Alimentary Pharmacology & Therapeutics最新文献

{"title":"Unveiling Drug‐Induced Autoimmune‐Like Hepatitis in Autoimmune Hepatitis Patients: A Multicenter Retrospective Study","authors":"Pinelopi Arvaniti, Ignasi Olivas, Ana Pascual‐Dapena, Mar Riveiro‐Barciela, Paula Esteban, Anna Aguilar, Indhira Pérez‐Medrano, Diana Horta, Arancha Caballero Marcos, Magdalena Salcedo, Isabel Conde, Elena Gómez, Inmaculada Castelló, Jesús Santa Bárbara, Álvaro Díaz‐González, Maria del Barrio, Sara Lorente, Beatriz Mateos, Ana Arencibia, Miguel Jiménez, Paqui Cuenca, Vanesa Bernal‐Monterde, Eva‐Maria Fernández, Sergio Rodríguez‐Tajes, Anna Pocurull, Helena Hernández‐Évole, Xavier Forns, Raul J. Andrade, Maria‐Carlota Londoño","doi":"10.1111/apt.70353","DOIUrl":"https://doi.org/10.1111/apt.70353","url":null,"abstract":"Background and AimsAcute or chronic exposure to drugs or herbal and dietary supplements (HDS) can cause drug‐induced autoimmune‐like hepatitis (DI‐ALH), a self‐limiting condition resembling autoimmune hepatitis (AIH). We investigated the prevalence of drug exposure among AIH patients at diagnosis to recognise cases of DI‐ALH and discern features predicting AIH development.MethodsWe retrospectively included 705 patients diagnosed with AIH. DI‐ALH was defined using published criteria. The clinical, biochemical, serological, and histological data of DI‐ALH and AIH were analysed to identify predictors of the evolution of each phenotype.ResultsMost patients were female (<jats:italic>n</jats:italic> = 496, 70%), with a median age of 57 years and a median follow‐up of 55 months. A 59% (<jats:italic>n</jats:italic> = 417) reported exposure to drugs or HDS, and 8% (<jats:italic>n</jats:italic> = 58) fulfilled the criteria for DI‐ALH. Statins and HDS were the most common culprits. Patients with DI‐ALH more frequently had acute severe or fulminant hepatitis (22% vs. 12%, <jats:italic>p</jats:italic> = 0.013) and higher transaminase levels (ALT: 966 vs. 591, <jats:italic>p</jats:italic> = 0.001) at diagnosis. In total, 97% of the patients received immunosuppression. DI‐ALH patients had a faster biochemical response than i‐AIH patients (4 vs. 5, <jats:italic>p</jats:italic> = 0.031), while treatment withdrawal was attempted in only 29% (<jats:italic>n</jats:italic> = 17). Approximately 30% (<jats:italic>n</jats:italic> = 17) of DI‐ALH cases presented a flare during follow‐up. Neither clinical, histological, nor serological findings nor RUCAM and RECAM could predict a DI‐ALH flare.ConclusionsDI‐ALH is often under‐recognised in clinical practice, leading to unnecessary long‐term immunosuppression. A causal relationship between drugs and AIH, along with an attempt to withdraw treatment and long‐term follow‐up, is essential to prevent overtreatment‐associated risks.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"3 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905822","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":"Editorial: Corticosteroid Responsive Acute Severe Ulcerative Colitis—Revisiting Maintenance Approaches in the Era of Advanced Therapies","authors":"Mukesh Kumar Ranjan,&nbsp;Sudheer Kumar Vuyyuru","doi":"10.1111/apt.70288","DOIUrl":"10.1111/apt.70288","url":null,"abstract":"&lt;p&gt;Acute severe ulcerative colitis (ASUC) is a severe form of ulcerative colitis (UC) flare that requires urgent and timely intervention. Approximately one-fourth of patients with UC experience ASUC during their lifetime [&lt;span&gt;1&lt;/span&gt;]. ASUC is characterised by frequent bloody bowel movements and systemic inflammatory features. If not adequately controlled, it can lead to toxic megacolon and colonic perforation, often necessitating emergency colectomy. Intravenous corticosteroids remain the first-line treatment, although only about two-thirds of patients respond [&lt;span&gt;2, 3&lt;/span&gt;]. For non-responders, medical rescue therapy with cyclosporin, infliximab, or off-label JAK inhibitors (JAKi) may induce response. The primary goal of medical therapy in ASUC is rapid induction of remission, followed by effective maintenance therapy. However, there is limited evidence to guide optimal maintenance therapy following successful induction with corticosteroids.&lt;/p&gt;&lt;p&gt;Singh et al. [&lt;span&gt;4&lt;/span&gt;] reported a retrospective propensity-matched analysis comparing the effectiveness and safety of azathioprine and tofacitinib as maintenance therapy in 115 adult patients with ASUC who responded to intravenous corticosteroids. The authors reported a significantly lower cumulative probability of event-free survival (defined as absence of rehospitalization, corticosteroid use, therapy escalation, or colectomy) at 1 year in the azathioprine than in the tofacitinib group (44.0% vs. 75.0%; &lt;i&gt;p&lt;/i&gt; = 0.01). Patients managed with azathioprine had higher rates of re-hospitalisation (15.4% vs. 0%; &lt;i&gt;p&lt;/i&gt; = 0.003) and treatment escalation (13.8% vs. 2.0%; &lt;i&gt;p&lt;/i&gt; = 0.02), and lower rates of symptomatic remission and combined symptomatic plus biomarker remission at 1 year (40.0% vs. 23.1%; &lt;i&gt;p&lt;/i&gt; = 0.05; 22.0% vs. 16.9%; &lt;i&gt;p&lt;/i&gt; = 0.49, respectively). Although colectomy rates were comparable between the tofacitinib and azathioprine groups, the overall incidence of colectomy remained very low. On multivariate analysis, prior exposure to immunomodulators was associated with reduced maintenance success. A sensitivity analysis excluding patients with prior azathioprine exposure yielded similar results. These findings are consistent with the randomised controlled ACTIVE trial, in which steroid-responsive patients were randomised to receive infliximab and azathioprine or azathioprine alone. The combination therapy group had significantly lower rates of treatment failure over 12 months' follow-up compared to the azathioprine monotherapy group (53.3% vs. 81.5%; &lt;i&gt;p&lt;/i&gt; = 0.03) [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;A single episode of ASUC substantially increases the risk of colectomy, with the risk rising further with subsequent episodes [&lt;span&gt;1&lt;/span&gt;]. Even in patients who initially respond to intravenous corticosteroids, the likelihood of relapse and eventual colectomy remains high. While steroid responders may have a lower colectomy risk than those who required medical rescue therapy d","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 7","pages":"754-755"},"PeriodicalIF":6.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905824","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":"Research Communication: Serum Metabolomic Signatures Predict Tumour Recurrence After Resection or Ablation in Patients With Early‐Stage Hepatocellular Carcinoma","authors":"Ashwini Arvind, Hiroaki Kanzaki, Fouzia Ahmed, Naoto Fujiwara, Yujin Hoshida, Amit G. Singal","doi":"10.1111/apt.70355","DOIUrl":"https://doi.org/10.1111/apt.70355","url":null,"abstract":"Patients with hepatocellular carcinoma (HCC) often experience recurrence after curative therapies, underscoring a need for risk stratification models. We validated 6 and 13‐metabolite signatures in patients who achieved complete response following surgical resection or local ablation. Of 78 patients, 32 (41.0%) died and 40 (51.3%) experienced recurrence, of whom 35 (87.5%) had early recurrence. In multivariable analysis, the 6‐metabolite signature was associated with early recurrence (aHR 2.8, 95% CI 1.1–7.5), and the 13‐metabolite signature was associated with overall recurrence (aHR 2.5, 95% CI 1.1–6.0). These data support the potential role of serum metabolites in post‐treatment risk stratification for HCC recurrence.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"24 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905846","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":"Editorial: Implementing Risk Assessment Tools for MetALD in Clinical Practice","authors":"Pedro Ochoa‐Allemant, Marina Serper","doi":"10.1111/apt.70320","DOIUrl":"https://doi.org/10.1111/apt.70320","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"107 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899273","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":"Editorial: Resecting Assumptions—Do Proctocolectomy Guidelines Hold Up? Author's Reply","authors":"Erik Lundqvist, Pär Myrelid, Caroline Nordenvall","doi":"10.1111/apt.70351","DOIUrl":"https://doi.org/10.1111/apt.70351","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"70 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899318","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: Crohn's Disease or Comorbidity? Reassessing Opioid Prescribing Patterns","authors":"Kuan-Ju Lin,&nbsp;Cheng-Hsien Hung,&nbsp;James Cheng-Chung Wei","doi":"10.1111/apt.70311","DOIUrl":"10.1111/apt.70311","url":null,"abstract":"<p>In their population-based matched cohort study, Osooli et al. reported that opioid use was markedly higher among patients with Crohn's disease (CD) than matched individuals from the general population, not only following but also preceding CD diagnosis [<span>1</span>]. Although this raises important concerns regarding pain management and prescribing practices in CD, several methodological issues and interpretative limitations warrant further examination.</p><p>First, the study did not account for comorbid chronic pain conditions frequently observed in CD. Crohn's disease has well-documented overlap with axial spondylarthritis [<span>2</span>], a group of inflammatory disorders independently linked to increased opioid use [<span>3</span>]. Without excluding this or adjusting for its presence, the study may have inadvertently attributed related prescriptions to CD. Moreover, the contribution of other painful conditions such as fibromyalgia or postoperative adhesion pain to opioid use was not described or controlled for. The observed opioid burden may thus reflect aggregate comorbidity effects rather than CD-specific pain alone.</p><p>Second, using the general population as a comparator may have introduced surveillance bias and comorbidity imbalance. Patients with CD interact more frequently with healthcare systems, increasing the likelihood that opioid prescriptions are captured, regardless of actual pain severity [<span>4</span>]. Moreover, comorbidities influencing both healthcare use and opioid risk—such as musculoskeletal disorders, depression, and malignancy—were not matched or adjusted for. These differences may contribute to the association, and the lack of propensity score matching limits comparability between cohorts.</p><p>Third, although the study reported inflammatory bowel disease treatment distribution, it did not explore heterogeneity within the CD cohort that may influence opioid use. Factors such as surgical history, biologic use intensity, and disease activity shape pain experience and prescribing decisions [<span>5</span>]. Without stratified analysis of subgroups—such as patients with refractory disease or post-surgical recovery—the observed association may obscure clinical variation and limit applicability across the broader CD population.</p><p>Finally, established risk factors for both CD severity and opioid use—such as smoking [<span>6</span>] and socioeconomic status [<span>7</span>]—were not considered. These variables correlate with pain burden and prescribing practices, and their omission raises the risk of residual confounding. Thus, the strength and specificity of the reported CD–opioid association may be overstated, especially if these unmeasured factors are unevenly distributed between cohorts.</p><p>Taken together, these limitations highlight the need for cautious interpretation of the reported association between CD and opioid use. While the study addressed a clinically relevant issue, the roles of comorbiditie","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 7","pages":"756-757"},"PeriodicalIF":6.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899327","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":"Letter: Crohn's Disease or Comorbidity? Reassessing Opioid Prescribing Patterns. Authors' Reply","authors":"Mehdi Osooli,&nbsp;Ola Olén","doi":"10.1111/apt.70356","DOIUrl":"10.1111/apt.70356","url":null,"abstract":"<p>Lin et al. have raised concerns [<span>1</span>] regarding methodological aspects and perceived limitations of our nationwide cohort study on (prescribed) opioid use patterns among individuals with Crohn's disease (CD) in Sweden [<span>2</span>]. Although their comments are thoughtful, they partly reflect a misunderstanding of our objectives.</p><p>The primary aim of our study was to describe prescribed opioid use from 2 years before and up to 5 years after a diagnosis of CD, compared with the general population. The secondary aim was to examine annual trends in prescribed opioid use among adults with a prevalent CD diagnosis and reference individuals from the general population. As emphasised in our discussion, the study was designed as a descriptive analysis; causal attribution of CD to opioid use was explicitly not an intended outcome.</p><p>Lin et al. proposed several methodological refinements. Although scientifically reasonable, these suggestions largely address questions distinct from those we set out to answer. Their critique therefore reflects alternative research goals rather than limitations of our design. We respond to their main points below.</p><p>They suggested that confounding from conditions such as spondyloarthritis, fibromyalgia or postoperative adhesion pain should have been controlled for. We agree that such adjustments would be essential in a causal analysis of CD's independent contribution to opioid use. However, our study deliberately aimed to characterise opioid use among adults with CD as they exist, including their real-world comorbidity burden. A complementary study focusing on causal inference would indeed be valuable but represents a different research question.</p><p>They further proposed using propensity score–matched comparisons to account for greater healthcare use and comorbidity among patients with CD. Such an approach could provide important insights in a study explicitly designed to isolate causal effects. However, in our study, the general population was included for context—not as a causal comparator. The descriptive design precludes adjustment strategies aimed at answering counterfactual questions.</p><p>They also noted that opioid use is heterogeneous, suggesting further stratification of clinically relevant subgroups, such as surgical patients. We agree this is an important area for future work. Indeed, we already reported variation in opioid use by trajectory groups (non-users, intermittent users and persistent users). However, more detailed subgroup analyses would be better suited for a dedicated paper to avoid diluting the current study's core findings.</p><p>In summary, Lin et al. have highlighted valuable directions for future research but have criticised our study for not pursuing questions beyond its intended scope. Our work provided a comprehensive description of opioid prescribing in CD. This is an essential foundation for subsequent studies that may employ causal methods, refined matching te","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"62 7","pages":"758-759"},"PeriodicalIF":6.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899271","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: Implementing Risk Assessment Tools for MetALD in Clinical Practice—Authors' Reply","authors":"Nikolaj Torp, Mads Israelsen, Stine Johansen, Aleksander Krag","doi":"10.1111/apt.70350","DOIUrl":"https://doi.org/10.1111/apt.70350","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"196 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899324","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":"Editorial: Resecting Assumptions—Do Proctocolectomy Guidelines Hold Up?","authors":"Vasantham Chaudhary, Jordan E. Axelrad","doi":"10.1111/apt.70322","DOIUrl":"https://doi.org/10.1111/apt.70322","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"38 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899274","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":"Long‐Term Follow‐Up of Patients in a Prospective Study of NA Discontinuation Identifies Different Patterns of HBsAg Loss","authors":"Simon J. Hume, Samuel Hall, Gareth Burns, Sara Vogrin, Daniel Tassone, Paul Desmond, Dilip Ratnam, Miriam T. Levy, Rohit Sawhney, Amanda Nicoll, Zina Valaydon, Simone I. Strasser, Meng Ngu, Marie Sinclair, Chris Meredith, Gayle V. Matthews, Kumar Visvanathan, Jacinta A. Holmes, Alexander J. Thompson","doi":"10.1111/apt.70332","DOIUrl":"https://doi.org/10.1111/apt.70332","url":null,"abstract":"Background and AimsDiscontinuing nucleos(t)ide analogues (NAs) may lead to functional cure (HBsAg loss) in selected patients with chronic hepatitis B (CHB). We evaluated the rates and predictors of HBsAg loss during long‐term follow‐up in a prospective cohort.MethodsThis real‐world extension study followed participants from a prospective trial of NA discontinuation. All patients had HBeAg‐negative CHB without cirrhosis. Efficacy outcomes (including HBsAg loss and decline) and safety outcomes [including hepatitis flare and hepatocellular carcinoma (HCC)] were evaluated.ResultsAmongst 97 participants (85% Asian), with a median follow‐up of 7 years, the cumulative incidence of HBsAg loss was 10%, 13% and 22% at 5, 7 and 9 years after stopping NA. HBsAg loss was associated with a lower end‐of‐treatment (EOT) HBsAg level (HR = 0.28, <jats:italic>p</jats:italic> &lt; 0.001), older age (HR = 1.14, <jats:italic>p</jats:italic> = 0.005) and peak off‐treatment HBV DNA level (OR = 0.50, <jats:italic>p</jats:italic> = 0.002). Participants with EOT HBsAg level ≤ 10 IU/mL experienced early HBsAg loss (&lt; 96 weeks) without ALT flares whilst those with EOT HBsAg level ≥ 10 IU/mL experienced late (≥ 96 weeks) HBsAg loss, often following ALT flares (5/8 cases). No cases of hepatic decompensation, liver transplantation or death occurred. Median liver stiffness did not increase. HCC was diagnosed in three individuals (4.4/1000 person‐years).ConclusionThe rate of functional cure increased during long‐term follow‐up but remained low. EOT HBsAg strongly predicted the likelihood and timing of HBsAg loss. ALT flares were associated with HBsAg decline, and in some cases, with delayed HBsAg loss.Trial Registration: The clinical study was supported by the National Health and Medical Research Council of the study clinical trial ID is NCT02581033","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"50 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899329","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}