Need For Systemic Steroids Research Articles

Healthy Lifestyle Is a Protective Factor from Moderate and Severe Relapses and Steroid Use in Inflammatory Bowel Disease: A Prospective Cohort Study.

A healthy lifestyle, including good adherence to a Mediterranean diet (MD) and regular physical exercise, may be an important factor during the course of inflammatory bowel disease (IBD). Our aim is to determine whether adherence to MD, physical activity, and the combination of both can impact on IBD course. This prospective cohort study includes 693 IBD outpatients who were in remission with a median follow-up time of 27 months (interquartile range 22-29 months). Each patient completed a survey to assess their adherence to the MD and physical activity. Healthy lifestyle was considered to be a proper adherence to both MD and an active lifestyle. Relapse during follow-up, severity of relapses, need for systemic steroids, and therapy changes were recorded. During the follow-up period, 188 patients (27.1%) experienced relapse, of which 56.1% were moderate or severe. Among patients with relapse, 85 (45%) required treatment with corticosteroids, and 15 (7.9%) were hospitalized. Patients with ulcerative colitis (CU) were more adherent to healthy lifestyle than patients with Crohn's disease (P = .011). Healthy lifestyle was associated with lower risk of moderate and severe relapses (adjusted Hazard ratio [aHR], 0.250; 95% confidence interval [CI], 0.093-0.670) and steroids use (aHR 0.292; 95% CI, 0.103-0.828) in IBD patients and with lower risk of moderate and severe relapses (aHR 0.270; 95% CI, 0.093-0.789) in UC patients. Healthy lifestyle has a favorable influence on promoting a milder disease course, and thus should be a crucial part of clinical management of patients with IBD.

P1172 Epidemiology and initial presentation of newly diagnosed inflammatory bowel diseases in a Danish population-based inception cohort – results from the IBD Prognosis Study

Abstract Background It is unclear whether the incidence of inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), continues to increase. In this study, we aimed to investigate the occurrence and initial disease presentation of IBD in a population-based setting. In addition, we aimed to identify predictors of an early severe disease presentation. Methods The study was conducted as part of IBD Prognosis Study, an ongoing Danish prospective population-based inception cohort study that includes incident patients with IBD according to the Copenhagen Diagnostic Criteria since May 2021, covering the catchment areas of approximately 20% of the Danish population (1.1 million). In this analysis, cutoff for data analysis was in May 2023. Crude incidence rates and European Standard Population (ESP)-adjusted rates were calculated. A multivariable logistical regression model was constructed to identify predictors of a severe disease presentation, defined as the composite need for systemic steroids, immunomodulators, biologics, or IBD-related surgery within three months of disease. Results In total, 554 patients (UC: 344, CD: 210) fulfilled the inclusion criteria, resulting in the following crude incidence rates per 100,000 person-years: IBD 23.4 (95% CI 21.5-25.4), UC 14.0 (12.6-15.6), and CD 8.6 (7.4-9.8). ESP-adjusted rates were: IBD 20.4 (18.2-22.9), UC 11.8 (10.2-13.0), and CD 7.9 (6.5-9.9) (Figure 1). Among patients with UC, 81 (26.3%) and 95 (30.8%) had left-sided or extensive colitis at disease onset, respectively, while 61 (30.3%) and 62 (30.8%) patients with CD had ileal or ileocolonic disease. Stricturing or penetrating CD behaviour was observed in 24 (11.9%) and 11 (5.5%) patients, respectively. A high proportion of patients needed hospitalization (CD: 68 (33.8%), UC: 60 (19.5%), p=0.001) and IBD-related surgery (CD: 21 (10.4%), UC: 10 (3.2%), p=0.004) at the time of diagnosis. In multivariable analysis, a severe disease presentation of UC at the time of diagnosis was associated with left-sided or extensive disease distribution, thrombocytosis, and increased levels of C-reactive protein (CRP) (Table 1). In patients with CD, stricturing, or perianal disease, as well as anemia, levels of albumin, CRP, and calprotectin were predictive of this endpoint (Table 1). Conclusion The incidence of UC and CD in Denmark appears stable compared to historical data from the previous decades.1 The study identified clinical predictors of a severe disease presentation from the time of diagnosis, emphasizing the critical need for early risk stratification and intervention strategies. Reference: 1 Dorn-Rasmussen M et al., J Crohns Colitis. doi: 10.1093/ecco-jcc/jjac138.

A comparative analysis of chronic inducible urticaria in 423 patients: Clinical and laboratory features and comorbid conditions.

Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria (CU) which require specific physical or non-physical triggers to occur. They may be isolated or may coexist with chronic spontaneous urticaria (CSU). Despite their frequent appearance in dermatology clinics, there is scarce information on the distinguishing features among the most common subtypes of CIndU as well as isolated CIndU versus CSU plus CIndU. To compare clinical and laboratory characteristics, and comorbid conditions among the most common CIndU types and isolated CIndU versus CSU plus CIndU. We retrospectively analysed CIndU patients and compared patients' demographic, clinical and laboratory characteristics across isolated CIndU, CSU plus CIndU, symptomatic dermographism (SD), cold urticaria (ColdU) and cholinergic urticaria (ChoU). A total of 423 patients (~70% isolated CIndU, ~30% CSU plus CIndU, ~5% mixed CIndU subtypes) were included in the study. The most frequent CIndU subtypes were SD (68.6%; 290/423), ColdU (11.4%; 48/423) and ChoU (10.9%; 46/423). Isolated CIndU patients were younger than CSU plus CIndU (33.74 ± 12.72 vs. 37.06 ± 11.84, p = 0.010). Angioedema, emergency referrals, need for systemic steroids, comorbid systemic disorders were more frequent and baseline urticaria control test scores were lower in CSU plus CIndU patients (vs. CIndU, p < 0.001, p = 0.008, p < 0.001, p = 0.031, p = 0.036, respectively). Among CIndU subtypes, ChoU patients were younger (24.9 ± 12.2 vs. 34.47 ± 12.12 vs. 31.38 ± 14.95; p < 0.001) and had male predominance (p < 0.001) while SD patients had no angioedema (p < 0.001) and had higher frequency of increased total IgE levels (p = 0.006). Isolated CIndU and CSU plus CIndU seems to be different endotypes of CU where CSU plus CIndU presents a more severe and refractory course. There are distinctive features of each CIndU subtype. These suggest involvement of different pathomechanistic pathways in these subtypes that need to be clarified in future studies.

Outcome of Very Early Onset Inflammatory Bowel Disease Associated With Primary Sclerosing Cholangitis: A Multicenter Study From the Pediatric IBD Porto Group of ESPGHAN.

Whether primary sclerosing cholangitis related to inflammatory bowel disease (PSC-IBD) diagnosed before 6 years (ie, VEO-IBD) has a distinct phenotype and disease course is uninvestigated. We aimed to analyze the characteristics and natural history of VEO-PSC-IBD, compared with early and adolescent-onset PSC-IBD. This is a multicenter, retrospective, case-control study from 15 centers affiliated with the Porto and Interest IBD group of ESPGHAN. Demographic, clinical, laboratory, endoscopic, and imaging data were collected at baseline and every 6 months. Inflammatory bowel disease-related (clinical remission, need for systemic steroids and biologics, and surgery) and PSC-related (biliary and portal hypertensive complications, need for treatment escalation and liver transplantation, cholangiocarcinoma, or death) outcomes were compared between the 2 groups. Sixty-nine children were included, with a median follow-up of 3.63 years (interquartile range, 1-11): 28 with VEO-PSC-IBD (23 UC [82%], 2 IBD-U [7%] and 3 [11%] CD), and 41 with PSC-IBD (37 UC [90%], 3 IBDU [7.5%] and 1 [2.5%] CD). Most patients with UC presented with pancolitis (92% in VEO-PSC-UC vs 85% in PSC-UC, P = .2). A higher number of patients with VEO-PSC-IBD were diagnosed with PSC/autoimmune hepatitis overlap syndrome than older children (24 [92%] vs 27 [67.5%] PSC-IBD, P = .03), whereas no other differences were found for PSC-related variables. Time to biliary strictures and infective cholangitis was lower in the VEO-PSC-IBD group (P = .01 and P = .04, respectively), while no difference was found for other outcomes. No cases of cholangiocarcinoma were reported. Primary sclerosing cholangitis related to inflammatory bowel disease has similar baseline characteristics whether diagnosed as VEO-IBD or thereafter. A milder disease course in terms of biliary complications characterizes VEO-PSC-IBD.

The effectiveness of ustekinumab and vedolizumab as third-line biologic therapy in patients with Crohn's disease.

The effectiveness of Ustekinumab (UST) and Vedolizumab (VDZ) in patients with Crohn's disease (CD) as third-line biologic therapies is unclear. We performed a multicentre, real-world assessment of the effectiveness of UST and VDZ among highly-refractory patients with CD. Data of consecutive patients with CD treated with UST and VDZ as third-line biologic therapy until December 2021 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). 143 patients (UST: n=113; VDZ: n=30) were included. At the end of induction, the rates of clinical response (CR) were 61.9% for UST and 60.0% for VDZ (p=1.00), with steroid-free clinical remission (SFCR) achieved in 38.1% of patients in the UST group and 43.3% of patients in the VDZ group (p=0.75). After 52 weeks of observation, the rates of CR were 65.9% for UST and 71.4% for VDZ (p=0.77), while the rates of SFCR were 51.8% for UST and 57.1% for VDZ (p=0.78). At multiple Cox proportional hazard regression model, age (HR 0.98; p=0.04) and need for systemic steroids at baseline (HR 3.29; p=0.003) were found to be independent predictors of treatment discontinuation. Both VDZ and UST showed high effectiveness as third-line biologic therapy in CD, without significant differences between them.

Paradigmenwechsel in der Asthmatherapie: neue Begriffe für ein neues Denken

There has been a paradigm shift in asthma treatment over the last decades: from symptom treatment to symptom prevention. This paradigm shift was made possible by the availability of disease-modifying anti-asthmatic drugs (DMAADs), particularly of inhaled steroids (either monotherapy as low-dosed as possible or in combination with slow-acting beta mimetics and/or slow-acting parasympatholytics), biologics and modern allergen immunotherapy (AIT). These drugs are not only highly effective but are also characterised by little adverse effects and sometimes even collateral efficacy (positive effects on typical asthma comorbidities). The aim of treatment with DMAADs is the induction and maintenance of asthma remission: a long-term abscence of symptoms and exacerbations, stable lung function and no need for systemic steroids for asthma treatment. This new term of asthma remission differs from the term asthma control, which only refers to a short time period and can also be achieved by the administration of systemic steroids; however, systemic steroids should no longer be used in long-term asthma treatment because DMAADs are a more effective treatment option with less side effects.

P210 Long-term outcome of very early onset inflammatory bowel disease associated with primary sclerosing cholangitis: a multicenter study from the Pediatric IBD Porto Group of ESPGHAN

Abstract Background Primary sclerosing cholangitis related to inflammatory bowel disease (PSC-IBD) diagnosed under the age of 6 years (i.e., VEO-IBD) may have unique characteristics and disease course. We aimed to analyze the characteristics and natural history of children with VEO PSC-IBD and compare them to children diagnosed with PSC-IBD at an older age. Methods This was a multicenter, retrospective, study evaluating patients diagnosed with both IBD and PSC before (VEO-PSC-IBD) or after the age of 6 years (PSC-IBD), followed at 14 centers affiliated with the Porto IBD Interest group of ESPGHAN. Demographic, clinical, laboratory, endoscopic, and imaging data were collected at baseline and every six months thereafter for a minimum follow-up of 12 months. IBD-related (clinical remission, need for systemic steroids, therapy escalation and surgery) and PSC-related outcomes (biliary and portal hypertensive complications, need for treatment escalation and liver transplantation, cholangiocarcinoma, and death) were analyzed at 1, 3, and 5 years. Results A total of 69 children with both IBD and PSC were included: 28 with VEO PSC-IBD [median age 5.2 (3.7-5.9) years, 21 UC (75%), 4 IBDU (14%) and 3 (15%) CD] and 41 with PSC-IBD [median age 15.7 (13.3-16.9) years, 34 UC (83%), 6 IBDU (1.5%) and 1 (0.2%) CD]. IBD was diagnosed prior to PSC in 28 of the 69 patients (40%), simultaneously in 30 (43%), and after PSC in 11 (16%), with no significant differences between VEO PSC-IBD and PSC-IBD. Most patients with UC presented with extensive disease at diagnosis (89% in VEO PSC-UC vs. 89% in PSC-UC, p = 0.72). Both groups presented most often with mild intestinal disease at diagnosis (mean PUCAI of VEO IBD-PSC 34±16, vs 31±19 of IBD-PSC, p=0.11; mean PCDAI 31±33 vs. 21±27, respectively, p=0.14). A higher number of VEO-IBD-PSC patients were diagnosed with autoimmune sclerosing cholangitis than older children [24 (86%) vs. 27 (66%) PSC-IBD, p=0.04], whereas no other differences were found for PSC-related variables. During follow-up, no significant differences were found in major IBD outcomes. The risk of developing biliary strictures and escalating therapy to vancomycin from ursodeoxycholic acid was lower in the VEO-PSC-IBD group (Figure 1 and 2, Log-rank p=0.02 and p=0.02), while no difference was found for portal hypertension and liver transplantation at 5-year follow-up. No cases of cholangiocarcinoma or death were reported. Conclusion IBD-PSC has similar baseline characteristics whether diagnosed as VEO-IBD or thereafter. However, a milder disease course in terms of biliary complications and the need for PSC-related therapy escalation, with an overall mild intestinal disease at presentation in all patients, characterize this specific subcohort of patients.

P309 Accuracy of PanMayo endoscopic score in predicting long-term disease outcomes in ulcerative colitis– a promising scoring system

Abstract Background Ulcerative colitis (UC) is a systemic immune-mediated disease that affects the colon continuously. Colonoscopy plays a crucial role in management of UC that helps to assess mucosal healing objectively along the colon. Different scoring systems are available to assess severity, however most of them does not take into consideration of disease extent. Extension modified (PanMayo) Mayo endoscopic subscore (MES) system has been shown to correlate with UCEIS and Riley scores and calprotectin. Our study aimed to assess the predictive power and accuracy of PanMayo score compared to MES, UCEIS and Dublin to predict mid- and long-term disease outcomes. Methods This is retrospective, two-center study. UC patients, who underwent colonoscopy due to any reason between 2016 and 2018, were consecutively enrolled. PanMayo, MES, UCEIS and Dublin scores and additionally the Nancy histology score (where available) were recorded with clinical and demographical data at baseline. Disease flare, need for change in therapy (incl. initiation of biologicals, need for systemic steroids), hospitalisations and colectomy were tracked amongst patients with clinical remission (pMayo&amp;lt;2) during an at least 3-years follow-up to assess predictive value of score systems. Log-rank, Cox regression analysis and Chi2 tests were used to analyse outcomes and Kaplan Meier curves were plotted. Results A total of 250 UC patients (male ratio: 0.45, median age 45 (IQR) 22.3 years) were enrolled with 156 (male ratio 0.49; mean age 46 IQR 20.8 years, Table 1.) of UC patients having baseline clinical remission. PanMayo, MES, and Dublin scores were positively associated with risk of disease flare (Figure 1.; p=0.002, p&amp;lt;0.01, p=0.003). Increasing MES score was coupled with risk of relapse (MES0=26.7%, MES1=53.1% and MES2-3=47.6%; p=0.008). PanMayo score (above 12 points), but not MES or UCEIS, was associated with the need of new biological (Figure 2.; 66.7% vs. 21.7%; p&amp;lt;0.001) and treatment escalation (33.3 vs. 11.5%; p=0.018), similar trend was found for the Dublin score for need for new biologicals. There was a strong trend for PanMayo to predict need for hospital admission (p=0.06). All scores were strongly associated with need for systemic corticosteroids. Colectomy rates were low. Nancy score showed only a trend to predict risk of clinical flare and need for corticosteroids. Conclusion Our study suggests that combined endoscopic assessment of the extent and severity may be more accurate in predicting disease outcomes in UC in clinical remission. PanMayo scores may be an alternative of the existing scoring system and was associated more granularly with disease outcomes. In addition, outcomes were different in patients with initial MES 0 and 1 scores.

P397 Advanced therapy persistence and need for dose optimisation in a cohort of Inflammatory Bowel Disease patients in Argentina: a real-world evidence multicenter study (REMAR study)

Abstract Background Treatment persistence, as well as time to dose optimisation, can be a proxy for a drug’s real-world therapeutic benefit. We sought to describe treatment persistence of biologics or small molecules in inflammatory bowel disease (IBD) patients and need for optimisation in patients with IBD in Argentina and their potential predictors. Methods A retrospective cohort study involving 13 hospitals from Argentina was undertaken. Adult patients with a diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) who received therapy with a biologic or a small molecule were included. Initiation date was registered for every therapy each patient received; in addition, treatment finalization as well as need for optimisation were registered. Treatment persistence was defined as the time between treatment initiation and treatment finalization, or as time between treatment initiation and last follow-up if patient continued with the treatment. Time to optimisation was defined as the time between treatment initiation and treatment dose optimisation. In patients that received more than one type of advanced therapy, treatment persistence and need for optimisation was analyzed separately for each treatment received. Kaplan-Meier analysis as well as Cox regression model were used to determine predictors of treatment persistence and need for optimisation. Results A total of 403 patients were included; 55.28% had a diagnosis of UC, mean age was 44.57±16 and 47.71% were male. Median time of follow-up was 80 months [IQR 41-152]. Adalimumab was the most frequently used biologic as a first-line treatment for CD and UC (59.78% and 51.39%, respectively), whereas ustekinumab and vedolizumab were the most frequently used agents for CD and UC patients previously exposed to biologics, respectively (41.42% and 36.73%). Median treatment persistence duration was 68 months [IQR 22-146]. History of steroid-dependency [HR 2.87 (1.02-8.12)], CD [0.42 (0.22-0.78]), prior biologic exposure [HR 2.25 (1-5.06)], dose optimisation [HR 2.93 (1.36-6.33)] and need for systemic steroids 6 months from treatment initiation [HR 4.98 (1.57-15.75)] were significant predictors of shorter treatment persistence. Median time to optimisation was 34 months [IQR 9-132]. CD [0.81 (0.55-0.94)], moderate-to-severe endoscopic activity [HR 1.91 (1-3.95)], prior biologic exposure [HR 2.29 (1.27-4.14)] and biologic initiation after 2017 [2.06 (1.09-3.55)] were significant predictors of need for dose optimisation. Conclusion A considerable proportion of IBD patients required dose optimisation or treatment finalization. Lower treatment persistence and time for dose optimisation were observed in UC patients and other factors were identified.

Организация помощи пациентам с тяжелой бронхиальной астмой, нуждающимся в лечении генно-инженерными биологическими препаратами, в Санкт-Петербурге

The proportion of patients with severe asthma among asthma patients is approximately 5–10%. Severe asthma is associated with a heavy economic burden and remains a major public health problem. Patients with severe asthma require significant use of healthcare resources, i.e., the rate of exacerbation-related hospital admissions and unscheduled emergency department visits is two- and three-fold, respectively, higher than that in non-severe asthma. The discovery of the molecular mechanisms of asthma pathogenesis allowed the development of biological genetically engineering therapies that provide an effective therapeutic option for severe asthma by improving the quality of life by reducing the rate of exacerbations, improving lung function, and reducing the need for systemic steroids with a good safety profile. Targets for existing biological agents include IgE, interleukins (IL)-4, 5, and 13, and thymic stromal lymphopoietin. These drugs include omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab, which were recently registered in Russia. Pharmacoeconomic analysis demonstrates a reduction in the costs of managing patients with severe asthma who receive targeted therapy despite the financial costs of its implementation. The choice of targeted drug is always a complex task that requires careful assessment of clinical, anamnestic, and laboratory parameters. In addition, monoclonal antibodies are an expensive treatment option. Currently, centers for genetically engineering biological therapies are being created to achieve effective routing and continuity in the management of these patients and to minimize financial costs. KEYWORDS: severe asthma, eosinophilic phenotype, genetically engineered biological therapy (GEBT), registry, medical commission, targeted therapy, monoclonal antibodies, type 2 immune response. FOR CITATION: Titova O.N., Volchkov V.A., Kuzubova N.A., Sklyarova D.B. Organization of medical care for patients with severe asthma requiring genetically engineered biological therapies in St. Petersburg. Russian Medical Inquiry. 2023;7(8):493–497 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-3.

P405 Primary non-response and loss-of-response to first-line biological therapies are more common in patients with Ulcerative Colitis than Crohn’s Disease – preliminary results from the Danish IBD Biobank Project

Abstract Background The use and cost of biological treatment in patients with inflammatory bowel diseases (IBD) continue to rise. Meanwhile, rates of primary non-response (PNR) and loss of response (LOR) are high. We aimed to investigate predictors of PNR and LOR in a real-world cohort of bio-naïve IBD patients. Methods This study included, 488 adult patients with IBD (52% UC, 47% CD, 1% IBDU) who initiated and completed induction therapy with a biological drug from May, 2019 – Oct, 2021 at five university hospitals covering, 2.1 M inhabitants. Clinical response to induction therapy was defined as a decrease at week, 14 in the Simple Clinical Colitis Activity Index (SCCAI)&amp;gt;1 in UC and a decrease in Harvey Bradshaw Index (HBI)&amp;gt;3 in CD patients. Clinical remission was defined as SCCAI&amp;lt;3 in UC and HBI&amp;lt;5 in CD. PNR was defined as lack of response or IBD surgery during the induction period. LOR was defined as need for systemic steroids, drug switch or IBD surgery during maintenance therapy. Multivariable logistic regression and COX-regression analyses were performed to assess predictors of outcomes. Results Biological treatment was initiated after a median of two years (IQR, 0–9.Table, 1). Most patients were treated with infliximab(97%) followed by adalimumab(2%) and vedolizumab (1%). Luminal activity was the most common indication(67%) followed by acute severe UC(17%) and need for post-operative prophylaxis(7%). Treatment was discontinued in, 27(6%) patients due to other reasons than PNR during induction therapy. PNR occurred in, 95(30%) of, 314 patients with available scores and was higher in UC patients (OR, 2.19,95%CI, 1.19–4.05,p=0.01.Table, 2), but lower in those who were former smokers (OR, 0.51,95%CI, 0.27–0.95,p=0.03). Clinical remission was achieved in, 234(52%) patients and lower in those with UC (OR, 0.48,95%CI, 0.32–0.74,p&amp;lt;0.01) or previous major surgery (OR, 0.48,95%CI, 0.25–0.92,p=0.03). LOR occurred in, 82(21%) of, 395 patients who received maintenance therapy. LOR rate was higher in patients with UC (HR, 2.00,95%CI, 1.20–3.33,p&amp;lt;0.01) and previous major surgery (HR, 2.85,95%CI, 1.47–5.52,p&amp;lt;0.01.Table, 3). UC was associated with a higher risk of drug discontinuation (HR, 1.85,95%CI, 1.20–2.85,p&amp;lt;0.01) and switch (HR, 2.01,95%CI, 1.17–3.46,p=0.01) whereas concomitant use of immunomodulator (IM) lowered the risk of both (HR, 0.47,95%CI, 0.27–0.81,p&amp;lt;0.01 and HR, 0.46,95%CI, 0.24–0.89,p=0.02.Table 4). Conclusion PNR occurred in one of four patients and LOR in one-fifth. Both PNR and LOR rates were higher in patients with UC. During maintenance therapy, UC patients had a higher risk of drug discontinuation and switch whereas concomitant use of IM decreased the risk of both. Funding: unrestricted grant from Takeda A/S, Louis-Hansen Fonden and public fund hosted by Hvidovre Hospital.

P406 Disease clearance in patients with ulcerative colitis treated with aminosalicylates

Abstract Background Current treatment goals in inflammatory bowel disease include clinical remission and endoscopic healing. A new concept of disease clearance (DC) is emerging as a new therapeutic target in ulcerative colitis (UC). Although not yet clearly defined, it reflects a combination of clinical, endoscopic, and histological remission1. Preliminary data suggest that DC is achievable with biologic therapy. Aim: to evaluate if patients treated with, 5-ASA with DC can maintain sustained remission and the incidence of negative disease outcomes. Methods We performed a retrospective cohort study including adult patients with confirmed UC treated with, 5-ASA. Patients performing colonoscopy with biopsies between, 2017 and, 2019, with at least, 1 year of follow-up were eligible for inclusion. DC was measured at baseline and was defined as clinical (partial Mayo score ≤2), endoscopic (endoscopic Mayo score ≤1) and histological remission (chronic inactive/quiescent colitis)1. Negative disease outcomes included need for systemic steroids, therapy escalation (immunomodulators and/or biologics) and UC-related hospitalization or surgery during follow-up. Kaplan-Meier analysis was performed. Results We included, 56 patients with UC treated with, 5-ASA and with DC at baseline. Mean age at diagnosis was, 41.2 ±, 15 years, 59% (n=33) were female and mean disease duration was, 6.9 ±, 7.3 months. History of smoking (current or former) was present in, 36% (n=20) of the patients. Most of the patients (54%) presented with left-sided colitis. Mean follow-up was, 34.6 ±, 10.7 months. During the follow-up, 14.3 % (n=8) had a negative outcome (flare requiring systemic corticosteroids (n=6), therapy escalation to immunomodulator or biologic treatment (n=6) or hospitalization (n=1)). None of the patients needed surgery. Negative outcomes were associated with shorter disease duration (3.4 vs, 7.4 years, p=0.003). No other factors were associated with the outcomes namely sex, UC extent, smoker status, age at diagnosis or previous use of corticosteroids. There was no difference on prognosis between patients with baseline endoscopic Mayo score, 0 or, 1 (p=, 0.066). In the survival analysis, the cumulative probability of maintaining remission was, 76% at, 3 years. Conclusion DC in UC patients treated with, 5-ASA was associated with a high cumulative probability of maintaining remission, suggesting that the benefits of such stringent endpoint may be independent of the therapy used. Reference 1. S Danese, S Schreiber, E Loftus, Jr., J F Colombel, L Peyrin-Biroulet, C Agboton, D Lindner, R Lirio, B Sands, P271 Evolving Targets in Ulcerative colitis: Defining Disease Clearance in the VARSITY Study, Journal of Crohn’s and Colitis,Volume, 15, Issue Supplement1, May, 2021, Page S305

Relationship between socioeconomic status, exposure to airborne pollutants, and chronic rhinosinusitis disease severity.

Air pollution directly interacts with airway mucosa, yet little is known about how pollutants affect upper airway inflammation. Studies have shown increased incidence of chronic rhinosinusitis (CRS), rhinitis, and asthma in areas with higher traffic pollution, and these neighborhoods are often associated with lower socioeconomic status (SES). The Area Deprivation Index (ADI) assesses neighborhood-level SES by zip code. The purpose of this study was to assess the relationship between SES and exposure to inhaled pollutants and CRS disease severity. CRS patients with and without nasal polyps (CRSwNP and CRSsNP, respectively) were identified (total patients=234; CRSwNP patients=138; CRSsNPpatients =96). Pollutant concentrations, including particulate matter 2.5 (PM2.5 ), black carbon (BC), and nitrogen dioxide (NO2 ), were measured at 70 sites within the defined countywide sites and used to estimate patient exposures. SES was measured by ADI state deciles. Disease severity metrics included the modified Lund-Mackay score (LMS), the need for systemic steroids, and functional endoscopic sinus surgery (FESS). Associations were analyzed and identified using linear, logistic, and Poisson multivariable regression. The distribution of CRSsNP and CRSwNP patients across ADI state deciles was similar. ADI, however, was a predictor of exposure to airborne pollutants (PM2.5 , BC, and NO2 ) with a 1.39%, 2.39%, and 2.49% increase in PM2.5 , BC, and NO2 per increasing decile increment (p<0.0001), respectively, which demonstrated a direct correlation between deprived neighborhoods and higher levels of exposure to PM2.5 , BC, and NO2 with an increase in pollutant levels per increase in ADI decile. Furthermore, ADI was a predictor for increased steroid treatment. Lower SES predicted higher exposure to air pollution and increased disease severity in patients with CRS as demonstrated by the increased need for steroid treatment.

Family history of asthma influences outpatient respiratory outcomes in children with BPD

Preterm children with bronchopulmonary dysplasia (BPD) are at increased risk for intermittent and chronic respiratory symptoms during childhood and adult life. Identifying children at higher risk for respiratory morbidities in the outpatient setting could help improve long-term outcomes. In this study, we hypothesized that a family history of asthma (FHA) is a risk factor for higher acute care usage and respiratory symptoms in preterm infants/children with BPD, following initial discharge home. Subjects were recruited from the Johns Hopkins Bronchopulmonary Dysplasia outpatient clinic between January 2008 and February 2020 (n = 827). Surveys were administered to caregivers and demographics and clinical characteristics were obtained through chart review. Demographic features associated with FHA included public health insurance, lower median household income, and nonwhite race. Children with FHA had higher odds of emergency department (ED) visits, systemic steroid use, nighttime respiratory symptoms, and activity limitations. There was no association between FHA and BPD severity. This study found that children with BPD and FHAwere more likely to have respiratory symptoms and acute care usage during the first 3 years of life and that FHA was associated with lower socioeconomic status. Although there was no association between FHA and BPD severity, FHA could predict an increased likelihood of both ED visits and need for systemic steroids in infants/children with BPD followed in the outpatient setting.

The effects of probiotics, prebiotics and synbiotics on the reduction of IBD complications, a periodic review during 2009-2020.

To perform a systematic review on randomized controlled trials to examine the efficacy of probiotics, prebiotics and synbiotics in the treatment of IBD. PubMed, Web of science, Scopus and Google Scholar were systematically searched from January 2009 to January 2020 using the following keywords: 'Inflammatory Bowel Disease', 'Probiotics' and 'Clinical trial'. The statistical analysis was performed using SPSS software version 24.0. A total of 1832 articles were found during the initial search and 21 clinical trials were eligible. Studies comparing the effects of probiotics and placebo among patients with active ulcerative colitis (UC) showed a significant difference in clinical outcomes. Moreover, probiotics improved the overall induction of remission rates among patients with Crohn's disease (CD). Probiotics significantly decreased the IL-1β, TNF-α and IL-8 levels. Also, the need for systemic steroids, hospitalization, surgery, as well as histological score and disease activity index significantly decreased in patients who used probiotic or pro-/synbiotics. The use of probiotics, as food supplements, can induce anti-inflammatory reactions, balance the intestinal homeostasis and induce remission in IBD. The efficacy of probiotics on remission induction is more reported in UC rather than CD. Larger well-designed clinical trials are needed to further determine whether probiotics are of clear benefits for remission in IBD.

Ileal or Colonic Histologic Activity Is Not Associated With Clinical Relapse in Patients With Crohn’s Disease in Endoscopic Remission

Goals of treatment for Crohn's disease (CD) are clinical and endoscopic remission. It is not clear whether histologic markers of healing associate with endoscopic remission in patients with CD. We identified patients with CD from a single institutional registry, and collected data from 129 patients (46.5% female; mean age 25 y; mean CD duration 14.5 y) who underwent colonoscopy evaluation and had simple endoscopic scores for CD below 3 (the definition of endoscopic remission). Histologic signs of CD activity were graded in 192 biopsies (90 ileum and 102 colon), and disease was classified as active (presence of crypt destruction, neutrophils, erosions or ulcerations), quiescent (presence of architectural distortion and chronic inflammatory infiltrate), or normal histology (none of these). The primary outcome was clinical relapse within 2 y (dose escalation, change in therapy, need for systemic steroids, or CD-related hospitalization or surgery). We performed multivariable regression adjusting for relevant confounders to examine the independent predictive value of histologic activity. Within 2 y of endoscopic evaluation, 42 patients (32.6%) had a clinical relapse. There were no significant differences in proportions of patients with active ileal CD (23.8%), quiescent CD (28.6%), or normal histology (37%) between those who relapsed and those remaining in remission (P = .43). There were no significant differences in proportions of relapses among patients with active colonic disease (38.1%), quiescent disease (35.0%), or normal histology (27.9%, P = .73). A linear regression analysis found no association between histologic features of active disease in ileal histology biopsies and symptom scores (Harvey Bradshaw index and simple inflammatory bowel disease questionnaire scores). In an analysis of biopsies from patients with CD who had achieved clinical and endoscopic remission, histologic remission was not associated with clinical relapse within 2 years.

Can Quadrupling Inhaled Glucocorticoid Dose During Early Asthma Exacerbation Reduce the Need For Systemic Steroids or Hospital Admission?

Synopsis: In this unblinded, multicenter, randomized control trial, patients with mild asthma who quadrupled the dose of their inhaled glucocorticoids upon initial signs of asthma control deterioration experienced fewer severe asthma exacerbations than patients who did not quadruple their inhaled glucocorticoid dose. Source: McKeever T, Mortimer K, Wilson A, et al. Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations. N Engl J Med. 2018;378:902–910.

Effect of Probiotic Use on Adverse Events in Adult Patients with Inflammatory Bowel Disease: a Retrospective Cohort Study.

Alterations of intestinal microflora are involved in the pathogenesis and natural history of inflammatory bowel diseases (IBDs). Manipulation of human gut microbiota with probiotics may be a therapeutic option. In this retrospective cohort study, the benefits of probiotic use in reducing adverse events were analyzed. Data from clinical charts of IBD patients followed up for at least 36months were retrieved. The occurrence of adverse events including the need for systemic steroids, hospitalization, and surgery related to IBD was analyzed according to age, gender, body mass index, treatments, IBD phenotype, disease duration, and probiotic use. The amount of probiotic use was calculated as the ratio of time under probiotic treatment to the disease duration starting from the date of the first probiotic administration and expressed as a percentage. Patients were stratified according to the percentage of probiotic use as ≤ 24%, 25-74%, and ≥ 75%, and the number of adverse events per patient-years was calculated. Results were adjusted for Crohn's disease (CD) and ulcerative colitis (UC) by multivariate analysis including study variables. Data from 200 patients (78 CD, 122 UC; 117 females; mean age 40.6 ± 15.3years; mean disease duration 12.1 ± 8.7years) were available. CD patients taking probiotics for 25-74% of the disease duration experienced a 64% reduction in total adverse events. The need for systemic steroids, hospitalization, and surgery dropped to zero events per person-year in UC patients and decreased by 93% (p < 0.001) in CD patients taking probiotics for ≥ 75% of the disease duration. Our findings suggest that the use of probiotics may be an additional therapeutic tool in patients with IBD.

A Team-based Approach to Improving Asthma Care in Primary Care Clinics. the Systematic Use of Act’s and Aap’s Resulted in a Decrease in the Need for Systemic Steroids and for Hospitalizations for Medically- homed Patients with Asthma

A Team-based Approach to Improving Asthma Care in Primary Care Clinics. the Systematic Use of Act’s and Aap’s Resulted in a Decrease in the Need for Systemic Steroids and for Hospitalizations for Medically- homed Patients with Asthma

Increased doses of inhaled corticosteroids during home management of asthma flare‐ups do not reduce the need for systemic steroids

Increased doses of inhaled corticosteroids during home management of asthma flare‐ups do not reduce the need for systemic steroids