P179 Treatment decisions and biologic adoption rates in newly diagnosed Crohn’s disease in Japan

Background Biologic therapy in Crohn’s disease (CD) has significantly improved treatment outcomes. Still, providing an optimal care for individual patient in real-world is complex. We report the real-world treatment decisions between biologics and systemic corticosteroids (SCS) and associated factors in newly diagnosed CD in Japan. Methods Patients with CD diagnosis (Index) and at least one CD therapeutic agent prescribed between 2006 and 2019 were screened from the JMDC database. JMDC is a health claims database where various sized (small to very large) companies’ employees and their dependents are enrolled. Subjects with a minimum 12-month CD-diagnosis-free enrolment period up to the Index, and a minimum 12-month observational period after the Index were included in the analysis. Subjects were categorised into 2 groups (A: without biologics, B: with biologics) based on their first-year treatment, and then further into 4 groups: SCS without biologics (A1), No SCS nor biologics (A2), Biologics with no prior SCS (B1), Biologics with prior SCS (B2). Results 859 subjects were included. 38.4% (B: n=330/859) initiated biologics within a year since diagnosis (Table 1). Among them, 73.3% (B2: n=242/330) initiated biologics without prior SCS, so-called a top-down approach. Among the rest who were not treated with biologics within the first year, 27.2% (A1: n=114/529) received SCS. B were 7.5 years younger on average and had a higher rate of perianal symptoms (43.0%) compared to A (22.9%). Trend analyses showed that the rates of biologic adoption in the first year have been relatively stable over a decade since 2008 to 2019 (Table 2). Conclusion Real-world treatment decisions in newly diagnosed CD were investigated, and perianal symptoms were strongly associated with biologic therapy. Biologic adoption rates in CD seemed higher and faster in Japan compared to Europe. According to a Danish study reported by Alulis et al. (2020), 28.5% of CD patients received biologics at some point during the whole study period, of which 46.2% received within a year. These figures suggest that 13.2% of newly diagnosed CD were treated with biologics within the first year in the Danish study compared to 38.4% in our study.

Lymphoma of the Uvula: Clinical, Morphological, Histopathological, and Genetic Characterization. A Nationwide Danish Study From 1980 to 2019

Background: In the head and neck region the uvula is a rare site for extranodal lymphomas to develop. In this national study, we present six cases and provide an overview of the current literature, characterizing the clinical and histopathological features of lymphomas involving this location.Materials and Methods: Clinical information was obtained retrospectively from patient records in a nationwide Danish study covering from 1980 through 2019. In order to validate the diagnoses, uvular tissue specimens were examined histologically and immunohistochemically and if relevant for subtyping, cytogenetic rearrangements were investigated.Results: We present six cases of lymphomas involving the uvula, of which four of the cases were diagnosed with a B-cell lymphoma (two diffuse large B-cell lymphomas, one extranodal marginal zone B-cell lymphoma and one Mantle cell lymphoma), while two were diagnosed with a T-cell lymphoma (one peripheral T-cell lymphoma and one natural killer/T-cell lymphoma). Presenting symptoms included swelling, pain and ulceration of the uvula. Treatment was comprised of radiotherapy and/or chemotherapy, with T-cell lymphomas showing a poorer outcome than B-cell lymphomas.Conclusion: Lymphoma of the uvula is rare, with few case reports being reported in the literature. The most frequent histological subtypes reported are extranodal marginal zone B-cell lymphoma and peripheral T-cell lymphoma. When encountering a swollen, painful and/or ulcerated uvula, the clinician should always consider malignancy as a possible cause. Lymphoma of the uvula is a possible diagnosis and if this is the case, there is a high risk of disseminated disease at the time of diagnosis.

Complexity and Simplicity in Doctor–Patient Email Consultations

New technologies have facilitated doctor–patient email consultations (e-consultations). Guidelines for e-consultation use in Denmark state that they should be used for simple, concrete and non-urgent queries; however, a small-scale Danish study suggested that doctors encounter e-consultations that do not match the guidelines. The purpose of this article is to explore whether e-consultations in Denmark reflect recommendations that they should be simple, short, concrete and well defined, and if not, what forms of complexity are evident. We inductively analysed 1,671 e-consultations from 38 patients aged 21–91 years communicating with 28 doctors, 6 nurses, 1 medical student and 8 secretaries. Results showed both quantitative complexity in terms of number of interaction turns, communicative participants, and questions asked, and qualitative complexity relating to patients’ psychosocial contexts and GPs’ biomedical disease perspective. Thus, despite existing guidelines and the leanness associated with the email medium, multiple forms of complexity were evident. This mismatch highlights the need for theoretical development as well as the value of re-examining existing policies and guidelines regarding expectations for e-consultation use.