Experimental and genetic evidence for the impact of CD5 and CD6 expression and variation in inflammatory bowel disease

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) resulting from the interaction of multiple environmental, genetic and immunological factors. CD5 and CD6 are paralogs encoding lymphocyte co-receptors involved in fine-tuning intracellular signals delivered upon antigen-specific recognition, microbial pattern recognition and cell adhesion. While CD5 and CD6 expression and variation is known to influence some immune-mediated inflammatory disorders, their role in IBD remains unclear. To this end, Cd5- and Cd6-deficient mice were subjected to dextran sulfate sodium (DSS)-induced colitis, the most widely used experimental animal model of IBD. The two mouse lines showed opposite results regarding body weight loss and disease activity index (DAI) changes following DSS-induced colitis, thus supporting Cd5 and Cd6 expression involvement in the pathophysiology of this experimental IBD model. Furthermore, DNA samples from IBD patients of the ENEIDA registry were used to test association of CD5 (rs2241002 and rs2229177) and CD6 (rs17824933, rs11230563, and rs12360861) single nucleotide polymorphisms with susceptibility and clinical parameters of CD (n=1352) and UC (n=1013). Generalized linear regression analyses showed association of CD5 variation with CD ileal location (rs2241002CC) and requirement of biological therapies (rs2241002C-rs2229177T haplotype), and with poor UC prognosis (rs2241002T-rs2229177T haplotype). Regarding CD6, association was observed with CD ileal location (rs17824933G) and poor prognosis (rs12360861G), and with left-sided or extensive UC, and absence of ankylosing spondylitis in IBD (rs17824933G). The present experimental and genetic evidence support a role for CD5 and CD6 expression and variation in IBD's clinical manifestations and therapeutic requirements, providing insight into its pathophysiology and broadening the relevance of both immunomodulatory receptors in immune-mediated disorders

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

5to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

El V Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2019, realizado del 6 al 8 de febrero de 2019 y organizado por la Universidad Politécnica Salesiana, ofreció a la comunidad académica nacional e internacional una plataforma de comunicación unificada, dirigida a cubrir los problemas teóricos y prácticos de mayor impacto en la sociedad moderna desde la ingeniería. En esta edición, dedicada a los 25 años de vida de la UPS, los ejes temáticos estuvieron relacionados con la aplicación de la ciencia, el desarrollo tecnológico y la innovación en cinco pilares fundamentales de nuestra sociedad: la industria, la movilidad, la sostenibilidad ambiental, la información y las telecomunicaciones. El comité científico estuvo conformado formado por 48 investigadores procedentes de diez países: España, Reino Unido, Italia, Bélgica, México, Venezuela, Colombia, Brasil, Estados Unidos y Ecuador. Fueron recibidas un centenar de contribuciones, de las cuales 39 fueron aprobadas en forma de ponencias y 15 en formato poster. Estas contribuciones fueron presentadas de forma oral ante toda la comunidad académica que se dio cita en el Congreso, quienes desde el aula magna, el auditorio y la sala de usos múltiples de la Universidad Politécnica Salesiana, cumplieron respetuosamente la responsabilidad de representar a toda la sociedad en la revisión, aceptación y validación del conocimiento nuevo que fue presentado en cada exposición por los investigadores. Paralelo a las sesiones técnicas, el Congreso contó con espacios de presentación de posters científicos y cinco workshops en temáticas de vanguardia que cautivaron la atención de nuestros docentes y estudiantes. También en el marco del evento se impartieron un total de ocho conferencias magistrales en temas tan actuales como la gestión del conocimiento en la universidad-ecosistema, los retos y oportunidades de la industria 4.0, los avances de la investigación básica y aplicada en mecatrónica para el estudio de robots de nueva generación, la optimización en ingeniería con técnicas multi-objetivo, el desarrollo de las redes avanzadas en Latinoamérica y los mundos, la contaminación del aire debido al tránsito vehicular, el radón y los riesgos que representa este gas radiactivo para la salud humana, entre otros

Nuevos mecanismos protectores en la enfermedad inflamatoria intestinal: sistema endocannabinoide y haptoglobina.

La Enfermedad Inflamatoria Intestinal (EII) (enfermedad de Crohn (EC) y Colitis Ulcerosa (CU)), es una enfermedad crónica, poligénica y compleja, de curso recurrente, que afecta al tracto gastrointestinal. Estudios recientes in vitro y modelos experimentales en animales sugieren que el Sistema Endocannabinoide (SE) y la Haptoglobina (Hp) pueden tener un papel protector en la EII. Estudio 1: Sistema Endocannabinoide y EII Se analizó, mediante Western-Blot e inmunohistoquímica, la presencia de los componentes del sistema endocannabinoide (receptores - CB1,CB2-, enzimas de síntesis -DAGL-α/β, NAPE-PLD-, y enzimas de degradación -FAAH y MAGL-) en mucosa de colon de individuos normales, y en pacientes con CU en fase activa, antes de iniciar el tratamiento, y en fase quiescente. Se identificó por primera vez la expresión de todos los componentes del SE en mucosa colónica normal. Como novedades destacan la localización de: CB1 en las células “goblet”; CB2 en las células de Paneth y en los plexos neuroentéricos; FAAH y MAGL en células plasmáticas y polimorfonucleares; enzimas de síntesis en las células epiteliales y en ambos plexos mientéricos. Además, se demostró la presencia de un tono endocannabinoide basal que se modifica en pacientes con CU, tanto en la fase activa como en la fase quiescente: - En pacientes con CU leve-moderada, en fase activa, existe un aumento de la expresión de CB2, cuyos niveles se recuperan en la fase quiescente. - En la fase activa existe una disminución de la expresión de NAPE-PLD, que se recupera en fase quiescente, y un aumento de DAGL-α y MAGL, que se mantienen en la fase quiescente. En conclusión, los componentes del SE se modifican durante la inflamación en la CU , fundamentalmente mediante un aumento de receptores CB2. Por lo tanto, el desarrollo de fármacos que aumenten el tono endocannabinoide durante la inflamación, podrían ser una nueva vía de investigación en la terapéutica de la EII. Estudio 2: Haptoglobina y EII. La Hp es una proteína con propiedades inmunomoduladoras. Existe un polimorfismo en el gen de la Hp, con 2 alelos: Hp1 y Hp2. El objetivo de este estudio fue investigar el papel genético y funcional de la Hp en la EII. Se genotiparon, utilizando PCR “touch-down", 1061 pacientes con EC , 755 con CU y 452 individuos sanos. La prevalencia de la Hp2 fue mayor en EC y en CU que en los controles. Estos resultados se confirmaron en tríos familiares de EII (464 con EC y 151 con CU), en los que el alelo Hp2 se transmite a los descendientes con mayor frecuencia. Se determinaron además los valores séricos de Hp en 62 individuos sanos. Se observaron valores inferiores en aquellos sujetos con genotipo 22. Se desarrollaron dos modelos murinos de colitis experimental (DSS y OXA) en los que demostró que los ratones KO para el gen de la Hp desarrollaban formas de colitis más graves. Además, en ratones KO para el gen de la Hp, los niveles de mRNA de IL-17, INF-γ, TNF e IL-6 en DSS-colitis y los de IL-13 en OXA-colitis se encontraban elevados. En la DSS-colitis, al añadir IL-23 en los ratones KO para el gen de la Hp, aumentaba significativamente la producción de IL-17. En resumen, el polimorfismo de la Hp está implicado en la susceptibilidad genética a padecer EII, lo que subraya la existencia de mecanismos patogénicos comunes con otras enfermedades de base inmunológica. Además, Hp desempeña un papel en la reducción de la severidad de la inflamación en la colitis experimental y modula la producción de IL-17, por lo que podría tener potenciales aplicaciones terapéuticas en la EII.Inflammatory Bowel Disease (IBD) (Crohn’s disease (CD) and Ulcerative Colitis (CU)), is a chronic, poligenic, complex and relapsing disease of the gastrointestinal tract. Recent studies in vitro and experimental animal models have suggested a protective role of the Endocannabinoid System (ES) and Haptoglobin in IBD. Study 1: Endocannabinoid system and IBD We examined, using Western-Blotting and immunohistochemistry, the expression of all components of ES (receptors - CB1, CB2-, biosynthesis enzymes -DAGL-α/β, NAPE-PLD-, and degradating enzymes -FAAH y MAGL- in healthy human colonic tissue, and in active UC patients, without any previous treatment, and in quiescent phase. We identified for the first time, the presence of all components of ES in normal colonic tissue. As novelties we pointed out the expression of: CB1 in globlet cells; CB2 in Paneth cells and in neuroenteric plexi; FAAH and MAGL in plasmatic cells and in polymorphonuclear cells; byosynthesis enzymes in epithelial cells and in both mienteric plexi. Besides, we evidenced the presence of a basal endocannabinoid tone modified in UC patients, in active flares as in quiescent phases: - In UC patients with mild-moderate flares, there was an increase in CB2 expression, that returned to normality in the quiescent phase. - In the active phase there was a decrease in NAPE-PLD expression, that recovered in the quiescent phase, and an increase in DAGL-α and MAGL expression, that is maintained in the quiescent phase. In conclusion, the ES components are altered during inflammation in UC, mainly by an increase in CB2 expression. Therefore, the development of new drugs raising the endocannabinoid tone during inflammation may lead to new therapeutical approaches in IBD. Study 2: Haptoglobin and IBD. Hp is a protein with immunomodulatory properties. There is a polymorphism in the Hp gene, with two different alleles: Hp1 and Hp2. The goal of this study was to investigate the role of Hp in IBD, both genetically and functionally. We genotyped, using a “touch-down” PCR, 1061 CD patients, 755 UC patients and 452 healthy individuals. Prevalence of Hp2 was higher in CD and UC patients than in controls. These results were confirmed in IBD trios families (464 CD trios and 151 UC trios) where Hp2 allele was over-transmitted to the affected offspring. We determined serum levels of Hp in 62 healthy controls. Serum Hp values were lower in individuals with genotype 22. We developed two murine models of experimental colitis (DSS and OXA) and we demonstrated that Hp KO mice developed more severe colitis. In Hp KO mice, mRNA levels of IL-17, INF-γ, TNF and IL-6 in DSS-colitis and mRNA levels of IL-13 en OXA-colitis were higher than in WT mice. In DSS-colitis, after adding IL-23, in Hp KO mice production of IL-17 was significantly increased. To summarized, the Hp polymorphism is implicated in genetic susceptibility to IBD, underscoring common pathogenic pathways with other immune-based diseases. Moreover, Hp has a role in reducing the severity of experimental colitis inflammation and it modulates IL-17 production, suggesting potencial therapeutical applications in IBD

Nuevos mecanismos protectores en la enfermedad inflamatoria intestinal : sistema endocannabinoide y haptoglobina /

La Enfermedad Inflamatoria Intestinal (EII) (enfermedad de Crohn (EC) y Colitis Ulcerosa (CU)), es una enfermedad crónica, poligénica y compleja, de curso recurrente, que afecta al tracto gastrointestinal. Estudios recientes in vitro y modelos experimentales en animales sugieren que el Sistema Endocannabinoide (SE) y la Haptoglobina (Hp) pueden tener un papel protector en la EII. Estudio 1: Sistema Endocannabinoide y EII Se analizó, mediante Western-Blot e inmunohistoquímica, la presencia de los componentes del sistema endocannabinoide (receptores - CB1,CB2-, enzimas de síntesis -DAGL-α/β, NAPE-PLD-, y enzimas de degradación -FAAH y MAGL-) en mucosa de colon de individuos normales, y en pacientes con CU en fase activa, antes de iniciar el tratamiento, y en fase quiescente. Se identificó por primera vez la expresión de todos los componentes del SE en mucosa colónica normal. Como novedades destacan la localización de: CB1 en las células "goblet"; CB2 en las células de Paneth y en los plexos neuroentéricos; FAAH y MAGL en células plasmáticas y polimorfonucleares; enzimas de síntesis en las células epiteliales y en ambos plexos mientéricos. Además, se demostró la presencia de un tono endocannabinoide basal que se modifica en pacientes con CU, tanto en la fase activa como en la fase quiescente: - En pacientes con CU leve-moderada, en fase activa, existe un aumento de la expresión de CB2, cuyos niveles se recuperan en la fase quiescente. - En la fase activa existe una disminución de la expresión de NAPE-PLD, que se recupera en fase quiescente, y un aumento de DAGL-α y MAGL, que se mantienen en la fase quiescente. En conclusión, los componentes del SE se modifican durante la inflamación en la CU , fundamentalmente mediante un aumento de receptores CB2. Por lo tanto, el desarrollo de fármacos que aumenten el tono endocannabinoide durante la inflamación, podrían ser una nueva vía de investigación en la terapéutica de la EII. Estudio 2: Haptoglobina y EII. La Hp es una proteína con propiedades inmunomoduladoras. Existe un polimorfismo en el gen de la Hp, con 2 alelos: Hp1 y Hp2. El objetivo de este estudio fue investigar el papel genético y funcional de la Hp en la EII. Se genotiparon, utilizando PCR "touch-down", 1061 pacientes con EC , 755 con CU y 452 individuos sanos. La prevalencia de la Hp2 fue mayor en EC y en CU que en los controles. Estos resultados se confirmaron en tríos familiares de EII (464 con EC y 151 con CU), en los que el alelo Hp2 se transmite a los descendientes con mayor frecuencia. Se determinaron además los valores séricos de Hp en 62 individuos sanos. Se observaron valores inferiores en aquellos sujetos con genotipo 22. Se desarrollaron dos modelos murinos de colitis experimental (DSS y OXA) en los que demostró que los ratones KO para el gen de la Hp desarrollaban formas de colitis más graves. Además, en ratones KO para el gen de la Hp, los niveles de mRNA de IL-17, INF-γ, TNF e IL-6 en DSS-colitis y los de IL-13 en OXA-colitis se encontraban elevados. En la DSS-colitis, al añadir IL-23 en los ratones KO para el gen de la Hp, aumentaba significativamente la producción de IL-17. En resumen, el polimorfismo de la Hp está implicado en la susceptibilidad genética a padecer EII, lo que subraya la existencia de mecanismos patogénicos comunes con otras enfermedades de base inmunológica. Además, Hp desempeña un papel en la reducción de la severidad de la inflamación en la colitis experimental y modula la producción de IL-17, por lo que podría tener potenciales aplicaciones terapéuticas en la EIIInflammatory Bowel Disease (IBD) (Crohn's disease (CD) and Ulcerative Colitis (CU)), is a chronic, poligenic, complex and relapsing disease of the gastrointestinal tract. Recent studies in vitro and experimental animal models have suggested a protective role of the Endocannabinoid System (ES) and Haptoglobin in IBD. Study 1: Endocannabinoid system and IBD We examined, using Western-Blotting and immunohistochemistry, the expression of all components of ES (receptors - CB1, CB2-, biosynthesis enzymes -DAGL-α/β, NAPE-PLD-, and degradating enzymes -FAAH y MAGL- in healthy human colonic tissue, and in active UC patients, without any previous treatment, and in quiescent phase. We identified for the first time, the presence of all components of ES in normal colonic tissue. As novelties we pointed out the expression of: CB1 in globlet cells; CB2 in Paneth cells and in neuroenteric plexi; FAAH and MAGL in plasmatic cells and in polymorphonuclear cells; byosynthesis enzymes in epithelial cells and in both mienteric plexi. Besides, we evidenced the presence of a basal endocannabinoid tone modified in UC patients, in active flares as in quiescent phases: - In UC patients with mild-moderate flares, there was an increase in CB2 expression, that returned to normality in the quiescent phase. - In the active phase there was a decrease in NAPE-PLD expression, that recovered in the quiescent phase, and an increase in DAGL-α and MAGL expression, that is maintained in the quiescent phase. In conclusion, the ES components are altered during inflammation in UC, mainly by an increase in CB2 expression. Therefore, the development of new drugs raising the endocannabinoid tone during inflammation may lead to new therapeutical approaches in IBD. Study 2: Haptoglobin and IBD. Hp is a protein with immunomodulatory properties. There is a polymorphism in the Hp gene, with two different alleles: Hp1 and Hp2. The goal of this study was to investigate the role of Hp in IBD, both genetically and functionally. We genotyped, using a "touch-down" PCR, 1061 CD patients, 755 UC patients and 452 healthy individuals. Prevalence of Hp2 was higher in CD and UC patients than in controls. These results were confirmed in IBD trios families (464 CD trios and 151 UC trios) where Hp2 allele was over-transmitted to the affected offspring. We determined serum levels of Hp in 62 healthy controls. Serum Hp values were lower in individuals with genotype 22. We developed two murine models of experimental colitis (DSS and OXA) and we demonstrated that Hp KO mice developed more severe colitis. In Hp KO mice, mRNA levels of IL-17, INF-γ, TNF and IL-6 in DSS-colitis and mRNA levels of IL-13 en OXA-colitis were higher than in WT mice. In DSS-colitis, after adding IL-23, in Hp KO mice production of IL-17 was significantly increased. To summarized, the Hp polymorphism is implicated in genetic susceptibility to IBD, underscoring common pathogenic pathways with other immune-based diseases. Moreover, Hp has a role in reducing the severity of experimental colitis inflammation and it modulates IL-17 production, suggesting potencial therapeutical applications in IBD

Memory T Cell subpopulations as early predictors of remission to vedolizumab in ulcerative colitis

Background: vedolizumab is a humanized monoclonal antibody targeting the α4β7 integrin used for the treatment of ulcerative colitis. Few biomarkers related to vedolizumab response have been identified. The aim of this work was to assess whether baseline circulating CD4+ and CD8+ memory T-lymphocyte subpopulations could help to identify patients with response to vedolizumab treatment in ulcerative colitis. Methods: prospective pilot study in 15 patients with active ulcerative colitis and previous failure to anti-TNFα starting vedolizumab treatment. Peripheral blood samples were obtained before the first dose of vedolizumab and at week 6 and 14 of treatment. Clinical remission was defined as a Mayo Clinic partial score of ≤2 points without any concomitant dose of steroids. Biochemical remission or endoscopic improvement was defined as fecal calprotectin <250 mcg/g or Mayo endoscopic subscore ≤1. Results: at week 14, nine patients achieved clinical remission and eight patients achieved biochemical remission or endoscopic improvement. Patients in clinical remission presented higher baseline CD8 α4β7 + memory T cells concentration when compared with patients with no remission. In addition, patients with biochemical remission or endoscopic improvement at week 14 presented higher baseline concentration of CD8 α4β7 + memory T cells. No differences were identified according to flare severity, extent of disease or type of anti-TNFα failure. There were no significant differences regarding changes in T cell subsets during vedolizumab induction. Conclusion: CD8+ α4β7 + memory T cells before starting vedolizumab therapy could be an early predictor of remission in ulcerative colitis patients and therefore help to select a subset of responders

The Genetic Diversity and Dysfunctionality of Catalase Associated with a Worse Outcome in Crohn&rsquo;s Disease

Chronic gut inflammation in Crohn&rsquo;s disease (CD) is associated with an increase in oxidative stress and an imbalance of antioxidant enzymes. We have previously shown that catalase (CAT) activity is permanently inhibited by CD. The purpose of the study was to determine whether there is any relationship between the single nucleotide polymorphisms (SNPs) in the CAT enzyme and the potential risk of CD associated with high levels of oxidative stress. Additionally, we used protein and regulation analyses to determine what causes long-term CAT inhibition in peripheral white mononuclear cells (PWMCs) in both active and inactive CD. We first used a retrospective cohort of 598 patients with CD and 625 age-matched healthy controls (ENEIDA registry) for the genotype analysis. A second human cohort was used to study the functional and regulatory mechanisms of CAT in CD. We isolated PWMCs from CD patients at the onset of the disease (na&iuml;ve CD patients). In the genotype-association SNP analysis, the CAT SNPs rs1001179, rs475043, and rs525938 showed a significant association with CD (p &lt; 0.001). Smoking CD patients with the CAT SNP rs475043 A/G genotype had significantly more often penetrating disease (p = 0.009). The gene expression and protein levels of CAT were permanently reduced in the active and inactive CD patients. The inhibition of CAT activity in the PWMCs of the CD patients was related to a low concentration of CAT protein caused by the downregulation of CAT-gene transcription. Our study suggests an association between CAT SNPs and the risk of CD that may explain permanent CAT inhibition in CD patients together with low CAT gene and protein expression

A faecal microbiota signature with high specificity for pancreatic cancer

Recent evidence suggests a role for the microbiome in pancreatic ductal adenocarcinoma (PDAC) aetiology and progression. To explore the faecal and salivary microbiota as potential diagnostic biomarkers. We applied shotgun metagenomic and 16S rRNA amplicon sequencing to samples from a Spanish case-control study (n=136), including 57 cases, 50 controls, and 29 patients with chronic pancreatitis in the discovery phase, and from a German case-control study (n=76), in the validation phase. Faecal metagenomic classifiers performed much better than saliva-based classifiers and identified patients with PDAC with an accuracy of up to 0.84 area under the receiver operating characteristic curve (AUROC) based on a set of 27 microbial species, with consistent accuracy across early and late disease stages. Performance further improved to up to 0.94 AUROC when we combined our microbiome-based predictions with serum levels of carbohydrate antigen (CA) 19-9, the only current non-invasive, Food and Drug Administration approved, low specificity PDAC diagnostic biomarker. Furthermore, a microbiota-based classification model confined to PDAC-enriched species was highly disease-specific when validated against 25 publicly available metagenomic study populations for various health conditions (n=5792). Both microbiome-based models had a high prediction accuracy on a German validation population (n=76). Several faecal PDAC marker species were detectable in pancreatic tumour and non-tumour tissue using 16S rRNA sequencing and fluorescence in situ hybridisation. Taken together, our results indicate that non-invasive, robust and specific faecal microbiota-based screening for the early detection of PDAC is feasible

Adalimumab vs Azathioprine in the Prevention of Postoperative Crohn's Disease Recurrence. A GETECCU Randomised Trial.

Postoperative recurrence of Crohn's disease [POR-CD] is almost certain if no prophylaxis is administered. Evidence for optimal treatment is lacking. Our aim was to compare the efficacy of adalimumab [ADA] and azathioprine [AZA] in this setting. We performed a phase 3, 52-week, multicentre, randomised, superiority study [APPRECIA], in which patients with ileocolonic resection were randomised either to ADA 160-80-40 mg subcutaneously [SC] or AZA 2.5 mg/kg/day, both associated with metronidazole. The primary endpoint was endoscopic recurrence at 1 year [Rutgeerts i2b, i3, i4], as evaluated by a blinded central reader. We recruited 91 patients [median age 35.0 years, disease duration 6.0 years, 23.8% smokers, 7.1% previous resections]. The study drugs were administered to 84 patients. Treatment was discontinued owing to adverse events in 11 patients [13.1%]. Discontinuation was significantly less frequent in the ADA [4.4%] than in the AZA group [23.2%] (dif.: 18.6% [95% CI 4.1-33.2], p = 0.011). According to the intention-to-treat analysis, therapy failed in 23/39 patients in the AZA group [59%] and 19/45 patients in the ADA group [42.2%] [p = 0.12]. In the per-protocol analysis [61 patients with centrally evaluable images], recurrence was recorded in 8/24 [33.3%] patients in the AZA and 11/37 [29.7%] in the ADA group [p = 0.76]. No statistically significant differences between the groups were found for recurrence in magnetic resonance images, biological markers of activity, surgical procedures, or hospital admissions. ADA has not demonstrated a better efficacy than AZA [both associated with metronidazole] for prophylaxis of POR-CD in an unselected population, although tolerance to ADA is significantly better. ClinicalTrials.gov NCT01564823

Trends in Targeted Therapy Usage in Inflammatory Bowel Disease : TRENDY Study of ENEIDA

Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn's disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment