Journal of Crohn's & colitis最新文献

{"title":"Histologic signatures as predictors of intestinal barrier impairment in inflammatory bowel disease: integration with endoscopic and molecular markers.","authors":"Antonio Lo Bello, Irene Zammarchi, Cecilia L Pugliano, Snehali Majumder, Robert Hughes, Rory Crotty, Brian Hayes, Louise Burke, Subrata Ghosh, Marietta Iacucci","doi":"10.1093/ecco-jcc/jjag076","DOIUrl":"10.1093/ecco-jcc/jjag076","url":null,"abstract":"<p><strong>Background and aims: </strong>Intestinal barrier impairment (BI) is a hallmark of inflammatory bowel disease (IBD), driving immune activation, neutrophil-mediated injury, and chronic mucosal damage. While endoscopy and molecular profiling provide insight into epithelial and vascular assessment, the combined prognostic role of histology and BI remains insufficiently defined. This study aimed to determine the association between histology-derived signatures and BI, and identify outcome predictors by integrating histologic, advanced imaging, and molecular data.</p><p><strong>Methods: </strong>IBD patients underwent in vivo epithelial and vascular barrier assessment using probe-based confocal laser endomicroscopy and endocytoscopy. Biopsies were collected for histologic and protein expression analysis. Epithelial (ZO-1, Claudin-2, E-cadherin) and vascular-barrier proteins (CD31, PV-1) were analyzed using confocal microscopy and automated quantification with QuPath. Correlation among histology, advanced imaging, and protein expression was assessed, together with the ability to predict outcome at 12 months of follow-up.</p><p><strong>Results: </strong>Eighty-eight IBD patients (52 Crohn's disease [CD] and 36 ulcerative colitis [UC]) were included. BI was identified in 35/52 (67%) CD and 28/36 (78%) UC patients. Epithelial and lamina propria neutrophils correlated strongly with epithelial BI (r = 0.6). Chronic inflammatory infiltrate correlated significantly with vascular BI (r = 0.5) and PV-1 expression (r = 0.3) in CD. Finally, CD patients with both barrier alterations (advanced imaging + PV-1) and inflammatory infiltrate showed a higher rate of adverse outcomes than those with single alterations.</p><p><strong>Conclusion: </strong>Histologic signatures correlate significantly with BI in IBD. Multimodal evaluation combining histology, advanced imaging, and molecular profiling improves outcome prediction beyond single-modality assessment and may identify patients with subclinical disease persistence, supporting accurate risk stratification and personalized management.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply: Therapeutic management and risk of colectomy in patients with acute severe ulcerative colitis and previous exposure to anti-tumor necrosis factor drugs: a comparative study of GETECCU.","authors":"Francisco Mesonero, Yamile Zabana, Ana Gutiérrez","doi":"10.1093/ecco-jcc/jjag078","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag078","url":null,"abstract":"","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histologic and combined histologic-endoscopic outcomes with mirikizumab in Crohn's disease: VIVID-1 trial results.","authors":"Vipul Jairath, Fernando Magro, Marijana Protic, Gert De Hertogh, Noam Harpaz, Tadakazu Hisamatsu, Geert D'Haens, Rish Pai, Guanglei Yu, Nathan Morris, Wen Tao Luo, Emily Hon, Rodrigo Escobar, Luc Biedermann, Walter Reinisch","doi":"10.1093/ecco-jcc/jjag077","DOIUrl":"10.1093/ecco-jcc/jjag077","url":null,"abstract":"<p><strong>Background and aims: </strong>Evaluation of microscopic inflammation is an emerging therapeutic target of Crohn's disease. The completed VIVID-1 trial evaluated histologic and combined histologic-endoscopic outcomes for mirikizumab relative to placebo and ustekinumab in moderately-to-severely active Crohn's disease.</p><p><strong>Methods: </strong>Two specimens from each of five intestinal segments (one ileal, four colonic) were obtained from the edge of ulcers, or the most inflamed mucosa at screening, and weeks (W)12 and 52. Histologic response was defined as the absence of epithelial neutrophils and epithelial damage, erosions and ulceration or ≥50% decrease in either the active Robarts Histopathology Index or the active Global Histologic Disease Activity Score, and was prespecified. Histologic remission was defined as absence of mucosal neutrophils, no epithelial damage, and no erosions and ulcers and was a prespecified endpoint. Post-hoc analyses included subgroup analyses, the proportions of patients achieving combined histologic-endoscopic outcomes, the agreement between histologic outcomes and endoscopic or clinical outcomes, segmental analyses, the assessment of cut-off points for fecal calprotectin, and the association between W12 histologic outcomes and selected W52 outcomes.</p><p><strong>Results: </strong>At W12, mirikizumab was superior to placebo for histologic response (P < .0001) and histologic remission (P = .001), with similar rates to ustekinumab (P = .58 and P = .44, respectively). At W52, mirikizumab-treated patients showed greater histologic response (P = .008) compared to ustekinumab, especially in patients who previously failed biologic therapies (P = .006). Combined histologic-endoscopic response at W52 was numerically higher for mirikizumab (P = .06) and reached statistical significance among biologic-failed patients (P = .02); however, combined remission rates were comparable across treatment arms.</p><p><strong>Conclusions: </strong>Mirikizumab was superior to placebo in achievement of all histology-based endpoints. Mirikizumab showed higher rates compared to ustekinumab for achievement of histologic response at W52. Early histologic response among endoscopic non-responders was associated with 1-year endoscopic outcomes. ClinicalTrials.gov, NCT03926130.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global phenotypic similarity in inflammatory bowel disease: the Eastern Mediterranean region perspective.","authors":"Mohammed Nabil Quraishi, Tine Jess, Badr Al-Bawardy","doi":"10.1093/ecco-jcc/jjag087","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag087","url":null,"abstract":"","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality metrics reflecting patient experience of gastrointestinal endoscopy in inflammatory bowel disease: results of national endoscopy dataset analysis.","authors":"Fiona Jones, Aonghus Lavelle, Finbar MacCarthy, Stephen Patchett, Ashraf Morcos, Manus Moloney, Garret Cullen, Eoin Slattery, Jan Leyden, Colm O'Morain, Laurence Egan, Irene Zammarchi, Marietta Iacucci, Glen A Doherty","doi":"10.1093/ecco-jcc/jjaf211","DOIUrl":"10.1093/ecco-jcc/jjaf211","url":null,"abstract":"<p><strong>Introduction: </strong>The European Society of Gastrointestinal Endoscopy has recently defined important performance measures for endoscopy in inflammatory bowel disease (IBD). The role of patient experience in quality assessment of endoscopy in IBD has yet to be defined. We undertook an observational study based on analysis of a large multi-center dataset with national coverage in Ireland. The aim was to analyze individual and composite metrics that reflect patients' experience with endoscopic procedures for IBD.</p><p><strong>Methods: </strong>Anonymized data were extracted from electronic procedure records of patients who underwent colonoscopy in 24 Irish hospitals. The performance indicator of colonic intubation (PICI), a novel composite score reflecting sedation rates and patient comfort, and IBD-specific endoscopic domains were evaluated.</p><p><strong>Results: </strong>Data from 261 524 colonoscopies were analysed from 2014 to 2020. Crohn's disease (CD) patients had a significantly lower odds ratio (OR) of achieving PICI compared to non-IBD patients (0.69, 0.65-0.74, P < .001). Severe colitis was also associated with a significantly lower OR of achieving PICI (OR 0.53, 0.38-0.74, P < .001). In total, 80.2% of CD patients had a comfort score ≤2 compared to 87.8% of those with ulcerative colitis (UC) and 84.2% without IBD. Additionally, 60.7% of patients with CD required a midazolam dose of 3 mg or more compared to 50.4% of those with UC and 76.7% of those without IBD. In total, 50% of CD patients required fentanyl doses >50 µg compared to 34% of UC patients and 30.3% of patients without IBD.</p><p><strong>Conclusion: </strong>This analysis of a large national endoscopy dataset highlights variability in quality metrics for IBD endoscopy and underscores the need for a metric such as PICI to more accurately capture and reflect patient endoscopic experience with IBD.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes following switch from risankizumab to guselkumab in Crohn's disease: a real-world case series.","authors":"Amar Farkouh, Nabil Nathoo-Khedri, Alice Dufresne, Homa Danaie, Robert Battat","doi":"10.1093/ecco-jcc/jjag089","DOIUrl":"10.1093/ecco-jcc/jjag089","url":null,"abstract":"<p><strong>Background: </strong>Risankizumab is an interleukin (IL)-23 inhibitor that is effective for the treatment of moderate-to-severe Crohn's disease (CD). However, many patients experience loss of response. Switching within the IL-23 inhibitor class to agents with more frequent dosing, such as guselkumab, may represent a salvage strategy, though no supporting data exist. We aimed to describe outcomes following switching between IL-23 antagonists.</p><p><strong>Methods: </strong>This case series included five CD patients at a Canadian tertiary care center with primary non-response or secondary loss of response to risankizumab who were switched to guselkumab. Data were collected at baseline, during risankizumab therapy, and after switching.</p><p><strong>Results: </strong>Five CD patients with inadequate response to risankizumab were included. One patient (20%) had primary non-response and four (80%) had secondary loss of response. Risankizumab duration ranged from 3 to 38 months (mean 17.4 ± 12.9). Four patients had active disease on baseline endoscopy before switching. Mean follow-up after switching was 3.8 ± 1.9 months. Mean CD-PRO2 improved from 22.7 to 5.2 post-switching. Clinical response (≥50% CD-PRO2 reduction) was achieved in 4/5 patients (80%), and clinical remission (CD-PRO2 < 8) was similarly achieved in 4/5 patients (80%). Among four patients with biochemical data, biochemical response (≥50% reduction in fecal calprotectin [FCal]) and remission (normalization of FCal) each occurred in 75%, with a mean FCal reduction of 618 µg/g. One patient had biochemical worsening despite clinical improvement. No safety concerns were reported.</p><p><strong>Conclusion: </strong>In CD patients with loss of response to risankizumab, switching to guselkumab may be effective in selected patients. Larger confirmatory studies are needed.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13303287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual chromoendoscopy with linked color imaging versus dye-chromoendoscopy in the surveillance of patients with long-standing colonic inflammatory bowel disease.","authors":"Roberto Gabbiadini, Gianluca Franchellucci, Francesco Minini, Arianna Dal Buono, Giuseppe Privitera, Marco Spadaccini, Giulia Migliorisi, Lorenzo Petronio, Valeria Farinola, Antonio Di Martino, Cristina Bezzio, Cesare Hassan, Alessandro Repici, Alessandro Armuzzi","doi":"10.1093/ecco-jcc/jjag085","DOIUrl":"10.1093/ecco-jcc/jjag085","url":null,"abstract":"<p><strong>Background and aims: </strong>Surveillance colonoscopy programmes in inflammatory bowel disease (IBD) are associated with reduced colorectal cancer (CRC) incidence. This study aims to compare the performance of virtual chromoendoscopy (VCE) using linked color imaging (LCI) and dye-chromoendoscopy (DCE) with methylene blue for the detection of colonic neoplastic lesions during surveillance colonoscopy in patients with IBD.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included patients with colonic IBD undergoing CRC surveillance colonoscopy between June 2018 and December 2024. The primary outcome was the total neoplastic lesions detected in each group. The secondary outcome was the neoplastic lesions detection rate. Propensity-score matching and multivariable Poisson and logistic regression were used to adjust for baseline differences and identify independent predictors.</p><p><strong>Results: </strong>311 patients were included (112 DCE, 199 LCI). The mean number of neoplastic lesions identified per colonoscopy was 0.116 with DCE and 0.085 with LCI (P = .472). Similarly, the neoplasia detection rate was comparable between techniques (8.03% for DCE vs 7.53% for LCI; odds ratio [OR] 1.07, 95% confidence interval [CI], 0.45-2.54, P = .874). After 1:1 propensity score matching, the chromoendoscopy modality (DCE vs LCI) was not associated with the total number of neoplastic lesions (IRR 0.77; 95% CI, 0.34-1.78; P = .543) and with the neoplastic lesions detection rate (OR 0.58; 95% CI, 0.21-1.65; P = .310).</p><p><strong>Conclusions: </strong>LCI-based VCE provides a neoplastic yield comparable to traditional DCE in patients with long-standing colonic IBD undergoing surveillance colonoscopy. As with other VCE modalities, LCI may be adopted as an alternative to DCE for dysplasia surveillance in IBD.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prior exposure to advanced therapy and timing of discontinuation and risk of serious infections in patients with inflammatory bowel disease initiating a new advanced therapy.","authors":"Virginia Solitano, Dhruv Ahuja, Yuchen Qi, Sagar B Patel, Marianne Hupé, Sudheer K Vuyyuru, Anna L Silverman, Ronghui Xu, Shane W Goodwin, Ola Olén, Ashwin N Ananthakrishnan, Vipul Jairath, Siddharth Singh","doi":"10.1093/ecco-jcc/jjag095","DOIUrl":"10.1093/ecco-jcc/jjag095","url":null,"abstract":"<p><strong>Introduction: </strong>Despite regulatory mandates for advanced therapy (AT) washout periods of up to 5 drug half-lives before enrolling patients in inflammatory bowel disease (IBD) trials, the evidence base for these requirements is largely empirical, and whether shorter intervals independently increase the risk of serious infections in real-world practice remains unknown.</p><p><strong>Methods: </strong>Using the OptumLabs Data Warehouse, we identified adult patients with IBD who initiated a new AT (tumor necrosis factor antagonists, vedolizumab, interleukin (IL)-12/23 or IL-23 antagonists, or Janus kinase inhibitors) between 2018 and 2023 using a class-specific new-user design. We examined whether exposure to AT within the preceding 12 months (vs no exposure to AT within that window) and timing of discontinuation (≤1 month, 1-<3 months, or 3-12 months) were associated with risk of serious infections using multivariable Cox proportional hazards regression.</p><p><strong>Results: </strong>Among 21 564 AT initiators (47 ± 18 years; 52% female; 57% Crohn's disease), 7490 (34.7%) had AT exposure within the preceding 12 months. Over a mean follow-up of 1.6 ± 0.9 y, 1955 (9.1%) experienced a serious infection. Prior AT exposure was associated with higher infection risk (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.07-1.33), consistent in inverse probability of treatment-weighted analyses (HR, 1.20 [1.06-1.37]). Among patients with prior exposure, timing of discontinuation was not associated with infection risk (HR, 1.17 [0.95-1.43] for ≤1 month vs 3-12 months; HR, 1.01 [0.83-1.22] for 1-<3 months), with no dose-response relationship on continuous modeling.</p><p><strong>Discussion: </strong>AT exposure within the preceding 12 months is associated with modestly higher risk of serious infection after initiating a new AT in IBD, but timing of discontinuation does not independently influence this risk.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical and surgical therapies for patients with inflammatory bowel diseases and prior or coexisting cancer: a Danish nationwide cohort study.","authors":"Jonathan Plovgaard, Mads Damsgaard Wewer, Flemming Bendtsen, Johan Burisch","doi":"10.1093/ecco-jcc/jjag073","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag073","url":null,"abstract":"<p><strong>Background and aims: </strong>As a result of an aging population and the rising incidence of inflammatory bowel diseases (IBD) across all age groups, more patients with IBD are being diagnosed with cancer both before and after their IBD diagnosis. We describe the treatment of patients with IBD with prior or coexisting cancer relative to patients with IBD and no cancer.</p><p><strong>Methods: </strong>Danish national registers were used to identify incident and prevalent patients with IBD, drug exposure, and cancer status, from 1996 to 2022. Cox regressions were used to compare medications and the risk of surgery among patients with and without cancer.</p><p><strong>Results: </strong>In total 59 494 patients with IBD (20 551 Crohn's disease [CD; 34.5%], 38 943 ulcerative colitis [UC; 65.5%]) were included. Of those, 2675 (4.5%) had been diagnosed with cancer prior to IBD. Of the remaining 56 819 patients with IBD, 6636 (11.7%) had their first cancer develop after their IBD diagnosis. Prior cancer was associated with reduced immunomodulator use for CD and UC, and increased anti-tumor necrosis factor (anti-TNF) use in UC. Furthermore, patients with CD and UC and a history of cancer had an increased risk of undergoing IBD-related surgery during follow-up. Patients who developed cancer during the course of their IBD largely had their anti-TNF and immunomodulator therapy discontinued following a cancer diagnosis.</p><p><strong>Conclusions: </strong>Patients with IBD and prior or coexisting cancer were treated differently from patients with no history of cancer. We observed greater caution around initiating immunosuppressants for patients with prior cancer, while more patients required IBD-related surgery. Greater caution was observed around reinitiating immunosuppressants for patients diagnosed with cancer.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of mirikizumab in patients with moderate-to-severe ulcerative colitis: the miri real multicenter study.","authors":"Ferdinando D'Amico, Fabrizio Fanizzi, Arianna Dal Buono, Roberto Gabbiadini, Olga M Nardone, Alessandra Zilli, Mariangela Allocca, Giorgia M Lauriola, Vipul Jairath, Laurent Peyrin-Biroulet, Gionata Fiorino, Fabiana Castiglione, Luca Massimino, Mauro Mastronardi, Alessandro Armuzzi, Silvio Danese","doi":"10.1093/ecco-jcc/jjag062","DOIUrl":"10.1093/ecco-jcc/jjag062","url":null,"abstract":"<p><strong>Background & aims: </strong>Mirikizumab, an IL-23 p19-targeting monoclonal antibody, is approved for moderate-to-severe ulcerative colitis (UC). Real-world evidence on its effectiveness and safety remains limited. We evaluated its effectiveness and safety in a real-world setting.</p><p><strong>Methods: </strong>This retrospective multicenter study included adult UC patients treated with mirikizumab at 5 Italian centers (June 2024-October 2025), with ≥24 weeks of follow-up. The primary outcome was clinical remission (CR, pMS ≤ 2 with rectal bleeding 0) at week(w)12. Secondary outcomes included intestinal ultrasound (IUS) remission, endoscopic remission, bowel urgency (BU) remission, fecal calprotectin (FC) normalization, and safety profile.</p><p><strong>Results: </strong>A total of 236 patients (60.2% male; median age 47) were included. 77.5% had prior exposure to advanced therapy. Mirikizumab significantly reduced pMS at w12 and w24 (both P < .001), with clinical remission in 46.6% and 55.5%, respectively. Mayo endoscopic score improved at both timepoints (P < .01 and P < .001) with 38% achieving endoscopic remission at w24. IUS remission was nonsignificant at w12 but significant at w24 (P < .0001). BU and FC improved at both timepoints (P < .001). Remission rates were similar in biologic-naive and biologic-exposed patients. Discontinuations were uncommon, adverse events were infrequent and non-serious, and liver tests showed no clinically relevant changes.</p><p><strong>Conclusions: </strong>In this real-world multicenter cohort, mirikizumab was associated with meaningful improvements across clinical, endoscopic, biochemical, and ultrasound outcomes, with low discontinuation rates and a favorable safety profile through 24 weeks. These findings support the effectiveness of selective IL-23 inhibition in routine care, including in patients with prior exposure to advanced therapies.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 6","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}