Citations

Abstract Background Iron deficiency is common in patients with inflammatory bowel disease (IBD), where poor absorption or prior surgery often renders oral iron supplementation ineffective, necessitating intravenous (IV) iron therapy. Hypophosphataemia, particularly associated with ferric carboxymaltose via fibroblast growth factor 23 dysregulation, is a recognized complication of IV iron therapy. It can result in severe outcomes such as rhabdomyolysis, osteomalacia, fractures, and convulsions. This study evaluates the risk of hypophosphataemia between ferric carboxymaltose and other IV iron formulations and its association with complications. Methods This retrospective propensity-matched study utilised the TriNetX database, a global repository of de-identified electronic health records. The first analysis compared ferric carboxymaltose to other IV iron formulations (iron sucrose, sodium ferric gluconate, ferumoxytol, ferric derisomaltose), matched on demographics (age, gender, ethnicity) and comorbidities (vitamin D deficiency, malnutrition, malabsorption, diabetes, CKD by stage, alcohol abuse, hyperparathyroidism, corticosteroid, diuretic, antacid, and bisphosphonate use) to assess hypophosphataemia risk. The second and third analyses evaluated hypophosphataemia-related complications in ferric carboxymaltose versus other formulations, both in the general population and in patients with IBD. Results We compared 115,242 ferric carboxymaltose patients to those on other IV iron formulations. Ferric carboxymaltose was associated with higher odds of severe (OR: 2.84, 2.22–3.64, p<0.0001) and moderate (OR: 1.37, 1.29–1.46, p<0.0001) hypophosphataemia but lower odds of mild hypophosphataemia (OR: 0.84, 0.79–0.88, p<0.0001). Among 25,586 hypophosphataemic patients, those on ferric carboxymaltose had lower odds of acute complications within 3 months, including muscle weakness (OR: 0.57, 0.47–0.70, p<0.0001), rhabdomyolysis (OR: 0.38, 0.20–0.75, p=0.003), disorientation (OR: 0.53, 0.46–0.61, p<0.0001), convulsions (OR: 0.59, 0.48–0.73, p<0.0001), cardiac arrhythmias (OR: 0.61, 0.54–0.69, p<0.0001), and respiratory failure (OR: 0.57, 0.50–0.64, p<0.0001). Over 2 years, chronic complications such as osteomalacia and fractures (23,508 patients each) showed no differences. In patients with IBD, no significant differences were observed in acute (2,688 each) or chronic complications (2,541 each) between cohorts. Conclusion Ferric carboxymaltose was linked to higher odds of severe and moderate hypophosphataemia but fewer acute complications than other IV iron formulations. The reasons for these differences remain unclear and warrant further research to understand the relationship between IV iron, hypophosphataemia, and clinical outcomes.

Abstract Objectives Patients with hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) experience a wide array of symptoms and system disorders. This study aimed to identify whether differences occurred in 115 self-reported symptoms and comorbidities in patients diagnosed with hEDS or HSD. Methods In this study we analysed self-reported data from an EDS Clinic intake questionnaire in patients diagnosed with hEDS, HSD or no hypermobile conditions. Results From 1 November 2019 to 7 March 2024, the EDS Clinic saw 2088 patients. Using the 2017 diagnostic criteria, 66.5% were diagnosed with HSD (n = 1389), 20.3% with hEDS (n = 423), 10.6% with historic HSD (H-HSD) or localized HSD (L-HSD) (n = 256) (hypermobile controls) and 2.6% were not diagnosed with hEDS, HSD, H-HSD or L-HSD (n = 55) (controls). Symptoms/comorbidities that occurred with high prevalence in both hEDS and HSD included joint pain (hEDS 82.0%, HSD 88.9%), allergy (hEDS 77.0%, HSD 77.0%), subluxations (hEDS 71.2%, HSD 72.6%), brain fog (hEDS 70.0%, HSD 74.7%), headache (hEDS 68.1%, HSD 69.1%), anxiety (hEDS 60.3%, HSD 69.3%), depression (hEDS 52.2%, HSD 58.0%), migraine (hEDS 53.7%, HSD 52.5%), nausea (hEDS 54.6%, HSD 59.5%) and constipation (hEDS 53.0%, HSD 57.2%). In contrast, 9/115 (8%) symptoms/comorbidities were self-reported significantly more often in hEDS but 42/115 (37%) in HSD. hEDS patients reported more symptoms that suggest a defect in collagen, such as dislocation, hernias and rectal prolapse, while HSD patients reported more joint, muscle, allergy, neurological, gastrointestinal, sleep and psychological symptoms/comorbidities. Conclusion Although we found an overlap in some symptoms and comorbidities self-reported by hEDS/HSD patients, such as allergy/atopy, headache/migraine and gastrointestinal symptoms, our findings suggest key differences exist between the two diagnoses, suggesting that hEDS and HSD may be distinct conditions.

Abstract Background and Aims Active inflammatory bowel disease (IBD) at conception is associated with adverse pregnancy outcomes. International guidelines address antenatal care, but contraception counseling and risk assessment are not addressed. Data on healthcare professionals’ guidance for women with IBD regarding contraception are scarce. We aimed to describe contraceptive use, preferences, knowledge, and barriers among women with IBD. Methods A 34-item questionnaire was administered to female IBD patients aged 18-45. Disease control was measured using PRO-2 and IBD-control questionnaire, and contraceptive preferences were assessed by the contraceptive features survey. Logistic regression explored associations between contraceptive use, attitudes, disease remission status, and other factors. Results Of 338 women surveyed, 243 (74%) used some form of contraception. Oral birth control pills (28%) and barrier methods (18%) were most used but 20% used long-acting methods. Women with active disease were more likely to use long-acting contraception (23%) compared to those in remission (17%). Contraceptive priorities were effectiveness (78%), ease of use (75%), and minimal side effects (68%). Only 25% women had discussed reproductive issues with their IBD clinician, though 85% were comfortable to do so. Preferred sources for reproductive counseling were IBD nurses (79%), general practitioners (75%), IBD doctors (68%), and gynecologists (49%). Conclusions A quarter of women with IBD were not using any contraception, and long-acting contraceptive use was low. Women prefer effective, easy-to-use contraceptives with minimal side effects but lack knowledge on effective contraception-related issues. Better education and proactive discussions between healthcare providers and patients could improve reproductive health in women with IBD.

Objective: Patients with inflammatory bowel disease (IBD) are commonly treated with immunosuppressive therapies that increase the risk for infections, including hepatitis B (HepB) virus. Adult patients with IBD have suboptimal seroprotection rates after vaccination with a 3-dose recombinant recombinant HepB vaccine. Heplisav-B is an adjuvanted 2-dose HepB series that is more immunogenic in the general adult population. Herein, we evaluated the immunogenicity of Heplisav-B in adult patients with IBD. Patients and Methods: We conducted a prospective observational study of adult patients with IBD who were not seroprotected to HepB virus and received a Heplisav-B series with postimmunization HepB surface antibody (anti-HBs) serologic testing. Postimmunization anti-HBs ≥10 IU/mL was considered seroprotection. The primary outcome was the rate of seroprotection. Secondary outcomes were rates of seroprotection in different age groups, those on immunosuppressive therapy, and previous HepB vaccine nonresponders using a univariate analysis. Results: Eighty-five patients met the inclusion criteria with the majority (72%) achieving seroprotection with a median anti-HBs level of 48.7 IU/mL and 28 patients (33%) having an anti-HBs level >100 IU/mL. Those on immunosuppressive therapy [49 (58%), 18 nonresponders, odds ratio: 0.34, 95% CI: 0.12-0.99] and primary nonresponders to a previous HepB series [22 (26%), 11 nonresponders, odds ratio: 0.26, 95% CI: 0.09-0.73] were less likely to achieve seroprotection. Seven patients who did not respond received a third dose of Heplisav-B, and 2 achieved seroprotection. Conclusions: Heplisav-B achieved higher rates of seroprotection than those seen with 3-dose recombinant HepB vaccines in patients with IBD and may be the preferred option.

Abstract Introduction There is limited real-world evidence comparing the effectiveness of ozanimod to vedolizumab as first-line advanced therapies in patients with ulcerative colitis (UC). Methods We conducted a retrospective cohort study using TriNetX, a multi-institutional US database in adults with UC who were initiated on ozanimod compared to vedolizumab between January 1, 2021 and 22 June, 2024. The primary outcome was to compare the risk of a composite outcome of corticosteroid use, colectomy, or change to another advanced therapy between the 2 cohorts within 12 months. 1:1 propensity score matching (PSM) was performed for demographics, comorbid conditions, disease extent, laboratory parameters, and previous corticosteroid use. The risk was expressed as an adjusted odds ratio (aOR) with 95% CIs. Results We identified 222 patients in the ozanimod cohort (mean age 41.2 ± 15.7, 46.3% male sex, 68% White, and 22.5% ulcerative proctitis), and 4145 patients in the vedolizumab cohort (mean age 47.4 ± 18.3, 45.2% male sex, 69.7% White, and 17.2% ulcerative proctitis). After PSM, there was no significant difference in the risk of the composite outcome (aOR 0.92, 95% CI, 0.63-1.36) and corticosteroid use (aOR 0.80, 95% CI, 0.53-1.18) between the 2 cohorts within 12 months. There was a higher risk of change in therapy in the ozanimod cohort (aOR 1.95, 95% CI, 1.09-3.49) compared to the vedolizumab cohort. Colectomy rates were low in both cohorts (<0.04%). Conclusions Our real-world study showed that ozanimod use is associated with similar corticosteroid use but higher odds of a change in therapy compared to vedolizumab when used as first-line therapy in patients with UC. Further prospective studies are needed to understand long-term outcomes.