Onuma Sattayalertyanyong, Zoann Nugent, Charles N. Bernstein
{"title":"Letter: From End‐Stage Renal Disease Association to Risk‐Stratified Kidney Surveillance in Inflammatory Bowel Disease—Authors' Reply","authors":"Onuma Sattayalertyanyong, Zoann Nugent, Charles N. Bernstein","doi":"10.1111/apt.71050","DOIUrl":"https://doi.org/10.1111/apt.71050","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"12 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149151781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Garre, Andrea Nuñez Ortiz, Saioa Rubio, María Teresa Diz-Lois Palomares, Sabino Riestra, Horacio Alonso-Galán, Estela Fernández-Salgado, Rocío Ferreiro-Iglesias, Milagros Vela, Ángel Ponferrada Díaz, Eugenia Sánchez Rodríguez, Vicent Hernández, Lara Arias García, Jesús Barrio, José María Huguet, Daniel Ginard, Montserrat Rivero, Isabel Vera, Inmaculada Alonso-Abreu, José Manuel Benítez, Mariam Aguas, Iago Rodríguez-Lago, Xavier Calvet, Luis Fernández-Salazar, Ana Echarri, María Teresa Arroyo, Mercè Navarro-Llavat, Pablo Vega, Mónica Sierra, Elena Guerra Del Río, Raquel Vicente, María José Casanova, Pablo Navarro, Jone Ortiz de Zarate, Pilar Varela Trastoy, Katerina Spicakova, Ana Gutiérrez, María Dolores Martín-Arranz, Concepción Piñero, Álvaro Hernández-Martínez, Emilio Torrella Cortés, José Miguel Marrero, Rufo H Lorente Poyatos, Lidia Martí Romero, Orencio Bosch, José María Duque, Montserrat Aceituno, Hipólito Fernández, Belén Crespo Suarez, Ana María Fuentes Coronel, Liliana Pozzati, Pilar Robledo, Eva Sesé Abizanda, Belén Herreros Martínez, Nuria Jiménez, Pilar López Serrano, Manuela Josefa Sampedro, Fernando Bermejo, Alfredo J Lucendo, Margarita Muñoz Vicente, Margarita Menacho, José Joaquín Ramírez Palanca, Raquel Camargo, Amalia Carmona, Sandra Torra Alsina, Margalida Calafat, José Luis F Forcelledo, Juan Nerín de la Puerta, Isabel Nicolás, Verónica Opio, Yolanda Ber, Abdel Bouhmidi, Alfredo Abraldes Bechiarelli, Carlos Castaño-Milla, Noelia Cruz, Jordi Gordillo, Amparo Sapiña, Alina López, Silvia Rodríguez Mondéjar, María Teresa Novella Durán, Belén Botella, Marcos Kutz, Lilyan Kolle, Ignacio Marín-Jiménez, Francisco J Martínez-Cerezo, Rebeca Irisarri, Eduardo Iyo, Óscar Roncero, Miriam Sabat, Yolanda Torres Domínguez, Cesar Ledezma, Eva María Zapata, María José Alcalá, Laia Lluis, Cristina Martínez Pascual, Isabel Blázquez Gómez, Luis Hernández, Laura Mata, Ana Monrobel, Alejandro Hernández Camba, Nuria Maroto, María Tejada, María Luisa Galve, María Montealegre, Daniel Hervías, Marta Soler, José Antonio Gómez-Valero, Manuel Barreiro-de Acosta, Pilar Soto Escribano, José Luis Cabriada, Daniel Ceballos, Maria Esteve, Alba García Rodríguez, Vanesa Royo, Fernando Gomollón, Cristina Verdejo Gil, Pilar Nos, Ruth de Francisco, María José García, Carmen Dueñas Sadornil, Cristina Rodríguez, Beatriz Sicilia, Borja M Fernandez-Felix, Javier P Gisbert, María Chaparro
Aims: This study aimed to describe the characteristics of newly diagnosed inflammatory bowel disease (IBD) patients and to analyse their clinical course within the first 5 years after diagnosis, including the need for surgery, hospitalisations and treatments.
Methods: This prospective and large multicentre incident cohort registry in Spain enrolled adults diagnosed with Crohn's disease (CD), ulcerative colitis (UC) or unclassified IBD (IBD-U) in 2017 and followed them for 5 years.
Results: A total of 3301 patients were enrolled: 1526 with CD, 1633 with UC and 142 with IBD-U. Their median age at diagnosis was 43 years (interquartile range 31-56) and approximately 50% were male. Within 5 years post-diagnosis, 30% received biologics or JAK inhibitors (JAKi), 34% were hospitalised at least once and 9% underwent surgery. The cumulative incidence of biologic/JAKi treatment, hospitalisations and surgeries was higher among CD patients. Use of biologics/JAKi correlated with a more aggressive CD phenotype, greater UC extent and younger age at diagnosis. Biologics/JAKi treatment was associated with lower hospitalisation risk in both CD (Hazard ratio [HR] = 0.4, 95% confidence interval [CI] = 0.2-0.6) and UC patients (HR = 0.5, 95% CI = 0.2-0.9). However, it was not associated with the risk of abdominal surgery in CD but was linked to an increased risk of surgery in UC (HR = 11.9, 95% CI = 4.6-30.4).
Conclusions: This large multicentre cohort demonstrated a higher use of biologics/JAKi during the first 5 years after IBD diagnosis than previously reported. Treatment with biologics/JAKi was associated with reduced risk of hospitalisation. However, under current clinical practice patterns, this therapeutic approach did not translate into lower risk of abdominal surgery.
{"title":"Clinical Course and Predictors of Biologic Therapy, Hospitalisation and Surgery: A Five-Year Prospective Study in Newly Diagnosed Inflammatory Bowel Disease.","authors":"Ana Garre, Andrea Nuñez Ortiz, Saioa Rubio, María Teresa Diz-Lois Palomares, Sabino Riestra, Horacio Alonso-Galán, Estela Fernández-Salgado, Rocío Ferreiro-Iglesias, Milagros Vela, Ángel Ponferrada Díaz, Eugenia Sánchez Rodríguez, Vicent Hernández, Lara Arias García, Jesús Barrio, José María Huguet, Daniel Ginard, Montserrat Rivero, Isabel Vera, Inmaculada Alonso-Abreu, José Manuel Benítez, Mariam Aguas, Iago Rodríguez-Lago, Xavier Calvet, Luis Fernández-Salazar, Ana Echarri, María Teresa Arroyo, Mercè Navarro-Llavat, Pablo Vega, Mónica Sierra, Elena Guerra Del Río, Raquel Vicente, María José Casanova, Pablo Navarro, Jone Ortiz de Zarate, Pilar Varela Trastoy, Katerina Spicakova, Ana Gutiérrez, María Dolores Martín-Arranz, Concepción Piñero, Álvaro Hernández-Martínez, Emilio Torrella Cortés, José Miguel Marrero, Rufo H Lorente Poyatos, Lidia Martí Romero, Orencio Bosch, José María Duque, Montserrat Aceituno, Hipólito Fernández, Belén Crespo Suarez, Ana María Fuentes Coronel, Liliana Pozzati, Pilar Robledo, Eva Sesé Abizanda, Belén Herreros Martínez, Nuria Jiménez, Pilar López Serrano, Manuela Josefa Sampedro, Fernando Bermejo, Alfredo J Lucendo, Margarita Muñoz Vicente, Margarita Menacho, José Joaquín Ramírez Palanca, Raquel Camargo, Amalia Carmona, Sandra Torra Alsina, Margalida Calafat, José Luis F Forcelledo, Juan Nerín de la Puerta, Isabel Nicolás, Verónica Opio, Yolanda Ber, Abdel Bouhmidi, Alfredo Abraldes Bechiarelli, Carlos Castaño-Milla, Noelia Cruz, Jordi Gordillo, Amparo Sapiña, Alina López, Silvia Rodríguez Mondéjar, María Teresa Novella Durán, Belén Botella, Marcos Kutz, Lilyan Kolle, Ignacio Marín-Jiménez, Francisco J Martínez-Cerezo, Rebeca Irisarri, Eduardo Iyo, Óscar Roncero, Miriam Sabat, Yolanda Torres Domínguez, Cesar Ledezma, Eva María Zapata, María José Alcalá, Laia Lluis, Cristina Martínez Pascual, Isabel Blázquez Gómez, Luis Hernández, Laura Mata, Ana Monrobel, Alejandro Hernández Camba, Nuria Maroto, María Tejada, María Luisa Galve, María Montealegre, Daniel Hervías, Marta Soler, José Antonio Gómez-Valero, Manuel Barreiro-de Acosta, Pilar Soto Escribano, José Luis Cabriada, Daniel Ceballos, Maria Esteve, Alba García Rodríguez, Vanesa Royo, Fernando Gomollón, Cristina Verdejo Gil, Pilar Nos, Ruth de Francisco, María José García, Carmen Dueñas Sadornil, Cristina Rodríguez, Beatriz Sicilia, Borja M Fernandez-Felix, Javier P Gisbert, María Chaparro","doi":"10.1111/apt.70987","DOIUrl":"https://doi.org/10.1111/apt.70987","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to describe the characteristics of newly diagnosed inflammatory bowel disease (IBD) patients and to analyse their clinical course within the first 5 years after diagnosis, including the need for surgery, hospitalisations and treatments.</p><p><strong>Methods: </strong>This prospective and large multicentre incident cohort registry in Spain enrolled adults diagnosed with Crohn's disease (CD), ulcerative colitis (UC) or unclassified IBD (IBD-U) in 2017 and followed them for 5 years.</p><p><strong>Results: </strong>A total of 3301 patients were enrolled: 1526 with CD, 1633 with UC and 142 with IBD-U. Their median age at diagnosis was 43 years (interquartile range 31-56) and approximately 50% were male. Within 5 years post-diagnosis, 30% received biologics or JAK inhibitors (JAKi), 34% were hospitalised at least once and 9% underwent surgery. The cumulative incidence of biologic/JAKi treatment, hospitalisations and surgeries was higher among CD patients. Use of biologics/JAKi correlated with a more aggressive CD phenotype, greater UC extent and younger age at diagnosis. Biologics/JAKi treatment was associated with lower hospitalisation risk in both CD (Hazard ratio [HR] = 0.4, 95% confidence interval [CI] = 0.2-0.6) and UC patients (HR = 0.5, 95% CI = 0.2-0.9). However, it was not associated with the risk of abdominal surgery in CD but was linked to an increased risk of surgery in UC (HR = 11.9, 95% CI = 4.6-30.4).</p><p><strong>Conclusions: </strong>This large multicentre cohort demonstrated a higher use of biologics/JAKi during the first 5 years after IBD diagnosis than previously reported. Treatment with biologics/JAKi was associated with reduced risk of hospitalisation. However, under current clinical practice patterns, this therapeutic approach did not translate into lower risk of abdominal surgery.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesca Ligori Malcolm, Colin J. Crooks, Joe West, Manpreet Bains, Elliann Fairbairn, Jeff Turner, Benjamin Hughes, Lynnette Jones, David J. Humes
Background Wales has the highest rate of colorectal cancer (CRC) in the UK. National guidelines recommend using the faecal immunochemical test (FIT) in patients presenting with symptoms of bowel cancer. FIT ≥ 10 μgHb/g in symptomatic patients is presumed to indicate a > 3% risk of CRC. However, evidence from England and Scotland has found that the risk is lower in certain demographic groups. Aims To examine 1‐year risk of CRC in Welsh patients with symptoms of suspected bowel cancer by demographics, iron deficiency anaemia (IDA), and FIT. Methods Cohort study of adults registered in the Welsh Longitudinal General Practice dataset with a FIT recorded from 01/01/2020–31/03/2024. Kaplan–Meier estimates were used to calculate 1‐year cumulative risks of CRC. Results We included 166,863 patients with a FIT; 19.2% had a FIT ≥ 10 μgHb/g. Within 1 year, 2864 (1.72%) were diagnosed with CRC; 90.2% of which were following FIT ≥ 10μgHb/g. A FIT cut‐off of ≥ 10 μgHb/g in isolation identified a > 3% risk of CRC across all age groups. In those with FIT ≥ 10μgHb/g, IDA resulted in an increase in predicted risk across all age groups. IDA aided stratification further in women < 50 years; risk of CRC was 6.45% (95% CI: 3.52–9.29) with a FIT ≥ 10 μgHb/g and IDA compared to 2.20% (95% CI: 1.57–2.83) without IDA. Conclusions In Wales, the risk of CRC following FIT ≥ 10 μgHb/g is higher than observed in English and Scottish cohorts. Stratification by demographics and blood results identified those at highest risk, but this did not fully explain the higher baseline risk observed in comparison to other UK nations.
{"title":"Population‐Based Cohort Study: Colorectal Cancer Risk Stratification in Symptomatic Patients Using the Faecal Immunochemical Test, Blood Results and Patient Characteristics in Wales","authors":"Francesca Ligori Malcolm, Colin J. Crooks, Joe West, Manpreet Bains, Elliann Fairbairn, Jeff Turner, Benjamin Hughes, Lynnette Jones, David J. Humes","doi":"10.1111/apt.71028","DOIUrl":"https://doi.org/10.1111/apt.71028","url":null,"abstract":"Background Wales has the highest rate of colorectal cancer (CRC) in the UK. National guidelines recommend using the faecal immunochemical test (FIT) in patients presenting with symptoms of bowel cancer. FIT ≥ 10 μgHb/g in symptomatic patients is presumed to indicate a > 3% risk of CRC. However, evidence from England and Scotland has found that the risk is lower in certain demographic groups. Aims To examine 1‐year risk of CRC in Welsh patients with symptoms of suspected bowel cancer by demographics, iron deficiency anaemia (IDA), and FIT. Methods Cohort study of adults registered in the Welsh Longitudinal General Practice dataset with a FIT recorded from 01/01/2020–31/03/2024. Kaplan–Meier estimates were used to calculate 1‐year cumulative risks of CRC. Results We included 166,863 patients with a FIT; 19.2% had a FIT ≥ 10 μgHb/g. Within 1 year, 2864 (1.72%) were diagnosed with CRC; 90.2% of which were following FIT ≥ 10μgHb/g. A FIT cut‐off of ≥ 10 μgHb/g in isolation identified a > 3% risk of CRC across all age groups. In those with FIT ≥ 10μgHb/g, IDA resulted in an increase in predicted risk across all age groups. IDA aided stratification further in women < 50 years; risk of CRC was 6.45% (95% CI: 3.52–9.29) with a FIT ≥ 10 μgHb/g and IDA compared to 2.20% (95% CI: 1.57–2.83) without IDA. Conclusions In Wales, the risk of CRC following FIT ≥ 10 μgHb/g is higher than observed in English and Scottish cohorts. Stratification by demographics and blood results identified those at highest risk, but this did not fully explain the higher baseline risk observed in comparison to other UK nations.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"23 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-10-09Epub Date: 2026-05-07DOI: 10.1111/apt.70717
Longying Zhang, Lifen Zhao, Lina Liu
<p>We read with great interest the study by Conley et al. [<span>1</span>], which identified a short-chain fatty acid (SCFA)-enriched faecal metabotype in patients with moderate-to-severe diarrhoea-predominant irritable bowel syndrome (IBS-D). The study is valuable because it moves beyond symptom-based classification and integrates faecal volatile organic compounds, metagenomic data, clinical symptom scores and whole-gut transit time. The finding that approximately one-third of patients exhibited an SCFA-enriched profile associated with abdominal pain, urgency, stool frequency and faster transit provides an important step towards biologically informed stratification of IBS-D.</p><p>However, one issue that deserves further consideration is that faecal SCFA enrichment does not necessarily indicate increased microbial SCFA production. Faecal SCFA abundance is shaped by microbial fermentation, epithelial absorption, stool water content and intestinal transit [<span>2</span>]. Because the SCFA-enriched group also had faster whole-gut transit, higher faecal SCFA levels may partly reflect reduced absorptive opportunity or altered dilution rather than enhanced production. Future studies could strengthen this interpretation by incorporating absolute SCFA quantification, stool water correction, segmental transit assessment and host absorption markers such as epithelial SCFA transporter expression.</p><p>Second, the SCFA-enriched metabotype may represent a rapid-transit diarrhoeal kinetic phenotype rather than an independent severe IBS-D subtype. Pain, urgency, loose stools, stool frequency and accelerated transit are closely interrelated in IBS-D [<span>3</span>]. Therefore, the observed association between SCFA enrichment and symptom severity may be partly mediated by transit dynamics [<span>4</span>]. Multivariable modelling, mediation analysis or structural equation modelling could help determine whether SCFA enrichment remains independently associated with pain or IBS severity after adjustment for whole-gut transit time, stool form and stool frequency.</p><p>Third, the comparator group labelled as the ‘Other’ metabotype may not be biologically homogeneous. It included diverse metabolites such as ketones, aldehydes, terpenes, organosulphur compounds, indole and phenols, whereas the non-negative matrix factorisation analysis further suggested at least two non-SCFA signatures [<span>5</span>]. Combining these distinct metabolic states into one reference group may obscure clinically relevant heterogeneity and exaggerate the contrast with the SCFA-enriched group [<span>6</span>]. Future research may benefit from multidimensional metabolic phenotyping rather than a binary SCFA versus non-SCFA framework.</p><p>In conclusion, this study provides an important foundation for metabolic stratification in IBS-D. Clarifying whether faecal SCFA enrichment reflects production, absorption, transit or their interaction will be essential before this metabotype can be tra
{"title":"Letter: Interpreting Faecal SCFA Enrichment in IBS-D—Metabolic Signal or Transit-Related Marker?","authors":"Longying Zhang, Lifen Zhao, Lina Liu","doi":"10.1111/apt.70717","DOIUrl":"10.1111/apt.70717","url":null,"abstract":"<p>We read with great interest the study by Conley et al. [<span>1</span>], which identified a short-chain fatty acid (SCFA)-enriched faecal metabotype in patients with moderate-to-severe diarrhoea-predominant irritable bowel syndrome (IBS-D). The study is valuable because it moves beyond symptom-based classification and integrates faecal volatile organic compounds, metagenomic data, clinical symptom scores and whole-gut transit time. The finding that approximately one-third of patients exhibited an SCFA-enriched profile associated with abdominal pain, urgency, stool frequency and faster transit provides an important step towards biologically informed stratification of IBS-D.</p><p>However, one issue that deserves further consideration is that faecal SCFA enrichment does not necessarily indicate increased microbial SCFA production. Faecal SCFA abundance is shaped by microbial fermentation, epithelial absorption, stool water content and intestinal transit [<span>2</span>]. Because the SCFA-enriched group also had faster whole-gut transit, higher faecal SCFA levels may partly reflect reduced absorptive opportunity or altered dilution rather than enhanced production. Future studies could strengthen this interpretation by incorporating absolute SCFA quantification, stool water correction, segmental transit assessment and host absorption markers such as epithelial SCFA transporter expression.</p><p>Second, the SCFA-enriched metabotype may represent a rapid-transit diarrhoeal kinetic phenotype rather than an independent severe IBS-D subtype. Pain, urgency, loose stools, stool frequency and accelerated transit are closely interrelated in IBS-D [<span>3</span>]. Therefore, the observed association between SCFA enrichment and symptom severity may be partly mediated by transit dynamics [<span>4</span>]. Multivariable modelling, mediation analysis or structural equation modelling could help determine whether SCFA enrichment remains independently associated with pain or IBS severity after adjustment for whole-gut transit time, stool form and stool frequency.</p><p>Third, the comparator group labelled as the ‘Other’ metabotype may not be biologically homogeneous. It included diverse metabolites such as ketones, aldehydes, terpenes, organosulphur compounds, indole and phenols, whereas the non-negative matrix factorisation analysis further suggested at least two non-SCFA signatures [<span>5</span>]. Combining these distinct metabolic states into one reference group may obscure clinically relevant heterogeneity and exaggerate the contrast with the SCFA-enriched group [<span>6</span>]. Future research may benefit from multidimensional metabolic phenotyping rather than a binary SCFA versus non-SCFA framework.</p><p>In conclusion, this study provides an important foundation for metabolic stratification in IBS-D. Clarifying whether faecal SCFA enrichment reflects production, absorption, transit or their interaction will be essential before this metabotype can be tra","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1316-1317"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70717","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: Prediction of Long‐Term Complications of Paediatric Liver Transplantation","authors":"S. Mahesh, J. P. Mann","doi":"10.1111/apt.71031","DOIUrl":"https://doi.org/10.1111/apt.71031","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"10 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-10-09Epub Date: 2026-08-17DOI: 10.1111/apt.70930
Leith Ghani, Claire S. Faulkner, Majd B. Aboona, Pradhan Hariharan, Pooja Rangan, Amal Altaf, David O. Garcia, Vincent L. Chen, Donghee Kim, Juan Pablo Arab, Mazen Noureddin, Luis Antonio Díaz, Ani Kardashian, Michael B. Fallon, Karn Wijarnpreecha
<div> <section> <h3> Background and Aim</h3> <p>Significant health disparities persist in alcohol-associated liver disease (ALD), largely driven by social determinants of health (SDOH). However, the influence of neighbourhood-level SDOH on ALD outcomes remains underexplored. In this study, we aimed to evaluate how neighbourhood-level SDOH are associated with disease burden, comorbid conditions, and mortality in individuals with ALD.</p> </section> <section> <h3> Methods</h3> <p>We conducted a retrospective cohort study of patients with ALD in the Banner Health System, representing hospitals across Arizona, California, Nevada, Wyoming and Colorado, from January 2012 to October 2024 using ICD codes. Neighbourhood-level SDOH were quantified using the Social Deprivation Index (SDI). Patients were stratified into quartiles based on SDI score, with Quartile 4 representing the most socioeconomically disadvantaged neighbourhoods. Primary outcomes included incidence of mortality, cirrhosis, major adverse liver outcome (MALO), Type 2 diabetes mellitus, any cancer, and major adverse cardiovascular events (MACE). A multivariable competing risk analysis was performed adjusting for age, sex, race/ethnicity, insurance type, primary language, smoking status, Type 2 diabetes mellitus, hypertension, hyperlipidemia, aspirin use, statin use, alcohol use disorder and a composite mental-health/substance-use disorder variable encompassing depression, anxiety disorders, post-traumatic stress disorder, bipolar disorder, schizophrenia, and non-alcohol substance use disorders.</p> </section> <section> <h3> Results</h3> <p>Among 11,394 patients with ALD and available SDI data, 6747 had ≥ 365 days of follow-up. The average age was 51 years and 65.6% were female; 68.8% were non-Hispanic White, 19.7% Hispanic, 5.9% Native American/Alaskan Native (NA), 3.2% Black, and 0.4% Asian/Pacific Islanders. Patients residing in the most disadvantaged neighbourhoods (Quartile 4) were significantly younger, more likely to be female, had a higher median BMI, and more frequently reported a non-English primary language compared with those in the least disadvantaged areas (Quartile 1). Patients in the most deprived neighbourhoods were more likely to be Hispanic, Black, or Native American/Alaska Native and to be uninsured or on Medicaid, whereas those in the least disadvantaged neighbourhoods predominantly had private insurance. Individuals in Quartile 4 had increased mortality (adjusted hazard ratio [aHR]: 1.48, 95% Confidence Interval [CI]: 1.09–2.01) compared with individuals in Quartile 1.</p> </section> <section> <h3> Conclusions</h3> <p>In this large and demographically di
{"title":"Neighbourhood Deprivation Is Associated With Greater Mortality in Patients With Alcohol-Associated Liver Disease","authors":"Leith Ghani, Claire S. Faulkner, Majd B. Aboona, Pradhan Hariharan, Pooja Rangan, Amal Altaf, David O. Garcia, Vincent L. Chen, Donghee Kim, Juan Pablo Arab, Mazen Noureddin, Luis Antonio Díaz, Ani Kardashian, Michael B. Fallon, Karn Wijarnpreecha","doi":"10.1111/apt.70930","DOIUrl":"10.1111/apt.70930","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Significant health disparities persist in alcohol-associated liver disease (ALD), largely driven by social determinants of health (SDOH). However, the influence of neighbourhood-level SDOH on ALD outcomes remains underexplored. In this study, we aimed to evaluate how neighbourhood-level SDOH are associated with disease burden, comorbid conditions, and mortality in individuals with ALD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of patients with ALD in the Banner Health System, representing hospitals across Arizona, California, Nevada, Wyoming and Colorado, from January 2012 to October 2024 using ICD codes. Neighbourhood-level SDOH were quantified using the Social Deprivation Index (SDI). Patients were stratified into quartiles based on SDI score, with Quartile 4 representing the most socioeconomically disadvantaged neighbourhoods. Primary outcomes included incidence of mortality, cirrhosis, major adverse liver outcome (MALO), Type 2 diabetes mellitus, any cancer, and major adverse cardiovascular events (MACE). A multivariable competing risk analysis was performed adjusting for age, sex, race/ethnicity, insurance type, primary language, smoking status, Type 2 diabetes mellitus, hypertension, hyperlipidemia, aspirin use, statin use, alcohol use disorder and a composite mental-health/substance-use disorder variable encompassing depression, anxiety disorders, post-traumatic stress disorder, bipolar disorder, schizophrenia, and non-alcohol substance use disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 11,394 patients with ALD and available SDI data, 6747 had ≥ 365 days of follow-up. The average age was 51 years and 65.6% were female; 68.8% were non-Hispanic White, 19.7% Hispanic, 5.9% Native American/Alaskan Native (NA), 3.2% Black, and 0.4% Asian/Pacific Islanders. Patients residing in the most disadvantaged neighbourhoods (Quartile 4) were significantly younger, more likely to be female, had a higher median BMI, and more frequently reported a non-English primary language compared with those in the least disadvantaged areas (Quartile 1). Patients in the most deprived neighbourhoods were more likely to be Hispanic, Black, or Native American/Alaska Native and to be uninsured or on Medicaid, whereas those in the least disadvantaged neighbourhoods predominantly had private insurance. Individuals in Quartile 4 had increased mortality (adjusted hazard ratio [aHR]: 1.48, 95% Confidence Interval [CI]: 1.09–2.01) compared with individuals in Quartile 1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large and demographically di","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1274-1287"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-10-09Epub Date: 2026-08-24DOI: 10.1111/apt.70940
Rewhandamzi Boms, Yusuke Shimakawa
<p>Chronic hepatitis B (CHB) remains a major public health challenge, disproportionately affecting low and middle-income countries [<span>1</span>]. Although effective antiviral therapy is available, identifying individuals who require treatment remains challenging in many resource-constrained settings because assessment of viral replication, liver inflammation and fibrosis relies on laboratory tests that are often inaccessible because of cost, centralized laboratory infrastructure and limited availability [<span>2</span>]. Field-adapted alternatives are beginning to emerge, including a hepatitis B core-related antigen rapid diagnostic test (HBcrAg-RDT) developed to identify individuals with high HBV DNA levels at the point of care [<span>3</span>]. Quantitative hepatitis B surface antigen (qHBsAg) provides complementary information for characterizing the phase of CHB infection, but its measurement also requires dedicated laboratory platforms rarely available in resource-limited settings [<span>4</span>]. Asmamaw and colleagues investigate whether measuring the time-to-positivity of a rapid HBsAg test can serve as a practical surrogate for qHBsAg [<span>5</span>].</p><p>Using prospectively collected samples from Spain and Ethiopia, the investigators evaluated the relationship between the time-to-positivity of a commercially available rapid HBsAg test and HBsAg concentrations quantified by chemiluminescent immunoassay. In each cohort, an optimal time-to-positivity threshold for identifying samples with qHBsAg below 1000 IU/mL was selected separately using receiver operating characteristic curve analysis and Youden's index. In Spain, a threshold of 2.37 min yielded a sensitivity of 68.2% and specificity of 91.4%. In Ethiopia, the corresponding threshold was shorter, at 1.61 min, and showed a sensitivity of 64.3% and specificity of 60.0%. These findings provide proof of concept that a conventional rapid HBsAg test may provide clinically relevant semi-quantitative information beyond the binary detection of HBsAg.</p><p>The substantial difference in optimal time-to-positivity thresholds between the Spanish and Ethiopian cohorts for distinguishing HBsAg concentrations above or below 1000 IU/mL suggests that a single universal cut-off may not be applicable across settings. Before widespread use, the optimal threshold may therefore need to be established and validated in each intended population and context, potentially limiting the simplicity and scalability of the approach. Operational feasibility also warrants careful consideration. Measuring time to positivity requires a reader to remain beside the test and continuously observe it from sample application until the test line appears, which may take several minutes and prevent the reader from attending to other tasks. Digital readers may eventually reduce the need for continuous human observation, but their feasibility, cost, and performance require evaluation under routine conditions.</p><p>Time-to-po
{"title":"Editorial: Beyond Positive or Negative—Unlocking Semi-Quantitative Information From a Rapid HBsAg Test","authors":"Rewhandamzi Boms, Yusuke Shimakawa","doi":"10.1111/apt.70940","DOIUrl":"10.1111/apt.70940","url":null,"abstract":"<p>Chronic hepatitis B (CHB) remains a major public health challenge, disproportionately affecting low and middle-income countries [<span>1</span>]. Although effective antiviral therapy is available, identifying individuals who require treatment remains challenging in many resource-constrained settings because assessment of viral replication, liver inflammation and fibrosis relies on laboratory tests that are often inaccessible because of cost, centralized laboratory infrastructure and limited availability [<span>2</span>]. Field-adapted alternatives are beginning to emerge, including a hepatitis B core-related antigen rapid diagnostic test (HBcrAg-RDT) developed to identify individuals with high HBV DNA levels at the point of care [<span>3</span>]. Quantitative hepatitis B surface antigen (qHBsAg) provides complementary information for characterizing the phase of CHB infection, but its measurement also requires dedicated laboratory platforms rarely available in resource-limited settings [<span>4</span>]. Asmamaw and colleagues investigate whether measuring the time-to-positivity of a rapid HBsAg test can serve as a practical surrogate for qHBsAg [<span>5</span>].</p><p>Using prospectively collected samples from Spain and Ethiopia, the investigators evaluated the relationship between the time-to-positivity of a commercially available rapid HBsAg test and HBsAg concentrations quantified by chemiluminescent immunoassay. In each cohort, an optimal time-to-positivity threshold for identifying samples with qHBsAg below 1000 IU/mL was selected separately using receiver operating characteristic curve analysis and Youden's index. In Spain, a threshold of 2.37 min yielded a sensitivity of 68.2% and specificity of 91.4%. In Ethiopia, the corresponding threshold was shorter, at 1.61 min, and showed a sensitivity of 64.3% and specificity of 60.0%. These findings provide proof of concept that a conventional rapid HBsAg test may provide clinically relevant semi-quantitative information beyond the binary detection of HBsAg.</p><p>The substantial difference in optimal time-to-positivity thresholds between the Spanish and Ethiopian cohorts for distinguishing HBsAg concentrations above or below 1000 IU/mL suggests that a single universal cut-off may not be applicable across settings. Before widespread use, the optimal threshold may therefore need to be established and validated in each intended population and context, potentially limiting the simplicity and scalability of the approach. Operational feasibility also warrants careful consideration. Measuring time to positivity requires a reader to remain beside the test and continuously observe it from sample application until the test line appears, which may take several minutes and prevent the reader from attending to other tasks. Digital readers may eventually reduce the need for continuous human observation, but their feasibility, cost, and performance require evaluation under routine conditions.</p><p>Time-to-po","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1306-1307"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70940","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-10-09Epub Date: 2026-08-17DOI: 10.1111/apt.70921
Malek Ayoub, Tsubasa Tsutsumi, Mary E. Rinella
Background
Metabolic dysfunction-associated steatohepatitis (MASH) is a leading indication for liver transplantation, and fibrosis stage most strongly predicts clinical outcomes. Pharmacologic treatment is now available with resmetirom and semaglutide holding conditional approval.
Aims
To describe the therapeutic landscape for MASH with a focus on anti-fibrotic impact.
Methods
Narrative review of Phase 2 and 3 trials, meta-analyses, epidemiological data, and trial registries.
Results
Historically, drugs targeting downstream fibrogenic or inflammatory pathways have had limited success in advanced development, whereas those improving metabolic dysfunction have had fared better. Fibrosis improvement by at least one stage was seen with resmetirom in up to 26% versus 14% placebo after 52 weeks and with semaglutide in 37% versus 22% after 72 weeks. Several agents in development (e.g., fibroblast growth factor 21 analogues, as well as dual and triple incretin agonists, pan-peroxisome proliferator-activated receptor agonist) report encouraging Phase 2 results, with Phase 3 trials ongoing. Compensated cirrhosis requires a distinct approach related to its fibrosis heterogeneity and burden of portal hypertension. This requires a delicate balance between efficacy and event rates that is further complicated by current regulatory constraints.
Conclusions
Fibrosis improvement in MASH is attainable by available drugs with further promise from emerging therapies. The link between treatment induced histological improvement or improvement in noninvasive tests and reduction in clinical outcomes remains unproven. A rich therapeutic pipeline with the promise of combination regimens and increased focus non-invasive endpoints suggests that the future looks bright for patients living with fibrotic MASH.
{"title":"Review Article: Fibrosis Reversal in Metabolic Dysfunction-Associated Steatohepatitis—The Promise of Emerging Therapeutics","authors":"Malek Ayoub, Tsubasa Tsutsumi, Mary E. Rinella","doi":"10.1111/apt.70921","DOIUrl":"10.1111/apt.70921","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metabolic dysfunction-associated steatohepatitis (MASH) is a leading indication for liver transplantation, and fibrosis stage most strongly predicts clinical outcomes. Pharmacologic treatment is now available with resmetirom and semaglutide holding conditional approval.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To describe the therapeutic landscape for MASH with a focus on anti-fibrotic impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Narrative review of Phase 2 and 3 trials, meta-analyses, epidemiological data, and trial registries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Historically, drugs targeting downstream fibrogenic or inflammatory pathways have had limited success in advanced development, whereas those improving metabolic dysfunction have had fared better. Fibrosis improvement by at least one stage was seen with resmetirom in up to 26% versus 14% placebo after 52 weeks and with semaglutide in 37% versus 22% after 72 weeks. Several agents in development (e.g., fibroblast growth factor 21 analogues, as well as dual and triple incretin agonists, pan-peroxisome proliferator-activated receptor agonist) report encouraging Phase 2 results, with Phase 3 trials ongoing. Compensated cirrhosis requires a distinct approach related to its fibrosis heterogeneity and burden of portal hypertension. This requires a delicate balance between efficacy and event rates that is further complicated by current regulatory constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fibrosis improvement in MASH is attainable by available drugs with further promise from emerging therapies. The link between treatment induced histological improvement or improvement in noninvasive tests and reduction in clinical outcomes remains unproven. A rich therapeutic pipeline with the promise of combination regimens and increased focus non-invasive endpoints suggests that the future looks bright for patients living with fibrotic MASH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1184-1196"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70921","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-10-09Epub Date: 2026-08-12DOI: 10.1111/apt.70904
Carmen Yagüe Caballero, Santiago García López, Ana Royo Esteban, Laura Figueras Panillo, Pilar Nos, Luisa de Castro, M. Dolores Martín-Arranz, Manuel Barreiro-de Acosta, Elena Ricart, Ruth de Francisco, Eva Iglesias, Antonio Giordano, Pilar Varela, Iago Rodríguez-Lago, Montserrat Rivero, Beatriz Sicilia, Merce Navarro-Llavat, Isabel Vera, Carles Suria, Jordi Guardiola, Jesús Barrio, Margalida Calafat, Ana Gutiérrez, Xavier Calvet, David Rafael de la Cruz, Francisco Mesonero, Cristina Martínez Pascual, Javier P. Gisbert, Carla J. Gargallo-Puyuelo, David Monfort i Miquel, Mónica Sierra, Laura Arranz, Cristina Rodríguez-Gutiérrez, Rufo Lorente, Fernando Bermejo, Lucía Márquez-Mosquera, Gisela Torres Vicente, José Lázaro Pérez-Calle, José M. Huguet, Laura Ramos, Ángel Ponferrada-Díaz, Daniel Ceballos, Mª. Teresa Diz-Lois Palomares, Eva Sesé Abizanda, Pablo Vega, Ramón Pajares, Javier Santos Fernández, Elena Betoré, David Busquets, Olga Merino, Carlos Martínez-Flores, Yamile Zabana, Manuela Josefa Sampedro González, Jone Ortiz de Zarate, Ana Fuentes Coronel, Empar Sainz Arnau, Daniel Carpio, Nuria Jiménez, Ignacio Marín-Jiménez, Luis Bujanda, Raquel Camargo Camero, Martín Irabien, María Abanades Tercero, Benito Velayos Jiménez, Pilar Robledo Andres, Ana María Trapero, Pedro G. Delgado-Guillena, Luís Hernández Villalba, Margarita Menacho, Nuria Rull Murillo, Carles Leal, Cristina Alba, Rosa Gómez Espín, Alfredo J. Lucendo, Manuel Van Domselaar, Laura García Alles, Eduardo Iyo Miyashiro, Ana Crespo Catalá, Pau Gilabert, Daniel Martín Rodríguez, Víctor Manuel Navas-López, María Calvo Iñiguez, Daniel Ginard, Teresa Martínez Pérez, Eugeni Domènech, Diego Casas Deza
Background
The expanding use of targeted therapies in inflammatory bowel disease has made treatment sequencing increasingly relevant, yet evidence on anti-TNF effectiveness after prior biologics with different mechanisms of action (MOA) remains limited. Our objective is to evaluate the durability of anti-TNF treatment in this scenario.
Methods
Multicentre study based on data from the ENEIDA registry. Patients who received second-line anti-TNF therapy after a first biologic with a different MOA for active luminal disease were identified. Using propensity score matching, each case was matched with three controls from two cohorts: patients treated with second-line anti-TNF after another anti-TNF and patients receiving first-line anti-TNF therapy. Treatment durability and short- and long-term clinical effectiveness were assessed.
Results
Sixty-six Crohn's disease patients and 117 UC patients receiving anti-TNF after other MOA were included. In CD, second-line anti-TNF therapy after a different MOA (62% ustekinumab) was associated with a higher risk of treatment discontinuation compared with first-line anti-TNF therapy (HR 1.55; 95% CI, 1.05–2.30), without significant differences in short- or long-term clinical effectiveness. In UC, anti-TNF therapy after a different MOA (90% vedolizumab) was associated with lower treatment durability compared with first-line anti-TNF therapy (HR 1.69; 95% CI, 1.31–2.19) and with anti-TNF after another anti-TNF agent (HR 1.91; 95% CI, 1.48–2.48), its remission rates significantly lower at both short- and long-term follow-up (p < 0.001).
Conclusions
Anti-TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first-line therapy or after another anti-TNF agent, especially in UC.
{"title":"Impact of Prior Biologic Mechanism of Action on Anti-TNF Effectiveness in Inflammatory Bowel Disease: An ENEIDA Registry Study","authors":"Carmen Yagüe Caballero, Santiago García López, Ana Royo Esteban, Laura Figueras Panillo, Pilar Nos, Luisa de Castro, M. Dolores Martín-Arranz, Manuel Barreiro-de Acosta, Elena Ricart, Ruth de Francisco, Eva Iglesias, Antonio Giordano, Pilar Varela, Iago Rodríguez-Lago, Montserrat Rivero, Beatriz Sicilia, Merce Navarro-Llavat, Isabel Vera, Carles Suria, Jordi Guardiola, Jesús Barrio, Margalida Calafat, Ana Gutiérrez, Xavier Calvet, David Rafael de la Cruz, Francisco Mesonero, Cristina Martínez Pascual, Javier P. Gisbert, Carla J. Gargallo-Puyuelo, David Monfort i Miquel, Mónica Sierra, Laura Arranz, Cristina Rodríguez-Gutiérrez, Rufo Lorente, Fernando Bermejo, Lucía Márquez-Mosquera, Gisela Torres Vicente, José Lázaro Pérez-Calle, José M. Huguet, Laura Ramos, Ángel Ponferrada-Díaz, Daniel Ceballos, Mª. Teresa Diz-Lois Palomares, Eva Sesé Abizanda, Pablo Vega, Ramón Pajares, Javier Santos Fernández, Elena Betoré, David Busquets, Olga Merino, Carlos Martínez-Flores, Yamile Zabana, Manuela Josefa Sampedro González, Jone Ortiz de Zarate, Ana Fuentes Coronel, Empar Sainz Arnau, Daniel Carpio, Nuria Jiménez, Ignacio Marín-Jiménez, Luis Bujanda, Raquel Camargo Camero, Martín Irabien, María Abanades Tercero, Benito Velayos Jiménez, Pilar Robledo Andres, Ana María Trapero, Pedro G. Delgado-Guillena, Luís Hernández Villalba, Margarita Menacho, Nuria Rull Murillo, Carles Leal, Cristina Alba, Rosa Gómez Espín, Alfredo J. Lucendo, Manuel Van Domselaar, Laura García Alles, Eduardo Iyo Miyashiro, Ana Crespo Catalá, Pau Gilabert, Daniel Martín Rodríguez, Víctor Manuel Navas-López, María Calvo Iñiguez, Daniel Ginard, Teresa Martínez Pérez, Eugeni Domènech, Diego Casas Deza","doi":"10.1111/apt.70904","DOIUrl":"10.1111/apt.70904","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The expanding use of targeted therapies in inflammatory bowel disease has made treatment sequencing increasingly relevant, yet evidence on anti-TNF effectiveness after prior biologics with different mechanisms of action (MOA) remains limited. Our objective is to evaluate the durability of anti-TNF treatment in this scenario.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multicentre study based on data from the ENEIDA registry. Patients who received second-line anti-TNF therapy after a first biologic with a different MOA for active luminal disease were identified. Using propensity score matching, each case was matched with three controls from two cohorts: patients treated with second-line anti-TNF after another anti-TNF and patients receiving first-line anti-TNF therapy. Treatment durability and short- and long-term clinical effectiveness were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-six Crohn's disease patients and 117 UC patients receiving anti-TNF after other MOA were included. In CD, second-line anti-TNF therapy after a different MOA (62% ustekinumab) was associated with a higher risk of treatment discontinuation compared with first-line anti-TNF therapy (HR 1.55; 95% CI, 1.05–2.30), without significant differences in short- or long-term clinical effectiveness. In UC, anti-TNF therapy after a different MOA (90% vedolizumab) was associated with lower treatment durability compared with first-line anti-TNF therapy (HR 1.69; 95% CI, 1.31–2.19) and with anti-TNF after another anti-TNF agent (HR 1.91; 95% CI, 1.48–2.48), its remission rates significantly lower at both short- and long-term follow-up (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Anti-TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first-line therapy or after another anti-TNF agent, especially in UC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1234-1247"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70904","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-10-09Epub Date: 2026-08-23DOI: 10.1111/apt.70947
Yuya Muramoto, Takeshi Kuwada, Masahiro Shiokawa
<p>Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) depends on the combined interpretation of clinical, endoscopic and histological findings. Serological markers such as ANCA and ASCA are used as adjuncts, but their accuracy in separating UC from CD is limited [<span>1</span>]. Anti-integrin αvβ6 autoantibodies were first reported in UC in 2021 [<span>2</span>]. Subsequent studies have confirmed their diagnostic value in independent cohorts [<span>3-5</span>], and anti-integrin αvβ6 autoantibodies have also been detected before the diagnosis of UC [<span>6</span>]. In this issue of <i>Alimentary Pharmacology & Therapeutics</i>, Truniger et al. prospectively studied 224 patients with established UC or CD [<span>7</span>].</p><p>Anti-integrin αvβ6 autoantibodies had an AUC of 0.897 (sensitivity 85.8%, specificity 87.1%), compared with 0.736 for the p/aANCA-positive/ASCA IgG-negative profile and 0.704 for the p/aANCA-positive/ASCA IgA-negative profile [<span>7</span>]. In this first direct comparison using the same serum samples, adding conventional ANCA/ASCA profiles provided little additional diagnostic information beyond anti-integrin αvβ6 autoantibodies, indicating that anti-integrin αvβ6 is a better serological discriminator between UC and CD than conventional testing.</p><p>The findings within CD are also informative. Positivity was 7.9% in ileal CD and 8.1% in ileocolonic CD, but 43.8% in colonic CD [<span>7</span>]. Because colonic CD is the phenotype in which separation from UC can be particularly difficult [<span>8</span>], this relatively high positivity may reduce the discriminatory value of anti-integrin αvβ6 in the subgroup in which it would be most clinically useful. It may also have biological implications, as integrin αvβ6 is induced in injured epithelium and contributes to transforming growth factor-β activation during mucosal repair [<span>2</span>]. The higher positivity in colonic CD may therefore reflect a shared colonic inflammatory pathway rather than simply false-positive results. Whether this has biological significance remains uncertain.</p><p>Whether anti-integrin αvβ6 autoantibodies are useful when the diagnosis is uncertain remains to be determined. In the present study, all patients had an established diagnosis of UC or CD, and those with indeterminate colitis were excluded. The performance of the assay in newly presenting patients, particularly those with colon-limited or unclassified disease, remains an important question.</p><p>In a direct, same-sample comparison, Truniger et al. show that anti-integrin αvβ6 autoantibodies are a better serological discriminator than ANCA and ASCA in established UC and CD. Whether this advantage extends to the diagnostically uncertain cases where it would be most valuable is the question that now warrants prospective study.</p><p><b>Yuya Muramoto:</b> conceptualization, writing – original draft, writing – review and editing. <b>Takeshi Kuwada:</b> writing – review
{"title":"Editorial: Anti-Integrin αvβ6 Autoantibodies for Distinguishing Ulcerative Colitis From Crohn's Disease","authors":"Yuya Muramoto, Takeshi Kuwada, Masahiro Shiokawa","doi":"10.1111/apt.70947","DOIUrl":"10.1111/apt.70947","url":null,"abstract":"<p>Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) depends on the combined interpretation of clinical, endoscopic and histological findings. Serological markers such as ANCA and ASCA are used as adjuncts, but their accuracy in separating UC from CD is limited [<span>1</span>]. Anti-integrin αvβ6 autoantibodies were first reported in UC in 2021 [<span>2</span>]. Subsequent studies have confirmed their diagnostic value in independent cohorts [<span>3-5</span>], and anti-integrin αvβ6 autoantibodies have also been detected before the diagnosis of UC [<span>6</span>]. In this issue of <i>Alimentary Pharmacology & Therapeutics</i>, Truniger et al. prospectively studied 224 patients with established UC or CD [<span>7</span>].</p><p>Anti-integrin αvβ6 autoantibodies had an AUC of 0.897 (sensitivity 85.8%, specificity 87.1%), compared with 0.736 for the p/aANCA-positive/ASCA IgG-negative profile and 0.704 for the p/aANCA-positive/ASCA IgA-negative profile [<span>7</span>]. In this first direct comparison using the same serum samples, adding conventional ANCA/ASCA profiles provided little additional diagnostic information beyond anti-integrin αvβ6 autoantibodies, indicating that anti-integrin αvβ6 is a better serological discriminator between UC and CD than conventional testing.</p><p>The findings within CD are also informative. Positivity was 7.9% in ileal CD and 8.1% in ileocolonic CD, but 43.8% in colonic CD [<span>7</span>]. Because colonic CD is the phenotype in which separation from UC can be particularly difficult [<span>8</span>], this relatively high positivity may reduce the discriminatory value of anti-integrin αvβ6 in the subgroup in which it would be most clinically useful. It may also have biological implications, as integrin αvβ6 is induced in injured epithelium and contributes to transforming growth factor-β activation during mucosal repair [<span>2</span>]. The higher positivity in colonic CD may therefore reflect a shared colonic inflammatory pathway rather than simply false-positive results. Whether this has biological significance remains uncertain.</p><p>Whether anti-integrin αvβ6 autoantibodies are useful when the diagnosis is uncertain remains to be determined. In the present study, all patients had an established diagnosis of UC or CD, and those with indeterminate colitis were excluded. The performance of the assay in newly presenting patients, particularly those with colon-limited or unclassified disease, remains an important question.</p><p>In a direct, same-sample comparison, Truniger et al. show that anti-integrin αvβ6 autoantibodies are a better serological discriminator than ANCA and ASCA in established UC and CD. Whether this advantage extends to the diagnostically uncertain cases where it would be most valuable is the question that now warrants prospective study.</p><p><b>Yuya Muramoto:</b> conceptualization, writing – original draft, writing – review and editing. <b>Takeshi Kuwada:</b> writing – review","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"64 9","pages":"1308-1309"},"PeriodicalIF":6.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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