5 major advances in inflammatory bowel disease (IBD) treatment

Lymphoma not associated with anti-TNF therapy in pediatric IBD patients 
Study title: Low risk of lymphoma in pediatric patients with inflammatory bowel disease treated using anti-tumor necrosis factor agents

Presented by Matthew D. Egberg, University of North Carolina, Chapel Hill

Significance: Anti-tumor necrosis factor (aTNF) drugs are among the most effective medications used to treat pediatric IBD. Despite their effectiveness, concerns regarding an association with lymphoma limit their use in everyday practice. Based on a large, geographically diverse administrative insurance claims database of 9,284 pediatric IBD patients, treatment with aTNF agents and/or immune modulators was not associated with an increased risk of malignancy. These results support prioritization of the clinical benefits of aTNF agents over the low risk for malignancy.

Noteworthy new drug in pipeline for Crohn’s disease
Study title: AZD4205, a selective, GI tract-enriched selective JAK1 inhibitor for Crohn’s disease: preclinical evidence and Phase I data

Presented by Mei Wang, Dizal Pharmaceuticals

Significance: There is no cure for Crohn’s disease and currently available drugs do not work for all patients, so advances in treatments are closely watched by physicians and patients. An early Phase I study shows promise for AZD4205 for the treatment of Crohn’s disease. AZD4205 is an oral, ATP-competitive, JAK1 selective inhibitor. Nonclinical data showed its higher drug concentration within the GI tract relative to plasma in the rodents, suggesting its potential as an effective and safe treatment option for patients with Crohn’s disease. AZD4205 was also evaluated in a Phase I study in healthy volunteers where it was well-tolerated with no drug-related adverse events. A Phase II study in moderate-to-severe Crohn’s disease is planned.

This microbiome-targeting diet improves symptoms for IBD patients
Study title: Diet as a microbiome-centered therapy for IBD

Presented by Ana Maldonado-Contreras, UMASS Medical School

Significance: IBD patients have an imbalance of gut bacteria, which contributes to inflammation. Researchers at UMASS Medical School developed the IBD-Anti-Inflammatory Diet (IBD-AID™) to restore the balance between helpful and harmful bacteria while promoting good nutrition. In their trial, the majority (61.3%) of patients who complied with the diet for at least eight weeks reported a dramatic decrease in disease severity. IBD-AID™ also prompted an increase in the abundance of bacteria that produce short-chain fatty acids (SCFAs) thus dampening inflammation and assisting in patient’s remission. The diet focuses on increased intake of prebiotic and probiotic foods and other beneficial foods while substituting certain carbohydrates and other adverse foods.

This research was funded in part by the AGA Research Foundation.

Thanks to biologics, less ulcerative colitis patients need their colon removed 
Study title: Natural history of colectomy among hospitalized patients with ulcerative colitis in the contemporary era of treatments

Presented by Fernando Velayos, Kaiser Permanente

Significance: The rate of colectomy (surgical removal of a patient’s colon) within the first year after hospital admission for ulcerative colitis has declined in the modern era of biologics. A study conducted at a large health care delivery organization identified that 5.3% of patients underwent colectomy during their first hospitalization for ulcerative colitis and 11.9% underwent colectomy within the first year after hospitalization, compared to historical rates of 20% and 30%, respectively, in the same population pre-biologics. This research provides cause for optimism that the natural history of colectomy in acute severe ulcerative colitis may be different and modifiable in the modern biologic era compared to the past.

Siblings close in age may make the best fecal microbiota donor for ulcerative colitis patients 
Study title: Donor selection of fecal microbiota transplantation is important to long-term maintenance of ulcerative colitis

Presented by Koki Okahara, Juntendo University Hospital

Significance: Fecal microbiota transplantation (FMT) is still an emerging treatment for ulcerative colitis. This study is the first to reveal importance of FMT donor selection for long-term maintenance for ulcerative colitis. Ulcerative colitis patients treated with fresh FMT from a spouse or relative following triple-antibiotic therapy (amoxicillin, fosfomycin and metronidazole) had a significantly higher response compared to patients who just received antibiotic therapy. Siblings relationship has a significantly higher maintenance rate at 12 months compared to parent–child relationship. Furthermore, response was significantly higher in cases where the age difference between donor and patient was less than 10 years.