A variety of exciting findings from inflammatory bowel disease (IBD) research were presented at the Congress of the European Crohn’s and Colitis Organisation (ECCO), held in Copenhagen, March 7–9.
Shixian Hu (Universitair Medisch Centrum Groningen, The Netherlands) reported on associations between genetic factors and the microbiome in patients with IBD. Hu et al performed whole-exome sequencing of genomes, and whole-genome shotgun sequencing of fecal samples, from 524 patients with IBD and 939 individuals without IBD (controls). They then analyzed interactions among exon variants, microbial taxa, and metabolic pathways. The authors associated mutations in CYP2D6, which has been associated with IBD and is a component of phase I drug metabolism, with decreased bacterial synthesis of vitamin K (PWY-5838). Hu et al also associated mutations in GPR151 with reduced bacterial degradation of glucose. The interaction analysis revealed an association between variants in BTNL2 and bacteroides specific to patients with IBD. Hu concluded that genetic alterations in patients with IBD affect intestinal microbes and their metabolites.
Arie Levine (Wolfson Medical Center, Israel), presented results from studies of the Crohn’s disease exclusion diet (CDED)—a whole-food diet coupled with partial enteral nutrition designed to reduce exposure to food components believed to have negative effects on the intestinal microbiome and barrier and innate immunity. The authors compared the CDED vs exclusive enteral nutrition in a 12-week randomized controlled trial of 74 children with mild to moderate luminal CD. The CDED and exclusive enteral nutrition each resulted in high rates of corticosteroid-free remission in the intent to treat analysis, with a significant decrease in inflammation (based on level of C-reactive protein). The CDED was tolerated by 97.5% of the children, compared to 73.7% for exclusive enteral nutrition. Levine concluded that these data support the use of CDED as a first-line therapy for children with luminal mild to moderate active CD, as well as the concept that diet affects inflammation in patients with CD.
Johann Burisch (North Zealand University Hospital, Denmark) presented findings from a population-based inception cohort of unselected patients with IBD, showing that overall direct expenditure on healthcare decreased over a 5-year follow-up period in parallel with increased expenditures on biologic agents for treatment—especially in patients with CD. Burisch et al provided evidence that treatment of IBD with biologic agents reduces expenditure on standard medical treatments, surgery, and hospitalization. Their findings indicate a cost-saving effect of biologic medications for IBD, despite their high initial cost.
Geert D’Haens (Academic Medical Centre, The Netherlands), presented findings from a multi-center, open-label, phase 2 extension study (OPERA II, NCT01298492) to assess the long-term safety and efficacy of a monoclonal antibody against MADCAM1 (called SHP647) in patients with moderate to severe CD. At baseline, 169 patients had already been classed as responders to this agent, and 89 as nonresponders. D’Haens presented results from 149 patients who received SHP647 (75 mg, subcutaneously) every 4 weeks from weeks 0–72 and were followed monthly for an additional 24 weeks. The group found that remission rates were sustained over 72 weeks of treatment SHP647, regardless of initial response to induction treatment or dose-escalation status. Levels of C-reactive protein and fecal calprotectin were higher in patients who received dose escalations than those who remained at 75 mg. D’Haens concluded that these findings support the long-term efficacy of SHP647.