Mater Group was formed in 2016 by aligning Mater Health, Mater Education, Mater Research and Mater Foundation under a single, unified banner. Mater provides care for some 500,000 patients each year. Mater was established in 1906 by the Sisters of Mercy. In 2002, Mater became an incorporated body, charged with the responsibility to continue the Mission of the Sisters of Mercy to "offer compassionate service to the sick and needy".
Eplerenone is a mineralocorticoid receptor antagonist with minimal affinity for androgen receptors. Mineralocorticoid receptor antagonists are efficacious in the management of resistant hypertension, obstructive sleep apnea, cardiac dysfunction, renal tubular disorders, hepatic cirrhosis, portal hypertension, diabetic nephropathy, proteinuric kidney disease, and chronic central serous chorioretinopathy in the general population. Five cases describing the use of eplerenone in pregnancy are discussed, the previous literature reviewed, and potential indications for the use of eplerenone in pregnancy discussed.
Perianal fistulising Crohn’s disease (pfCD) is a challenging phenotype that markedly affects quality of life. Anti-TNF therapy, particularly infliximab, is commonly used first-line, yet primary non-response and secondary loss of response remain frequent. Adalimumab is often used second-line despite limited evidence. This study evaluated real-world outcomes of first- versus second-line adalimumab in pfCD to inform therapeutic sequencing. A multicentre retrospective cohort study included adult pfCD patients treated between 2005 and 2024. The primary outcome compared adalimumab second-line (after infliximab) versus first-line using changes in the Perianal Disease Activity Index (PDAI). Secondary outcomes were hospitalisation and antibiotic use. Response was assessed at early (£24 weeks) and late (>24 weeks) time points. Analyses used Mann–Whitney U for continuous and Fisher’s exact for categorical variables. Of 167 patients, 107 received adalimumab first-line and 60 second-line. Among those previously exposed to infliximab, 45% stopped due to loss of response after initial response, 16% had non-response despite adequate levels, 25% ceased due to intolerance or adverse effects, and 11% due to patient preference. Second-line patients were older, had higher BMI, fewer smokers, and more stricturing disease, with similar immunomodulator use. PDAI pain improvement was greater with first-line therapy early (46% vs 4%, p < 0.01) but not late (50% vs 9%, p = 0.07). Hospitalisations, including for surgical management, were higher second-line (13% vs 11%, p = 0.04) at > 24 weeks. No differences were observed in PDAI discharge sub scores, clinical healing or response, or antibiotic use. More first-line patients remained on adalimumab (77% vs 28%, p < 0.01) over follow-up (median 82 months, IQR 73), although treatment duration before cessation was similar (40 vs 40 months, p = 0.47). Dose escalation was comparable (54% vs 37%, p = 0.71). The distinction between true non-response and secondary loss of response was limited by the absence of pharmacokinetic data and incomplete documentation. In pfCD, first-line adalimumab delivers greater improvements in PDAI pain sub scores and fewer hospitalisations on late outcomes assessment compared with second-line use. Adalimumab is effective after infliximab failure despite its similar mechanism of action, positioning it as a viable second-line option. Future studies incorporating standardised clinical and patient-reported outcome measures with radiological endpoints are needed to refine therapeutic sequencing in this high-risk population. Conflict of interest: Dr. Hartley, Imogen: Scholarship to attend conference- Celltrion Tassone, Daniel: No conflict of interest Winata, Leon Shin-ha: No conflict of interest Sy, Meredith: No conflict of interest Chow, Jocelyn Hui Ching: No conflict of interest McCurdy, Jeffrey: No conflict of interest Ravikulan, Abhimati: No conflict of interest Gabrielson, Stefan: No conflict of interest Su, Heidi: Advisory Board - Takeda, Johnson & Johnson Speaker fees - Takeda, Johnson & Johnson, GSK Xia, Bowen: No conflict of interest Keung, Charlotte: No conflict of interest Lai, Karen Hei-Tung: No conflict of interest Mak, Joyce Wing Yan: No conflict of interest Welman, Christopher J: No conflict of interest Thin, Lena: Pfizer- advisory board fees, research grants Takeda- research grant, advisory board fees JNJ- advisory board fees Abbvie- advisory board fees Neuroscientific - advisory committee Celltriom- advisory board fees Chen, Lynna: No conflict of interest Nguyen, Andrew: No conflict of interest Srinivasan, Ashish: AS has served as a speaker for Arrotex Pharmaceuticals and has received advisory fees or conference support from AstraZeneca, AbbVie, Takeda Pharmaceuticals, and Dr Falk Pharma. Wu, Hsin-Yun: No conflict of interest Wei, Shu Chen: Consultancy fees: AbbVie, Bristol Myers Squibb, Cornerstones, Ferring Pharmaceuticals Inc., Janssen/J & J, Pfizer, Sanofi, SPYRE, Takeda, ThermoFisher. Lectures and/or speakers’ bureau payments: AbbVie, Bristol Myers Squibb, Celltrion, CornerStones, Excelisior, Ferring Pharmaceuticals Inc., Janssen/J & J, Pfizer, Takeda, ThermoFisher. Van Wees, Jacoba: No conflict of interest Sparrow, Miles P.: Educational grants or research support – Gilead, Celltrion Speaker’s fees – Janssen, Abbvie, Ferring, Takeda, Pfizer, Celltrion, Eli Lilly, Dr. Falk Pharma Advisory boards or consultancy fees – Janssen, Takeda, Pfizer, Celgene, Abbvie, MSD, Emerge Health, Gilead, BMS, Celltrion, Eli Lilly, Alimentiv Lai, Mark: No conflict of interest Kalasabail, Sanjna: No conflict of interest Borok, Nira: No conflict of interest Connor, Susan Jane: Grant: Research Support: Abbvie, Agency for Clinical Innovation, Amgen, BMS, Chiesi, Celltrion, DrFalk, Ferring, Janssen, Medical Research Future Fund, Pfizer, South Western Sydney Local Health District, Sydney Partnership for Health, Research and Enterprise, Takeda and The Leona M and Harry B Helmsley Charitable Trust Personal Fees: Ad Boards: Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Ferring, GSK, Janssen, Organon, Pfizer, Takeda Speaker Fees: Abbvie, Cornerstones Health, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Sydney IBD School, Takeda Educational Support: DrFalk, Sandoz, Takeda Chen, Cheng-Yu: No conflict of interest Shibu, Roney: No conflict of interest Mohsen, Waled: No conflict of interest An, Yoon-Kyo: Yoon-Kyo An has received speaking and consulting fees from Abbvie, Bristol Myers Squibb, Celltrion, Chiesi, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Shire and Takeda served on advisory boards member for Abbvie, Bristol Myers Squibb, Chiesi, Janssen, NPS Medicine wise, Microba received research and educational funding from Abbvie, Celltrion, Dr Falk, Janssen, Pfizer, Sandoz and Takeda. Tan, Ethan: No conflict of interest Xu, Ziheng: No conflict of interest Garg, Mayur: No conflict of interest Lo, Sheng Wei: No conflict of interest De Cruz, Peter: No conflict of interest Pelly, Theo: No conflict of interest Hart, Ailsa: Grant: Takeda Personal Fees: Abbvie, Amgen, Arena, AZ, Falk, Celltrion, Eli Lilly, Ferring, Genentech/ Roche, GSK, Pfizer, Takeda, Napp, Pharmacosmos, Janssen (J & J), Bristol-Myers Squibb, Gilead, Galapagos, Alfasigma Ding, Nik John Sheng: Grant: Forcrohn’s, ECCO, GESA Personal Fees: Abbvie, Pfizer, Ferring ANZIBD Consortium, ANZIBD Consortium: No conflict of interest
Introduction The optimal treatment target for Crohn’s disease (CD) is unknown. Targeting transmural healing (TMH) may be associated with a lower risk of complications than clinical and endoscopic outcomes. The Study to Evaluate Transmural Healing as a Treatment Target in Crohn’s Disease (VECTORS) aims to investigate TMH as a potential treatment target and its long-term benefits in patients with CD.Methods and analysis VECTORS is a phase 4, interventional, parallel-group, multicentre, randomised controlled trial. Approximately 304 adult patients with moderately to severely active CD from multiple international sites will be enrolled and randomly assigned in a 1:1 ratio to treatment target group 1 (corticosteroid-free intestinal ultrasound-based response or TMH plus clinical and biomarker remission) or group 2 (corticosteroid-free clinical and biomarker remission). All patients receive vedolizumab according to the standard dosing regimen, with an additional dose at week 10, followed by a treatment escalation algorithm to reach the assigned targets. Randomisation will be stratified by prior advanced therapy exposure, disease location and disease duration. The primary objective is to determine if treatment target group 1 is superior to group 2 for the primary efficacy outcome of corticosteroid-free endoscopic remission at week 48. CD-related complications (key secondary outcome) are assessed at week 96.Ethics and dissemination The trial is conducted in compliance with the protocol and applicable regulatory requirements and is approved by institutional review boards/independent ethics committees at the country or site level. Patients’ written informed consents are obtained and documented prior to trial participation. Findings will be disseminated in peer-reviewed journals and at scientific congresses.Trial registration numbers NCT06257706; EUCT, 2023-509096-16-00.
