Therapeutic Advances in Gastroenterology最新文献

{"title":"Management of gastrointestinal adverse effects in immune-based combination therapy for advanced renal carcinoma: when the oncologist meets the gastroenterologist.","authors":"Angelo Del Gaudio, Loris Riccardo Lopetuso, Valeria Pavese, Erica Palesandro, Ilaria Campisi, Marcello Tucci, Franco Scaldaferri","doi":"10.1177/17562848251358174","DOIUrl":"10.1177/17562848251358174","url":null,"abstract":"<p><p>The advent of combination immunotherapy has revolutionized the treatment of metastatic renal cell carcinoma (mRCC), leveraging immune checkpoint inhibitors and tyrosine kinase inhibitors to improve survival outcomes. However, these advancements come with a significant challenge: the management of adverse effects, which can impair patients' quality of life and lead to therapy discontinuation. This review explores the prevalence, mechanisms, and management of gastrointestinal (GI) toxicity associated with immunotherapy combinations for mRCC from the gastroenterologist's perspective. Diarrhea, colitis, nausea, and vomiting are the most frequently reported adverse events, often necessitating a multidisciplinary approach for timely diagnosis and intervention to mitigate risks and ensure therapeutic continuity. We highlight the management strategies, ranging from symptomatic treatment and dietary modifications to advanced therapies for severe cases, even discussing the emerging approaches for refractory cases. By integrating oncological and gastroenterological expertise, clinicians can optimize outcomes for patients while minimizing GI-related complications.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251358174"},"PeriodicalIF":3.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Submucosal fibrosis in large colorectal serrated lesions in cases receiving endoscopic submucosal dissection.","authors":"Erik Manriquez-Alegria, Naohisa Yoshida, Reo Kobayashi, Naoto Iwai, Ken Inoue, Osamu Dohi, Lucas Cardoso, Hideyuki Konishi","doi":"10.1177/17562848251360097","DOIUrl":"10.1177/17562848251360097","url":null,"abstract":"<p><strong>Background: </strong>Submucosal fibrosis is a known risk factor for adverse outcomes in colorectal endoscopic submucosal dissection (ESD). However, evidence regarding the presence and impact of fibrosis in colorectal serrated lesions (CSLs) remains limited.</p><p><strong>Objectives: </strong>This study aimed to evaluate the association between CSLs and submucosal fibrosis, and to assess the impact of fibrosis presence on therapeutic outcomes of colorectal ESD.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive colorectal ESD cases performed between 2020 and 2024. Only lesions ⩾20 mm were included; cases were classified as CSLs and adenoma + T1 cancer according to histological diagnosis. CSLs included sessile serrated lesions (SSL), traditional serrated adenomas, SSL with dysplasia, and unclassified serrated adenomas. Patient/lesion characteristics, presence of fibrosis, severe fibrosis, and ESD outcomes were assessed. Multivariate analyses, including CSLs' histology, were performed to identify factors associated with the presence of submucosal fibrosis and severe fibrosis.</p><p><strong>Results: </strong>A total of 445 colorectal ESD cases were included, comprising 72 CSLs and 373 adenoma + T1 cancer. CSLs were significantly associated with a lower presence of fibrosis (34.7% and 48.5%, <i>p</i> = 0.04) and severe fibrosis (6.9% vs 18.2%; <i>p</i> = 0.03) compared to adenoma + T1 cancer. In multivariate analysis, CSLs' histology (odds ratio (OR): 0.58; <i>p</i> = 0.04), lesion size ⩾40 mm (OR: 2.03; <i>p</i> < 0.01), and rectal location (OR: 0.40; <i>p</i> < 0.01) were significantly related to fibrosis presence. Lesion size ⩾40 mm (OR: 2.45; <i>p</i> < 0.01) and polypoid morphology (OR: 3.42; <i>p</i> < 0.01) were significantly related to severe fibrosis.</p><p><strong>Conclusion: </strong>CSLs' histology was negatively correlated with submucosal fibrosis in colorectal ESD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251360097"},"PeriodicalIF":3.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12332352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overtreatment in colorectal cancer prevention: comparison between surgical and endoscopic treatment of benign colonic polyps.","authors":"Noelia Sala-Miquel, Lucía Medina-Prado, Carolina Mangas-Sanjuan, Sandra Baile-Maxía, Cristina Alenda, Lucía Madero-Velázquez, Francisco A Ruiz-Gómez, Eva Serrano, Enrique Santana, Victor Ausina, María Sáez-Rico, Pedro Zapater, Juan Martínez-Sempere, Rodrigo Jover","doi":"10.1177/17562848251351214","DOIUrl":"10.1177/17562848251351214","url":null,"abstract":"<p><strong>Background: </strong>The growing number of premalignant colonic lesions undergoing surgical treatment can lead to increased overtreatment.</p><p><strong>Objectives: </strong>We assessed the magnitude of overtreatment by comparing rates of adverse events related to surgical and endoscopic treatment of complex benign polyps.</p><p><strong>Design: </strong>This was a single-center retrospective study conducted at a tertiary care hospital.</p><p><strong>Methods: </strong>This study included patients with benign colonic lesions treated surgically during 2005-2021 and compared with a cohort with complex lesions (Size, Morphology, Site, and Access (SMSA) ⩾3) treated endoscopically during 2018-2022. Adverse events, need for reintervention, mortality, and length of hospital stay were compared using propensity score (PS)-matching analysis. The cohorts were matched 1:1 with adjustment for sex, age, SMSA, and size as covariates. Surgical and endoscopic adverse events were described using the Clavien-Dindo (surgical group) and AGREE (endoscopic group) classifications.</p><p><strong>Results: </strong>Of 240 included patients, PS matching yielded 71 pairs. Adverse events were more frequent with surgical treatment (odds ratio (OR) 3.27; 95% confidence interval (CI) 1.59-6.71), as were severe adverse events (OR 7.5; 95% CI 2.1-27.0), need for reintervention (OR 25.6; 95% CI 3.3-200.0), and mean length of hospital stay (10 vs 0 days, <i>p</i> < 0.001). One (1.4%) patient in the surgical group and none in the endoscopic group died (<i>p</i> = 0.39).</p><p><strong>Conclusion: </strong>An excess of severe adverse events with surgical treatment of complex benign polyps reflects overtreatment. Adequate pathways must be established for referral of these lesions for endoscopic treatment.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251351214"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Octreotide infusion as a treatment for hepatic hydrothorax in a hospital-at-home program: case report from Mayo Clinic.","authors":"Igor Dumic, Margaret R Paulson, Michael J Maniaci, Leah W Webster, Corey Wachter, Andrew Turunen, Charles W Nordstrom","doi":"10.1177/17562848251362573","DOIUrl":"10.1177/17562848251362573","url":null,"abstract":"<p><p>Hepatic hydrothorax (HH) is a rare but serious complication of end-stage liver disease that is often refractory to conventional medical and procedural management. This case report describes a 75-year-old woman with HH secondary to cirrhosis from metabolic-associated steatotic liver disease. Her clinical course was marked by recurrent hospitalizations, refractory right-sided pleural effusion, and multiple unsuccessful interventions including diuretics, serial thoracenteses, an indwelling pleural catheter, and chemical pleurodesis. Notably, the persistence of pleural fluid despite resolution of ascites ultimately led to the formation of a thoracic fistula, with pleural drainage volumes exceeding 4 L/day. Further invasive procedures, such as transjugular intrahepatic portosystemic shunt or liver transplantation, were declined by the patient. She was enrolled in Mayo Clinic's hospital-at-home (HaH) program, where continuous intravenous octreotide was initiated at a dose of 25 mcg/h. This resulted in a significant reduction in pleural output-from over 4000 mL to less than 100 mL daily. After clinical stabilization, the patient transitioned to subcutaneous octreotide and remained clinically stable for over 6 months, with improved quality of life and no significant adverse effects. To our knowledge, this is the first reported case of continuous intravenous octreotide infusion for HH administered safely in a home-based acute care setting. This case underscores the potential therapeutic role of octreotide in managing refractory HH and highlights the feasibility of delivering complex cirrhosis-related care through a HaH model with multidisciplinary collaboration. Further research is warranted to assess the long-term efficacy, safety, and cost-effectiveness of octreotide in this context and to explore broader application in home hospital environments.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251362573"},"PeriodicalIF":3.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective evaluation study of a novel endoscopic revision technique after metal stent deployment for hepatic hilar obstruction.","authors":"Kouji Kamawaki, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Hiroki Nishikawa","doi":"10.1177/17562848251359410","DOIUrl":"10.1177/17562848251359410","url":null,"abstract":"<p><strong>Background: </strong>Malignant hilar biliary obstruction (MHBO) can be treated by stent deployment under endoscopic retrograde cholangiopancreatography. In case of unresectable MHBO, uncovered self-expandable metal stent (UCSEMS) deployment might be recommended. However, endoscopic revision is challenging. To overcome this issue, we previously described a novel revision technique called the \"molting technique,\" but its technical feasibility is still unclear.</p><p><strong>Objective: </strong>The present study aimed to evaluate the technical feasibility of the molting technique in a prospective setting.</p><p><strong>Design: </strong>A single-center prospective study.</p><p><strong>Methods: </strong>Technical success was defined as successful endoscopic revision using the molting technique. If endoscopic revision using the molting technique in the hepatic bile duct failed on either side, the technique was considered a technical failure.</p><p><strong>Results: </strong>A total of 20 patients were prospectively enrolled in this study. The technical success rate was 90% (18/20). The mean procedure time was 20.6 ± 8.5 min, and clinical success was obtained in 94.4% of patients (17/18). The mean duration of stent patency after endoscopic revision was 118.2 days. Finally, adverse events were observed in three patients (pancreatitis, <i>n</i> = 2, cholangitis, <i>n</i> = 1), all of whom were successfully treated conservatively.</p><p><strong>Conclusion: </strong>In conclusion, the molting technique might be helpful as an option for endoscopic revision for multiple UCSEMS deployments for selected patients.</p><p><strong>Trail registration: </strong>University Hospital Medical Information Network 000044572.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251359410"},"PeriodicalIF":3.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between glycemic control and hepatocellular carcinoma risk in people with type 2 diabetes, stratified by chronic hepatitis B or C infection.","authors":"I-Wen Chen, Chung-Huei Huang, Pi-Hua Liu, Cheng-Wei Lin, Shih-Yuan Hung, Yu-Yao Huang","doi":"10.1177/17562848251356198","DOIUrl":"10.1177/17562848251356198","url":null,"abstract":"<p><strong>Background: </strong>Chronic viral hepatitis is a major risk factor for hepatocellular carcinoma (HCC). Though diabetes is another risk of HCC, it remains indeterminant as to whether glycemic burden in individuals with type 2 diabetes (T2D) should be differentially managed according to the presence of chronic hepatitis B virus (HBV) or hepatitis C virus (HCV).</p><p><strong>Objectives: </strong>To evaluate the association between glycemic burden and HCC risk in individuals with T2D, stratified by viral hepatitis status, including HBV and HCV.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>This study analyzed 30,055 individuals with T2D from the Chang Gung Research Database (2009-2016), stratified into non-HBV/non-HCV, HBV, and HCV groups. Glycemic burden was assessed using baseline glycated hemoglobin (HbA1c), high HbA1c variability, and optimal glycemic control, defined as maintaining HbA1c <7% for more than 80% of the follow-up period. Cox proportional hazard models were used to identify HCC risk factors.</p><p><strong>Results: </strong>Over a mean follow-up of 6.4 years, 644 individuals (2.14%) developed HCC. Viral hepatitis was the predominant independent risk factor, followed by elevated fibrosis-4 (FIB-4) scores, male sex, older age, low albumin, and low platelet count. Neither baseline HbA1c nor high HbA1c variability was associated with HCC risk in the overall T2D population or stratified groups. However, optimal glycemic control was significantly associated with reduced HCC risk in individuals with HBV (adjusted hazard ratio (HR) = 0.671, 95% confidence interval (CI) = 0.465-0.969, <i>p</i> = 0.033) and demonstrated a potentially beneficial role in non-HBV/non-HCV patients with presumed metabolic dysfunction-associated fatty liver disease (presumed MAFLD; adjusted HR = 0.574, 95% CI: 0.309-1.065, <i>p</i> = 0.079).</p><p><strong>Conclusion: </strong>Optimal glycemic control may reduce HCC risk in individuals with T2D and HBV and potentially benefits those with presumed MAFLD, although its role in HCV-related HCC appears limited. These findings highlight the need for tailored glycemic management strategies based on viral hepatitis type.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251356198"},"PeriodicalIF":3.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of EUS-guided portal pressure gradient measurement with concomitant EUS-liver elastography and EUS-guided liver biopsy in patients with chronic liver disease: a single center experience.","authors":"Muhammad Nadeem Yousaf, Ahmad Hassan Ali, Sohum A Patwa, Sanket Basida, Nicholas McGee, Jacob Cebulko, Darian Fard, Alexander Malik, Xheni Deda, Ghassan M Hammoud","doi":"10.1177/17562848251359015","DOIUrl":"10.1177/17562848251359015","url":null,"abstract":"<p><strong>Background: </strong>Risk stratification in liver disease includes liver elastography (LE) and portal pressure gradient (PPG) measurement.</p><p><strong>Objectives: </strong>We examined the efficacy and safety of endoscopic ultrasound (EUS)-liver biopsy (EUS-LB) and the correlation between EUS-PPG and EUS-LE in patients with liver disease.</p><p><strong>Study design: </strong>This is a prospective and retrospective, single-center study.</p><p><strong>Methods: </strong>Data from patients who underwent concomitant EUS-LE, EUS-PPG, and EUS-LB were analyzed. Histologically, significant fibrosis (SF) was considered F2-F4, non-significant fibrosis (NSF) as F0-F1, advanced fibrosis (AF) as F3-F4, and non-advanced fibrosis (NAF) as F0-F2.</p><p><strong>Results: </strong>In total, 25 patients underwent EUS-PPG measurement; 60% were male (mean age, 60 years). EUS-LE and EUS-LB were performed in 88% and 96% of patients, respectively (the technical success rate was 100%). The mean number of portal tracts was 14.3. Histological diagnosis was achieved in all patients; 67% had SF. The mean EUS-LE was 24.1 kPa, and the mean PPG was 4.6 mmHg. Portal hypertension (PH; PPG >5 mmHg) and clinically significant PH (PPG >10 mmHg) were found in 44% and 12%, respectively. Patients with SF had a higher mean PPG (5.9 vs 2.8 mmHg; <i>p</i> = 0.003) and mean shear wave measurement (SWM; 30.0 vs 15.6 kPa; <i>p</i> = 0.02) compared to the NSF group. Patients with AF had a higher mean PPG (6.0 vs 3.4 mmHg; <i>p</i> = 0.01) and mean SWM (32.0 vs 18.8 kPa; <i>p</i> = 0.04) compared to the NAF group. There were no significant adverse events.</p><p><strong>Conclusion: </strong>Concomitant EUS-LB and PPG is safe. EUS-PPG and EUS-LE correlate with the degree of fibrosis on histology. Larger studies are needed to optimize their values in clinical practice.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251359015"},"PeriodicalIF":3.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a novel model based on clinical characteristics to predict natural disease course progression in patients with stricturing Crohn's disease.","authors":"Yu Wang, Xiaomin Wu, Weitong Gao, Xiaolong Chen, Haoyin Chen, Zishan Liu, Yao Zhang, Yubei Gu, Ren Mao","doi":"10.1177/17562848251358705","DOIUrl":"10.1177/17562848251358705","url":null,"abstract":"<p><strong>Background: </strong>Stricturing Crohn's disease (CD) is heterogeneous, and risk factors for natural disease course progression remain unclear.</p><p><strong>Objectives: </strong>The study aims to construct a predictive model based on commonly used clinical indicators to identify high-risk stricturing CD prone to natural disease course progression.</p><p><strong>Design: </strong>Retrospective multicenter study.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of clinical data from stricturing CD patients. The natural disease course progression was defined as progression to penetrating disease or surgery. The data were split into a test cohort and an internal validation cohort in a 7:3 ratio. Classification models, including logistic regression (LR), random forest (RF), and extreme gradient Boosting (XGB) models, were constructed and validated in an independent external validation cohort.</p><p><strong>Results: </strong>The study included 341 patients, with 190 in the internal training cohort, 81 in the test cohort, and 70 in the external validation cohort. Obstructive symptoms, globulin (GLB), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) are independent predictors of natural disease course progression. LR, RF, and XGB models were developed to predict the occurrence of natural disease course progression within 2 years. In the internal test cohort, the areas under the receiver-operating characteristic curves of the LR, RF, and XGB models were 0.861, 0.492, and 0.559, respectively. In the external validation cohort, the LR model also achieved the highest area under the receiver operating characteristic curve value of 0.752.</p><p><strong>Conclusion: </strong>In patients with stricturing CD, obstructive symptoms score, CRP, ESR, and GLB were independent and validated predictors of natural disease course progression. A prognostic nomogram based on the LR model was developed to aid in evaluating the prognosis of stricturing CD patients.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251358705"},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world outcomes from the UK IBD Registry on second-line biologic therapy following anti-TNF exposure in Crohn's disease: results from the BISCUITS study.","authors":"Frederick Taylor, Giorgio Bartalucci, Catherine Gleave, Liz Dobson, Keith Bodger, Susanna Dodd, Stuart Bloom, Alun Passey, Riikka Nissinen, Daniel Wirth, Andreas Duva, Jennifer Lee, J R Fraser Cummings","doi":"10.1177/17562848251352446","DOIUrl":"10.1177/17562848251352446","url":null,"abstract":"<p><strong>Background: </strong>Selection of second-line therapy in Crohn's disease (CD) patients after failure of first-line TNFα-inhibitor (TNFi) therapy to optimise outcomes remains challenging in real-world clinical practice.</p><p><strong>Objectives: </strong>This study aimed to provide real-world outcomes of CD patients who failed first-line TNFi therapy and switched to either another TNFi or to a biologic with a different mechanism of action. Patients were stratified as to whether they switched because of primary non-response or secondary loss of response to initial TNFi.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>CD patients whose first biologic therapy was a TNFi and switched to another biologic therapy between 26 August 2015 and 31 March 2021 were identified in records held by the UK IBD Registry. Patients were enrolled at study sites, and data were validated by clinical teams. Patients were grouped as within-class switchers (WCS) if their second-line (index) biologic therapy was another TNFi, or out-of-class switchers (OCS) if their index therapy was vedolizumab or ustekinumab. Patients were followed up for at least 1 year. Time to drug discontinuation and outcomes at 1 year after index therapy start were analysed using Cox regression and binary logistic regression models, before and after baseline covariate adjustment through inverse probability of treatment weighting.</p><p><strong>Results: </strong>A total of 180 adult CD patients were included in the study. OCS were less likely to discontinue index therapy in both unweighted analysis (hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.42-0.96, <i>p</i> = 0.03) and weighted analysis (HR: 0.58, 95% CI: 0.38-0.90, <i>p</i> = 0.01), and more likely to show index drug persistence at 1 year in both unweighted analysis (adjusted odds ratio (aOR): 3.66, 95% CI: 1.81-7.67, <i>p</i> < 0.001) and weighted analysis (aOR: 3.95, 95% CI: 2.04-7.89, <i>p</i> < 0.001). These findings were consistent across all secondary endpoints of steroid-free and/or surgery-free index drug survival at 1 year.</p><p><strong>Conclusion: </strong>Patients switching from a TNFi to either vedolizumab or ustekinumab exhibited significantly higher rates of drug persistence compared to those switching to another TNFi, particularly among those experiencing primary non-response to the initial TNFi.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251352446"},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monthly intravenous maintenance treatment with ustekinumab regains clinical response in patients with Crohn's disease who no longer respond to the drug when administered subcutaneously.","authors":"Berta López-Sáez, Ariadna Altadill, Eduard Brunet-Mas, Belen Garcia-Sagué, Luigi Melcarne, Laura Patricia Llovet, Luis Enrique Frisancho, Anna Puy, Sergio Lario, Maria Jose Ramirez-Lazaro, Jorge Del Estal, Albert Villoria, Xavier Calvet Calvo","doi":"10.1177/17562848251358147","DOIUrl":"10.1177/17562848251358147","url":null,"abstract":"<p><strong>Background: </strong>Several studies have assessed the efficacy of re-induction and subcutaneous intensification of ustekinumab (UST) to regain clinical remission of inflammatory bowel disease (IBD). However, very few have evaluated the effectiveness of intravenous UST for this purpose.</p><p><strong>Objectives: </strong>The aims of the study were to evaluate the efficacy of high-dose intravenous UST (USTiv) for regaining remission in Crohn's Disease (CD) and to assess the safety of the drug.</p><p><strong>Design: </strong>Observational, retrospective, single-center study.</p><p><strong>Methods: </strong>All patients who had received intravenous UST to regain remission until June 2023 were included. Clinical response was evaluated using the Harvey-Bradshaw Index. Drug survival was calculated using Kaplan-Meier curves.</p><p><strong>Results: </strong>Twenty-three patients (52% female, mean age 40.5 ± 13.9) with CD were included. Seven (30%) patients had an incomplete primary response to UST, while 16 (70%) presented a secondary loss of response. Clinical response rates for USTiv administered monthly were 17/23 (73.9%) at week 8, 14/23 (60.9%) at week 16, and 10/12 (83.3%) at 1 year. Clinical remission rates were 11/23 (47.8%), 9/23 (39.1%), and 8/12 (66.7%), respectively. Median drug survival was 15.3 ± 7.7 months. Two patients (8%) experienced recurrent mild respiratory infections. No patients discontinued USTiv due to adverse events.</p><p><strong>Conclusion: </strong>More than half of the patients with CD who underwent maintenance treatment with USTiv regained clinical response after failing with subcutaneous UST treatment. No significant adverse events were observed.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251358147"},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}