Alimentary Pharmacology & Therapeutics最新文献

{"title":"Increasing healthcare costs in inflammatory bowel disease 2007–2020 in Sweden","authors":"?sa H. Everhov,&nbsp;Jonas S?derling,&nbsp;Gustaf Befrits,&nbsp;Hamed Khalili,&nbsp;Gabriella Br?ms,&nbsp;Martin Neovius,&nbsp;SWIBREG study group,&nbsp;Johan Askling,&nbsp;Jonas Halfvarson,&nbsp;Jonas F. Ludvigsson,&nbsp;Ola Olén","doi":"10.1111/apt.17675","DOIUrl":"https://doi.org/10.1111/apt.17675","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inflammatory bowel disease has been linked to increasing healthcare costs, but longitudinal data on other societal costs are scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess costs, including productivity losses, in patients with prevalent Crohn's disease (CD) or ulcerative colitis (UC) in Sweden between 2007 and 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We linked data from national registers on all patients with CD or UC and a matched (sex, birthyear, healthcare region and education) reference population. We assessed mean costs/year in Euros, inflation-adjusted to 2020, for hospitalisations, out-patient visits, medications, sick leave and disability pension. We defined excess costs as the mean difference between patients and matched comparators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2007 and 2020, absolute mean annual societal costs in working-age (18–64 years) individuals decreased by 17% in CD (−24% in the comparators) and by 20% in UC (−27% in comparators), due to decreasing costs from sick leave and disability, a consequence of stricter sick leave regulations. Excess costs in 2007 were dominated by productivity losses. In 2020, excess costs were mostly healthcare costs. Absolute and excess costs increased in paediatric and elderly patients. Overall, costs for TNF inhibitors/targeted therapies increased by 274% in CD and 638% in UC, and the proportion treated increased from 5% to 26% in CD, and from 1% to 10% in UC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Between 2007 and 2020, excess costs shifted from productivity losses to direct healthcare costs; that is, the patients' compensation for sickness absence decreased, while society increased its spending on medications. Medication costs were driven both by expanding use of TNF inhibitors and by high costs for newer targeted therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 7","pages":"692-703"},"PeriodicalIF":7.6,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.17675","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6946865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age at treatment initiation predicts response in children with chronic hepatitis B","authors":"Xiaoli Wu,&nbsp;Zhenzhen Yao,&nbsp;Xin Lai,&nbsp;Yingping Gu,&nbsp;Songxu Peng","doi":"10.1111/apt.17667","DOIUrl":"10.1111/apt.17667","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accumulating evidence suggests that age has a significant impact on disease progression and outcome of hepatitis B virus (HBV) infection. However, its effect on treatment response has not yet been fully elucidated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the associations of age at treatment initiation with clinical treatment outcomes in children with chronic hepatitis B (CHB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 306 treatment-naïve children with CHB. Participants were divided into three groups based on the age at which they started antiviral treatment: 1–3 years, 4–6 years and 7–17 years. The primary outcome of this study was HBsAg loss; secondary outcomes included HBeAg clearance and DNA undetectability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 306 subjects, 200 (65.4%) were male. Median (IQR) duration of follow-up was 26 (17, 42) months. There were 139 (45.4%), 79 (25.8%) and 88 (28.6%) of participants in the 1–3 years, 4–6 years and 7–17 years groups, respectively. After adjusting for other covariates, age at treatment initiation was negatively associated with the occurrence of HBsAg loss (1–3 years: HR = 5.07, 95% CI = 2.91–8.82; 4–6 years: HR = 2.42, 95% CI = 1.31–4.46) and HBeAg clearance (1–3 years: HR = 1.73, 95% CI = 1.18–2.53). In addition, we observed linear dose–responses relationships between age at treatment initiation and the probability of HBsAg loss and HBeAg clearance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In children with CHB receiving antiviral treatment, HBsAg loss and HBeAg clearance were frequently observed. Age at treatment initiation can predict treatment response, including HBsAg loss and HBeAg clearance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 9","pages":"866-873"},"PeriodicalIF":7.6,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10015096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton pump inhibitor use and the risk of metachronous gastric cancer after H. pylori eradication in patients who underwent endoscopic resection for gastric neoplasms: A population-based cohort study","authors":"Eun Jeong Gong,&nbsp;Hye-Kyung Jung,&nbsp;Bora Lee,&nbsp;Jitaek Hong,&nbsp;Jong Wook Kim,&nbsp;Cheol Min Shin,&nbsp;Young Hoon Youn,&nbsp;Kwang Jae Lee","doi":"10.1111/apt.17676","DOIUrl":"https://doi.org/10.1111/apt.17676","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The association between proton pump inhibitors (PPI) use and gastric cancer remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate the impact of long-term PPI use on metachronous gastric cancer after <i>Helicobacter pylori</i> eradication in high-risk patients who underwent endoscopic resection of gastric neoplasms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Korean National Health Insurance Services database, we identified 1836 PPI users and 12,218 non-users among patients who received <i>H. pylori</i> eradication therapy after endoscopic resection for gastric neoplasms between 2009 and 2014. We then compared the incidence of metachronous gastric cancer between the PPI user and non-user groups. We conducted sensitivity analysis using various time lags and propensity score-matched analysis to ensure the robustness of the results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After a median follow-up of 7.3 years, the incidence of metachronous gastric cancer was significantly higher in the PPI user group than in the non-user group, with a crude hazard ratio of 6.20 (95% confidence interval, 5.78–6.65). After adjustment, PPI use was associated with the development of metachronous gastric cancer, with an adjusted hazard ratio of 5.51 (95% confidence interval, 5.12–5.92). The PPI user group was categorised into three subgroups according to the cumulative PPI dose; the increased risk of metachronous gastric cancer remained significant regardless of the PPI dose. Moreover, these results remained robust after applying various time lags and propensity score-matched analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long-term PPI use is associated with an increased risk of metachronous gastric cancer in patients who undergo <i>H. pylori</i> eradication therapy after endoscopic resection of gastric neoplasms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 7","pages":"668-677"},"PeriodicalIF":7.6,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6932532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review with meta-analysis: Medical therapies for treatment of ulcerative proctitis","authors":"Achuthan Aruljothy,&nbsp;Siddharth Singh,&nbsp;Neeraj Narula,&nbsp;Gordon W. Moran,&nbsp;Sudheer K. Vuyyuru,&nbsp;Malcolm Hogan,&nbsp;Alexa Zayadi,&nbsp;John K. MacDonald,&nbsp;Benedicte Caron,&nbsp;Silvio Danese,&nbsp;Laurent Peyrin?Biroulet,&nbsp;Christopher Ma,&nbsp;Vipul Jairath","doi":"10.1111/apt.17666","DOIUrl":"https://doi.org/10.1111/apt.17666","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ulcerative proctitis (UP) is a common highly symptomatic form of ulcerative colitis that can be difficult to treat.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the efficacy of medical treatments for UP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, EMBASE, and CENTRAL on 23 November 2022 for randomised controlled trials (RCTs) of medical therapy for adults with UP. Primary outcomes included induction and maintenance of clinical remission. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for each outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 53 RCTs (<i>n</i> = 4096) including 46 induction studies (<i>n</i> = 3731) and seven maintenance studies (<i>n</i> = 365). First-line therapies included topical 5-aminosalicylic acid (5-ASA), conventional corticosteroids, budesonide, and oral 5-ASA. Therapy for refractory UP included topical tacrolimus and small molecules. Topical 5-ASA was superior to placebo for induction (RR 2.72, 95% CI 1.94–3.82) and maintenance of remission (RR 2.09, 95% CI 1.26–3.46). Topical corticosteroids were superior to placebo for induction of remission (RR 2.83, 95% CI 1.62–4.92). Topical budesonide was superior to placebo for induction of remission (RR 2.34, 95% CI 1.44–3.81). Combination therapy with topical 5-ASA and topical corticosteroids was superior to topical monotherapy with either agent. Topical tacrolimus was superior to placebo. Etrasimod was superior to placebo for induction (RR 4.71, 95% CI 1.2–18.49) and maintenance of remission (RR 2.08, 95% CI 1.31–3.32).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Topical 5-ASA and corticosteroids are effective for active UP. Topical 5-ASA may be effective for maintenance of remission. Tacrolimus may be effective for induction of remission. Etrasimod may be effective for induction and for maintenance of remission. Trials should include UP to expand the evidence base for this under-represented population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 8","pages":"740-762"},"PeriodicalIF":7.6,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41083706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review article: Emerging and current management of acute-on-chronic liver failure","authors":"Mohsin F. Butt,&nbsp;Rajiv Jalan","doi":"10.1111/apt.17659","DOIUrl":"https://doi.org/10.1111/apt.17659","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute-on-chronic liver failure (ACLF) is a clinically and pathophysiologically distinct condition from acutely decompensated cirrhosis and is characterised by systemic inflammation, extrahepatic organ failure, and high short-term mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To provide a narrative review of the diagnostic criteria, prognosis, epidemiology, and general management principles of ACLF. Four specific interventions that are explored in detail are intravenous albumin, extracorporeal liver assist devices, granulocyte-colony stimulating factor, and liver transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed and Cochrane databases for articles published up to July 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Approximately 35% of hospital inpatients with decompensated cirrhosis have ACLF. There is significant heterogeneity in the criteria used to diagnose ACLF; different definitions identify different phenotypes with varying mortality. Criteria established by the European Association for the Study of the Liver were developed in prospective patient cohorts and are, to-date, the most well validated internationally. Systemic haemodynamic instability, renal dysfunction, coagulopathy, neurological dysfunction, and respiratory failure are key considerations when managing ACLF in the intensive care unit. Apart from liver transplantation, there are no accepted evidence-based treatments for ACLF, but several different approaches are under investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The recognition of ACLF as a distinct entity from acutely decompensated cirrhosis has allowed for better patient stratification in clinical settings, facilitating earlier engagement with the intensive care unit and liver transplantation teams. Research priorities over the next decade should focus on exploring novel treatment strategies with a particular focus on which, when, and how patients with ACLF should be treated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 8","pages":"774-794"},"PeriodicalIF":7.6,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.17659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41083732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STAR SIGN study: Evaluation of COVID-19 vaccine efficacy against the SARS-CoV-2 variants BQ.1.1 and XBB.1.5 in patients with inflammatory bowel disease","authors":"Simon Woelfel,&nbsp;Joel Dütschler,&nbsp;Marius K?nig,&nbsp;Alex Dulovic,&nbsp;Nicole Graf,&nbsp;Daniel Junker,&nbsp;Vasileios Oikonomou,&nbsp;Claudia Krieger,&nbsp;Samuel Truniger,&nbsp;Annett Franke,&nbsp;Annika Eckhold,&nbsp;Kristina Forsch,&nbsp;Seraina Koller,&nbsp;Jacqueline Wyss,&nbsp;Niklas Krupka,&nbsp;Melanie Oberholzer,&nbsp;Nicola Frei,&nbsp;Nora Geissler,&nbsp;Peter Schaub,&nbsp;STAR SIGN Study Investigators,&nbsp;Werner C. Albrich,&nbsp;Matthias Friedrich,&nbsp;Nicole Schneiderhan-Marra,&nbsp;Benjamin Misselwitz,&nbsp;Wolfgang Korte,&nbsp;Justus J. Bürgi,&nbsp;Stephan Brand","doi":"10.1111/apt.17661","DOIUrl":"https://doi.org/10.1111/apt.17661","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vaccine-elicited immune responses are impaired in patients with inflammatory bowel disease (IBD) treated with anti-TNF biologics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess vaccination efficacy against the novel omicron sublineages BQ.1.1 and XBB.1.5 in immunosuppressed patients with IBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective multicentre case–control study included 98 biologic-treated patients with IBD and 48 healthy controls. Anti-spike IgG concentrations and surrogate neutralisation against SARS-CoV-2 wild-type, BA.1, BA.5, BQ.1.1, and XBB.1.5 were measured at two different time points (2–16 weeks and 22–40 weeks) following third dose vaccination. Surrogate neutralisation was based on antibody-mediated blockage of ACE2-spike protein–protein interaction. Primary outcome was surrogate neutralisation against tested SARS-CoV-2 sublineages. Secondary outcomes were proportions of participants with insufficient surrogate neutralisation, impact of breakthrough infection, and correlation of surrogate neutralisation with anti-spike IgG concentration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Surrogate neutralisation against all tested sublineages was reduced in patients with IBD who were treated with anti-TNF biologics compared to patients treated with non-anti-TNF biologics and healthy controls (each <i>p</i> ≤ 0.001) at visit 1. Anti-TNF therapy (odds ratio 0.29 [95% CI 0.19–0.46]) and time since vaccination (0.85 [0.72–1.00]) were associated with low, and mRNA-1273 vaccination (1.86 [1.12–3.08]) with high wild-type surrogate neutralisation in a β-regression model. Accordingly, higher proportions of patients treated with anti-TNF biologics had insufficient surrogate neutralisation against omicron sublineages at visit 1 compared to patients treated with non-anti-TNF biologics and healthy controls (each <i>p</i> ≤ 0.015). Surrogate neutralisation against all tested sublineages decreased over time but was increased by breakthrough infection. Anti-spike IgG concentrations correlated with surrogate neutralisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with IBD who are treated with anti-TNF biologics show impaired neutralisation against novel omicron sublineages BQ.1.1 and XBB.1.5 and may benefit from prioritisation for future variant-adapted vaccines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 7","pages":"678-691"},"PeriodicalIF":7.6,"publicationDate":"2023-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6875308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Elderly onset inflammatory bowel disease—Treat to target approach is still warranted","authors":"Bridgette Andrew,&nbsp;Ashish Srinivasan,&nbsp;Annie Zhou,&nbsp;Abhinav Vasudevan","doi":"10.1111/apt.17645","DOIUrl":"https://doi.org/10.1111/apt.17645","url":null,"abstract":"&lt;p&gt;Editors,&lt;/p&gt;&lt;p&gt;There is a relative paucity of data comparing the impact that the age of IBD onset may have on therapeutic choice, drug persistence, and need for surgery; hence we commend Nørgård and colleagues for providing Nationwide registry data to help inform these important issues.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The authors reported that patients with IBD diagnosed after the age of 60 were less likely to be initiated on steroid-sparing therapies within 1 and 5 years of their diagnosis compared to those diagnosed at a younger age; with lower rates of corticosteroid discontinuation at 1 and 5 years, and higher rates of surgery at 5 years. Additionally, 5-ASA initiation was lower in the elderly cohort but therapy persistence at 1 and 5 years was higher than in the adult-onset cohort. These findings suggest that elderly onset IBD patients are prescribed less therapy and have fewer adjustments. In an era of treat-to-target, and therapy escalations to meet more stringent treatment targets, the data suggest that elderly onset IBD is undertreated with medical therapy, and treatment goals are possibly focused on symptom control rather than disease remission, or concerns regarding the safety of anti-TNF and immunomodulator therapy in the elderly cohort limit their use. Elderly patients are over twice as likely to experience serious adverse events with anti-TNF therapy than those aged under 40, so it is understandable why such therapies would be avoided.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We would be interested to learn if these trends will change with greater availability of biological agents with a more favourable safety profile, as data in this cohort were limited since follow-up finished in 2020. The vedolizumab data provided in the paper suggest increasing clinician preference since it became available. The safety of gut-specific therapy using vedolizumab is exemplified by data documenting no increased risk of infection or malignancy, and comparable efficacy across age demographics.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Ustekinumab has comparable safety to vedolizumab,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; albeit across smaller observational cohort studies. These data highlight that newer advanced therapies may be preferred in older patients where infectious or malignant complications are of greater concern.&lt;/p&gt;&lt;p&gt;The recent availability of small molecule advanced therapies such as janus kinase inhibitors (JAK-I) and sphingosine 1-phosphate (S1P) receptor modulators offer an additional advantage with oral administration and fast onset. However, caution should be exercised, in a cohort with a greater prevalence of cardiovascular co-morbidity, particularly in the case of JAK-I. Data extrapolated from the rheumatologic JAK-I literature, which may approximate to this population, emphasised concerns regarding increased rates of venous thromboembolism, herpes zoster infection and cardiovascular events.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; However, whether JAK selectivity mitigates an element","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 5","pages":"556-557"},"PeriodicalIF":7.6,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.17645","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6055699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Is vedolizumab the preferred biologic therapy for biologic-naïve patients with ulcerative colitis?","authors":"Takayuki Yamamoto","doi":"10.1111/apt.17628","DOIUrl":"https://doi.org/10.1111/apt.17628","url":null,"abstract":"&lt;p&gt;Real-world data complement randomised controlled trials (RCTs) by providing insights into treatment effectiveness, safety and utilisation patterns in diverse populations, offering a broader perspective on the impact of interventions. To date, a relatively large amount of real-world data has been reported regarding vedolizumab.&lt;span&gt;&lt;sup&gt;1-5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In retrospective studies,&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; prior exposure to a tumour necrosis factor (TNF) antagonist was associated with a reduced probability of achieving clinical and endoscopic remission in patients with ulcerative colitis (UC) who were treated with vedolizumab. Another study&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; found that although the incidence of loss of response (LOR) to vedolizumab was comparable in anti-TNF-naÏive and exposed patients, those who experienced LOR to anti-TNF agents before vedolizumab were almost twice as likely to experience LOR to vedolizumab. In a large retrospective study (EVOLVE),&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; first-line biologic therapy in biologic-naive patients with UC indicated that vedolizumab and anti-TNF agents were equally effective at controlling clinical symptoms. Nevertheless, rates of treatment persistence at two years were higher in patients treated with vedolizumab. Real-world data from the PANIC study&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; found that first-line vedolizumab had significantly longer persistence than first-line infliximab. First-line vedolizumab persistence was significantly longer than second-line vedolizumab, but first-line infliximab persistence was not statistically significantly different from second-line infliximab. Based on these results, vedolizumab should be considered as the first-line biological agent for UC.&lt;/p&gt;&lt;p&gt;The study by Bokemeyer &lt;i&gt;et al&lt;/i&gt;&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; has added new real-world data regarding the effectiveness of vedolizumab. To date, this is the largest real-world study on this issue. Although it was not a randomized controlled trial, it utilised propensity-score-adjusted analysis, a statistical method that minimises bias related to patient characteristics. This study prospectively compared the effectiveness of vedolizumab and anti-TNF agents in patients with UC who were biologic-naïve at the end of the induction period and during maintenance treatment at one and two years. After achieving similar effectiveness to anti-TNF agents during the induction period, vedolizumab demonstrated significantly higher remission rates than anti-TNF agents after two years. These findings support the use of vedolizumab as a first-line biologic in UC. One limitation of this study is that biomarkers and endoscopic findings were not evaluated in all patients, which prevented a rigorous comparison of these end points.&lt;/p&gt;&lt;p&gt;When considering this issue and integrating the findings of this study&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; with previous research, it can be concluded that vedolizumab is the preferred biologic therapy for biologic-naïve patients ","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 5","pages":"546-547"},"PeriodicalIF":7.6,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.17628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5789165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Featured Cover","authors":"Simon M. D. Baunwall,&nbsp;Mette M. Hansen,&nbsp;Sara E. Andreasen,&nbsp;Marcel K. Eriksen,&nbsp;Nina R?g?rd,&nbsp;Jens Kelsen,&nbsp;Anne K. Grosen,&nbsp;Susan Mikkelsen,&nbsp;Christian Erikstrup,&nbsp;Jens F. Dahlerup,&nbsp;Christian L. Hvas","doi":"10.1111/apt.17022","DOIUrl":"https://doi.org/10.1111/apt.17022","url":null,"abstract":"<p>The cover image is based on the Original Article <i>Donor, patient age and exposure to antibiotics are associated with the outcome of faecal microbiota transplantation for recurrent Clostridioides difficile infection: A prospective cohort study</i> by Simon M. D. Baunwall et al., https://doi.org/10.1111/apt.17642 Image Credit: Nina Rågård\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 5","pages":"i"},"PeriodicalIF":7.6,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.17022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"6158094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: One step closer to personalised nutrition therapy for irritable bowel syndrome","authors":"Sarah L. Melton,&nbsp;Emma P. Halmos","doi":"10.1111/apt.17633","DOIUrl":"https://doi.org/10.1111/apt.17633","url":null,"abstract":"&lt;p&gt;The Low FODMAP diet (LFD) has become a mainstay in the management of irritable bowel syndrome (IBS) due to its high rates of symptom improvement. However, it is onerous and at least 30% of patients who follow the diet do not respond.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The ability to predict and select those who are most likely to respond would be of great benefit in clinical practice and potentially avoid trialling a taxing diet.&lt;/p&gt;&lt;p&gt;Past candidates for predictors of dietary response to a LFD have fallen short, despite their valid hypothesis. To date, data around microbiota in IBS predicting LFD response have been conflicting, both before and following FODMAP restriction; one study even challenged the idea that a LFD is detrimental to colonic microbiota.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Emerging data have indicated that the metabolites of microbiota, rather than the microbiota themselves, may prove to be the signal to determine dietary management. Wilson &lt;i&gt;et al&lt;/i&gt; have identified that faecal metabolites, but not microbiota, predicted response to a LFD in addition to a new metabolite medium in urine.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This is a welcomed addition to the existing literature and may indicate that we are one step closer to personalised nutrition therapy for IBS.&lt;/p&gt;&lt;p&gt;One metabolite extensively evaluated to identify responders to a LFD is breath hydrogen. The idea that this marker would identify specific carbohydrate delivery to the colon and predict dietary response, but has been futile, thought due to the poor test reproducibility and the irrelevant clinical utility of providing supraphysiological doses of pure FODMAP solutions.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; Indeed, trial evidence has shown that large doses of completely unabsorbed FODMAPs (&lt;i&gt;e.g&lt;/i&gt;., lactulose) do not predict dietary response.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; It may be that other colonic metabolites have potential to predict response to a LFD.&lt;/p&gt;&lt;p&gt;While Wilson &lt;i&gt;et al&lt;/i&gt; showed the metabolite faecal propionate as a predictor, the data for faecal short chain fatty acids  in relation to FODMAP ingestion are inconsistent, perhaps as stool only represents 5% of colonic SCFA.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; However, faecal volatile organic compounds (VOC) have already shown promise to predict LFD response in 97% of IBS patients in one study.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; The lower urinary creatinine and higher TMAO (trymethylamine &lt;i&gt;N&lt;/i&gt;-oxide) at baseline in responders could represent a lower muscle mass and higher meat intake, respectively, but baseline protein, as a surrogate marker of meat intake, did not differ between groups. One dietary measure lacking in this study was diet quality, which is a possible confounder as a LFD can improve diet quality, also leading to symptomatic improvement.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; This is supported by the finding that responders had higher urinary citrate (associated with fruit and vegetable intake) after the LFD. However, urinary hippurate was conflicting this id","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"58 5","pages":"554-555"},"PeriodicalIF":7.6,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.17633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5789180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}