IBD Updates: How to Get Rid of Pesky Antibodies to Infliximab, Neoplasia in pouch, Vit D associated with improved IBD outcomes

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JZ Jagt et al. JPGN 2024; 78:57–67.Open Access! Effectiveness of strategies to suppress antibodies to infliximab in pediatric inflammatory bowel disease.

Anti‐infliximab antibodies were detected in 52/288 patients (18%)after a median of 15.3 months. Key findings:

  • Of the 49 studied patients, 19 had low titers and 30 had high titers
  • Of 19 low‐ATIs, 16 (84%) underwent treatment escalation with infliximab (IFX)
  • Among 30 patients with high‐ATIs, 17 (57%) continued with IFX; immunomodulators were started in seven patients
  • At 24 months of follow‐up, 73% of low‐ATI patients and 50% of high‐ATI patients could continue with IFX without steroids.
  • Interestingly, a large number of patients (3 of 17 in high titer group that continued IFX and 4 of 19 in the low titer group that continued IFX) did not have follow-up therapeutic drug monitoring (or availability of results)
  • ATIs were positively associated with infusion reactions
  • Overall, the authors conclude that dose optimization and/or use of an immunomodulator can help patients remain on infliximab (high and low titer)

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SA Urquhart et al. Inflammatory Bowel Diseases, Volume 30, Issue 2, February 2024, Pages 183–189. The Incidence of Pouch Neoplasia Following Ileal Pouch–Anal Anastomosis in Patients With Inflammatory Bowel Disease

Key findings: Out of 1319 patients, 10 (0.8%) developed neoplasia following IPAA (median follow-up of 8.6 yrs, mean age at time of IPAA was 36 years).  Presence of extensive colitis, primary sclerosing cholangitis, backwash ileitis, and rectal dysplasia at the time of IPAA were significantly associated with increased risk of pouch neoplasia. 

My take: The low rate of neoplasia along with risk factors should be considered in determining surveillance.

M Valvano et al. Inflammatory Bowel Diseases, Volume 30, Issue 2, February 2024, Pages 281–291. Effectiveness of Vitamin D Supplementation on Disease Course in Inflammatory Bowel Disease Patients: Systematic Review With Meta-Analysis

Methods: Randomized clinical trials (n=12) involving IBD patients treated with vitamin D supplementation, compared with placebo, that evaluated the risk of clinical relapse and disease activity were included

Key findings: The pooled risk ratio of clinical relapse was 0.64 (95% confidence interval, 0.46-0.89; I2 = 25%) among 458 IBD patients. (There were only 67 patients with ulcerative colitis in these studies)

Conclusion of authors: “This meta-analysis shows that vitamin D supplementation can reduce the risk of clinical relapse in IBD patients, especially in CD patients in clinical remission.” The dose and duration of vitamin D treatment to reduce the risk of relapse is unclear.

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