P580 Biologic therapy in pregnancy and inflammatory bowel disease: a prospective 7 year study: clinical outcome

Abstract Background The SARS-CoV-2 pandemic has led to a remodeling of care activity, including the inflammatory bowel disease (IBD) centers. According to international recommendations, we did not discontinue immunosuppressive or biologic drugs and reorganized biologic drug infusions’ administration to minimize the risk of infection. The aim of this study is to describe the clinical outcome of SARS-CoV-2 infection and the adherence to the scheduled biologic therapies in a single tertiary center including both IBD adult and pediatric patients treated with biological agents during COVID-19 pandemic. Methods Demographic information, clinical data and the adherence to the therapy were collected in all consecutive IBD patients treated with biologic agents from March 2020 to February 2021. Moreover, we reported the clinical outcome of IBD patients infected with SARS-CoV-2. Results A total of 278 subjects (171 male) treated with a biologic agent (34 children) were included. The mean age was 41.6 ± 17.3 years (range 5 – 88), and the mean disease duration was 12.7 ± 10.1 years (range 0.2 – 49). One hundred eleven patients (39.9 %) had ulcerative colitis, and 167 (60.0 %) had Crohn’s disease. About the therapy: 73 patients were receiving infliximab, 93 adalimumab, 20 golimumab, 59 vedolizumab, 29 ustekinumab, and 4 an experimental compound. 31 patient, including 1 child, (11.1 %) were treated with combination therapy. The mean Charlson Comorbidity Index was 1.5 (range 0 – 8). Twenty one patients (2 pediatrics and nineteen adults) (7.5 %) had a confirmed diagnosis of SARS-COV-2 infection. Only one of them (an adult man) was hospitalized but did not require intensive care unit measures. Compared to cumulative SARS-CoV-2 infection in the general population in our Region, the cumulative incidence of SARS-CoV-2 infection in our cohort was significantly higher (7.5% vs 4.0%, p < 0.002). Twelve adult patients (4.3%) postponed biologic therapy for fear of SARS-CoV-2 infection during the first wave of the pandemic, and two of them (16.6%) experienced a clinical relapse. Conclusion In our cohort, the adherence to biologic therapy was high during the pandemic, but the rate of clinical relapse in patients who postponed the scheduled administration of therapy was relevant. Although the incidence of SARS-CoV-2 infection was significantly higher than in general population, the clinical impact was mild as no patients experienced a severe form of COVID-19.

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How to Avoid Treating Irritable Bowel Syndrome with Biologic Therapy for Inflammatory Bowel Disease

Digestive Diseases ◽

10.1159/000268125 ◽

2009 ◽

Vol 27 (1) ◽

pp. 80-84 ◽

Cited By ~ 7

Author(s):

William J. Sandborn

Keyword(s):

Inflammatory Bowel Disease ◽

Irritable Bowel Syndrome ◽

Bowel Disease ◽

Biologic Therapy ◽

Inflammatory Bowel ◽

Irritable Bowel

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P725 Trends in biologic use prior to resective surgery for inflammatory bowel disease: A Canadian population-based study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.853 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S583-S584

Author(s):

D Chopra ◽

E Kennedy ◽

A V Weizman ◽

A Tennakoon ◽

L E Targownik

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Disease Duration ◽

Biologic Therapy ◽

Demographic Data ◽

Biologic Agent ◽

Primary Role ◽

Resective Surgery ◽

Inflammatory Bowel ◽

Incident Cases

Abstract Background Despite advances in medical therapy for inflammatory bowel disease (IBD), surgery is required in 50–80% of patients with Crohn’s disease (CD) and 20–30% of patients with ulcerative colitis (UC). Given that fibrostenotic disease may be playing a primary role in patients undergoing resective surgery, practices around biologic administration in this setting need to be clarified. We aimed to describe the pre-operative trends in biologic utilisation for IBD patients undergoing resective surgery. Methods The University of Manitoba IBD Epidemiology Database was used to identify all persons with IBD who underwent resective surgery between April 2005 and 2018. Demographic data were extracted to explore the baseline characteristics of persons on biologic therapy prior to IBD resective surgery. Proportion calculations were used to assess how often a new biologic agent was initiated within 3, 6, and 12 months prior to resective surgery. Results were stratified by type of IBD (UC vs. CD) and disease duration (<3 or ≥3 years) for incident cases. Results A total of 1412 IBD-related resective surgeries were identified from April 2005 to 2018. 67.1% of resective surgeries were performed for CD and 32.9% for UC. Results of analysis are presented below: Conclusion Overall, in Manitoba, rates of biologic initiation or re-start in the pre-operative period for IBD resective surgery are relatively small. Biologic therapy was initiated or re-started more frequently for CD than UC, and when disease duration was less than 3 years. This is reassuring and suggests that physicians are rarely choosing to initiate biologic therapy in futile situations. Work should be performed to see if these findings can be replicated in other practice settings.

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Biologic therapy for inflammatory bowel disease comes of age

Current Gastroenterology Reports ◽

10.1007/s11894-007-0064-6 ◽

2007 ◽

Vol 9 (6) ◽

pp. 485-488 ◽

Cited By ~ 3

Author(s):

Stephen B. Hanauer

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Biologic Therapy ◽

Inflammatory Bowel

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PTU-076 Management Of Inflammatory Bowel Disease (ibd) In Pregnancy In The Northern Deanery: Abstract PTU-076 Table 1

Gut ◽

10.1136/gutjnl-2014-307263.150 ◽

2014 ◽

Vol 63 (Suppl 1) ◽

pp. A72.1-A72

Author(s):

C Parker ◽

M Gunn

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Inflammatory Bowel ◽

In Pregnancy

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Safety of azathioprine in pregnancy in inflammatory bowel disease

Gastroenterology ◽

10.1016/0016-5085(90)91027-4 ◽

1990 ◽

Vol 99 (2) ◽

pp. 443-446 ◽

Cited By ~ 194

Author(s):

E.M. Alstead ◽

J.K. Ritchie ◽

J.E. Lennard-Jones ◽

M.J.G. Farthing ◽

M.L. Clark

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Inflammatory Bowel ◽

In Pregnancy

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Effectiveness of Dose De-escalation of Biologic Therapy in Inflammatory Bowel Disease: A Systematic Review

The American Journal of Gastroenterology ◽

10.14309/ajg.0000000000000783 ◽

2020 ◽

Vol 115 (11) ◽

pp. 1768-1774

Author(s):

Derek H. W. Little ◽

Sahar Tabatabavakili ◽

Seth R. Shaffer ◽

Geoffrey C. Nguyen ◽

Adam V. Weizman ◽

...

Keyword(s):

Systematic Review ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Biologic Therapy ◽

Inflammatory Bowel

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Phenotypic Features and Longterm Outcomes of Pediatric Inflammatory Bowel Disease Patients with Arthritis and Arthralgia

The Journal of Rheumatology ◽

10.3899/jrheum.170168 ◽

2017 ◽

Vol 44 (11) ◽

pp. 1636-1643 ◽

Cited By ~ 2

Author(s):

Osnat Nir ◽

Firas Rinawi ◽

Gil Amarilyo ◽

Liora Harel ◽

Raanan Shamir ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Medical Records ◽

Biologic Therapy ◽

Joint Involvement ◽

Pediatric Inflammatory Bowel Disease ◽

History Of ◽

Inflammatory Bowel ◽

Phenotypic Features ◽

Pediatric Ibd

Objective.The natural history of pediatric inflammatory bowel disease (IBD) patients with joint involvement has not been clearly described. Thus, we aimed to investigate phenotypic features and clinical outcomes of this distinct association.Methods.The medical records of patients with pediatric IBD diagnosed from 2000 to 2016 were reviewed retrospectively. Main outcome measures included time to first flare, hospitalization, surgery, and biologic therapy.Results.Of 301 patients with Crohn disease (median age 14.2 yrs), 37 (12.3%) had arthritis while 44 (14.6%) had arthralgia at diagnosis. Arthritis and arthralgia were more common in women (p = 0.028). Patients with arthritis and arthralgia demonstrated lower rates of perianal disease (2.7% and 4.5% vs 16.9%, p = 0.013), whereas patients with arthritis were more likely to be treated with biologic therapy (HR 2.05, 95% CI 1.27–3.33, p = 0.009). Of 129 patients with ulcerative colitis (UC; median age 13.7 yrs), 3 (2.3%) had arthritis and 16 (12.4%) had arthralgia at diagnosis. Patients with arthralgia were treated more often with corticosteroids (p = 0.03) or immunomodulator therapies (p = 0.003) compared with those without joint involvement. The likelihood to undergo colectomy was significantly higher in patients with arthralgia (HR 2.9, 95% CI 1.1–7.4, p = 0.04). During followup (median 9.0 yrs), 13 patients developed arthritis (3.3%). Arthralgia at diagnosis was a significant predictor for the development of arthritis during followup (HR 9.0, 95% CI 2.86–28.5, p < 0.001).Conclusion.Pediatric IBD patients with arthritis have distinct phenotypic features. Arthralgia at diagnosis is a predictor for colectomy in UC and a risk factor for the development of arthritis during followup.

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