Background/Objectives: Differential diagnosis between Crohn's disease (CD) and ulcerative colitis (UC) can be sometimes difficult resulting in the diagnosis of unspecified inflammatory bowel diseases (IBD-U). Data suggest that IgG antibodies against integrin αvβ6 (V6 Ab) help to identify UC patients. Recent studies suggest that measuring V6 Ab serum levels may be valuable for differential diagnostic purposes. The primary objective of the study was to assess the sensitivity and specificity of V6 Ab serum-level measurement in our IBD population to differentiate between colonic/ileocolonic CD and UC with an established diagnosis. Furthermore, we assessed the correlation between disease characteristics, activity and V6 Ab serum levels in UC patients. Methods: Consecutive IBD patients with an established diagnosis undergoing control colonoscopy in a tertiary IBD center were included. Baseline demographic data, current treatment, disease extent, clinical, biomarker, endoscopic and histologic disease activity were collected. V6 Ab serum levels were measured with the Anti-Integrin αvβ6 ELISA Kit (RUO). Patients' written informed consent was obtained. Results: A total of 40 IBD patients, including 10 CD and 30 UC patients (15 with clinical activity and 15 in clinical remission) were enrolled. V6 Ab serum levels were significantly higher in UC patients compared to CD (p = 0.039). ROC analysis found 1.33 U/mL to be the best cut-off level (p = 0.04; AUC: 0.71) with 100% sensitivity and 50% specificity and a positive predictive value of 85.7% and a negative predictive value of 100% to differentiate between UC and CD. No significant correlation was found between V6 Ab serum levels and CRP (p = 0.057), fecal calprotectin (p = 0.77), endoscopic activity (p = 0.624) or disease extent (p = 0.624) in UC patients. Conclusions: Our study supports the value of V6 Ab serum level measurement as a differential diagnostic tool in IBD patients; however, the optimal cut-off value is yet to be determined. Our data do not support its role in disease activity monitoring.

BACKGROUND:The aim of this study was to determine if Crohn's disease (CD) and ulcerative colitis (UC) manifest similarly in different parts of the world. METHODS:Investigators of cohort studies from around the world were contacted to provide the most recent data from their CD and UC cohorts. Each cohort provided summated and averaged data on pre-specified variables. The Montreal Classification was used for phenotype assessment. Age at diagnosis was stratified into less than 17 years, 17-39 years, and >39 years. Disease location for CD was stratified as ileum only, colon only, ileocolon, upper gastrointestinal and proximal small bowel disease, and perineal penetrating disease. Disease behavior for CD was stratified into inflammatory disease, stricturing disease, and penetrating disease. Location for UC was stratified into proctitis, left-sided colitis, and extensive including subtotal and pancolitis. Reports were classified geographically as Asia, Latin America, South Africa, and "Western" (ie, North America, Europe, and Oceania). These categories were collapsed to "Western" and "non-Western" for analyses. RESULTS:Data from 54 868 patients with IBD were included. For CD, data were available from nine Western cohorts, 12 Asian cohorts, three Latin American cohorts, and one African cohort. For UC, eight Western cohorts were compared with 11 Asian cohorts, three Latin cohorts, and one African cohort. The demographic and phenotypic distribution for CD and UC in comparisons between Western and non-Western countries were no different. Western cohorts had longer disease durations than non-Western cohorts. CONCLUSION:No significant differences were seen in any phenotypic data between the cohorts, suggesting that IBD is similar worldwide.

BACKGROUND:Endoscopic and histologic evaluation is part of routine clinical practice to confirm the presence of active disease in ulcerative colitis. Faecal calprotectin (FCAL) levels show a positive correlation with endoscopic indices, relapse, and response to treatment. Existing studies have not clearly determined cut-off values for endoscopic and histologic remissions. AIMS:Our study aims to determine an optimal FCAL threshold for discriminating between endoscopic and histologic active disease and remission in UC, based on the Mayo Endoscopic Score (MES) and the Geboes Histologic Score. METHODS:We performed a pooled analysis of retrospective and prospective studies of patients with UC from four academic centres. Key inclusion criteria were adult UC patients undergoing colonoscopy, with FCAL measurements. Receiver operating characteristic curves were computed on 80% of the data using 5-fold cross-validation to determine the optimal FCAL threshold for predicting active UC based on specificity (spec) and sensitivity. Optimal thresholds were then tested on the remaining 20% of the data. Active endoscopic disease was assessed using MES 0-1 versus 2-3 and MES 0 versus 1-3, and active histologic disease or remission was evaluated using GHS < 3.1 versus GHS ≥ 3.1 and GHS ≤ 2.0 versus GHS > 2.0. RESULTS:A total of 741 patients with UC were included in our analysis. For MES 0 versus 1-2-3, the AUC was 0.716 (95% CI: 0.701-0.731, p < 0.0001) with an optimal threshold of 154.3 μg/g (specificity: 0.69 [95% CI: 0.65-0.72], sensitivity: 0.64 [95% CI: 0.60-0.69]). For MES 0-1 versus 2-3, the AUC increased to 0.802 (95% CI: 0.797-0.807, p < 0.0001), with an optimal FCAL threshold of 234.6 μg/g (specificity: 0.74 [95% CI: 0.74-0.75], sensitivity: 0.69 [95% CI: 0.62-0.75]). For GHS ≤ 2.0 versus GHS > 2.0, the AUC was 0.656 (95% CI: 0.647-0.664, p < 0.0001), with an optimal threshold of 117.6 μg/g (specificity: 0.61 [95% CI: 0.56-0.66], sensitivity: 0.59 [95% CI: 0.56-0.63]). For GHS < 3.1 vs. GHS ≥ 3.1, the AUC was 0.752 (95% CI: 0.743-0.762, p < 0.0001), with an optimal threshold of 166.2 μg/g (specificity: 0.69 [95% CI: 0.66-0.73], sensitivity: 0.69 [95% CI: 0.63-0.76]). Given the high AUC for MES 0-1 vs. MES 2-3, we tested different FCAL thresholds from the literature and propose a threshold of 170 μg/g to maximize sensitivity (sensitivity: 0.801 [95% CI: 0.729-0.873], specificity: 0.648 [95% CI: 0.641-0.656], LR+ 2.311 [95% CI: 2.001-2.670], LR- 0.289 [95% CI: 0.196-0.427], accuracy 67.62% [95% CI: 65.95-69.30]) and limit the proportion of false negatives. CONCLUSIONS:Our study demonstrates that FCAL can predict both active endoscopic and histological disease with acceptable sensitivities and specificities. The proposed cut-off values will help guide clinical practice to achieve the recommended treatment outcomes. Further studies are warranted to validate our results.

The prevalence of inflammatory bowel diseases is increasing among the elderly. Older patients with inflammatory bowel disease represent a vulnerable population whose treatment strategies are significantly impacted by comorbidities and frailty. We present the case of a 69-year-old, Hungarian, nonsmoker female patient with a history of elderly-onset inflammatory bowel disease. The patient has longstanding type 2 diabetes (on insulin since 2011) and is being treated for hypertension and hyperlipidemia. In 2011, a diagnosis of left-sided ulcerative colitis was made, presenting with symptoms of fever and bloody diarrhea. Following the ineffectiveness of several conservative treatment modalities, the patient initially underwent adalimumab therapy, exhibiting primary nonresponse. Subsequently, the treatment was switched to vedolizumab, but she later developed secondary loss of response. She was diagnosed with end-stage renal disease and was started on hemodialysis in January 2022. In May 2023, because of severe endoscopic and symptomatic disease activity (endoscopic Mayo score 3, partial Mayo score 6, C-reactive protein 26.0 mg/L, hemoglobin 111 g/L, albumin 39 g/L), infliximab therapy was initiated. We measured serial serum drug and anti-drug antibody concentrations to monitor the efficacy of the therapy and the effect of hemodialysis on drug concentrations. The patient responded to infliximab therapy, leading to clinical remission. Infliximab serum drug concentrations remained unaffected by hemodialysis. This case clearly illustrates the impact of comorbidities and the importance of a multidisciplinary approach in the management of elderly patients with inflammatory bowel disease. We demonstrated that infliximab therapy is effective and safe in the presence of concomitant severe inflammatory bowel disease and end-stage renal disease requiring hemodialysis.

INTRODUCTION:Up to 50% of patients with Crohn's disease (CD) will require surgery, and 70% to 90% experience endoscopic recurrence (ER) within the first year postoperatively. Despite various treatments, there are scant data on their comparative efficacy to prevent recurrence. This study aimed to compare the efficacy of medical treatments in preventing postoperative recurrence of CD. METHODS:A comprehensive literature review was conducted through January 2025. We included randomized controlled trials and prospective cohort studies, excluding pediatric studies, single-arm trials, and dose comparison studies. The primary endpoint was assessing ER (Rutgeerts score ≥i2) at 6 months, and secondary outcomes were clinical recurrence (Crohn's Disease Activity Index ≥150, Hanauer score ≥2, or Harvey-Bradshaw Index ≥8) at 6, 12, and ≥18 months postoperatively. Frequentist random-effects network meta-analysis was conducted, reporting odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS:A total of 42 studies were included, of which 38 were randomized controlled trials, with a total of 2260 patients. At 6 months, adalimumab (ADA) ranked highest in reducing ER (surface under the cumulative ranking curve [SUCRA] = 84.5%), followed by vedolizumab (VDZ) (SUCRA = 74.5%). ADA significantly reduced ER compared with thiopurines (THPs) (OR, 0.33; 95% CI, 0.12-0.91), probiotics (OR, 0.17; 95% CI, 0.03-0.99), and vitamin D (OR, 0.07; 95% CI, 0.01-0.37). VDZ did not significantly differ from THPs, ADA, or metronidazole. At 12 months, infliximab (IFX) (SUCRA= 93%) and ADA (SUCRA = 90%) had the lowest ER, with IFX showing significant reductions compared with THPs, metronidazole, and 5-aminosalicylic acid. Similar findings were observed at 18 months, with IFX and ADA maintaining the lowest ER rates. For clinical recurrence, no significant differences were observed among therapies at 6 months; however, at 12 months, ADA and IFX were superior to most therapies, including THPs and budesonide. CONCLUSION:Anti-tumor necrosis factor agents, namely ADA and IFX, are the most effective treatments in reducing postoperative recurrence of CD, followed by VDZ. THPs and antibiotics ranked lower than biologics. Nonpharmacological interventions such as curcumin, vitamin D, and probiotics did not demonstrate efficacy in reducing postoperative recurrence.

Introduction:Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease that is often complicated by severe pruritus, which can profoundly impair quality of life. In select cases, intractable pruritus is an independent indication for liver transplantation (LT) even in the absence of advanced liver disease, recurrent cholangitis, or malignancy. Conventional pharmacological and endoscopic therapies frequently provide only partial or transient relief, highlighting the need for mechanism-based treatments. Case Presentation:We report the case of a 32-year-old man with long-standing PSC and Crohn's disease (CD) who developed severe treatment-refractory pruritus despite multiple conventional pharmacologic therapies and endoscopic biliary interventions. In the absence of advanced liver disease or malignancy, he underwent LT evaluation primarily due to debilitating pruritus significantly impairing quality of life, with secondary consideration given to medically and endoscopically challenging but manageable recurrent dominant common bile duct stricture and episodes of acute cholangitis. Upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, was initiated for a CD flare, after which pruritus completely resolved within 48-72 h. Maintenance therapy with upadacitinib 30 mg daily has sustained symptom-free status for over 27 months, markedly improving quality of life and allowing the patient to remain inactive on the liver transplant waitlist. Conclusion:This case demonstrates the rapid and durable resolution of PSC-associated pruritus with JAK1 inhibition. Effective symptom control allowed deferral of LT driven primarily by quality-of-life impairment, with the patient remaining inactive on the waitlist. To our knowledge, this is the first reported case of successful treatment of PSC-associated pruritus with upadacitinib, supporting further investigation of JAK1 inhibition as a potential therapeutic strategy for cholestatic pruritus.

Background/Objectives: Inflammatory bowel diseases (IBD) including ulcerative colitis and Crohn’s disease can be associated with other immune-mediated inflammatory diseases (IMIDs) and extraintestinal manifestations (EIM) including dermatological manifestations, ophthalmologic manifestations, musculoskeletal manifestations and neurological manifestations. The aim of this narrative review is to discuss the optimal management and treatment strategy of IBD with immune-mediated inflammatory disease and extraintestinal manifestations. Methods: This review is based on published studies searched in PubMed until 31 December 2025. Our search focused on systemic reviews, review articles, randomized trials, cohort studies, guidelines and case series. Results: In IBD, the presence of additional immune-mediated inflammatory diseases (IMIDs) should be considered a poor prognostic factor, prompting closer disease monitoring and earlier escalation to or optimization of advanced therapy. Therapeutic management requires careful consideration including a multidisciplinary approach and a selection of the most appropriate treatment option(s) based on the presence, severity of IBD and/or IMIDs and/or EIM. For patients with refractory disease affecting multiple organs, emerging strategies include dual biologic therapies. Conclusions: The optimal management of IBD with associated IMIDs/EIM should be multidisciplinary in close cooperation among specialists to align treatment goals and management plans.

Background: Crohn's disease complicated by intra-abdominal abscesses often requires surgery. Percutaneous drainage may prevent surgery, but optimal post-drainage management is unclear. We aimed to analyze the long-term outcomes of Crohn's disease with intra-abdominal abscesses after intervention. Methods: Patients with penetrating Crohn's disease and a single intra-abdominal abscess were enrolled in this multicenter, international, retrospective study after the detection of the abscess (baseline), with a minimum follow-up of 12 months. Those requiring urgent bowel resection were excluded. Patients were grouped by elective surgical need after successful (catheter insertion with effective drainage) percutaneous drainage (controls: no pre-resection drainage). The primary outcome was abscess recurrence. We also assessed stoma rate, post-procedural complications, hospitalizations, advanced treatment need, postoperative luminal recurrence, and need for re-drainage. Results: We studied 157 patients with Crohn's disease (9 countries; males: 58%, median age: 32.4 [interquartile range: 25-39 years]); 89/157 underwent percutaneous drainage (median follow-up: 95.9 weeks [interquartile range: 58-104]). Abscess recurrence did not differ by drainage (p = 0.221). Abscess size was associated with advanced-treatment initiation (Odds ratio: 0.978; 95% confidence interval: 0.960-0.997, p = 0.023) and postoperative luminal recurrence (Odds ratio: 1.044, 95% confidence interval: 1.012-1.078, p = 0.007). Time to resection was longer after drainage, and ROC analysis raised predictive value for re-drainage (16.6 weeks post-drainage; AUC = 0.82, 95% confidence interval: 0.73-0.92). Patients without drainage had more post-procedural complications. Conclusions: Abscess size should guide management. Delayed resection may increase re-drainage odds, whereas surgery alone may have higher complication rates. Percutaneous drainage can safely postpone resection.

Extensive pseudopolyposis in ulcerative colitis (UC) is rare and can lead to protein-losing enteropathy (PLE) with severe hypoalbuminemia. We report an 18-year-old male with steroid-dependent UC complicated by extensive colonic pseudopolyposis causing PLE. This represents one of the few reported cases of PLE secondary to extensive colonic pseudopolyposis in UC. He presented with profound hypoalbuminemia reaching a nadir of 1.0-1.5 g/dL, malnutrition, iron-deficiency anemia, and deep-vein thrombosis. Colonoscopy and imaging revealed dense pseudopolyps from the proximal sigmoid to the cecum, with minimal inflammation. Renal and hepatic causes of protein loss were excluded through routine urinalysis, the absence of proteinuria, normal creatinine levels, normal liver enzymes, and unremarkable renal and hepatic imaging. Although formal quantitative PLE testing, such as α-1 antitrypsin clearance, was unavailable at our center, the persistent severe hypoalbuminemia, minimal inflammatory activity, and exclusion of alternative etiologies strongly supported a diagnosis of pseudopolyposis-associated PLE. Management included multiple biologics, steroid tapering, total parenteral nutrition, and anticoagulation; colectomy was declined. Clinicians should maintain a high index of suspicion for PLE in UC patients with extensive pseudopolyposis and hypoalbuminemia disproportionate to the degree of inflammation.

Abstract Background Ulcerative Colitis (UC) is a chronic inflammatory bowel disease characterized by relapsing inflammation of the colon. Current therapeutic goals emphasize clinical and endoscopic remission; however, histological remission has emerged as an important target due to its association with reduced relapse rates and improved long-term outcomes. Despite this, limited data exist on the concordance of histological activity between colonic segments, especially in UC patients in clinical remission. This study investigates the correlation between histological disease activity in the rectosigmoid colon (RSC) and other colonic segments in patients with UC in clinical remission. Methods This prospective study analyzed data from 203 UC patients in clinical remission, defined as a partial Mayo score ≤2 and rectal bleeding score = 0 for at least three months. Colonoscopies with segmental biopsies were performed, and histological activity was assessed using the Geboes score. Histological remission was defined as a Geboes score <2A.0, while active disease was classified as ≥3.1. Correlation between histological activity in the RSC and other colonic segments was evaluated using Spearman’s correlation coefficients and logistic regression. Statistical significance was defined as p < 0.05. Results Among the 203 patients, the median age was 45 years, with 55.1% having pancolitis. Histological activity in the RSC showed poor correlation with other colonic segments. In patients with a RSC Geboes score of ≥3.1, the correlation coefficient between the RSC and descending colon was 0.05 (p = 0.62), between the RSC and transverse colon was -0.03 (p = 0.71), and between the RSC and right colon was 0.12 (p = 0.09). In patients with a RSC Geboes score of <2A.0, the correlation coefficient between the RSC and descending colon was 0.12 (p = 0.22), between the RSC and transverse colon was 0.05 (p = 0.59), and between the RSC and right colon was 0.18 (p = 0.01). Even among patients with pancolitis, histological concordance between segments remained low. These findings underscore substantial segmental variability in histological activity. Conclusion Flexible sigmoidoscopy (FS) is commonly used to monitor UC due to its practicality; however, our findings suggest FS may not reliably reflect proximal histological disease. The lack of concordance highlights the limitations of FS in accurately assessing histological remission, including in patients with pancolitis or extensive colitis. Full colonoscopy with segmental biopsies remains the gold standard for comprehensive disease evaluation and management. Further research is warranted to refine histologic assessment strategies in UC.

Abstract Background Ustekinumab (UST) and vedolizumab (VED) have proven to be effective therapies for ulcerative colitis (UC), with similar safety profiles. There are limited real-world studies comparing the effectiveness between UST and VED in UC, especially after anti-TNF failure1–4. Our aim was to evaluate the real-world efficacy and safety of UST and VED in UC patients previously exposed to anti-TNF therapies across multiple Canadian institutions. Methods This was a multicentre retrospective study looking at 12 months of clinical data for patients with UC who had previously been exposed to at least one anti-TNF. These patients were from McGill University Health Centre, Hamilton Health Sciences, and London Health Sciences Centre. The primary outcome was clinical remission at 6 months, defined by a partial Mayo score (pMS) ≤ 2, Mayo Endoscopic Score (MES) ≤ 1, or physician’s judgement of clinical remission. Secondary outcomes included clinical remission at 12 months, clinical response, biochemical remission and response, and drug persistence at 12 months. Clinical response was defined as a decrease in pMS ≥ 2 points or physician’s judgement of clinical response. Biochemical remission was defined as c-reactive protein (CRP) < 5mg/L and/or fecal calprotectin (FCP) < 250μg/g. Biochemical response was defined as a reduction of CRP or FCP by 50% from baseline. These parameters were all evaluated at 6 and 12 months. Adverse events were summarized for all patients after 12 months. Results One hundred and fifty patients were included: 28 in UST and 122 in VED. Mean age was 38.4 (SD 15.6) in UST and 43.8 (SD 16.8) in VED. Percentage of female patients was 67.9% in UST and 53.3% in VED. Mean baseline partial mayo score was 3.78 (SD 3.07) for UST and 4.48 (SD 2.43) for VED. Mean disease duration was 10.63 years (SD 8.44) for UST and 11.80 years (SD 8.25) for VED. There was no significant difference in clinical remission between UST or VED, for data that was available at each time point (UST 65.0% vs. VED 72.6%, p=0.49 at 6 months; UST 68.4% vs. VED 82.3%, p=0.17 at 12 months). There was no significant difference between UST and VED for biochemical remission at 6 and 12 months. Higher MES at baseline was negatively associated with clinical remission in UST and VED with univariate analysis, though only significant in VED when adjusted for sex, age, and disease duration (OR 0.07, 95% CI [0-0.26], p=0.0006). There was no significant difference between drug persistence at 12 months (95.0% UST vs. 91.5% VED, p=0.41). Infectious adverse events were similar between groups (17.9% UST vs. 4.1% VED, p=0.07), with no serious adverse events. Conclusion This real-world multicentre Canadian study shows similar efficacy and safety profiles for UST and VED in UC over 1 year. References 1.Holvoet T, Truyens M, De Galan C, et al. Safety and Effectiveness of Vedolizumab and Ustekinumab in Elderly Patients with Inflammatory Bowel Disease: A Real-Life Multicentric Cohort Study. J Clin Med. 2024;13(2). doi:10.3390/JCM13020365 2.Nomura K, Shibuya T, Odakura R, et al. Comparison of the Effectiveness of Vedolizumab and Ustekinumab in Patients with Ulcerative Colitis: A Real-World Retrospective Study. Biomedicines. 2024;12(9):1991. doi:10.3390/BIOMEDICINES12091991 3.Fumery M, Serrero M, Bouguen G, et al. Real-World Comparison of the Effectiveness between Ustekinumab and Vedolizumab in Patients with Ulcerative Colitis Exposed to at least One Anti-TNF Agent. J Crohns Colitis. 2024;18(10):1615-1621. doi:10.1093/ECCO-JCC/JJAE063 4.Meyer A, Fumery M, Peyrin-Biroulet L, et al. Comparative real-world effectiveness of vedolizumab and ustekinumab for patients with ulcerative colitis: a GETAID multicentre cohort study. Scand J Gastroenterol. 2022;57(12):1454-1462. doi:10.1080/00365521.2022.2095668

Abstract Background Limited comparative data is available on the real-world effectiveness and safety of tofacitinib (TOFA) and upadacitinib (UPA) in ulcerative colitis (UC). Methods We conducted an international, multicenter, real-life retrospective cohort study to assess and compare the short-term effectiveness of TOFA and UPA in bio-experienced, moderate-to-severe UC. The primary outcome was week 12 corticosteroid-free remission (CSFR) defined as clinical remission (CR; partial Mayo score [pMayo]<2 with a rectal bleeding subscore of 0) and C-reactive protein (CRP) ≤5 mg/L, as well as not receiving local and systemic steroids ≥30 days. The secondary outcomes were CR and biochemical remission (defined as CRP ≤5 mg/L and fecal calprotectin [Fcal] ≤ 250 mg/g) assessed at week 8 and week 12. Data was handled by intention to treat analysis. We performed multivariable logistic regression models with backward stepwise elimination to control potential confounders and to reduce bias. The most reliable models were selected based on ROC analyzes with highest area under the curve (AUC). Statistical power was calculated on the primary outcome with the number of subjects involved, resulting in 1-β=0.97. Results With the participation of 13 tertiary IBD centres, a total of 350 UC patients (Table 1.; mean age: 38.6 ± 13.8 years; 58.6% male) were enrolled in the study. Patients receiving UPA were more likely (OR=4.01 [95%CI: 1.49-10.82]) to achieve CSFR by week 12 compared to the patients on TOFA (47.1% vs. 22.4%). Additionally, higher baseline pMayo (OR=0.76 [95%CI: 0.59-0.98]) and baseline concomitant steroid use (OR=0.17 [95%CI: 0.08-0.40]) decreased the probability of reaching the primary outcome (AUC=0.80). Furthermore, UPA-treated UC patients were more likely to achieve CR at week 8 (54.8% vs. 26.4%; OR=4.06 [95%CI: 1.66-9.93; AUC=0.76]), and at week 12 (69.2% vs. 45.1%; OR=2.3 [95%CI: 1.04-5.13]; AUC=0.80), as well as biochemical remission at week 12 (43.3% vs. 27.3%; OR=6.96 [95%CI: 2.59-18.7]) than patients receiving TOFA. IBD-related hospitalisation was needed in 6.1% (15/246) of the patients on TOFA, as compared to 1.9% (2/104) of patients receiving UPA. Near-significant difference was observed in colectomy rates between the two patient groups (UPA vs. TOFA: 0% vs. 3.7%; p=0.066). Herpes zoster infection was reported in 1.6% (4/246) of the TOFA-treated patients, and in 1.0% (1/104) of the UPA-treated patients. No venous thromboembolism was observed. Conclusion Based on our real-life data, UPA might be associated with better short-term clinical outcomes compared with TOFA in refractory, moderate-to-severe UC.

Introduction: Secukinumab is an interleukin (IL)-17A inhibitor approved for psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Its use has been reported to be associated with inflammatory bowel disease (IBD) flare and new onset. Case Presentation: We report a case of a 56-year-old woman with longstanding ulcerative colitis (UC) in remission, who developed a severe UC flare after initiating secukinumab for refractory PsA. She presented with extensive ulcerations, systemic inflammation needing hospitalization, and change of treatment to risankizumab. Conclusion: This case highlights the emerging evidence of IL-17A blockade in IBD, potentially leading to adverse events, and adds to the growing body of evidence regarding the management of such complications with novel therapeutic approaches in severe cases. Physicians should be aware of this possibility when using IL-17A blockade in patients with pre-existing IBD.

BACKGROUND & AIMS:Approval of new therapies for inflammatory bowel disease (IBD) requires rigorously designed and well-executed randomized controlled trials (RCTs). Corticosteroids remain a cornerstone of IBD induction therapy, and many patients in trials are enrolled while taking corticosteroids. Despite this, approaches to corticosteroid management in RCTs have been highly heterogeneous, often differing from clinical practice. This negatively impacts patients' willingness to participate due to prolonged corticosteroid exposure and may potentially bias outcomes in the clinical trial. Our aim is to provide comprehensive standardized recommendations on key aspects of corticosteroid use in IBD clinical trials through a multiphase, international expert consensus, with a goal to help inform and standardize practice in future RCTs. METHODS:The consensus was informed by a systematic review of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, which determined the corticosteroid management rules used in placebo-controlled trials of advanced therapies in IBD. International expert consensus recommendations for all aspects of corticosteroid management in RCTs were then developed using a modified Delphi process with 2 rounds of survey questions and a ratification meeting. RESULTS:These recommendations propose management of corticosteroids during screening, induction, and maintenance phases of pharmacologic trials in IBD and define corticosteroid-related end points. We emphasize the need for minimizing corticosteroid exposure through expedited tapering and shorter fixed-dosing periods that more closely reflect clinical care and provide recommendations for standardized definitions of corticosteroid-free remission. CONCLUSIONS:These recommendations will serve to optimize trial design and facilitate appropriate, acceptable, and standardized RCT corticosteroid handling practices.