IBD Journal Scan

Key articles from high impact journals in last month

Editorial Recommendations

FEBRUARY-2025

Small molecules Edge over biologics in achieving clinical remission and endoscopic improvement in UC

This network meta-analysis evaluates the comparative efficacy of biologics and small molecules in achieving remission in moderate to severe ulcerative colitis (UC). A comprehensive literature search was conducted up to May 2024, including 36 Phase 3 randomized controlled trials with 14,270 UC patients. Upadacitinib demonstrated the highest efficacy in clinical remission (99.6%) and endoscopic improvement (99.2%), while risankizumab and guselkumab ranked highly for histological remission. Upadacitinib also led in maintaining remission outcomes. These findings highlight the effectiveness of small molecules and novel interleukin-23 inhibitors as promising alternatives to traditional biologics in UC management.

Appropriateness of Treat to Target strategy in Asymptomatic IBD

This study examines the appropriateness of altering treatment in asymptomatic patients with ulcerative colitis and Crohn’s disease who have active endoscopic disease. Using the RAND/UCLA Appropriateness Method, nine IBD specialists evaluated 126 clinical scenarios, considering disease progression, prior treatments, complications, and patient-specific factors like age and pregnancy plans. Therapy changes were deemed appropriate in 96 cases, particularly for patients with progressive or extensive disease, while uncertainty remained in 27 cases of mild or stable conditions. Changes were considered inappropriate for those with prior exposure to multiple therapies or minimal disease activity. No significant disagreements emerged among panelists.

Real-life efficacy of Darvadstrocel in perianal fistulising CD

This retrospective multicenter study evaluated the effectiveness of darvadstrocel therapy for managing perianal fistulas in Crohn’s disease (CD). Among 223 patients, perianal clinical remission was achieved in 78.2% at 26 weeks and 62.3% at 52 weeks. Factors associated with treatment failure included higher baseline PDAI scores, a greater number of fistulas, and delayed surgical preparation. Clinical response rates were 84.8% and 79.8% at weeks 26 and 52, with 77.8% of patients reporting symptom improvement. Adverse events were reported in 13.5% of cases, primarily abscesses and proctalgia. The findings suggest promising real-world efficacy, safety, and high patient satisfaction.

Vedolizumab in chronic pouchitis: efficacious and safe

This study assessed the efficacy of vedolizumab in achieving mucosal healing (MH) and its association with clinical improvements in chronic pouchitis. In a randomized, double-blind, placebo-controlled trial, vedolizumab significantly reduced ulcer count and increased ulcer-free patients compared to placebo at weeks 14 and 34. More patients achieved reductions in ulcerated pouch surface area and remission based on endoscopic and histologic evaluations. MH at week 14 was linked to higher rates of clinical remission at both weeks 14 and 34. These findings support vedolizumab’s effectiveness in promoting mucosal healing and improving clinical outcomes in chronic pouchitis patients.

Long-term Report: Vedolizumab in the Paediatric group is safe and appears to be more effective for UC than CD

This multicenter, prospective cohort study (VEDOKIDS) evaluated the long-term efficacy and safety of vedolizumab maintenance therapy in pediatric patients with inflammatory bowel disease (IBD). Enrolling 137 children across six countries, the study found that vedolizumab significantly reduced disease activity, with clinical improvements evident by week 6 and sustained through week 54. Complete remission was achieved in 25% of Crohn’s disease patients and 47% of those with ulcerative colitis or unclassified IBD. Vedolizumab-related adverse events, including headache and myalgia, occurred in 21% of patients but were not severe. These findings support vedolizumab as a viable off-label treatment in pediatric IBD.