A Response to "Heavy Metals and Inflammatory Bowel Disease" Using Linked Sources of Real-World Data.

COVID-19 Vaccination Is Safe and Effective in Patients With Inflammatory Bowel Disease: Analysis of a Large Multi-institutional Research Network in the United States

Risk of Severe Coronavirus Disease 2019 in Patients With Inflammatory Bowel Disease in the United States: A Multicenter Research Network Study

Inflammatory Bowel Disease Clinical

Background Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions of aberrant gut inflammation. The increasing prevalence of IBD in parallel with increasing human exposure to heavy metals (HMs) has raised concern regarding the contribution of HMs to gut pathology. Emerging evidence has implicated HMs as influential factors in IBD pathogenesis, however, our current understanding of how HMs impact gut barrier integrity, inflammation, and dysbiosis is limited in the context of IBD and deserving of further attention. Aims The preliminary study aim was to establish a foundational understanding of serum levels of certain HMs in IBD. Additionally, we aimed to characterize a correlation between HM concentrations in serum and gut tissue. Methods Using Inductively Coupled Plasma Mass Spectrometry (ICP-MS), serum concentrations of Aluminum (Al), Chromium (Cr), Mercury (Hg), and Titanium (Ti) were measured in individuals with CD, UC, multiple sclerosis (MS), and in healthy controls (HC), where MS was used as an immune-mediated inflammatory disease control. A bivariate analysis was used to evaluate associations between HM levels and specific disease groups. Logistic regression analysis was used to assess HM outcomes predicted by disease groups and healthy controls while controlling for demographic factors. Results Relative to HCs, the proportion of higher serum levels of Al (79% vs. 38.6%, p<0.001), and Hg (63% vs 37.2%, p<0.001) were greater in CD. Whereas higher Ti levels were lower in CD (59%), UC (14.0%), and MS (6.1%) relative to HCs (84.1%); p-values <0.0002, <0.0001, and 0.001 respectively. In MS, the proportion of higher levels of Cr were greater compared to HCs (83.7% vs 38.0%, p<0.001) and Hg (57.1% vs 37.2%,p=0.025).When controlling for demographic factors, the odds of having higher serum Al (OR=6.41[CB1], 95%CI 3.04-13.5) and Hg (OR=2.27, 95%CI 1.13-4.57) were significantly greater in CD relative to HCs. In contrast, the odds of having elevated serum Ti were significantly lower in CD (OR=0.25, 95%CI 0.11-0.57) and UC (OR=0.02, 95%CI 0.01-0.08) relative to HCs. The odds of having increased Cr were 12 times greater for MS relative to HC [OR=12.33, 95%CI (3.83-39.7)]. In our investigation of gut biopsies, we did not find a correlation between HM levels in serum and intestinal tissue. Conclusions Our investigation demonstrated significant differences in serum HM levels between CD, UC, MS, and HCs. These results support the need for further exploration into the specific involvement of HMs in IBD. Funding Agencies None

Inflammatory bowel disease (IBD) comprises digestive disorders resulting from non-infectious inflammation of the colon and gastrointestinal tract. With its global prevalence on the rise, IBD poses significant challenges to healthcare systems. There is a need for more accurate disease burden estimates to guide decision-making processes within the health sector. As a part of the Belgian national burden of disease study (BeBOD), this study aims to estimate the burden of IBD in Belgium based on locally available data. We estimated the Belgian IBD burden in 2020 in terms of mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life years (DALYs). As there is no single comprehensive data source on prevalence of IBD in Belgium, a critical appraisal of existing local and national data sources was conducted. Prevalence data were combined with disability weights to yield YLDs. YLLs were calculated using the most recent Global Burden of Disease (GBD) 2019 reference life table and the number of deaths caused by non-infective IBD (ICD-10 K50-52). Cause of death data were extracted from Statbel, the Belgian statistical office. The best available data source to estimate the IBD prevalence in Belgium was a widespread network of general practitioners. The prevalence of IBD was 1.5% in 2020. The prevalence-based YLD for IBD was 220 YLDs per 100 000, while the YLL rate was 11.5 per 100 000. We estimated 26 276 DALYs caused by IBD in 2020. Of the total DALYs caused by IBD, 5% were due to YLLs and 95% were due to YLDs. Our burden estimates for IBD in Belgium were however higher than those of the GBD study. IBD imposes a low fatal burden, whereas the burden of morbidity is more prominent. Our findings could be useful for policy makers to justify and prioritize resource allocation. Integrating the current research in BeBOD will allow monitoring the burden of IBD over time. Key messages • Inflammatory bowel disease is characterized by a substantial non-fatal burden due to chronic relapsing and persistent symptoms. • National inflammatory bowel disease burden estimates are useful to guide decision-making within the health sector.

: The objective of the present study was to quantify the national pediatric inpatient inflammatory bowel disease (IBD) burden in terms of the number of IBD-related hospitalizations, the number of days spent in the hospital, and hospitalization costs. : Hospitalizations for children and adolescents 20 years and younger with a primary diagnosis of either Crohn disease (CD) or ulcerative colitis (UC) were selected from the 2006 Kids' Inpatient Database (KID). Length of the hospital stay in days (LOS) and charges for the hospitalization were found directly in the Kids' Inpatient Database, and cost was calculated using the hospital's cost-to-charge ratio. Predictor variables included patient characteristics, such as age and severity of illness, and hospital characteristics. Ordinary-least-squares regressions were developed and estimated to explain hospitalization costs. : In 2006, there were 10,777 IBD-related hospitalizations. The total and mean costs for CD were $66.3 million and $10,176 (95% confidence interval [CI] $9647-$10,705), and for UC were $48.6 million and $11,836 (95% CI $10,760-$12,912). For CD, 0- to 5-year-old patients had the highest mean LOS (8.10, 95% CI 5.53-10.67, days) and mean cost ($13,894, 95% CI $9053-$18,735), whereas, for UC, 11- to 15-year-old patients had the highest mean LOS (7.49, 95% CI 6.88-8.10, 95% CI 5.53-10.67, days) and mean cost ($13,407, 95% CI $11,704-$15,110). : For a pediatric disease with a rather low prevalence rate, the estimated annual inpatient pediatric burden of IBD is a sizeable $152.4 million (2010 US$) and 64,985 days spent in the hospital. As medications and outpatient treatments improve for the treatment of IBD, there is an opportunity for significant reduction in inpatient burden.

Several studies indicated that inflammatory bowel disease (IBD) may contribute to increased susceptibility to primary biliary cholangitis (PBC). However, the causal relationship between IBD and PBC remains unclear. The genetic variant data of patients with IBD and PBC were obtained from published genome-wide association studies (GWASs). The IBD data were further divided into a discovery dataset and a validation dataset depending on the data source. We conducted a two-sample Mendelian randomization (MR) analysis using the inverse variance weighting (IVW), MR-Egger, weighted median (WM), MR robust adjusted profile score (MR-RAPS), and maximum likelihood (ML) methods, with IVW being the main focus, to verify the causal relationship between IBD and PBC. Additionally, a series of sensitivity analyses were performed to ensure the reliability of the results. In the discovery cohort, the IVW analysis results (OR = 1.114, P = 0.011) indicated a significant association between IBD and PBC. The MR-RAPS (OR = 1.130, P = 0.007) and ML (OR = 1.115, P = 0.011) analyses yielded results consistent with those of IVW in confirming IBD as a risk factor for PBC. In the validation cohort, consistent findings were observed regarding the causal relationship between IBD and PBC using IVW, MR-RAPS, and ML analyses; all three methods identified IBD as a risk factor for developing PBC. By the IVW analysis, Crohn's disease (CD) emerged as the most prominent subtype of IBD associated with an increased risk of developing PBC in both the discovery cohort (OR = 1.068, P = 0.049) and the validation cohort (OR = 1.082, P = 0.019). The results of the MR analysis suggest a causal relationship between IBD and PBC, highlighting the necessity for proactive PBC prevention in patients with IBD, particularly those with CD.

BNT162b2 Messenger RNA COVID-19 Vaccine Effectiveness in Patients With Inflammatory Bowel Disease: Preliminary Real-World Data During Mass Vaccination Campaign

Valid data on the incidence of inflammatory bowel disease (IBD) in children and adolescents in Germany have not yet been published. Unpublished data of the Pediatric IBD Registry of Saxony (primary data source) have shown a decrease in age-specific incidence rates after the 14th year of age; therefore, a second data source was collected from adult gastroenterologists in Leipzig. All patients up to 25 years of age with a newly diagnosed IBD from adult gastroenterologists in Leipzig between 2005 and 2009 were included in the second data source: a total of 150 young patients with only two patients before age of 16 and 11 patients before age of 18 years. Using a second data source, the incidence of IBD in children and adolescents up to the completion of the 18th year, as determined by IBD Registry, was corrected from 6.6/100,000 (95%-CI 5.4–8.4) to an actual incidence of 11.0/100,000 (95%-CI 9.1–12.9). Age-specific incidence of IBD was also corrected, increasing continuously until the 18th year was completed. Nearly all patients up to 15 years (completeness 87.5%) were recorded by pediatricians to the IBD Registry. The actual incidence up to the age of 18 years for IBD in Leipzig is one of the highest worldwide. To obtain valid epidemiologic data up to the age of 18, the inclusion of adult gastroenterologists are necessary.

Background Secukinumab is a selective interleukin-17a inhibitor (anti-IL17) and an effective treatment option for psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Phase III study safety data indicate a possible risk of inflammatory bowel disease (IBD), a link which is biologically plausible as IL-17 is known to influence intestinal immunopathology. Real world data for secukinumab gastrointestinal safety are limited. We set out to describe the post-licensing experience of secukinumab in routine care, evaluating both baseline evaluation of pre-existing IBD as well as incident gastrointestinal adverse effects. Methods We undertook a retrospective cohort study. Ten centres from the South East of England participated. All records for patients commencing secukinumab at each centre between 2016-2019 were reviewed. A fully anonymised data collection form was used to collate patient information. Questions sought to answer whether IBD screening had occurred prior to secukinumab initiation. All gastrointestinal adverse events were reviewed. IBD-related adverse events after initiation were defined as: definite (biopsy confirmed, objective inflammation from biomarkers, clear temporal association, improvement on drug withdrawal), probable (as per definite, but without biopsy confirmation) or possible (gastrointestinal symptoms not fulfilling definite or probable criteria). Results Data for 306 patients were available: 124 (40.5%) with AS and 182 (59.5%) with PsA. 106 (34.6%) of patients had documented assessment for IBD prior to initiation; 7 of which already had pre-existing diagnoses of IBD. 24 (7.8%) patients experienced gastrointestinal related adverse events after starting secukinumab; 18 of which were formally investigated for bowel disease due to symptoms. Amongst patients who developed gastrointestinal symptoms, 4 (1.3%) had definite, 7 (2.3%) probable and 13 (4.2%) possible IBD. Out of the 4 with definite IBD; all were AS patients, all stopped secukinumab, three had pre-existing IBD and one (0.3%) case of de-novo IBD required surgical management for an inflammatory perianal abscess. All 7 patients with probable IBD had symptom resolution on withdrawal of secukinumab. Of these, 4/7 were PsA and 3/7 were AS. For the 13 patients that fulfilled possible IBD criteria, symptoms resolved without intervention and continued secukinumab treatment. Conclusion Absolute rates of new IBD in patients starting secukinumab are low. In addition, a majority of patients developing new gastrointestinal symptoms did not develop objective evidence of IBD or stop therapy. However, our experience suggests that in people with pre-existing IBD the risk is much higher. Only one-third of patients had documented evidence of screening for IBD at baseline. Given that only one patient developed de-novo IBD in the cohort, our experience would not support the practice of pre-screening for IBD prior to starting anti-IL17 therapy. Further research to evaluate this would be wise to focus specifically on the characteristics of AS patients, stratifying IBD risk prior to anti-IL17 initiation. Disclosures I.A. Onac: Other; Education support to attend conference from Abbvie. C. Tacu: Honoraria; Novartis Pharmaceutical UK - Speaker Fee. Other; education support- course - Novartis. B.D. Clarke: None. M. Lloyd: Other; departmental support from Novartis. V. Hajela: None. T. Batty: None. J. Thoroughgood: None. S. Smith: None. H. Irvine: None. D. Hill: None. G. Baxter: None. N. Horwood: Other; attend conferences from Lilly and Abbvie. S. Mahendrakar: Other; Education support to attend conferences from Lilly. R. Rajak: Honoraria; Honoraria for speaker: Eli Lilly, Amgen, Internis, Roche, UCB, Abbvie. Honoraria for chairing: Roche, Novartis, Eli Lilly, UCB. S. Griffith: Other; None declared. P. Kiely: Honoraria; Abbvie, BMS, Gilead, Lilly, Novartis, Sanofi. Member of speakers’ bureau; Abbvie, BMS, Lilly, Novartis, Sanofi. J.B. Galloway: Honoraria; Speaker fees, travel support and grants from Lilly, Abbvie, BMS, Celgene, Janssen, Pfizer, UCB, Sanofi.

Uptake of third doses of SARS-CoV-2 vaccines among people with inflammatory bowel disease in Ontario, Canada

Objective:The metabolites produced by the gut microbiota are of interest to scientists. The objective of this review was to provide an updated summary of progress regarding the microbiota and their metabolites and influences on the pathogenesis of inflammatory bowel disease (IBD).Data sources:The author retrieved information from the PubMed database up to January 2018, using various combinations of search terms, including IBD, microbiota, and metabolite.Study selection:Both clinical studies and animal studies of intestinal microbiota and metabolites in IBD were selected. The information explaining the possible pathogenesis of microbiota in IBD was organized.Results:In IBD patients, the biodiversity of feces/mucosa-associated microbiota is decreased, and the probiotic microbiota is also decreased, whereas the pathogenic microbiota are increased. The gut microbiota may be a target for diagnosis and treatment of IBD. Substantial amounts of data support the view that the microbiota and their metabolites play pivotal roles in IBD by affecting intestinal permeability and the immune response.Conclusions:This review highlights the advances in recent gut microbiota research and clarifies the importance of the gut microbiota in IBD pathogenesis. Future research is needed to study the function of altered bacterial community compositions and the roles of metabolites.

BackgroundMultidimensional data mining from an integrated environment of different data sources is frequently performed in computational system biology. The molecular mechanism from the analysis of a complex network of gene-miRNA can aid to diagnosis and treatment of associated diseases.MethodsIn this work, we mainly focus on finding inflammatory bowel disease (IBD) associated microRNAs (miRNAs) by biclustering the miRNA-target interactions aided by known IBD risk genes and their associated miRNAs collected from several sources. We rank different miRNAs by attributing to the dataset size and connectivity of IBD associated genes in the miRNA regulatory modules from biclusters. We search the association of some top-ranking miRNAs to IBD related diseases. We also search the network of discovered miRNAs to different diseases and evaluate the similarity of those diseases to IBD.ResultsAccording to different literature, our results show the significance of top-ranking miRNA to IBD or related diseases. The ratio analysis supports our ranking method where the top 20 miRNA has approximately tenfold attachment to IBD genes. From disease-associated miRNA network analysis we found that 71% of different diseases attached to those miRNAs show more than 0.75 similarity scores to IBD.ConclusionWe successfully identify some miRNAs related to IBD where the scoring formula and disease-associated network analysis show the significance of our method. This method can be a promising approach for isolating miRNAs for similar types of diseases.

<p dir="ltr">Inflammatory bowel disease (IBD) and chronic kidney disease (CKD) are chronic conditions with a bidirectional relationship influenced by immune dysregulation, chronic inflammation, and gut-kidney axis interactions. IBD, characterized by persistent gastrointestinal inflammation, is associated with kidney complications such as nephrolithiasis and interstitial nephritis, often stemming from systemic effects or adverse drug reactions. Colectomy, a surgical intervention frequently required in severe IBD cases, can lead to dehydration and electrolyte imbalances, increasing the risk of kidney damage. While biologic therapies have transformed IBD treatment by targeting specific immune pathways to reduce inflammation and induce remission, they carry potential risks, including rare kidney complications like drug-induced interstitial nephritis. The intricate interplay between IBD and CKD remains underexplored, underscoring the need for comprehensive research to improve patient care and outcomes.</p><p dir="ltr">This thesis aims to advance our understanding of the bidirectional relationship between IBD and kidney diseases through large-scale epidemiological studies utilizing real-world data.</p><p dir="ltr">Study I investigated the relationship between reduced kidney function, measured by estimated glomerular filtration rate (eGFR), and the risk of developing IBD in a large adult population. Over nearly a decade of follow-up, reduced eGFR was associated with a higher risk of IBD, particularly Crohn's disease, with stronger associations observed in women. These findings suggest that impaired kidney function may predispose individuals to IBD.</p><p dir="ltr">Study II examined the association between IBD and kidney-related complications, including CKD and acute kidney injury (AKI). Over a median 9-year follow-up, IBD patients were found to have significantly increased risks of CKD and AKI compared to non-IBD individuals. More than 10% of IBD patients developed CKD within 10 years of diagnosis, emphasizing the importance of regular kidney function monitoring and timely nephrological care.</p><p dir="ltr">Study III explored the relationship between colectomy and the risk of AKI and kidney failure in patients with biopsy-confirmed IBD within a large Swedish nationwide population. During a median follow-up of 14 years, colectomy was associated with increased risks of these kidney outcomes, particularly in patients with total colectomy, prolonged stoma periods, or ulcerative colitis. These findings highlight the need for targeted kidney function monitoring in high-risk IBD populations undergoing colectomy.</p><p dir="ltr">Study IV assessed the risk of kidney complications in IBD patients treated with vedolizumab compared to infliximab or adalimumab. Adapting a target trial emulation framework, the study revealed that vedolizumab was associated with higher risks of AKI and CKD compared to infliximab, with elevated but less pronounced risks compared to adalimumab. Younger patients were particularly vulnerable to AKI. These findings underscore the importance of close kidney function monitoring in IBD patients initiating vedolizumab therapy.</p><p dir="ltr">In conclusion, this thesis provides robust real-world evidence on the complex interplay between IBD and kidney diseases. The findings emphasize a critical need for vigilant kidney function monitoring in IBD patients, particularly those undergoing colectomy or initiating vedolizumab therapy, to improve clinical outcomes and patient care.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Yang Y,</b> Ludvigsson JF, Olen O, Sjölander A, Carrero JJ. Estimated Glomerular Filtration Rate and the Risk of Inflammatory Bowel Disease in Adults: A Swedish Population-Based Study. Inflammatory Bowel Diseases. 2024;30(5):718-725. <a href="https://doi.org/10.1093/ibd/izac267" rel="noreferrer" target="_blank">https://doi.org/10.1093/ibd/izac267</a></p><p dir="ltr">II. <b>Yang Y,</b> Ludvigsson JF, Olen O, Sjölander A, Carrero JJ. Absolute and Relative Risks of Kidney and Urological Complications in Patients With Inflammatory Bowel Disease. American Journal of Gastroenterology. 2024;119(1):138-146. <a href="https://doi.org/10.14309/ajg.0000000000002473" rel="noreferrer" target="_blank">https://doi.org/10.14309/ajg.0000000000002473</a></p><p dir="ltr">III. <b>Yang Y,</b> Ludvigsson JF, Forss A, Faucon AL, Faye AS, Olen O, Sjölander A, Carrero JJ. Risk of Kidney Failure in Patients With Inflammatory Bowel Disease Undergoing Colectomy: A Nationwide Cohort Study. Clinical Gastroenterology and Hepatology. 2024;22(11):2291-2298.e17. <a href="https://doi.org/10.1016/j.cgh.2024.05.010" rel="noreferrer" target="_blank">https://doi.org/10.1016/j.cgh.2024.05.010</a></p><p dir="ltr">IV. <b>Yang Y,</b> Forss A, Voghera S, Ludvigsson JF, Faucon AL, Sjölander A, Olén O, Carrero JJ. Adverse kidney events in patients with inflammatory bowel disease initiating biologics with vedolizumab, infliximab or adalimumab. [Manuscript]</p>

<p dir="ltr">Inflammatory bowel disease (IBD) and chronic kidney disease (CKD) are chronic conditions with a bidirectional relationship influenced by immune dysregulation, chronic inflammation, and gut-kidney axis interactions. IBD, characterized by persistent gastrointestinal inflammation, is associated with kidney complications such as nephrolithiasis and interstitial nephritis, often stemming from systemic effects or adverse drug reactions. Colectomy, a surgical intervention frequently required in severe IBD cases, can lead to dehydration and electrolyte imbalances, increasing the risk of kidney damage. While biologic therapies have transformed IBD treatment by targeting specific immune pathways to reduce inflammation and induce remission, they carry potential risks, including rare kidney complications like drug-induced interstitial nephritis. The intricate interplay between IBD and CKD remains underexplored, underscoring the need for comprehensive research to improve patient care and outcomes.</p><p dir="ltr">This thesis aims to advance our understanding of the bidirectional relationship between IBD and kidney diseases through large-scale epidemiological studies utilizing real-world data.</p><p dir="ltr">Study I investigated the relationship between reduced kidney function, measured by estimated glomerular filtration rate (eGFR), and the risk of developing IBD in a large adult population. Over nearly a decade of follow-up, reduced eGFR was associated with a higher risk of IBD, particularly Crohn's disease, with stronger associations observed in women. These findings suggest that impaired kidney function may predispose individuals to IBD.</p><p dir="ltr">Study II examined the association between IBD and kidney-related complications, including CKD and acute kidney injury (AKI). Over a median 9-year follow-up, IBD patients were found to have significantly increased risks of CKD and AKI compared to non-IBD individuals. More than 10% of IBD patients developed CKD within 10 years of diagnosis, emphasizing the importance of regular kidney function monitoring and timely nephrological care.</p><p dir="ltr">Study III explored the relationship between colectomy and the risk of AKI and kidney failure in patients with biopsy-confirmed IBD within a large Swedish nationwide population. During a median follow-up of 14 years, colectomy was associated with increased risks of these kidney outcomes, particularly in patients with total colectomy, prolonged stoma periods, or ulcerative colitis. These findings highlight the need for targeted kidney function monitoring in high-risk IBD populations undergoing colectomy.</p><p dir="ltr">Study IV assessed the risk of kidney complications in IBD patients treated with vedolizumab compared to infliximab or adalimumab. Adapting a target trial emulation framework, the study revealed that vedolizumab was associated with higher risks of AKI and CKD compared to infliximab, with elevated but less pronounced risks compared to adalimumab. Younger patients were particularly vulnerable to AKI. These findings underscore the importance of close kidney function monitoring in IBD patients initiating vedolizumab therapy.</p><p dir="ltr">In conclusion, this thesis provides robust real-world evidence on the complex interplay between IBD and kidney diseases. The findings emphasize a critical need for vigilant kidney function monitoring in IBD patients, particularly those undergoing colectomy or initiating vedolizumab therapy, to improve clinical outcomes and patient care.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Yang Y,</b> Ludvigsson JF, Olen O, Sjölander A, Carrero JJ. Estimated Glomerular Filtration Rate and the Risk of Inflammatory Bowel Disease in Adults: A Swedish Population-Based Study. Inflammatory Bowel Diseases. 2024;30(5):718-725. <a href="https://doi.org/10.1093/ibd/izac267" rel="noreferrer" target="_blank">https://doi.org/10.1093/ibd/izac267</a></p><p dir="ltr">II. <b>Yang Y,</b> Ludvigsson JF, Olen O, Sjölander A, Carrero JJ. Absolute and Relative Risks of Kidney and Urological Complications in Patients With Inflammatory Bowel Disease. American Journal of Gastroenterology. 2024;119(1):138-146. <a href="https://doi.org/10.14309/ajg.0000000000002473" rel="noreferrer" target="_blank">https://doi.org/10.14309/ajg.0000000000002473</a></p><p dir="ltr">III. <b>Yang Y,</b> Ludvigsson JF, Forss A, Faucon AL, Faye AS, Olen O, Sjölander A, Carrero JJ. Risk of Kidney Failure in Patients With Inflammatory Bowel Disease Undergoing Colectomy: A Nationwide Cohort Study. Clinical Gastroenterology and Hepatology. 2024;22(11):2291-2298.e17. <a href="https://doi.org/10.1016/j.cgh.2024.05.010" rel="noreferrer" target="_blank">https://doi.org/10.1016/j.cgh.2024.05.010</a></p><p dir="ltr">IV. <b>Yang Y,</b> Forss A, Voghera S, Ludvigsson JF, Faucon AL, Sjölander A, Olén O, Carrero JJ. Adverse kidney events in patients with inflammatory bowel disease initiating biologics with vedolizumab, infliximab or adalimumab. [Manuscript]</p>