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Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract that is associated with malnutrition. Malnutrition is associated with poor clinical outcomes in patients with IBD and therefore early identification of those at risk for malnutrition is crucial. We aimed to evaluate how frequently nutrition screening occurs in a large, tertiary care outpatient IBD center and to initiate an intervention to improve malnutrition screening for patients with IBD.We used a traditional plan-do-study-act quality improvement technique to understand our current malnutrition screening practices and institute an intervention to improve screening. To do this, we utilized a modified Malnutrition Universal Screening Tool (mMUST) and integrated this into the electronic health record. We then evaluated the intervention and the impact on IBD related clinical outcomes.Prior to the intervention, few patients with IBD were screened for malnutrition. However, the number of patients screened for malnutrition significantly improved with the study intervention and those who were identified as high-risk had increased nutrition follow up including serum micronutrient evaluations and referral to a dedicated registered dietician.This study demonstrated the feasibility and impact of a malnutrition screening program in ambulatory IBD patients. Those patients identified as high risk for malnutrition who engaged in nutrition care had improved clinical outcomes including reduced hospitalizations and emergency room visits.

BACKGROUND Upadactinib (UPA) was recently approved for ulcerative colitis (UC) for patients 18 and older, and there is promising data for its use in adult Crohn’s disease (CD). It is currently also approved for use in atopic dermatitis (AD) down to the age of 12, but doses used are lower than in inflammatory bowel disease (IBD). There is currently no data on its use for pediatric IBD; we present here a case series of patients ≤18 years on UPA. METHODS We identified ≤18yo patients who were started on UPA for the indication of IBD +/- AD and completed ≥58 days of therapy at a single, US center. Data, with relevant descriptive statistics, were gathered on demographics, disease subtype, Montreal classification, indication for UPA, time on UPA, number of biologic failures, tofacitinib use, concomitant biologic use, adverse events, and clinical and biomarker remission (8-16 week clinical remission: HBI RESULTS 12 patients (Median age at UPA start: 16.5y, Interquartile Range [IQR]: 4; 67% female) completed 8 or more weeks (Median [IQR] days: 118 [80]) of UPA (Table 1). Two-thirds of patients had CD. A quarter of patients (25%) had concomitant AD. All patients were diagnosed CONCLUSION No new safety signals were seen during induction dosing of UPA in teenage patients with IBD. In this very refractory group, nearly all patients achieved clinical & biomarker remission. Further study on the effectiveness and safety of UPA needs to be performed in pediatric patients.

BACKGROUND The human leukocyte antigen (HLA) allele group HLA-DQA1*05 has been associated with the development of antidrug antibodies (ADA) to tumor necrosis factor antagonists (anti-TNF)1 in the inflammatory bowel disease (IBD) population, except in the setting of proactive optimization2. We performed a meta-analysis to determine the prevalence of HLADQA1*05 carriage, to define the association of HLA-DQA1*05 on immunogenicity and loss of response (LOR) to anti-TNF, and to explore the impact of therapeutic drug monitoring (TDM) on this association. METHODS A systematic search of EMBASE, MEDLINE, Web of Science, and SCOPUS was conducted and identified 49 studies. Fourteen studies were included in the meta-analysis according to our inclusion and exclusion criteria. Two reviewers independently assessed eligibility and extracted data. Data extraction focused on the prevalence of HLADQA1*05 carriage, management style of the subjects (proactive TDM vs not), use of combination therapy with immunomodulators (IMM), and association of the variant with ADA and LOR. To examine the potential mitigating effect of management style, three forest plots were generated for each outcome including: 1. all studies, 2. studies using solely proactive TDM, and 3. studies where TDM was either not defined or not performed. RESULTS The prevalence of HLADQA1*05 carriage was 43.3% across the 14 manuscripts. Ten studies used data from adult populations, 2 reported on pediatrics only, and 2 reported on a mix of pediatrics and adults. Nine studies took place in Europe, and 5 occurred in North America. A little over half (57%) were abstracts. All studies included some patients on combination therapy with IMM. Data analysis confirmed that possessing the HLADQA1*05 variant leads to an increased ADA risk (OR 1.63 [95% CI: 1.35 - 1.98]). When focusing on the studies that used proactive optimization of anti-TNF therapy, the variant was no longer a risk factor for developing ADA (OR 0.37 [95% CI: 0.19 - 0.70]). Without proactive optimization, the carriage of HLADQA1*05 appears to consistently be associated with a higher risk of immunogenicity (OR 1.93 [95% CI: 1.58 - 2.36]) (Figure 1). HLADQA1*05 was also found to be a risk factor for LOR (HR 1.84 [95% CI: 1.53 - 2.22]) (Figure 2); insufficient data were available for the studies with proactive TDM on LOR. CONCLUSION Prevalence of HLADQA1*05 carriage is consistent across studies from both North America and Europe. This variant increases the risk of ADA and LOR to anti-TNF. However, in studies that used solely proactive TDM, variant carriage no longer conferred a risk for ADA. 1. Sazonovs A, et al. Gastro. 2020;158(1):189-199. 2. Spencer EA, et al. Gastro. 2022;162(6):1746-1748.e1743.