COMBINATION OF ADVANCED THERAPIES IN PATIENTS WITH COMPLEX INFLAMMATORY BOWEL DISEASE

Background and aim: Dual Targeted Therapy (DTT) is a novel therapeutic strategy proposed for the management of patients with complex inflammatory bowel disease (IBD). Our aim was to evaluate the safety and effectiveness of this approach in a real-life setting Materials and methods: In this single centre retrospective cohort study, we collected data on IBD patients receiving DTT from 2017 to 2022. Baseline characteristics, clinical activity of intestinal and extraintestinal disease, C-reactive protein (CRP) levels, endoscopic assessment and adverse events (AEs) were recorded. Clinical remission, CRP normalization, endoscopic remission and occurrence of AEs were investigated at baseline and during follow up Results: Sixteen patients were identified;indications for DTT were: uncontrolled IBD (11 patients), uncontrolled extraintestinal manifestations (EIMs) (6 patients: 4 spondyloarthritis, 2 psoriatic disease). Patients received vedolizumab (VDZ, 14, 87.5%), ustekinumab (UST, 8, 50%), anti-TNFα (7, 43.8%), sekukinumab (2, 12.5%), tofacitinib (1, 6.3%). The most common combinations were: VDZ+UST (6 patients, 37.5%) and adalimumab+VDZ (3, 18.8%). At baseline, 15/16 (93.8%) and 4/6 (66.6%) patients had active intestinal and EI symptoms, respectively;14 (87.5%) patients had positive CRP and 5 (31.3%) were receiving oral steroids. Median follow-up duration on DTT was 15 months (IQR 11-22). Clinical intestinal remission was reported by 6/16 (37.5%) and 3/11 (27.3%) patients at 6 and 12 months, respectively. Clinical remission of EIMs was reported by 3/7 (42.9%) at 6 and 5/7 (71.4%) patients at 12 months, respectively. CRP normalization was observed in 3/16 (18.8%) and 6/11 (54.5%) patients at 6 and 12 months, respectively. 80% of patients on steroid therapy at baseline discontinued them within 6 months. Endoscopic assessments were available for 8 patients, with endoscopic remission in 2, endoscopic improvement in 3 and no improvement in 3. Four patients (25%) experienced an AE (1 COVID-19 and reactivation of perianal disease;1 mild pneumonitis and reactivation of perianal disease;1 drug-induced pneumonitis;1 arthralgia and COVID-19). Finally, 1 patient underwent colectomy due to uncontrolled disease. Three patients discontinued DTT: 2 because of treatment failure, 1 because of an AE (drug-induced pneumonitis) Conclusions: DTT can be considered a reasonably safe and effective treatment in complex IBD patients, either with uncontrolled intestinal inflammation or with concomitant EIMs, when other therapeutic options have failed

The educational role of IBD nurses in Italy in vaccinations: do not miss the moment for COVID-19.

OBJECTIVE: The role of nurses has great educational-scientific potential in COVID-19 vaccination. The aim of this work is to clarify whether the educational role of IBD nurses in vaccination is perceived by IBD patients. MATERIALS AND METHODS: A cross-sectional study was carried out, through a questionnaire, to evaluate how many IBD patients received health education about vaccinations from the dedicated nurses (IBD nurses). RESULTS: There were four hundred questionnaires, 310 patients (77.5%) answered all questions. The nurse does not appear to help educate patients on influenza vaccination (66.1%) or pneumococcal vaccination (81.6%). Disclosed patients have many doubts about the new COVID-19 vaccination (74.4%) and many seek information (74.8%) and think that the nurse can provide the necessary information (70%). CONCLUSIONS: IBD nurses do not seem very active in the vaccination education role, and they do not meet patients' expectations, which are conversely very high.

Impact of COVID-19 outbreak on clinical practice and training of younggastroenterologists: A european survey

Aims SARS-CoV-2 disease (COVID-19) is a major challenge for the healthcare system and physicians, imposing changes indaily clinical activity. We aimed to describe what European trainees and young gastroenterologists know about COVID-19and identify training gaps to implement educational programs. Methods A prospective web-based electronic survey was developed and distributed via e-mail to all members of the ItalianYoung Gastroenterologist and Endoscopist Association and to European representatives. Results One hundred and ninety-seven subjects participated in the survey, of whom 14 (7.1 %) were excluded. Themajority were gastroenterologists in training (123, 67.7 %) working in institutions with COVID-19 inpatients (159, 86.9 %),aged ≤30 years (113, 61.8 %). The activity of Gastroenterology Units was restricted to emergency visits and endoscopy,with reductions of activities of up to 90 %. 84.5 % of participants felt that the COVID-19 outbreak impacted on theirtraining, due to unavailability of mentors (52.6 %) and interruption of trainee's involvement (66.4 %). Most participantsreferred absence of training on the use of personal protective equipment, oxygen ventilation systems and COVID-19therapies. Conclusions COVID-19 outbreak significantly impacted on gastroenterologists' clinical activity. The resources currentlydeployed are inadequate, and therefore educational interventions to address this gap are warranted in the next future.