In utero exposure to anti-TNFα drugs does not seem to be associated with increased short-term or long-term risk of severe infections in children.

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Background There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn’s disease. Aim The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn’s disease complicated with symptomatic strictures. Methods In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn’s disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up. Results Overall, 262 patients with Crohn’s disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab ( N = 141, 54%) or adalimumab ( N = 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19–85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn’s disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18–2.22; and HR 1.55, 95% CI 1.1–2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness. Conclusions Anti-TNF agents are effective in approximately a quarter of patients with Crohn’s disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.

HIIT improved significantly maximal oxygen uptake (6.1 + 3.6 mL/kg/min or 24.6%), reduced 2 h post load blood glucose (-33.7 + 47.9 mg/dL or -12.5%) and body fat (-4.3 + 5.6 kg). No significant changes were observed in the non-adherent group. Conclusions: HIIT exercise reduces blood glucose after an oral load in glucose intolerant patients. (Rev Med Chile 2014; 142: 34-39)

Background and aims Extra-intestinal manifestations are frequently reported in inflammatory bowel diseases. However, data comparing the effect of vedolizumab and ustekinumab on articular extra-intestinal manifestations are limited. The aim was to evaluate differences in new onset and evolution of pre-existing joint extra-intestinal manifestations during both treatments. Methods An international multicentric retrospective study was performed on inflammatory bowel disease patients who started vedolizumab or ustekinumab between May 2010 and December 2020. Extra-intestinal manifestations were assessed at baseline and joint extraintestinal manifestations were evaluated throughout the 2-year follow-up. Arthropathy was defined by joint inflammation (arthritis/sacroiliitis), diagnosed by a rheumatologist, and arthralgia as articular pain without confirmed inflammation. Additionally, skin, ocular and hepatic extra-intestinal manifestations were assessed at baseline. Uni- and multivariate analyses were performed. Results In total 911 patients (vedolizumab:584; ustekinumab:327) were included. Deterioration of pre-existing arthropathy and rate of new onset arthropathy were not significantly associated with vedolizumab over ustekinumab. Arthropathy was reason to stop treatment in 6 vedolizumab and 2 ustekinumab patients. The odds of developing new arthralgia within 6 months was higher in patients who took vedolizumab compared to ustekinumab (aOR: 2.28 [1.01-5.15], p=0.047). However, this effect was not sustained during the 2-year follow-up (aOR: 1.35 [0.80-2.29], p=0.259). Deterioration of pre-existing arthralgia was comparable between ustekinumab and vedolizumab treated patients. In 2 vedolizumab-treated patients arthralgia was reason to stop treatment. Conclusions Vedolizumab and ustekinumab can be used safely in patients with articular extra-intestinal manifestations. Only a temporary increased risk for developing arthralgia has been observed under vedolizumab.