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Background Vedolizumab (VDZ) is less effective in Inflammatory Bowel Disease (IBD) when used in anti-Tumor Necrosis Factor (TNF) failures as compared to anti-TNF naïve patients. However, the outcomes of sequencing anti-TNF after VDZ failure remain unknown. We report on the effectiveness and safety of anti-TNF as a second-line biologic after VDZ failure in pediatric IBD patients. Methods Data was collected as part of an ongoing pediatric IBD observational treatment registry and included demographics, disease behavior, location, disease activity (Harvey Bradshaw index (HBI) for Crohn’s disease (CD) or partial Mayo score (pMS) for ulcerative colitis (UC) and IBD-unspecified (IBD-U)), adverse events, treatment and surgical history. Primary outcome was steroid-free clinical remission at last follow up. Secondary outcomes were CRP normalization and adverse events including infusion reactions, infections, hospitalizations, and IBD related surgeries. Descriptive statistics summarized the data (median [interquartile range (IQR)]) and univariate analyses tested associations. Results A total of 21 children and young adults (6 CD:14 UC:1 IBD-U; 19/21 colonic only disease) were treated with VDZ for a median [IQR] duration of 25 [11–59] weeks. VDZ was discontinued due to primary non-response (57%), secondary loss of response (38%), or an adverse event (5%). Nineteen (90%) patients were induced with infliximab (IFX), 1 with adalimumab, and 1 with golimumab and were followed for a median of 100 [35–148] weeks after anti-TNF induction (Table 1). Fifteen (71%) patients remained on anti-TNF therapy at last follow up for a median duration of 53 [34–112] weeks. All 15 patients achieved steroid-free clinical remission, and 9 (60%) patients also had a normal CRP (Figure 1). Remission rates were numerically higher in UC/IBD-U vs. CD (80% vs. 50% P = 0.27). All 6 (28%) patients (3 CD and 3 UC) who discontinued anti-TNF therapy after a median duration of 15 [7–24] weeks initially had a primary non-response to VDZ. Three patents had a primary non-response to anti-TNF, 2 had a secondary loss of response, and 1 had an anaphylactic infusion reaction. No serious adverse events, hospitalizations or serious infections attributable to anti-TNF therapy occurred. Conclusions Our results suggest that anti-TNF therapy is efficacious and safe after primary failure with VDZ in pediatric IBD patients and this was particularly so in patients with colonic disease location, regardless of IBD classification.

Background Few studies have assessed the efficacy of asynchronous curricula (AC) in GME. In 2018 we introduced the John Hopkins Physician Education & Assessment Center, a module-based pediatric primary care AC to replace in-person didactics (IPD). While residents liked the concept of AC, usage was low. This led to further investigation to optimize the impact of AC, resulting in a new blended curriculum (BC). Aim Identify barriers to AC use; compare usage and satisfaction with AC alone vs. BC; determine if poor AC use in 2018 impacted knowledge as measured on the pediatric in-training exam (ITE). Design A survey was sent to residents exposed to 1 year of AC to assess barriers and preference for IPD vs. AC. Results prompted design of a BC for 2019 with monthly resident-led conferences and faculty-led board review on assigned modules with incentives for module completion (MC). After 6 months of BC use, satisfaction and MC were assessed. ITE scores were collected from 2018 and 2019 for those exposed to a year of IPD and then a year of AC. Questions on primary care topics (PCT) were identified and a PCT subscore was computed. Results 22/32 residents (69%) exposed to 1 year of AC completed the survey. 73% preferred a blend of IPD and AC, whereas prior to AC, 65% preferred AC to IPD. 68% cited either lack of protected time (41%) or accountability (23%) as barriers to MC. After 6 months of exposure to BC, 35/57 residents (61%) responded to the next survey; there was no preference for any one BC component. MC for AC vs. BC was compared for 52 residents; median MC in 6 months increased by 3 in BC (p Conclusion A BC with in-person components and more accountability led to higher MC, underscoring the need to accommodate diverse learning styles. Resident PCT scores decreased significantly after 1 year of the underutilized AC. Further study will determine the impact of better BC participation on PCT scores.