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Introduction: The concept of deep remission in Crohn’s disease (CD) is being increasingly recognized as a cornerstone predictor of clinical behaviour and prognosis.1,2 Indeed, mucosal healing has been shown to be associated with increased rates of clinical remission, fewer hospitalizations, and fewer abdominal surgeries.1 Therefore, video capsule endoscopy (VCE) has become an attractive noninvasive tool to assess small bowel mucosal damage in patients with CD.3 However, none of the available VCE scoring indices, used to diagnose and measure small bowel involvement in CD, had been prospectively validated.

Introduction: Crohn’s disease (CD) is a chronic, systemic inflammatory disorder that affects mainly the gastrointestinal tract, with a raising incidence in all ethnic and age groups (1).
The primary aim of its treatment is to achieve a sustained clinical and endoscopic remission in order to delay associated complications (1). Although different biologic therapies have been developed and tested in the last decade, anti-TNF remains the only available registrated biological agent for the treatment of CD in Europe (1).
The infiltration of lymphocytes in the intestinal mucosa has previously been described as an important pathogenic pathway in CD. The adhesion of the alfa4beta7 integrin on lymphocytes to MAdCAM-1 on endothelial cells is followed by the infiltration of these lymphocytes from the circulation into the gastrointestinal tract (GI) (3). Vedolizumab is a humanized monoclonal IgG1 antibody that targets integrin alfa4beta7, thereby inhibiting the adhesion of lymphocytes to MAdCAM-1. Natalizumab, a non-gut selective humanized monoclonal antibody against the cell adhesion molecule α4-integrin had already proven its efficacy in the induction and maintenance of remission in active CD, but is associated with systemic side-effects, including a life-threatening progressive multifocal leukoencephalopathy (PML) (3,4).

Introduction: Promising times lie ahead for physicians who are treating IBD patients and some patients are already as excited as their physicians. This excitement is the result of a new class of biologicals that will become available for the treatment of IBD patients more than fifteen years after the introduction of the TNF antagonists. The latter have proven to be very efficacious in both Crohn’s disease and ulcerative colitis but the long-term benefit is hampered by loss of response in almost half of the patients, the formation of antibodies and the increased risk of infections (1). Hence, an alternative therapeutic option is more than welcomed.
Vedolizumab, a humanized monoclonal antibody directed against α4β7 integrin, is a member of this new class of biologicals which are called the leucocyte trafficking inhibitors. These antibodies inhibit the interaction between leukocytes and the intestinal vasculature, thereby decreasing the influx of inflammatory cells into inflamed gastrointestinal mucosa. This class of drugs is not entirely new as a less gut-selective integrin inhibitor, natalizumab, had already been approved by the U.S. Food and Drug Administration (FDA) for both induction of remission and maintenance of remission for moderate to severe Crohn‘s disease. . However, natalizumab has been linked with progressive multifocal leukoencephalopathy (PML), a lethal complication resulting from the reactivation of the JC virus (2), which hampered its registration in Europe. The GEMINI 1 trial is the first randomized, double-blind, placebo-controlled trial to investigate the use of vedolizumab as induction and maintenance therapy in UC patients. Together with the GEMINI 2 trial (3), these are among the largest clinical studies ever performed in patients with IBD.

The management of Ulcerative Colitis (UC) increasingly involves the use of a biologic agent. Placebo-controlled trials have demonstrated the efficacy of both adalimumab, a tumour necrosis factor (TNF) inhibitor, and vedolizumab, an integrin inhibitor. However, variation in study design makes comparison between such trials difficult. This is particularly evident when comparing rates of clinical remission in the placebo groups of different trials. For example, in the ULTRA 2 trial, which established the superiority of adalimumab over placebo in moderate to severe UC, the 52-week clinical remission rate in the placebo group was just 8.5% compared to 15.9% in GEMINI 1, the placebo-controlled trial of vedolizumab [1,2]. In the absence of head-to-head trials between biologics there is a lack of data to inform clinicians of the best choice of agent. VARSITY is the first head-to-head trial to compare the efficacy and safety of vedolizumab and adalimumab in moderate to severely active UC.

Introduction: Crohn‘s disease (CD) is characterized by the presence of expanded adipose tissue located at the mesenteric attachment around areas of inflamed intestine [1]. The inflamed adipose tissue marked with macrophage and T cell infiltration, endothelial cell activation and fibrosis, is an active endocrine and immune organ and serves as a source of pro- and anti-inflammatory cytokines. Microscopically mesenteric adipocytes in CD were described to be small with a 4-fold increased number compared to healthy controls [2]. Adipose tissue in obesity (visceral/omental and subcutaneous) also shows inflammation and is not only characterized by increased numbers of adipocytes, but also by adipocyte enlargement [3].

Introduction: Inflammatory Bowel Diseases (IBD) are mainly diagnosed during the second and third decades of life. Therefore, female patients may develop active disease before or during time of pregnancy. As yet, large-scale studies have reported negative effects of IBD on pregnancy, including spontaneous abortions, preterm deliveries and small-for-gestational-age babies. No long-term data are available. In a subgroup of female IBD patients, the fear of potential harm of their offspring is leading to voluntarily remaining childless.

Introduction: Conventional therapeutics cannot prevent complications in Crohn’s disease (CD) and although novel treatment strategies, including TNF-neutralizing antibodies, have greatly increased the therapeutic armamentarium, many patients still have to undergo surgery (1). For this reason, development of new treatments that induce long-term remission is required.