporosis and elevated serum sclerostin levels compared to healthy individuals. The increased serum sclerostin in β-TM patients may reflect impaired bone formation and increased bone loss, thus facilitating osteoporosis development.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102709"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does antibiotic therapy for anal abscess reduce the risk of fistula surgery? A retrospective study","authors":"Amine Antonin Alam,&nbsp;Nadia Fathallah,&nbsp;Manuel Aubert,&nbsp;Paul Benfredj,&nbsp;Elise Pommaret,&nbsp;Vincent de Parades","doi":"10.1016/j.clinre.2025.102706","DOIUrl":"10.1016/j.clinre.2025.102706","url":null,"abstract":"<div><h3>Background</h3><div>Management of first-time perianal abscesses remains controversial. While the French school of proctology systematically investigates fistulas, other approaches advocate simple incision, given that over 60 % of patients do not develop recurrence. The role of post-incision antibiotic therapy is also debated. This study aimed at evaluating our department’s approach to managing first perianal abscesses and identifying predictive factors for recurrence.</div></div><div><h3>Methods</h3><div>We retrospectively included all patients presenting in 2019 with a first perianal abscess treated by incision under local anesthesia, with or without antibiotic therapy post-incision. Patients with evident fistulas underwent surgery. Recurrence was defined as a new abscess or purulent opening. The primary outcome was the rate of patients requiring fistula surgery and/or experiencing abscess recurrence; secondary outcomes included identification of recurrence predictors.</div></div><div><h3>Results</h3><div>Among the 336 patients who consulted for an abscess, 109 were included. Among 109 patients (mean age 43 ± 13 years; 74 % male), 55 had incision alone, and 54 underwent fistula surgery. The mean follow-up for patients with incision alone was approximately 30 months, during which 18 % (10 patients) experienced abscess recurrence. Univariate logistic regression analysis revealed smoking and absence of antibiotic therapy post-incision as predictive of recurrence with (OR 0.44) were predictive of recurrence. Gender, age, BMI, diabetes, Crohn's disease, HIV infection, prior NSAID use, and abscess location were not predictive. Multivariate analysis was not conducted due to insufficient data.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that 41 % of patients who underwent incision for a first perianal abscess did not experience recurrence during the follow-up period. Additionally, the administration of antibiotic therapy post-incision was associated with a reduced likelihood of recurrence. However, randomized trials are warranted to validate these findings and specify the optimal antibiotic regimen.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102706"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of third-line advanced therapies in patients with ulcerative colitis: A multicentre retrospective cohort study","authors":"Anaïs Bertrand ,&nbsp;Antoine Meyer ,&nbsp;Julien Kirchgesner ,&nbsp;Mathieu Uzzan ,&nbsp;Vered Abitbol ,&nbsp;Antoine Assaf ,&nbsp;Charlotte Gagnière ,&nbsp;Philippe Seksik ,&nbsp;Aurelien Amiot","doi":"10.1016/j.clinre.2025.102699","DOIUrl":"10.1016/j.clinre.2025.102699","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness of advanced therapies beyond second-line therapies has been poorly described in patients with ulcerative colitis (UC).</div></div><div><h3>Aim</h3><div>To describe the outcomes of third-line advanced therapy in patients with UC in a real-world setting.</div></div><div><h3>Methods</h3><div>We conducted a multicentre retrospective study in patients with UC who received third-line advanced therapy after the failure of a first-line anti-TNF agent and second-line vedolizumab. The primary endpoints were steroid-free clinical remission at weeks 14 and 54.</div></div><div><h3>Results</h3><div>We analysed 237 therapeutic sequences in 150 patients (55 with an anti-TNF agent, 80 with tofacitinib, and 102 with ustekinumab), accounting for 245.3 patient-years. Steroid-free clinical remission at week 14 was achieved in 14 (25.5 %) patients treated with an anti-TNF agent, 40 (50.0 %) with tofacitinib, and 54 (52.9 %) with ustekinumab (RR = 1.96 [1.19–3.25] for tofacitinib and RR = 2.08 [1.28–3.39] for ustekinumab, compared with an anti-TNF agent, respectively). Steroid-free clinical remission at week 54 was achieved in 16 (29.1 %) patients in the anti-TNF group, 37 (46.2 %) in the tofacitinib group and 56 (55.4 %) in the ustekinumab group (RR = 3.07 [0.98–9.60] for tofacitinib and RR = 3.09 [1.01–9.43] for ustekinumab, compared with anti-TNF, respectively). In total, 13.7 % of the patients underwent colectomy. Adverse events occurred in 94 (39.7 %) patients and were less frequent with ustekinumab.</div></div><div><h3>Conclusion</h3><div>In this retrospective study, third-line advanced therapies resulted in a high rate of steroid-free clinical remission at weeks 14 and 54, especially in patients treated with ustekinumab and tofacitinib.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102699"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}