Publications by authors named "Ian Arnott"
Background And Aims: Over the last decade, treatment options for moderate-to-severe ulcerative colitis (UC) have expanded. However, comparative studies between these agents are limited, especially among biologic-naïve patients. We aimed to compare the persistence, effectiveness and safety of tofacitinib and vedolizumab as the first advanced treatment for patients with UC.
View Article and Find Full Text PDFBackground: Long-term vedolizumab (VDZ) outcomes in real-world cohorts have been largely limited to 1-year follow-up, with few bio-naïve patients or objective markers of inflammation assessed.
Objectives: We aimed to assess factors affecting VDZ persistence including clinical, biochemical and faecal biomarker remission at 1, 3 and 5 years.
Design: We performed a retrospective, observational, cohort study.
Article Synopsis
- The study aimed to evaluate the effectiveness of early medical prophylaxis versus waiting for endoscopy findings in preventing postoperative recurrence (POR) in patients with Crohn's disease after ileocaecal resection (ICR).
- Out of 346 patients, those receiving early prophylactic treatment (Cohort 1) had significantly lower endoscopic recurrence rates compared to those who only received treatment based on endoscopy results (Cohort 2).
- While both groups did not show significant differences in severe endoscopic POR or time to surgical recurrence, the proactive group had a lower treatment burden when using immunomodulators.
Background: Filgotinib is a small molecule with preferential inhibition of Janus kinase type 1, approved for the treatment of ulcerative colitis in Scotland in May 2022. We present the first real-world experience on its use in clinical practice.
Methods: In this retrospective, observational, cohort study we assessed patients with active ulcerative colitis who received filgotinib in NHS Lothian, Scotland.
Article Synopsis
- The ACE Index was initially developed to predict steroid non-response in patients with acute ulcerative colitis (UC) and has now been validated in a larger, independent patient cohort.
- In a study of 800 patients, the ACE Index showed a positive predictive value of 62.5% for those scoring a maximum of 3, indicating a significant portion did not respond to IV steroids, while 79.8% of patients with a score of 0 did respond.
- The validation suggests the ACE Index can assist in identifying high-risk patients for steroid non-response in acute UC cases, but further research is needed to enhance its accuracy and clinical application.
Background And Aims: Healthcare quality improvement (QI) is the systematic process to continuously improve the quality of care and outcomes for patients. The landmark Inflammatory Bowel Disease (IBD) UK National Audits provided a means to measure the variation in care, highlighting the need to define the standards of excellence in IBD care. Through a consensus approach, we aimed to establish key performance indicators (KPIs), providing reliable benchmarks for IBD care delivery in UK.
View Article and Find Full Text PDFBackground: Switching from originator infliximab (IFX) to biosimilar IFX is effective and safe. However, data on multiple switching are scarce. The Edinburgh inflammatory bowel disease (IBD) unit has undertaken three switch programmes: (1) Remicade to CT-P13 (2016), (2) CT-P13 to SB2 (2020), and (3) SB2 to CT-P13 (2021).
View Article and Find Full Text PDFBackground: The UNITI trial reports efficacy of ustekinumab (UST) dose intensification in Crohn's disease (CD) from 12- to 8-weekly, but not 4-weekly. We aimed 1) to assess the cumulative incidence of UST dose intensification to 4- or 6-weekly, 2) to identify factors associated with dose intensification, and 3) to assess the effectiveness of this strategy.
Methods: We performed a retrospective, observational cohort study in NHS Lothian including all UST treated CD patients (2015-2020).
Background: Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves.
Aims: To assess patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high-quality care.
Background: Crohn’s and Ulcerative Colitis Questionnaire-32 (CUCQ-32) is a validated questionnaire to measure the quality of life (QoL) in Inflammatory Bowel Disease (IBD). However, it does not have stoma-specific questions and can be lengthy. This study aimed to validate a subset of the CUCQ-32 that would be suitable for patients with a stoma.
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- In NHS Lothian, the incidence of collagenous colitis (CC) significantly increased from 1998-2003 to 2013-2018, with diagnosed cases rising from 25 to 224.
- The mean annual incidence jumped from 0.5 to 4.3 cases per 100,000 people, especially high in females over 60, whose rates surged from 2.3 to 22.4 per 100,000.
- The total number of colonoscopies conducted more than doubled, reflecting increased detection of CC parallels with the rising number of procedures performed.
Objective: It is unclear how the compounding prevalence of inflammatory bowel disease (IBD) has translated into the causes and rates of hospitalisation, particularly in an era of increased biologic prescribing. We aimed to analyse these trends in a population-based IBD cohort over the last 10 years.
Design: The Lothian IBD registry is a complete, validated, prevalent database of IBD patients in NHS Lothian, Scotland.
The 2021 National report from IBD UK included responses from over 10 000 patients with inflammatory bowel disease, over 70% of whom reported having at least one flare in the last 12 months. As the first-line treatment for patients with mild and moderate ulcerative colitis, the action and delivery mechanisms of mesalazine are crucial for successful management of the disease. The choice of the most appropriate formulation of mesalazine and securing patient concordance and adherence to treatment remains a challenge for healthcare professionals.
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- The study aimed to evaluate the long-term effectiveness and safety of the adalimumab biosimilar SB5 in patients with inflammatory bowel disease (IBD), comparing those who switched from the ADA originator and those who started directly on SB5.
- A total of 481 IBD patients were analyzed, with 70.8% of those who switched to SB5 remaining on the treatment after a year, while 60.3% of new users also persisted beyond that timeframe.
- Overall, no significant changes in clinical outcomes were observed post-switch, suggesting that switching to SB5 is both effective and safe for long-term use in IBD patients.
Article Synopsis
- The study aimed to identify factors that lead to poor wound healing in patients with perianal Crohn's disease after undergoing proctectomy, particularly in the context of biologic therapies.
- A review of 103 patient records revealed that 58.3% experienced wound healing failure at 6 months, and 39.8% at 12 months, with male gender being the only significant predictor of poor healing.
- The findings indicated that prior exposure to biologic therapies like infliximab and adalimumab was not linked to wound healing outcomes, while lower pre-operative C-reactive protein levels were associated with better healing at 6 months.
SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD.
View Article and Find Full Text PDFA 75-year-old man was admitted with a 3-month history of worsening diarrhoea and weight loss. He was on long-term immunosuppression following cardiac transplantation. Investigations revealed herpes simplex oesophagitis and stool samples were positive for norovirus.
View Article and Find Full Text PDFBackground And Aim: Ustekinumab is a monoclonal antibody that targets interleukin-12/23. In Scotland, it was approved for the treatment of moderate to severe Crohn's disease in 2017. The objective of this study was to establish the real-world effectiveness and safety of ustekinumab in the treatment of Crohn's disease.
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- The study aimed to assess how changes in the prescribing of biological treatments for ulcerative colitis (UC) in the UK affected colectomy rates between 2005 and 2018.
- It found a significant rise in the initiation of maintenance biological therapy, from 0.05 to 1.26 per 100 UC patients, while colectomy rates dropped from 1.47 to 0.44 per 100 patients in the same timeframe.
- The results suggest that increased use of biological therapy after 2015 is linked to a notable decline in colectomy rates, indicating a positive impact on patient outcomes.
Background & Aims: The level of fecal calprotectin (FC) correlates with endoscopic evidence of inflammation in Crohn's disease (CD). A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in the induction of mucosal healing at 12 months. We investigated whether normalization of FC within 12 months of diagnosis of CD is associated with a reduction in disease progression.
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