Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology practice recommendations for medical management and monitoring of inflammatory bowel disease in Asia

Abstract

Inflammatory bowel disease (IBD) has increased in incidence and prevalence in Asian countries since the end of the 20th century. Moreover, differences in the cause, phenotypes, and natural history of IBD between the East and West have been recognized. Therefore, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have established recommendations on medical management of IBD in Asia. Initially, the committee members drafted 40 recommendations, which were then assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight statements were rejected as this indicated that consensus had not been reached. The recommendations encompass pretreatment evaluation; medical management of active IBD; medical management of IBD in remission; management of IBD during the periconception period and pregnancy; surveillance strategies for colitis‐associated cancer; monitoring side effects of thiopurines and methotrexate; and infections in IBD.

Safety and Efficacy of Vedolizumab in a Patient With Crohn's Disease After Developing An Active Tuberculosis Infection Associated With Infliximab-Biosimilar: A Case Report

“…The Asian Organization for Crohn's and Colitis (AOCC) recommends that IBD patients be screened for TB by chest radiography and a tuberculin skin test (TST) and/or IGRA before the initiation of anti-TNF agents. 5,6 In the present case, CT revealed a nodular lesion at the apex of the right lung. However, he did not have any symptoms, and his IGRA and several culture tests as well as a PCR examination were all negative.…”

“…Different scienti c organizations from all over the world have published guidelines and recommendations concerning active and latent TB. [4][5][6] However, active TB can still occur in IBD patients treated with anti-TNF agents despite compliance with recommended preventive measures. 7 Furthermore, no therapeutic strategy for IBD patients who develop active TB associated with anti-TNF agents has yet been established.…”

Randomised clinical trial: dose optimising strategy by NUDT15 genotyping reduces leucopenia during thiopurine treatment of Crohn's disease

“…4 The most common and serious adverse event is leucopenia (thiopurine-induced leucopenia), especially in Asian populations. [5][6][7] According to our previous multi-centre study in China, 24.2% of patients with inflammatory bowel disease (IBD) developed thiopurine-induced leucopenia. 8 As a result, the factors that can predict the risk of thiopurine-induced leucopenia and reduce the drug toxicity before treatment initiation are of great significance.…”

“…Moreover, the three TPMT variants showed no significant effect in IBD patients in Asia. 6,14 Considering the cost-effectiveness, whether pre-screening of NUDT15 alone could effectively identify patients who require dose adjustments needs to be explored. In addition, the efficacy after dose adjustment was not considered in the previous study, which is also important for decision-making in clinical practice.…”

Association Between Genetic Polymorphisms of Metabolic Enzymes and Azathioprine-Induced Myelosuppression in 1,419 Chinese Patients: A Retrospective Study

“…Azathioprine (AZA) is a classic immunosuppressant that is widely used for post-transplant rejection, severe rheumatoid arthritis, systemic lupus erythematosus, pemphigus ( Joly et al, 2020 ), inflammatory bowel disease ( Ran et al, 2020 ), dermatomyositis, and other diseases ( Mack et al, 2020 ). It is also recommended for the treatment of immune checkpoint inhibitor-related renal and musculoskeletal adverse events ( Thompson et al, 2020 ).…”