Publications by authors named "Emily C L Wong"
Introduction: The Modified Multiplier of the SES-CD (MM-SES-CD) refines the assessment of endoscopic Crohn's Disease (CD) severity by differentially weighting parameters in the original SES-CD. A threshold of <22.5 for MM-SES-CD suggests endoscopic remission and correlates with a low risk of long-term disease progression.
View Article and Find Full Text PDFBackground And Aims: Inflammatory bowel disease (IBD) trials often stratify patients by prior biologic exposure, including prior biologic failure or intolerance. This study aimed to assess clinical outcomes in IBD patients with prior biologic failure versus intolerance treated with ustekinumab or vedolizumab.
Methods: A post-hoc analysis of ulcerative colitis (UC) and Crohn's disease (CD) clinical trials for ustekinumab (UNITI, UNIFI) and vedolizumab (GEMINI-1, GEMINI-2) was performed.
Introduction: It is unclear if steroid tapering protocols can affect clinical trial outcomes in ulcerative colitis [UC], particularly fixed versus adaptive steroid tapering. Fixed steroid tapering involves incremental dose decreases at prespecified intervals, and adaptive steroid tapering uses investigator discretion as determined by the patient's response.
Methods: In this post-hoc analysis from six clinical trials of UC [VARSITY, ACT 1, PURSUIT, GEMINI1, OCTAVE, and ULTRA2], responders to induction therapy with baseline corticosteroid use were considered as the primary population of interest.
Vedolizumab is a first-line treatment option for ulcerative colitis. There are differences in incidence of ulcerative colitis between males and females, but whether sex affects treatment outcomes is less clear. We examined sex-based differences in patients with ulcerative colitis initiated on vedolizumab from two major randomized controlled trials (RCTs).
View Article and Find Full Text PDFBackground & Aims: We assessed Modified Multiplier Simple Endoscopic Score for Crohn's Disease (MM-SES-CD) and Simple Endoscopic Score for Crohn's Disease (SES-CD) thresholds that are best associated with low likelihood of long-term disease progression.
Methods: Data from 61 patients with early Crohn's disease (CD) who participated in the CALM long-term extension study were used as the derivation cohort and validated using the McMaster inflammatory bowel disease database (n = 99). The primary outcome was disease progression (new internal fistula/abscess, stricture, perianal fistula or abscess, CD-related hospitalization or surgery) since the end of the CALM trial.
Article Synopsis
- The study analyzed the 1-year outcomes of early and delayed responders to biologic therapies in patients with Crohn's disease (CD) using data from the SEAVUE clinical trial.
- Participants were categorized as early responders if they showed significant improvement by week 8, while delayed responders improved by week 16.
- Results indicated no significant differences in clinical remission at week 56 between early and delayed responders, although delayed responders showed a notable decrease in inflammation markers by week 8 compared to nonresponders.
Predictors of histologic response to mepolizumab in pediatric eosinophilic esophagitis.
Eur J Gastroenterol Hepatol
October 2023
Background: Eosinophilic esophagitis (EoE) is a chronic, allergic disease of the esophagus. Current treatment options are limited. One experimental therapy is antibodies against interleukin-5 (IL-5).
View Article and Find Full Text PDFBackground & Aims: Differences in 1-year outcomes among early compared with delayed responders to vedolizumab have been shown in ulcerative colitis. However, it is unclear whether similar differences exist with ustekinumab, and what factors differentiate delayed responders from nonresponders.
Methods: This study was a post hoc analysis of patient-level data from the UNIFI clinical trial.
Objective: In the absence of head-to-head clinical trials, indirect comparative studies are needed to help position therapies in ulcerative colitis (UC). We aimed to compare the efficacy of infliximab vs. tofacitinib for moderate-severe UC among biologic-naïve participants at post-induction.
View Article and Find Full Text PDFIntroduction: We developed and internally validated a prognostic scoring index for ulcerative colitis (UC) patients that includes baseline patient-reported outcomes (PROs), biomarkers, endoscopy, and histology for achieving 1-year endoscopic improvement (EI).
Methods: This post hoc analysis included 644 patients treated with ustekinumab induction therapy. Data were randomly split to obtain a 70% training and 30% testing cohort.
Article Synopsis
- The study investigated the efficacy of histo-endoscopic mucosal improvement (HEMI) versus endoscopic improvement (EI) in patients with ulcerative colitis (UC) during two evaluation periods: 14 weeks post-induction and 1 year post-maintenance.
- An analysis of 620 participants from the VARSITY trial showed that although similar rates of clinical remission were achieved between those who attained HEMI and EI at the 1-year mark, HEMI was linked to greater reductions in disease activity and inflammatory markers like fecal calprotectin and C-reactive protein.
- Ultimately, HEMI did not provide extra prognostic benefits predicting one-year outcomes compared to EI, yet it did indicate lower clinical disease
Food Processing and Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.
Clin Gastroenterol Hepatol
September 2023
Background & Aims: Several studies have been published on the association between food processing and risks of Crohn's disease (CD) and ulcerative colitis (UC), with some variability in results. We performed a systematic literature review and meta-analysis to study this association.
Methods: From PubMed, Medline, and Embase until October 2022, we identified cohort studies that studied the association between food processing and the risk of CD or UC.
Article Synopsis
- Indirect treatment comparisons using patient-level data are becoming common in inflammatory bowel disease research, specifically looking at adalimumab and vedolizumab for moderate-severe ulcerative colitis (UC).
- A pooled analysis of 518 biologic-naïve UC patients showed a higher rate of clinical remission for vedolizumab compared to adalimumab after 6 weeks, with results reflecting those from the RCT VARSITY.
- The findings suggest that indirect comparisons of clinical trial data can help inform treatment choices and support drug positioning when direct comparisons are lacking.
Introduction: We aimed to evaluate the real-world effectiveness and safety of tofacitinib for the treatment of ulcerative colitis (UC).
Methods: REMIT-UC is a Canadian multicenter cohort study. Standardized data collection was performed on 334 consecutive adult outpatients with UC treated with tofacitinib.
Background & Aims: Several medications have been suspected to contribute to the etiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and the risk of developing IBD using the Prospective Urban Rural Epidemiology cohort.
Methods: This was a prospective cohort study of 133,137 individuals between the ages of 20 and 80 from 24 countries.
Article Synopsis
- In placebo-controlled trials for Crohn's disease, some patients experience improvement, but the reasons behind this placebo response are not well understood.
- A post hoc analysis of three clinical trials involving 683 placebo-treated patients revealed predictors for clinical remission, such as low C-reactive protein, high albumin levels, and disease duration of less than five years.
- The findings suggest that future trial designs should consider reducing placebo responses by stratifying or excluding participants based on disease duration and severity.
Background: This analysis evaluates the association between baseline patient-reported symptom (PRS) severity in Crohn's disease (CD), including abdominal pain, stool frequency, general well-being, and achievement of clinical and endoscopic outcomes. We compared baseline PRS to baseline endoscopic scores for the prediction of endoscopic remission (ER).
Methods: This post hoc analysis of 2 clinical trials of infliximab in CD included 601 patients and evaluated baseline PRS variables (abdominal pain, stool frequency, and general well-being) as measured by the Crohn's disease activity index and their association with 6-month clinical remission (CR) (Crohn's Disease Activity Index<150), corticosteroid-free CR, and week 26/54 ER (absence of mucosal ulceration).
Article Synopsis
- This study examined the relationship between ulcer size after treatment and the likelihood of achieving remission in Crohn's disease patients one year later.
- Data from 283 patients indicated that those with larger ulcers (≥5 mm) post-treatment were significantly less likely to reach endoscopic remission compared to those with smaller or no ulcers.
- The findings suggest prioritizing objective measures like ulcer size over patient-reported symptoms when assessing treatment effectiveness in clinical settings and trials.
Pilot study of an elimination diet in adults with mild to moderate Crohn's disease.
Eur J Gastroenterol Hepatol
December 2022
Background: There remains limited data supporting the efficacy of dietary therapy in adults with Crohn's disease (CD). This was a pilot study of the McMaster Elimination diet for CD (MED-CD), which excludes several potentially detrimental ingredients commonly found in the Western diet.
Methods: Prospective study in adults with mild-moderately active CD [Harvey-Bradshaw Index (HBI) scores 5-16] and endoscopic disease activity of >7 (or ≥4 for isolated ileal disease) as measured by the Simple Endoscopic Score for Crohn's disease (SES-CD).
Although inflammatory bowel disease [IBD] affects an increasingly diverse patient population, most patients in IBD clinical trials are White. Acknowledging current barriers and taking meaningful action is required at multiple levels to improve racial diversity across clinical trials in IBD. Ultimately, improving racial diversity in trials can in turn improve the care received by the diverse patients seen in clinical practice.
View Article and Find Full Text PDFArticle Synopsis
- - The study compares the clinical outcomes of patients with ulcerative colitis (UC) who respond early vs. those who respond later to treatments with vedolizumab and adalimumab.
- - Results indicate that early responders to vedolizumab are significantly more likely to achieve sustained clinical remission (week 52) and endoscopic improvement compared to those who respond later.
- - However, there were no notable differences in outcomes between early and late responders to adalimumab, suggesting different efficacy profiles for these medications in UC treatment.
Predictors of Placebo Induction Response and Remission in Ulcerative Colitis.
Clin Gastroenterol Hepatol
April 2023
Background & Aims: High placebo response rates in clinical trials of ulcerative colitis (UC) have been reported previously. However, data from patient-level analyses are lacking. We assessed factors associated with clinical and endoscopic placebo response among placebo-treated patients in clinical trials of UC.
View Article and Find Full Text PDFBackground: There is a need to better understand the positioning of biologic therapies for long-term outcomes in biologic-naïve Crohn's disease (CD). We assessed the comparative effectiveness of infliximab and ustekinumab among induction responders for 1-year outcomes.
Methods: This post hoc analysis included data from 220 biologic-naïve CD participants with response to induction therapy from 2 clinical trial programs.
Article Synopsis
- Patient-reported outcomes (PROs) in clinical trials for ulcerative colitis (UC) are important, but their long-term prognostic value is still uncertain.
- A post-hoc analysis of 611 patients treated with vedolizumab or adalimumab showed that early improvement in stool frequency and rectal bleeding is linked to better one-year outcomes like endoscopic improvement and clinical remission.
- Patients with mild symptoms at week 6 were more likely to achieve positive outcomes after one year, suggesting that simplified evaluations of PROs can effectively assess early responses to UC treatments.