P004 A PERSPECTIVE ON PORTRAYAL: MEN AND MINORITIES ARE UNDER-REPRESENTED ON BIOLOGIC WEBSITES

Abstract Introduction Biologics are important options for inflammatory bowel disease (IBD) management. It has been reported that people of color (POC) with IBD are less frequently prescribed biologics compared to whites. Drug manufacturers’ websites are often designed to improve patient awareness and understanding of medical conditions and treatment. There is a paucity of information evaluating racial minorities depicted on pharmaceutical websites focused on biologic therapy. This study evaluated minority representation on websites of common biologic therapies used for IBD. Methods Websites for 4 major biologics were evaluated (Humira, Remicade, Stelara, Entyvio) for minority representation. Stock photos and videos were analyzed. Individuals were categorized based upon perceived ethnicity (person of color [POC], racially ambiguous [RA], white), gender, and role (patient, provider). Individuals were categorized independently by 3 investigators. Repeat images, incomplete facial images, inactive background role in videos, or images in which there was disagreement among all investigators were excluded. Statistical analysis was performed using two-sample t-test with significance set at p<0.05. Results In the 4 websites, there were 102 total subjects (49 photos, 53 videos). There were 89 white, 11 POC, and 2 RA subjects with 33 males (32 white, 1 POC, 0 RA) and 69 females (57 white, 10 POC, 2 RA). There were significantly less POC compared to whites in photos (14.2% vs 81.6%; p=0.0003) and videos (7.0% vs 93.0%; p=0.001). Males were less frequently represented than females in photos (33.3% vs 66.7%; p=0.0096) and videos (32.3% vs 67.7%; p=0.0238). There were no males of color in photos. Humira portrayed 10 POC, Entyvio portrayed 1 POC and none were identified on Remicade and Stelara websites. Humira included 1 white, male provider, and Remicade 1 female POC provider. Stelara and Entyvio included no providers in either photos or videos. There were no images or videos about which all 3 reviewing investigators disagreed. All websites included at least 1 image with which a single investigator disagreed. Only Humira and Vedolizumab included a video with single investigator disagreement. Discussion Biologic therapy has a significant role in IBD treatment and should be considered for all IBD patients who have the appropriate indications. Pharmaceutical websites can have a role in increasing patient understanding and acceptance of therapy. Patients may have increased acceptance of treatment based upon portrayed images. While this study revealed that males and POC were significantly less represented on biologic websites, it may reflect gender and minority group IBD prevalence. However, consideration should be given to increase minority representation on biologic websites to enhance male and POC acceptance of therapeutic options and potentially improve clinical outcomes.

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P490 Assessment of body weight changes in patients with inflammatory bowel diseases initiating biologic therapy: A prospective cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.619 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S430-S430

Author(s):

N Borren ◽

W Tan ◽

A Jess ◽

P H M Li ◽

J Garber ◽

...

Keyword(s):

Body Weight ◽

Cohort Study ◽

Weight Gain ◽

Disease Activity ◽

Inflammatory Bowel Diseases ◽

Prospective Cohort ◽

Biologic Therapy ◽

Biologic Therapies ◽

Bowel Diseases ◽

Inflammatory Bowel

Abstract Background Biologic therapies are effective in inducing sustained clinical and endoscopic remission in inflammatory bowel diseases. While side effects are infrequent, prior studies have inconsistently suggested that tumour necrosis factor α (anti-TNF) therapy may be associated with weight gain. We performed this prospective study to compare weight gain across different biologic therapy classes with distinct mechanisms of action. Methods This prospective cohort study recruited patients with moderate to severe IBD initiating outpatient biologic therapy with anti-TNF (infliximab, adalimumab), vedolizumab or ustekinumab. Weight measurements were performed at weeks 0, 14, 30 and 54. Disease activity at these time points was assessed using the Harvey Bradshaw Index (HBI) for CD and Simple Clinical Colitis Activity Index (SCCAI) for UC. Remission was defined as HBI <4 or SCCAI 2. Changes in weight between baseline and each of the follow-up visits were modelled as a continuous variable and multivariate regression assessed the independent effect of therapeutic class on this outcome. Results Our study enrolled 314 patients (197 CD, 117 UC) initiating biologic therapy with 120 patients starting anti-TNF (38%), 140 patients started vedolizumab (45%) and 54 patients on ustekinumab (17%). All patients provided their weight and height at baseline; 261, 184 and 131 patients provided data on weight at week 14, week 30 and week 54, respectively. The mean baseline body weight was similar among all therapeutic classes. Patients initiating UST were more likely to have Crohn’s disease (CD), have perianal involvement and have prior biologic exposure. From baseline, the weight significantly increased at week 14 with a mean of 0.36 kg ( ± 3.8kg, p = 0.004) and continued to increase compared with baseline with 0.96 kg ( ± 3.9kg, p < 0.001) and 1.29 kg ( ± 4.2kg, p < 0.001) at week 30 and 54, respectively (Figure 1). On univariate and multivariable analysis, no significant differences between any of the biologic therapies for weight gain was seen at any time point (weight gain anti-TNF: 0.31 kg, 1.06 kg, 1.33 kg; VDZ: 0.30 kg, 0.83 kg, 1.10 kg; UST: 0.63 kg, 1.21 kg, 2.31 kg at week 14, week 30, week 54, respectively) (Figure 2). Weight gain at week 14 was significantly higher in those with CD (+1.25 kg, 95% CI 0.19–2.30, p = 0.021) and being on steroids at baseline (+1.07kg, 95% CI 0.03–2.10, p = 0.043). Early weight gain predicted continued weight gain at week 30 (+0.83kg, 95% CI 0.63–1.03, p < 0.001) and week 54 (+0.48, 95% CI 0.21–0.74, p = 0.001). Neither clinical response to therapy nor disease activity parameters showed any statistical association with weight gain. Conclusion There was no difference in weight gain between the different biologic therapeutic classes.

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Remission of Recalcitrant Psoriasis on Combined Biologic Therapy With Infliximab and Ustekinumab

Journal of Psoriasis and Psoriatic Arthritis ◽

10.1177/24755303211029598 ◽

2021 ◽

pp. 247553032110295

Author(s):

Kayla H. Taylor ◽

Steven R. Feldman

Keyword(s):

Ulcerative Colitis ◽

Adverse Effects ◽

Biologic Therapy ◽

Biologic Therapies ◽

Case Presentation ◽

Inflammatory Bowel ◽

Psoriatic Lesions ◽

Long Term Adverse Effects ◽

Systemic Therapies

Introduction: Anti-TNF treatment is effective for inflammatory bowel disease (IBD), however it also has the potential to cause paradoxical psoriasis which can be challenging to manage. Discontinuation of anti-TNF agents may improve psoriatic lesions but may worsen IBD. Combining biologic therapies, though not yet commonly practiced, may be a useful approach to the treatment of both conditions. Case Presentation: We describe a case of paradoxical palmoplantar psoriasis in a 48-year-old woman with ulcerative colitis (UC). Her UC was well-managed on infliximab. Following trials of several other topical and systemic therapies for her psoriatic lesions, she ultimately received relief on combined ustekinumab and infliximab therapy without flare of her IBD. Discussion: While other publications report success using ustekinumab for paradoxical psoriasis following cessation of infliximab, this case report highlights successful treatment using a combination of ustekinumab and infliximab with no reported adverse effects at 3 months. Conclusion: Discontinuation of the anti-TNF agent and use of a single biologic that may treat both IBD and psoriasis is a treatment option. Additionally, combining biologic therapies, though not yet commonly practiced, may be a useful, albeit costly, approach to prevent potential flares of IBD that may accompany cessation of some biologics. Further studies may be beneficial to assess for long term adverse effects.

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Adverse Events Following SARS-CoV-2 mRNA Vaccination Among Patients with Inflammatory Bowel Disease

10.1101/2021.03.30.21254607 ◽

2021 ◽

Author(s):

Gregory J. Botwin ◽

Dalin Li ◽

Jane Figueiredo ◽

Susan Cheng ◽

Jonathan Braun ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

General Population ◽

Adverse Events ◽

Bowel Disease ◽

Biologic Therapy ◽

Inflammatory Diseases ◽

Biologic Therapies ◽

Vaccine Trials ◽

Immune Mediated ◽

Inflammatory Bowel

AbstractPatients with immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD) on immunosuppressive and biologic therapies were largely excluded from SARS-CoV-2 mRNA vaccine trials. We thus evaluated post-mRNA vaccination adverse events (AE) in 246 vaccinated adults with IBD participating in a longitudinal vaccine registry. In general, AE frequency was similar to that reported in the general population. As in the general population, AE were more common among younger patients, and those with prior COVID-19. We additionally found that AE were less common in individuals receiving biologic therapy. Those with IBD and other IMID on these commonly prescribed therapies can be reassured that the AE risk is likely not increased, and may be reduced, while on biologics.

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Evaluation of cytokine levels as putative biomarkers to predict the pharmacological response to biologic therapy in inflammatory bowel diseases

Minerva Gastroenterologica e Dietologica ◽

10.23736/s1121-421x.19.02621-7 ◽

2020 ◽

Vol 65 (4) ◽

Cited By ~ 2

Author(s):

Lorenzo Bertani ◽

Luca Antonioli ◽

Matteo Fornai ◽

Gherardo Tapete ◽

Giovanni Baiano Svizzero ◽

...

Keyword(s):

Inflammatory Bowel Diseases ◽

Biologic Therapy ◽

Pharmacological Response ◽

Cytokine Levels ◽

Bowel Diseases ◽

Inflammatory Bowel

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“Over-zealous Parents, Over-programmed Families”: Asian Americans, Academic Achievement, and White Supremacy

Sociology of Race and Ethnicity ◽

10.1177/23326492211018483 ◽

2021 ◽

pp. 233264922110184

Author(s):

Pawan Dhingra

Keyword(s):

Asian Americans ◽

Asian American ◽

White Supremacy ◽

Minority Group ◽

People Of Color ◽

White Educators ◽

Asian American Students ◽

American Students ◽

High Achieving ◽

K 12

Discussions of white supremacy focus on patterns of whites’ stature over people of color across institutions. When a minority group achieves more than whites, it is not studied through the lens of white supremacy. For example, arguments of white supremacy in K-12 schools focus on the disfranchisement of African Americans and Latinxs. Discussions of high-achieving Asian American students have not been framed as such and, in fact, can be used to argue against the existence of white privilege. This article explains why this conception is false. White supremacy can be active even when people of color achieve more than whites. Drawing from interviews and observations of mostly white educators in Boston suburbs that have a significant presence of Asian American students, I demonstrate that even when Asian Americans outcompete whites in schools, white supremacy is active through two means. First, Asian Americans are applauded in ways that fit a model minority stereotype and frame other groups as not working hard enough. Second and more significantly, Asian Americans encounter anti-Asian stereotypes and are told to assimilate into the model of white educators. This treatment is institutionalized within the school system through educators’ practices and attitudes. These findings somewhat support but mostly contrast the notion of “honorary whiteness,” for they show that high-achieving minorities are not just tools of white supremacy toward other people of color but also targets of it themselves. Understanding how high-achieving minorities experience institutionalized racism demonstrates the far reach of white supremacy.

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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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