Gastroenterology Month in Review: April 2024

April was yet another active month in the field of gastroenterology, a fitting continuation of what has been a busy 2024 thus far. Previously coined as irritable bowel syndrome (IBS) awareness month, April is also now host to World IBS Day, a medical holiday the HCPLive editorial team spotlighted with a feature about stigma and misconceptions hindering patient care. This month also saw a third approval for vedolizumab (Entyvio) with its indication in Crohn disease (CD), colorectal cancer screening insight at the 2024 American College of Physicians (ACP) Internal Medicine Meeting, and new research in inflammatory bowel disease (IBD), all of which we spotlight in this April 2024 month in review.

Spotlighting World IBS Day

Putting Patients First: Breaking Stigma, Dispelling Misconceptions to Improve IBS Care

In recognition of World IBS Day, celebrated every year on April 19, the editorial team of HCPLive Gastroenterology put together a feature project to highlight the marginalization of the condition and common misconceptions that continue to hinder care. For further insight into the issue, we spoke with Brian Lacy, MD, PhD, a gastroenterologist at Mayo Clinic in Jacksonville; Hannibal Person, MD, assistant professor and medical director of the Center for Diversity and Health Equity at the University of Washington; Anthony Lembo, MD, vice chair of research at Cleveland Clinic Digestive Disease Institute; and Mark Pimentel, MD, executive director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai; as well as Jeffrey Roberts, a patient advocate and founder of World IBS Day.

Pipeline Updates

Subcutaneous Vedolizumab Approved for Moderate-to-Severe Crohn Disease

Vedolizumab earned its third approval in April, this time for moderately to severely active CD, just 7 months after it was approved for moderate to severe ulcerative colitis (UC). Based on data from the VISIBLE 2 trial, the approval indicates the agent for maintenance therapy after induction therapy with intravenous vedolizumab. Results of the trial suggested a statistically significant proportion of patients receiving subcutaneous vedolizumab 108 mg maintenance therapy administered every 2 weeks achieved long-term clinical remission compared to the placebo group (48% vs. 34%; P <.01) at week 52.

“The approval of subcutaneous ENTYVIO in Crohn’s disease delivers on our goal of providing treatment options that can help patients achieve remission of their ulcerative colitis or Crohn’s disease, while also providing them flexibility and choice of route of administration. With ENTYVIO Pen, patients have the option of administering their maintenance treatment at home or on the go,” said Brandon Monk, senior vice president and head of US Gastroenterology Business Unit at Takeda Pharmaceuticals.

Conference Coverage

Timothy Wilt, MD, MPH: What Age Should Patients Get Screened for Colorectal Cancer?

As part of HCPLive’s coverage of the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston this month, we sat down with Timothy Wilt, MD, MPH, professor of medicine and public health in the division of general internal medicine at the Minneapolis VA Health Care System, to discuss key takeaways from his session on recent updates in colorectal cancer screening recommendations. Specifically, he referenced ACP’s suggestion that patients start screening at age 50 due to uncertainty around the benefits and harms of screening in asymptomatic average-risk adults between the ages of 45 - 49.

“ACP believes we could do better to reduce disparities, improve equity, and reduce colon cancer incidence and death by focusing those resources on individuals where there's greater certainty of benefit, and those who need it who have not been getting screened, those between the ages of 50 and 75,” Wilt explained.

Timothy Wilt, MD, MPH: Discussing Colorectal Cancer Screening Options Recommended by ACP

In a second segment of his interview in Boston, Wilt discussed screening tests ACP does and does not recommend, again attributed to considerations regarding the burden and costs associated with different screening modalities.

New Research in IBD

Patient-Reported Bowel Urgency Burden in IBD Underscores Need for Assessment in Clinical Settings

Findings from this study highlight the negative impact of bowel urgency and bowel urgency-related accidents on the daily lives of patients with UC and CD despite the use of biologic and conventional IBD therapies, calling attention to the need for the development of novel treatment strategies to reduce these experiences as well as patient-reported outcome (PRO) measures.

“Assessment of bowel urgency and bowel urgency-related accidents must be considered in clinical trials and by healthcare providers in routine clinical examinations,” lead investigator Vipul Jairath, MBChB, DPhil, John and Susan McDonald Endowed Chair in Inflammatory Bowel Disease Clinical Research at Western University and chief medical officer at Alimentiv, and colleagues wrote. “Our findings may facilitate the development of appropriate PRO measures to assess and discuss bowel urgency in clinical practice and clinical trials, manage symptoms, and disseminate the impacts of treatments on disease activity and severity.”

Tofacitinib Treatment Before Colectomy Carries Minimal Postoperative Complication Risk

In a first-of-its-kind study examining the safety of preoperative exposure to tofacitinib in comparison with biologics in patients with UC undergoing colectomy, results showed no significant differences between tofacitinib, anti-tumor necrosis factor-α (TNF)s, vedolizumab, and ustekinumab for early and late complications, infections, and sepsis following surgery. Tofacitinib and biologics had similar rates of adverse events, but urgent surgery and high doses of steroids before surgery were confirmed to be associated with a higher risk of early surgical complications.