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Background: Tight control of disease activity, medication side effects, and adherence are crucial to prevent disease complications and improve quality of life in patients with inflammatory bowel disease (IBD). The chronic nature and increasing incidence of IBD demand health care innovations to guarantee future high-quality care. Previous research proved that integrated care by telemedicine can improve outcomes of chronic diseases. Currently available IBD telemedicine tools focus on specific patient subgroups. Therefore, we aimed to (1) develop a telemedicine system suitable for all patients with IBD in everyday practice and (2) to test this system's feasibility.Methods: With a structured iterative process between patients, dietitians, IBD nurse-specialists, and gastroenterologists, myIBDcoach was developed. During 3 months, myIBDcoach's feasibility was tested by 30 consecutive outpatients with IBD of 3 hospitals. Thereafter, patients and health care providers completed a questionnaire covering satisfaction, accessibility, and experiences with myIBDcoach.Results: MyIBDcoach enables continuous home-monitoring of patients with IBD and optimizes disease knowledge and communication between patients and health care providers. Besides disease activity, medication adherence, and side effects, myIBDcoach monitors malnutrition, smoking, quality of life, fatigue, life-events, work participation, stress, and anxiety and depression and provides e-learnings for patient empowerment. Patients graded the system with a mean of 7.8 of 10, and 93% would recommend myIBDcoach to other patients.Conclusions: We developed myIBDcoach, which enables integrated care for all patients with IBD, regardless of disease severity or medication use. The feasibility study showed high satisfaction and compliance of patients and health care providers. To study myIBDcoach's efficacy, a multicenter randomized controlled trial has been initiated.

BACKGROUND It is important to identify factors that can reduce the incidence of immunogenicity against anti-tumor necrosis factor medication in patients with inflammatory bowel disease. The objective of our study was to evaluate the influence of cotreatment with immune modulators (IMs) on trough levels (TLs) and antidrug antibodies. METHODS The records of all patients with inflammatory bowel disease at the Leiden University Medical Center who received either adalimumab or infliximab (IFX) in the year 2011 and/or 2012 (n = 352) were retrospectively evaluated about the assessment of TL and antibodies and use of IM. RESULTS Two hundred seventeen patients were included (108 patients IFX; 109 patients adalimumab). Mean TL in the IFX group was higher in the combination therapy group compared with the monotherapy group, 4.6 versus 7.5 µg/mL, P = 0.04. In the adalimumab group, the difference was not significant. In patients with IFX monotherapy, the incidence of antibody formation was higher compared with patients with combination therapy (29.8% versus 5.7%, P = 0.001). IFX patients with a suboptimal dose of IM had a higher TL compared with patients who had an optimal dose, P = 0.02. The incidence of antibody formation was lower in IFX patients who immediately started with IMs compared with patients who did not (33.3% versus 66.7%, P = 0.04). CONCLUSIONS The influence of combination therapy with IM on TL and antibodies to anti-tumor necrosis factor medication was significant for IFX-treated patients. Patients who started combination therapy immediately developed antibodies less often than patients who started later with concomitant medication.

G A A b st ra ct s that patients require higher doses of IFX than standard induction dosing in Acute Severe UC to achieve therapeutic levels. By delivering IFX at shorter intervals during induction, higher trough levels could be achieved, and patients could be successfully treated medically without the need for colectomy. Methods Retrospective analysis of a prospectively maintained database of patients with IBD (n=3,200). Patients who required hospitalisation and were given rescue infliximab for acute severe colitis from June 2005-September 2013 at a single academic centre were identified. In 2011 an accelerated dosing protocol for IFX was introduced. Patients given standard dosing (SD) received IFX at time 0, 2, and 6 weeks and 8 weekly thereafter. Patients given accelerated dosing (AD) received all three induction doses of IFX within 2 weeks and 8 weekly thereafter. Rates of colectomy were compared between the 2 groups at 3,6 and 12 months. Results 52 patients received rescue infliximab; 38 received SD and 14 received AD. There were no differences in median CRP (SD= 54, AD= 38 p=0.4), median albumin (SD=23, AD=22.5, p=0.64), median platelet count (SD=390, AD=414, p=0.84), median haemoglobin(11.0 SD, 10.5AD p=0.76) or median disease duration (SD=11.8 years, AD=5.3 years, p=0.47) between the 2 groups on the day of induction. 18/38 (47.3%) required surgery in the standard regimen and 4/14 (28.5%) in the accelerated regimen during follow-up. Rate of colectomy at 3 months was significantly lower with AD versus SD; 1/14 (7.1%) vs 14/38 (36.8%), fisher exact test p=0.04. A trend toward reduced colectomy rate remained at 6 months; 2/14 (14.3%) versus 14/38 (36.8%), p=0.18. At 12 months colectomy rates were more comparable; 4/14(29%) versus 15/38 (39%), p=0.53. Conclusion Use of an accelerated induction regimen with IFX is protective against early colectomy in acute severe colitis. These findings suggest that higher IFX doses may be required in severe colitis due to high levels of TNFα and more rapid drug clearance. A more aggressive dosing strategy, guided by measurement of IFX levels, may assist in maintaining early success in avoiding colectomy. Patient Demographics and Outcomes

by the Modification of Diet in Renal Disease (MDRD) Study Equation and CockcroftGault (CG) Equation at baseline (the first recorded value) and > 1 yr of follow-up. A control group included pts with IBD not treated with mesalamine with > 1 yr follow-up. Results: There were 155 pts with IBD (mean duration: 12.9 yrs, range: 1-45 yrs) who were treated with mesalamine identified (96 with Crohn's disease and 69 with ulcerative colitis). Among them, 75 were female and the mean age was 40.0 yrs (range 18-81 yrs). The mean follow-up in this group was 4.2 yrs (range: 0.6-9.5 yrs). The mean duration of therapy with mesalamine was 10.7 yrs. The control group included 30 pts with IBD (mean duration: 13.9 yrs, range: 2-37 yrs). Among them, 14 were female and mean age was 38.9 yrs (range: 20-66 yrs). The mean follow-up in this cohort was 3.8 yrs (range: 1.0-8.6 yrs). Results are in table 1 (mean values ± SD). There was a statistically significant difference between pts on low and medium dose mesalamine regarding creatinine clearance monitored by CG equation both at baseline and after follow-up (p