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International audience; BACKGROUND:Antibodies to infliximab [ATI] and trough levels to infliximab [TRI] are associated with loss of response in inflammatory bowel diseases [IBD]. The best way to predict loss of response [LOR] to infliximab [IFX] is unknown.METHODS:We conducted a prospective observational cohort study enrolling all IBD patients who were in clinical remission at Week 14 after IFX treatment initiation. TRI, ATI and C-reactive protein [CRP] level were measured at Week 22 [T1] and thereafter at every other IFX infusion. Loss of clinical response was defined by a flare requiring therapeutic change [IFX dose intensification, initiation of another drug class, and/or surgery].RESULTS:A total of 93 patients [59 Crohn's disease, mean duration of follow-up 17.2 months] were included; 32 patients [34.4%] lost clinical response during follow-up. Cumulative probability of LOR was 50% at 20 months. Mean TRI at T1 was significantly lower in IBD patients with stable ATI as compared with those with transient ATI or without ATI [0.052, 3.34 ,and 4.29 µg/ml, respectively; p = 0.001 between no ATI vs stable ATI, and p = 0.005 between stable and transient ATI] [p = 0.0001]. Three independent factors were predictive of LOR after Cox proportional hazards modelling: TRI > 5.5 µg/ml (hazard ratio [HR]: 0.21; 95% confidence interval [CI]: 0.05-0.89;p = 0.034) at T1, CRP > 5mg/l [HR: 2.5; 95% CI: 1.16-5.26; p = 0.019] at T1, and stable ATI defined by two consecutive ATI > 20ng/ml [HR: 3.77; 95% CI: 1.45-10.0; p = 0.007]. Transient ATI did not influence LOR.CONCLUSIONS:LOR can be predicted based on a combination of CRP, TRI and stable ATI with a high degree of accuracy.

International audience; BACKGROUND AND AIMS: The usefulness of anti-glycan antibodies alone or combined with anti-Saccharomyces cerevisiae [ASCA] or perinuclear antineutrophil cytoplasmic [pANCA] antibodies for diagnosis of inflammatory bowel disease [IBD], differentiation between Crohn's disease [CD] and ulcerative colitis [UC], disease stratification including IBD phenotype, and also for determination of the course of the disease, remain unclear. METHODS: A large panel of serological anti-glycan carbohydrate antibodies, including anti-mannobioside IgG antibodies [AMCA], anti-chitobioside IgA [ACCA], anti-laminaribioside IgG antibodies [ALCA], anti-laminarin [anti-L] and anti-chitine [anti-C] were measured in the serum from a cohort of 195 patients with IBD] [107 CD and 88 UC]. The respective accuracy of isolated or combined markers for diagnosis, disease differentiation, stratification disease phenotype, and severity of the disease course, defined by a wide panel of criteria obtained from the past medical history, was assessed. RESULTS: The positivity of at least one anti-glycan antibody was detected in a significant higher proportion of CD and UC compared with healthy controls [p \textless 0.0001 and p \textless 0.0007, respectively]. Whereas ASCA and ANCA antibody status had the highest efficacy to be associated with CD in comparison with UC (area under receiver operating characteristic curve [AUROC] = 0.70 for each], the adjunction of anti-laminarin antibody substantially improved the differentiation between CD and UC [AUROC = 0.77]. Titres of ACCA [\textgreater 51U/ml] and anti-laminarin [\textgreater 31U/ml] were significantly linked with a higher association with steroid dependency (odds ratio [OR] =2.0 [1.0-4.0], p = 0.03 and OR = 2.4 [1.1-5.2], p = 0.02, respectively]. We further defined the respective performance of anti-glycan antibodies to discriminate between patients with severe or not severe CD and UC course and determined the associated optimal cut-off values: severe CD course was significantly more likely in case of AMCA \textgreater 77U/ml [OR = 4.3; p = 0.002], ASCA \textgreater 63U/ml [OR = 3.5; p \textless 0.009] and at a lesser degree ACCA \textgreater 50U/ml [OR = 2.8; p \textless 0.02] and severe UC course was significantly associated with AMCA \textgreater 52U/ml [OR = 3.4; p = 0.04] and ACCA \textgreater 25U/ml [OR = 3.0; p \textless 0.04]. CONCLUSIONS: Anti-glycan antibodies are valuable serological markers, especially AMCA antibodies that may help clinicians to promptly classify patients into high risk for severe disease.

attending a regional meeting were asked to complete the survey. Attitudes were assessed using framework analysis. Responses were coded into categories. Preferences were analysed by quantifying scores for each component and calculating the percentages of clinicians’ who agreed, were neutral or disagreed. Results: 38% (16/42) of attendees completed the questionnaire. The following themes emerged. Four inter-related but distinct advantages were identified. 1. Increased patient participation/ownership. 2. Greater knowledge and understanding. 3. Improved patient-provider communication. 4. Enhanced safety. Potential concerns were categorised into three themes. 1. Interpretation of the data. 2. Extra workload. 3. Inequalities of service. Pre-conditions were organizational and included informed consent, opt-in only, automation of data transfer, security and restriction of selected data. 100% of the respondents agreed a summary of their history and medicines should be included. 94% agreed that a symptommonitoring tool would be useful. 88% and 63% agreed patients should have access to their letters and bloods. The biggest concern identified would be providing imaging and endoscopy reports with only 31% agreeing, 44% neutral and 25% disagreeing. Many felt reports would be misinterpreted and cause anxiety. An online forum and email support divided opinion, with 56% agreeing and 44% neutral or disagreeing to these services. Concerns were raised with moderating email contact and content of the forum. Conclusions: Previous research has shown many e-health technologies fail in routine practice due to lack of stakeholder involvement. Clinicians’ views are critical to successfully implement a web-based service designed to improve the delivery of care. These views have been incorporated into the design of an IBD portal system.