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Summary: Background: Ustekinumab is approved for ulcerative colitis (UC). Aims: To assess the durability of ustekinumab in patients with UC and its short‐term effectiveness, durability and tolerability in clinical practice. Methods: Retrospective, multicentre study of patients who had received their first ustekinumab dose at least 16 weeks before inclusion. Patients were followed until treatment discontinuation or last visit. Only patients with active disease at the start of ustekinumab treatment were considered in the effectiveness analysis. Patients who stopped ustekinumab before their last visit were considered not to be in subsequent remission. Results: We included 620 patients; 155 (25%) discontinued ustekinumab during follow‐up (median 12 months). Rate of discontinuation was 20% per patient‐year of follow‐up. Anaemia at baseline (hazard ratio, HR 1.5; 95% confidence interval [CI] 1.1–2.1), steroids at baseline (HR 1.5; 95% CI 1.06–2.08) and more severe clinical activity at baseline (HR 1.5; 95% CI 1.09–2.06) were associated with higher risk of discontinuation. At the end of induction, 226 (40%) patients were in steroid‐free clinical remission. Moderate–severe vs mild disease activity at baseline (odds ratio [OR] 0.3; 95% CI 0.2–0.5), male sex (OR 0.5; 95% CI 0.4–0.8), and increased number of previous biologics (OR 0.6; 95% CI 0.6–0.8) were associated with lower likelihood of steroid‐free clinical remission at week 16. One hundred and seventy‐six patients (28%) had at least one adverse event. We observed no negative impact of ustekinumab on extraintestinal manifestations and/or immune‐mediated diseases. Conclusions: Ustekinumab durability in UC was relatively high, and treatment was effective in highly refractory patients. The safety profile was consistent with previous studies. [ABSTRACT FROM AUTHOR]

Introduction:The internet is emerging as a source of information for patients with inflammatory bowel disease (IBD). However, it is not always reliable and may cause anxiety. We aim to assess patients' information habits and patients' and professionals' perceptions of a national website integrated as an educational resource for the IBD unit. Methods:Patients aged 18–65 years, comfortable with the internet, and attending follow-ups at participating IBD units (March–June 2019) and their professionals were invited to evaluate a recommended website through an online survey. Results:Three hundred eighty-nine patients and 95 professionals completed the survey. The internet (n = 109; 27.4%) was the second preferred source of information after the health care team (n = 229; 57.5%). Eighty percent of patients searched the internet for information on their disease and 28.6% did so at least once a week (n = 114), especially newly diagnosed ones (<2 years). Patients valued a website recommended by their professional (n = 379; 95.2%) and endorsed by the National Working Group (n = 377; 94.7%). They would attend online educational initiatives on the website (n = 279; 70.1%) and complete periodical surveys to improve its usefulness (n = 338; 84.9%). According to IBD professionals, this type of website is the best patient source of supplementary information (n = 76; 80%) and they "prescribe" it to most patients (67.0 ± 25.2%), especially the newly diagnosed patients (52.7 ± 26.5%). It effectively integrates routine face-to-face education (n = 95; 100%). Conclusions:Patients of IBD units, especially newly diagnosed ones, appreciate a trusted e-Health resource to back up professional information. The favorable opinion of patients and professionals will allow its use in training interventions. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effectiveness and safety of tofacitinib in ulcerative colitis [UC] in real life. Methods Patients from the prospectively maintained ENEIDA registry and treated with tofacitinib due to active UC were included. Clinical activity and effectiveness were defined based on Partial Mayo Score [PMS]. Short-term response/remission was assessed at Weeks 4, 8, and 16. Results A total of 113 patients were included. They were exposed to tofacitinib for a median time of 44 weeks. Response and remission at Week 8 were 60% and 31%, respectively. In multivariate analysis, higher PMS at Week 4 (odds ratio [OR] = 0].2; 95% confidence interval [CI] = 0].1–0.4) was the only variable associated with lower likelihood of achieving remission at Week 8. Higher PMS at Week 4 [OR = 0.5; 95% CI = 0.3–0.7] and higher PMS at Week 8 [OR = 0.2; 95% CI = 0.1–0.5] were associated with lower probability of achieving remission at Week 16. A total of 45 patients [40%] discontinued tofacitinib over time. Higher PMS at Week 8 was the only factor associated with higher tofacitinib discontinuation [hazard ratio = 1.5; 95% CI = 1.3–1.6]. A total of 34 patients had remission at Week 8; of these, 65% had relapsed 52 weeks after achieving remission; the dose was increased to 10 mg/12 h in nine patients, and five of them reached remission again. Seventeen patients had adverse events. Conclusions Tofacitinib is effective and safe in UC patients in real practice, even in a highly refractory cohort. A relevant proportion of patients discontinue the drug over time, mainly due to primary failure. [ABSTRACT FROM AUTHOR]

We present the case of a 64-year-old male diagnosed with corticosteroid-dependent ulcerative colitis in 1999, who underwent total proctocolectomy with a J-pouch in 2005. Three years later, he developed recurrent histologically confirmed pouchitis, with clinical worsening. Several therapies were tried, including Infliximab, which provided stability for six years, until the development of antibodies led to moderate pouchitis in the rectal stump. Attempts with Adalimumab, Vedolizumab, and Ustekinumab failed, leading to worsening cuffitis, pouchitis, and anastomotic stenosis. Tofacitinib was started at 10 mg/12h, leading to a >50% reduction in fecal calprotectin and a PDAI drop from 4 to 0 within four weeks. After reducing the dose to 5 mg/12h, disease control was maintained, and the patient remains asymptomatic after two years and seven months, with normal colonoscopy findings showing complete mucosal healing. Despite advances in treatment, around 15% of ulcerative colitis patients require surgery, and 30-50% of those develop acute or chronic cuffitis or pouchitis. Tofacitinib, a JAK inhibitor, is approved for ulcerative colitis but has shown inconsistent results in treating pouchitis and cuffitis. While some studies report a lack of efficacy, others show potential responses in refractory cases. More research with larger patient cohorts is needed to better understand the role of JAK inhibitors in this context.

Introduction: Real-world data on the effectiveness of upadacitinib for inflammatory bowel disease (IBD) are limited. To assess upadacitinib persistence, effectiveness, and safety in a real-world scenario., Methods: Retrospective multicenter study of patients with IBD who received upadacitinib before 31st December 2022 and at least 12 weeks before the recruitment date. Clinical effectiveness was assessed based on partial Mayo score for ulcerative colitis (UC) and Harvey-Bradshaw index for Crohn's disease (CD)., Results: We included 100 patients (68 with CD, and 32 with UC). Patients had previously received a median of 4 advanced therapies. Twenty-three discontinued the treatment (median follow-up 7.6 months). CD (vs UC) (hazard ratio 3.7; 95% confidence interval [CI]: 1.04-12.9) and age below 40 years at upadacitinib initiation (hazard ratio 2.4; 95% CI: 1.0-5.8) were associated with treatment discontinuation in multivariable analysis. Clinical remission for IBD was achieved in 59% of patients at week 8, 64% at week 12, and 42% at week 52. The proportion of patients with UC previously exposed to tofacitinib (n = 25) who achieved clinical remission was 78% at week 12, and 50% at week 52. Factors associated with clinical remission at week 12 were UC diagnosis (odds ratio [OR] 4.6; 95% CI: 1.3-17), mild or moderate activity at baseline (OR 8; 95% CI: 1.1-56), and not smoking (OR 4.4; 95% CI: 1.5-13). Dose escalation recaptured remission in 60% of patients with relapse. Eighty percent of patients with active immune-mediated diseases or extraintestinal manifestations improved with upadacitinib. Forty-three patients reported adverse events, 11 of them serious., Discussion: Upadacitinib is effective and safe for treating patients with highly refractory IBD, even in previously treated with Janus kinase inhibitors., (Copyright © 2024 by The American College of Gastroenterology.)

Protein-losing enteropathy is a relatively uncommon syndrome characterized by excessive loss of proteins into the intestinal lumen. It can be caused by various etiologies. Inflammatory bowel disease (IBD) is the first condition we think of when we meet a patient with intestinal ulcers and hypoproteinemia. However, there are many other complicated and relatively novel etiologies, which we must be aware of in order to perform an appropriate differential diagnosis, such as the one we present.

Introduction: The internet is emerging as a source of information for patients with inflammatory bowel disease (IBD). However, it is not always reliable and may cause anxiety. We aim to assess patients' information habits and patients' and professionals' perceptions of a national website integrated as an educational resource for the IBD unit. Methods: Patients aged 18-65 years, comfortable with the internet, and attending follow-ups at participating IBD units (March-June 2019) and their professionals were invited to evaluate a recommended website through an online survey. Results: Three hundred eighty-nine patients and 95 professionals completed the survey. The internet ( n  = 109; 27.4%) was the second preferred source of information after the health care team ( n  = 229; 57.5%). Eighty percent of patients searched the internet for information on their disease and 28.6% did so at least once a week ( n  = 114), especially newly diagnosed ones (<2 years). Patients valued a website recommended by their professional ( n  = 379; 95.2%) and endorsed by the National Working Group ( n  = 377; 94.7%). They would attend online educational initiatives on the website ( n  = 279; 70.1%) and complete periodical surveys to improve its usefulness ( n  = 338; 84.9%). According to IBD professionals, this type of website is the best patient source of supplementary information ( n  = 76; 80%) and they "prescribe" it to most patients (67.0 ± 25.2%), especially the newly diagnosed patients (52.7 ± 26.5%). It effectively integrates routine face-to-face education ( n  = 95; 100%). Conclusions: Patients of IBD units, especially newly diagnosed ones, appreciate a trusted e-Health resource to back up professional information. The favorable opinion of patients and professionals will allow its use in training interventions.

Introduction: The objective of this study was to assess the durability, short-term and long-term effectiveness, and safety of tofacitinib in ulcerative colitis (UC) in clinical practice., Methods: This is a retrospective multicenter study including patients with UC who had received the first tofacitinib dose at least 8 weeks before the inclusion. Clinical effectiveness was based on partial Mayo score., Results: A total of 408 patients were included. Of them, 184 (45%) withdrew tofacitinib during follow-up (mean = 18 months). The probability of maintaining tofacitinib was 67% at 6 m, 58% at 12 m, and 49% at 24 m. The main reason for tofacitinib withdrawal was primary nonresponse (44%). Older age at the start of tofacitinib and a higher severity of clinical activity were associated with tofacitinib withdrawal. The proportion of patients in remission was 38% at week 4, 45% at week 8, and 47% at week 16. Having moderate-to-severe vs mild disease activity at baseline and older age at tofacitinib start were associated with a lower and higher likelihood of remission at week 8, respectively. Of 171 patients in remission at week 8, 83 (49%) relapsed. The probability of maintaining response was 66% at 6 m and 54% at 12 m. There were 93 adverse events related to tofacitinib treatment (including 2 pulmonary thromboembolisms [in patients with risk factors] and 2 peripheral vascular thrombosis), and 29 led to tofacitinib discontinuation., Discussion: Tofacitinib is effective in both short-term and long-term in patients with UC. The safety profile is similar to that previously reported., (Copyright © 2023 by The American College of Gastroenterology.)