Last week, teams from Spirit Group travelled to the Bella Center in Copenhagen to attend the 14th Congress of ECCO.
Delegates from across the globe came together at the biggest European congress for Inflammatory Bowel Disease to learn about the latest discoveries and updated therapies in the field of biomarkers, and how advancing technology (prominently, artificial intelligence) will impact the entire medical community, from researchers to physicians to patients. With over 1,000 abstracts shared over the course of the congress, we have selected our top highlights from the week to share with you here.
- ABX464 demonstrated safety and efficacy in a proof-of-concept Phase IIa study in 32 patients with ulcerative colitis (presented by Jean-Marc Steens, OP21). ABX464 is a first-in-class small molecule that binds the cap binding complex, thereby enhancing splicing of an lncRNA, which ultimately leads to increased levels of miR-124, a potent anti-inflammatory microRNA
- Mirikizumab, a p19-directed anti-IL-23 antibody, demonstrated safety and efficacy over the first 52 weeks of maintenance (presented by Geert D’Haens, OP38). Efficacy was similar in patients who had previous exposure to biologics, and in those who were biologic-naïve, and was observed with two dose regimens of mirikizumab
- Can the old dog learn new tricks? A new subcutaneous formulation of infliximab showed similar efficacy and safety to the intravenous formulation and demonstrated consistent drug exposure during maintenance treatment (Walter Reinisch, DOP62). This may expand treatment options for infliximab, as maintaining specific trough levels of infliximab was shown to significantly increase remission rates in the PRECISION study (DOP56)
Updates on established therapies
- The Phase IIIb study VARSITY demonstrated superior clinical remission and mucosal healing with vedolizumab compared with adalimumab in patients with ulcerative colitis; the clinical superiority of vedolizumab was most pronounced in the anti-TNF-naïve subpopulation (presented by Stefan Schreiber, OP34)
- No new safety concerns were identified in the GEMINI long-term safety study of 9 years (presented by Remo Panaccione, OP26). The study included patients with Crohn’s disease or ulcerative colitis who received vedolizumab every 4 weeks
- Updates on the UNIFI Phase III study showed that ustekinumab maintenance is safe and effective in patients with ulcerative colitis (presented by William Sandborn, OP37). In addition, further analyses in a subset of UNIFI patients showed that ustekinumab induction leads to suppression of inflammatory pathways and normalisation of colonic gene signature (OP13)
- Updates on the OCTAVE studies (DOP41, DOP43) showed that tofacitinib is effective at inducing and maintaining remission and mucosal healing over 52 weeks regardless of prior anti-TNF exposure
- A long-term follow-up of patients who completed the CALM study showed that remission at 1 year correlates with a decreased risk of disease complications over the next 3 years (presented by Clara Yzet, OP35). However, there was no statistically significant difference in long-term disease course between patients who were in the treat-to-target versus conventional management group
The era of Big Data
- Hospital digital records grow by 48% each year. Every day the medical community invents new ways to use patient clinical records to gain a deeper understanding of disease predisposition and predict response to treatment. Some of the caveats may be defining data ownership, and if it belongs to patients rather than hospitals, and whether giving researchers access to such data will be complicated by the GDPR guidelines
- A pilot study in Spain aims to integrate the clinical records of 3000 patients into a multidimensional model that will predict the course and outcomes of Crohn’s disease (PREMONITION-CD). Ignacio Hernandez-Medrano and colleagues are using computer linguistics to help transcribe free text medical records into specific data points that can subsequently be analysed by a machine. AI will not replace a physician, but we can harness its power to free physicians from many tasks and let them concentrate on interacting with patients
- In the next couple of decades, we can expect to see a new wave of robotic surgery technology that will be more digitalised and integrated and will use machine learning to provide surgeons with actionable insights
What’s in a gut?
- The results of a high-resolution genome–microbiome association study showed that the microbiome composition can be influenced by host genetics (presented by Shixian Hu, OP1)
- Luc Biedermann (OP6) reported that the composition of mucosa-associated microbiota in patients in remission correlates with the host’s psychological wellbeing
- Yet another study showed that individualised microbial variations in quiescent CD can precede and predict disease flare (DOP36)
- Interestingly, both studies used machine learning to predict these associations; the study of Luc Biedermann and colleagues had 80–90% prediction accuracy
- Is it possible that, in the future, therapeutic manipulation of microbiota may help improve patients’ quality of life and perhaps even prevent relapse?
- As mentioned by Arthur Kaser, IBD is not one disease, but a spectrum of diseases that are affected by hundreds of candidate genetic mutations and an as yet unknown number of environmental factors. Currently available treatments are mostly generic suppressors of intestinal inflammation, but we are moving towards a future of personalised medicine
- A number of candidate biomarkers are currently being explored. In order to utilise them effectively, the diagnostic and clinical classification systems need to be adjusted (for example, Montreal classification does not match the known molecular profiles of patient subpopulations). Further research is needed to integrate DNA/RNA and protein data with microbiome profiling
- In the future, multi-omics-based analyses may help predict response to therapy and guide treatment decisions
A thought-provoking and thoroughly informative congress all round! If you have any questions or thoughts on any of the findings above, do not hesitate to contact our experienced team at Spirit Group here. We’re already looking forward to seeing what ECCO 2020 brings!