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Background Oral corticosteroids are first-line agents to induce remission in moderately active ulcerative colitis [UC], but are associated with adverse effects. We compared the efficacy and safety of tofacitinib and prednisolone for induction of remission in moderately active UC. Methods This was a single-centre, prospective, open-label, randomized, active-controlled pilot study. Eligible patients [aged ≥18 years] had moderately active UC. Participants were randomly assigned to receive either prednisolone [40 mg daily, tapered by 5 mg every week] or tofacitinib [10 mg twice daily] for 8 weeks. The primary endpoint was composite remission [defined as total Mayo clinic score ≤2, with endoscopic sub-score of 0 and faecal calprotectin <100 µg/g] at 8 weeks. Results Seventy-eight patients were randomly assigned to either of the treatment groups. At week 8, the proportion of patients achieving composite remission in the tofacitinib [7/43, 16.28%] and prednisolone groups [3/35, 8.57%] were not significantly different (odds ratio [OR] 2.07, 95% confidence interval [CI] 0.49–8.70; p  = 0.31). The time to achieve symptomatic remission [normal stool frequency with absence of rectal bleeding] was similar (10 days, interquartile range [IQR 7–18.75] and 10 days [IQR 5–12.5] for tofacitinib and prednisolone, respectively; p  = 0.25) in the two groups. One patient each in the tofacitinib and prednisolone group discontinued treatment due to development of pulmonary tuberculosis and pustular acne, respectively. One patient receiving tofacitinib developed herpes zoster, but did not require cessation of therapy. No serious adverse events or major adverse cardiovascular events were observed. Conclusion In patients with moderately active UC, there was no difference in the efficacy and safety of tofacitinib and oral prednisolone for induction of remission at 8 weeks. Trail Registration Clinical Trials Registry of India [CTRI/2021/10/037641] [ABSTRACT FROM AUTHOR]

Background/Aims: Inflammatory bowel disease (IBD) is increasingly being recognized in elderly patients. Data on clinical spectrum of elderly-onset IBD patients is lacking from India. Methods: A cross-sectional retrospective analysis of a prospectively maintained database of patients diagnosed with IBD was conducted at 2 centers in India. The clinical spectrum of elderly-onset IBD including demographic profile (age and sex), clinical presentation, disease characteristics (disease behavior and severity, extent of disease), and treatment were recorded and compared with adult-onset IBD. Results: During the study period, 3,922 (3,172 ulcerative colitis [UC] and 750 Crohn's disease [CD]) patients with IBD were recorded in the database. A total of 186 patients (4.74%; 116 males [62.36%]) had elderly-onset IBD (69.35% UC and 30.64% CD). Diarrhea, blood in stools, nocturnal frequency and pain abdomen were the commonest presentations for UC, whereas pain abdomen, weight loss and diarrhea were the most frequent symptoms in CD. For both elderly onset UC and CD, majority of the patients had moderately severe disease. Left-sided colitis was the commonest disease location in UC. Isolated ileal disease and inflammatory behavior were the most common disease location and behavior, respectively in CD. 5-Aminosalicylates were the commonest prescribed drug for both elderly onset UC and CD. Thiopurines and biologics were used infrequently. Prevalence of colorectal cancer was higher in elderly onset IBD. Conclusions: Elderly onset IBD is not uncommon in India. Both the elderly onset UC and CD were milder, with no significant differences in disease characteristics (disease extent, location and behavior) when compared to adult-onset IBD. Colorectal cancer was more common in elderly onset IBD. [ABSTRACT FROM AUTHOR]

Background Faecal microbiota transplantation [FMT] has been shown to be effective for induction of remission in patients with active ulcerative colitis [UC]. At present, the clinical factors impacting the response to FMT in UC remain unclear. Methods Patients with active UC treated with multisession FMT via colonoscopy at weeks 0, 2, 6, 10, 14, 18 and 22 were analysed. Response to FMT was defined as achievement of corticosteroid-free clinical remission at week 30. Patient and disease characteristics were evaluated to determine the predictors of response to FMT. Results Of 140 patients with active UC treated with FMT, 93 (mean age 34.96 ± 11.27 years, 62.36% males [ n  = 58], mean Mayo clinic score 8.07 ± 2.00) who completed the multisession FMT protocol were analysed. Fifty-seven [61.29%] patients achieved clinical remission. Younger age (odds ratio [OR] for age 0.93, 95% confidence interval [CI] 0.89–0.97, p  = 0.001), moderate [Mayo clinic score 6–9] disease severity [OR 3.01, 95% CI 1.12–8.06, p  = 0.025] and endoscopic Mayo score 2 [OR 5.55, 95% CI 2.18–14.06, p  < 0.001] were significant predictors of remission on univariate analysis. Younger age, disease extent E2 and endoscopic Mayo score 2 [OR 0.925, 95% CI 0.88–0.97, p  = 0.002; OR 2.89, 95% CI 1.01–8.25, p  = 0.04; and OR 8.43, 95% CI 2.38–29.84, p  = 0.001, respectively] were associated with clinical remission on multivariate logistic regression. A mathematical model [nomogram] was developed for estimating the probability of remission with the FMT protocol. Conclusion Younger age, disease extent E2 and endoscopic Mayo score 2 significantly predict achievement of clinical remission with FMT in active UC. The prediction model can help in selecting individuals for FMT. Validation in larger cohorts is needed. [ABSTRACT FROM AUTHOR]