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Abstract: Background and Aim: Secondary loss of response to adalimumab (ADA‐LOR) commonly occurs in patients with Crohn's disease (CD) treated with adalimumab (ADA). We evaluated the efficacy of concomitant elemental diet (ED) therapy to reduce ADA‐LOR in adult CD patients. Methods: Patients were divided into either an ED (≥900 kcal/day) or a non‐ED group (<900 kcal/day). Cumulative non‐ADA‐LOR rates were compared between groups. The effects of ED intake to reduce ADA‐LOR were also assessed in antitumor necrosis factor‐alpha (TNF‐α)‐naïve and infliximab (IFX)‐intolerant or refractory CD patients. Serum ADA and TNF‐α levels were measured. Results: We enrolled 117 CD patients into the ED (n = 25) or non‐ED (n = 92) groups. Although the cumulative non‐ADA‐LOR rate was higher in the ED group than in the non‐ED group, ED intake was not an independent reducing factor for ADA‐LOR (adjusted hazard ratio = 0.725; 95% confidence interval: 0.448–1.180; P = 0.196) in all patients. ED intake was significantly more effective in reducing ADA‐LOR in IFX‐intolerant or refractory patients than in anti‐TNF‐α‐naïve patients in a dose‐related manner (P for interaction <0.20). Serum ADA levels did not differ between the groups. Serum TNF‐α levels were significantly lower in the ED group than in the non‐ED group at week 28 (P = 0.044) and week 52 (P = 0.043). Conclusions: Concomitant ED therapy reduced ADA‐LOR in IFX‐intolerant or refractory patients in a dose‐related manner. Reductions in the TNF‐α levels by concomitant ED intake may contribute to reduce ADA‐LOR in CD patients. [ABSTRACT FROM AUTHOR]

Objectives: Low‐volume polyethylene glycol plus ascorbic acid (PEG‐Asc) reduces the dosage of colonoscopic bowel preparation (BP) solution, but is still poorly tolerated. Adding laxatives to the BP solution reduces the volume of fluid required, without affecting quality. This study aimed to compare 1 L PEG‐Asc plus 24 mg senna (1L‐PEG/AS) and conventional 2 L PEG‐Asc (2L‐PEG/A) regimens on BP quality and patient tolerability. Methods: A single‐center, randomized, investigator‐blinded, noninferiority trial was performed between June and August 2022. Outpatients scheduled for colonoscopy were randomized (1:1) to the 1L‐PEG/AS or 2L‐PEG/A group. The Boston Bowel Preparation Scale (BBPS) was used to evaluate BP quality. Adverse events and tolerability were surveyed using questionnaires. Results: Overall, 344 patients received 1L‐PEG/AS or 2L‐PEG/A regimens. The baseline characteristics and adverse events of the two groups were comparable. The 1L‐PEG/AS group showed noninferior adequate BP rates compared with the 2L‐PEG/A group (88% vs. 89%, P = 1.00); overall BBPS was 7.1 ± 1.5 and 7.2 ± 1.5, respectively (P = 0.39). Higher willingness to repeat the BP was observed in the 1L‐PEG/AS group (85% vs. 62%, P < 0.01). Conclusions: The 1L‐PEG/AS regimen was comparable to the 2L‐PEG/A regimen in terms of BP adequacy, requiring lower BP solution volumes, with better patient tolerance. Thus, it may be a suitable alternative to the conventional BP solution for colonoscopy. The Japan Registry of Clinical Trials (jRCT1051220043). [ABSTRACT FROM AUTHOR]