Sandro da Costa Ferreira

Background: Despite recent advances in the medical treatment of ulcerative colitis (UC) involving the use of biological agents and small molecules, a proportion of patients with UC still require surgical treatment. Objective: This study evaluated patient characteristics and factors associated with colectomy in patients with UC at a tertiary IBD center. Methods: This is a retrospective and observational study utilizing the database at our university hospital. The sample comprised 232 patients diagnosed with UC, with a mean age of 46.45±15.00 years, 60.3% of whom were women. The patients were divided into two groups depending on whether or not they had undergone colectomy between January 2001 and December 2018. Results: Of all 50 (21.6%) patients underwent colectomy. Clinical intractability (40.0%) and acute severe colitis (22%) were the main indications for colectomy. Longer disease duration (P=0.035), pancolitis (82.0% vs 6.0%; P<0.001) when compared to proctitis, higher endoscopic Mayo sub-score (Mayo 3: 22.0% vs Mayo 1: 5.5%; P<0.0001), and initial use of biological agents (14.0% vs 1.1%; P0.05). Conclusion: Our study shows that a longer disease duration, extensive disease (pancolitis), and higher severity of UC at diagnosis were associated with a poor prognosis, culminating in a higher need for surgical intervention.

Background: Reports on the long-term impact on quality of life (QoL) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) are scarce in Latin America. Objective: To evaluate QoL after IPAA in an inflammatory bowel disease (IBD) referral center in Brazil. Methods: From March 2023 to August 2023, a standardized questionnaire was administered to patients with UC who had previously undergone IPAA surgery. The questionnaire addressed: (1) daily bowel movement frequency, (2) daytime and nighttime fecal incontinence, (3) need for daily medication such as loperamide, (4) fecal urgency, (5) social limitations, (6) fatigue, (7) impact on sexual life, (8) use of diapers, and (9) impact on work ability. Results: In total, 28 patients completed the questionnaire. Most patients were female (19, 67.9%), with a mean age of 44.8±10.2 years and an average follow-up time of 13.8 years. Patients reported an average of 6.0±1.8 bowel movements per day, with 27 (96.4%) experiencing diarrhea. Diaper use was generally unnecessary (22, 78.6%). Most patients had nocturnal bowel movements (24, 85.7%) and fecal urgency (17, 60.7%). Antidiarrheal medication (loperamide) was required by 21 patients (75%) to reduce bowel movement frequency. Despite high satisfaction levels with IPAA (22, 78.6%), patients reported negative impacts on bowel habits and several QoL domains, including fatigue (27, 96.4%), sexual life (18, 64.3%), social and work activities (22, 78.6%), and feelings of shame (21, 75%). However, dietary restrictions were minimal (17, 60.7%). Conclusion: Although long-term satisfaction with IPAA is high, patients experience significant negative impacts on bowel habits and QoL. These findings underscore the need for targeted strategies to improve outcomes and support for future IPAA patients.

Background/Objectives: Golimumab has proven efficacy in inducing and maintaining remission in moderate-to-severe ulcerative colitis (UC). This study evaluated the short-term and long-term effectiveness and safety of golimumab for the treatment of patients with active UC in Brazil. Methods: This observational, multicenter, retrospective, cohort study included patients with moderate-to-severe UC treated with golimumab. The primary outcome was corticosteroids-free clinical remission at weeks 24 and 54, defined as a partial Mayo score (PMS) of 0 or 1, without the need for corticosteroids (CS,) in continued treatment with golimumab. Secondary outcomes were clinical response, defined as a reduction in PMS of 50% or 3 points, and endoscopic remission, defined as a Mayo endoscopic subscore of 0. We also evaluated persistence with golimumab during follow-up. Results: Seventy-three patients were enrolled in the study. The rates of CS-free remission at weeks 24 and 54 were 43.8% and 63%, respectively. Clinical response was achieved in 50.7% and 71.2% of patients at weeks 24 and 48, respectively. Among patients undergoing endoscopic evaluation, CS-free endoscopic remission was observed in 80.8% of patients at week 24 and in 84.4% at week 54. The cumulative probability of retaining golimumab was 86.1% (95% CI 78–94) at 54 weeks. Adverse events leading to golimumab discontinuation occurred in three patients (4.1%). Conclusions: Golimumab was effective and safe as induction and maintenance therapy in patients with moderate-to-severe ulcerative colitis, leading to a high rate of persistence with golimumab maintenance after 1 year of follow-up.

Over the past decade, the therapeutic armamentarium for inflammatory bowel disease (IBD) has substantially expanded with the incorporation of multiple classes of advanced therapies. Currently, in addition to tumor necrosis factor-α inhibitors, the therapeutic arsenal for IBD includes anti-integrin agents, interleukin (IL)-12/23p40 and IL-23p19 antibodies, Janus kinase inhibitors, and sphingosine 1-phosphate receptor modulators. Although advances in IBD pharmacotherapy have enabled disease remission and improved control of intestinal inflammation in many individuals previously considered clinically 'intractable', they have also increased the complexity of decision-making related to the initial positioning and sequencing of therapies in the heterogeneous clinical presentations of IBD. Until molecular and genetic markers capable of predicting therapeutic responses become available in practice, the choice of initial and subsequent therapy in individuals with IBD is based on factors including disease severity, phenotype, risk of complications, comorbidities, extraintestinal manifestations, and the balance between efficacy, safety, convenience, and access. This review explores the factors that influence treatment decisions regarding initial therapy selection and sequencing across IBD scenarios, offering practical tips for personalizing therapy based on the safety and efficacy of advanced treatments and the individual's risk of disease- or therapy-related adverse outcomes.

Ulcerative colitis (UC) significantly impacts patients' quality of life (QoL). Therapeutic strategies have increasingly focused on achieving histological and endoscopic remission in addition to clinical outcomes and patient-reported measures. Real-world data on the effectiveness of golimumab to achieve histologic remission is scarce. This was a multicenter, cohort study including 73 patients with moderate-to-severe UC treated with golimumab across Brazilian centers. Outcomes were assessed at weeks 24 and 54 and included histological remission (Nancy histological index [NHI]), endoscopic remission (Mayo endoscopic subscore [MES]), inflammatory biomarkers (CRP and fecal calprotectin), and QoL (IBDQ-36). Correlations between histological scores with endoscopic outcomes and QoL were analyzed using Spearman test. At week 24, 32.4% of patients achieved complete histological remission (NHI grade 0), and 80.8% achieved endoscopic remission (MES 0 or 1). At week 54, 55.2% of patients had histological remission and 84.4% of patients achieved endoscopic remission. Mean CRP levels decreased from 13.16 mg/dL at baseline to 1.35 mg/dL at week 54 (p < 0.001), and mean calprotectin decreased from 2113.2 mcg/g to 106.9 mcg/g (p < 0.001). QoL significantly improved, with IBDQ-36 scores increasing from 121.5 at baseline to 182.1 at week 24 and 194.2 at week 54 (p = 0.002). Significant correlations were observed between NHI with MES and IBDQ-36 at week 24. Golimumab has achieved sustained efficacy in the induction of histological and endoscopic remission and improvement in QoL in patients with moderate-to-severe UC in a real-world setting. These results support the use of golimumab as an effective, patient-centered therapeutic option, particularly when multidimentional disease control is the goal.

To assess the real-life, long-term effectiveness and safety of tofacitinib in a large cohort of patients with refractory or difficult-to-treat ulcerative colitis (UC). This multicenter, retrospective, observational cohort study included patients with moderately to severely active UC who received tofacitinib for at least 8 weeks. Clinical remission and response, endoscopic response and remission, biochemical response and remission, steroid-free clinical remission, primary and secondary loss of response, drug discontinuation, the need for dose optimization, the need for colectomy, and adverse events were evaluated over up to 30 months. We included 127 patients with UC, with a mean age of 40.3 ± 14.2 years; 58.2% were male, 75.6% had pancolitis, and 79.5% had previously failed at least one biological therapy, predominantly anti-TNF agents (70.1%). Clinical remission was observed in 31.5% of patients at weeks 12-16, 46.5% at 26 ± 4 weeks, and 37.0% at 1 year. Steroid-free clinical remission was achieved in 28.6%, 44.8%, and 37.1% of patients at the same time points, respectively. Biochemical remission was achieved in 33.6% of patients at 26 ± 4 weeks and 29.3% at 1 year. Endoscopic response and endoscopic remission within 1 year were observed in 46.0% and 15.3% of patients, respectively. Ten patients (7.9%) required colectomy, and 13 patients (10.2%) required hospitalization, all of whom had been previously exposed to biologics. The colectomy rate was significantly greater in patients with serum albumin levels ≤ 3.5 g/dL (21.4% vs. 4.1%, p = 0.013). In this large, long-term real-world study involving patients with predominantly biologically refractory UC, tofacitinib effectively induced clinical remission and endoscopic improvement and prevented colectomy for more than 30 months, with a favorable safety profile. Notably, baseline hypoalbuminemia was associated with higher colectomy rates.

Guillain-Barré Syndrome in a Patient Receiving Anti-Tumor Necrosis Factor for Crohn Disease: Coincidence or Consequence? - Article abstract #943709

Background: Real-world data on the effectiveness and safety of ustekinumab (UST) in ulcerative colitis (UC) are lacking in Latin America. In this study, we aimed to describe the effectiveness and safety of UST in a real-world multicenter cohort of Brazilian patients with UC. Methods: We conducted a multicenter retrospective observational cohort study, including patients with moderate-to-severe UC (total Mayo score 6–12, with an endoscopic subscore of 2 or 3) who received UST. The co-primary endpoints were clinical remission, defined as a total Mayo score ≤2 at 1 year, with a combined rectal bleeding and stool frequency subscore of ≤1, and endoscopic remission (endoscopic Mayo subscore of 0) within 1 year from baseline. Secondary endpoints included clinical response between weeks 12 and 16, endoscopic response within 1 year of starting UST, steroid-free clinical remission at week 52, and biochemical remission at week 52. We also evaluated UST treatment persistence and safety. Results: A total of 50 patients were included (female, n = 36, 72.0%), with a median disease duration of 9.2 years (1–27). Most patients had extensive colitis (n = 38, 76.0%), and 43 (86.0%) were steroid dependent at baseline. Forty patients (80.0%) were previously exposed to biologics (anti-TNF drugs, n = 31; vedolizumab [VDZ], n = 27). The co-primary endpoints of clinical remission at 1 year and endoscopic remission within 1 year were achieved by 50.0% and 36.0% of patients, respectively. Clinical response at weeks 12–16 was 56.0%, and endoscopic response, steroid-free clinical remission, and biochemical remission at week 52 were 68.0%, 46.5%, and 50.0%, respectively. The UST treatment persistence rate at 24 months was 73.7%. During the follow-up, 10 patients (20.0%) were hospitalized, mostly due to disease progression, and 3 patients required colectomy. Nine patients (18.0%) discontinued the drug mainly due to a lack of effectiveness. Twenty-seven adverse events (AEs) were reported, 16 of which were considered as serious AEs. Conclusions: In this real-world cohort of difficult-to-treat UC patients, UST was associated with improvements in clinical, biochemical, and endoscopic outcomes. The safety profile was favorable, consistent with the known profile of UST.

To evaluate patient characteristics and factors associated with surgical resection in patients with Crohn’s disease (CD).