[Overview and update on treatment in ulcerative colitis].

INTRODUCTION: Ulcerative colitis is characterized by a chronic intestinal inflammation limited to the mucosa of the colon, of variable proximal extent. Main symptoms are diarrhea, possibly bloody, and abdominal pain. It evolves with phases of relapse and remission. The diagnosis of ulcerative colitis is made based on clinical, endoscopic, and histologic findings. Currently, the various drug treatment options act by, among other things, reducing the activity of the immune system locally or systemically. In mild to moderate forms, 5-ASA remains the mainstay of both induction and maintenance treatment. In more severe flares, cortisone is the treatment of choice. To limit the prolonged/repeated intake of corticosteroids, there are several options of biologics with distinct ranges of action and safety profiles for inducing and/or maintaining remission. Therapeutic goals are evolving and go beyond achieving clinical remission. Endoscopic and histological remission are new targets to further improve quality of life and limit long-term complications, such as colorectal cancer.

[Number needed to treat: a useful toolto evaluate the effectiveness of a treatment?] / Number Needed to Treat : un bon outil pour évaluer l'utilité d'un médicament ?

This article reviews the clinical implications and limitations of the number needed to treat (NNT). Clinicians can quickly use this rather intuitive statistical value to assess the expected effectiveness of a treatment and explain it to patients. However, careful attention must be paid to the outcomes used in defining an NNT, as well as, the rate of the specific event in the population and the duration of observation. Conflicts of interest may also affect this easily manipulated statistical tool. Some often prescribed treatments have an NNT well above 20, implying an uncertain benefit for the patient, which emphasizes the need to carefully weigh the risk-benefit balance (NNT vs. NNH: number needed to harm) when prescribing. This review shows particularly low NNTs for anti-infectious agents compared to other drugs frequently used in medical practice.

Cet article revoit les implications cliniques et les limitations du NNT (Number Needed to Treat). C'est une valeur intuitive rapidement utilisable afin d'évaluer l'efficacité attendue d'un traitement et facilement abordable pour le patient. Cependant, on restera très attentif aux issues cliniques étudiées, au risque de base de l'événement dans la population et à la durée d'observation utilisés. Des conflits d'intérêts peuvent aussi affecter cet outil statistique facilement manipulable. Certains traitements largement prescrits présentent un NNT au-delà de 20, donc un bénéfice incertain pour le patient, imposant de soigneusement peser la balance risques-bénéfices (NNT vs NNH (Number Needed to Harm)) lors de la prescription initiale. Le NNT est particulièrement bas pour les agents anti-infectieux, comparés à d'autres traitements courants.

SARS-CoV-2 vaccination in inflammatory bowel disease patients is not associated with flares: a retrospective single-centre Swiss study.

INTRODUCTION: Vaccination hesitancy is an important barrier to vaccination among IBD patients. The development of adverse events is the main concern reported. The purpose of this monocentric study was to assess SARS-CoV-2 vaccination safety in IBD patients by evaluating the postvaccination flare risk and incidence of overall adverse events. METHODS: Surveys were handed out on three consecutive months to each patient presenting at the Crohn-Colitis Centre, where they documented their vaccination status and any side effects experienced after vaccination.Dates of flares occurring in 2021 were recorded from their electronic medical records. Baseline and IBD characteristics and flare incidence were compared between the vaccinated and unvaccinated patients, and among the vaccinated population before and after their vaccination doses. The characteristics of patients who developed side effects and of those who did not were compared. RESULTS: We enrolled 396 IBD patients, of whom 91% were vaccinated. The proportion of patients who experienced flares was statistically not different between the vaccinated and the unvaccinated population (1.8 vs 2.6 flares per 100 person-months (p = 0.28)). Among vaccinated patients, there was no difference across the prevaccination, 1 month post any vaccination, and more than 1 month after any vaccination periods, and between the Spikevax and Cominarty subgroups. Overall, 46% of patients reported vaccination side effects, mostly mild flu-like symptoms. CONCLUSION: SARS-CoV-2 vaccination with mRNA vaccines seems safe, with mostly mild side effects. The IBD flare risk is not increased in the month following any vaccination.

Swiss expert opinion: current approaches in faecal microbiota transplantation in daily practice.

INTRODUCTION: Faecal microbiota transplantation (FMT) is an established therapy for recurrent C. difficile infection, and recent studies have reported encouraging results of FMT in patients with ulcerative colitis. Few international consensus guidelines exist for this therapy, and thus FMT policies and practices differ among European countries. As of 2019, stool transplants are considered a non-standardised medicinal product in Switzerland, and a standardised production process requires authorisation by the Swiss Agency for Therapeutic Products. This authorisation leads to prolonged administrative procedures and increasing costs, which reduces treatment accessibility. In particular, patients with ulcerative colitis in Switzerland can only benefit from FMT off-label, even though it is a valid therapeutic option. Therefore, this study summarised the available data on FMT and established a framework for the standardised use of FMT. METHODS: A panel of Swiss gastroenterologists with a special interest in inflammatory bowel disease was established to identify the current key issues of FMT. After a comprehensive review of the literature, statements were formulated about FMT indications, donor screening, stool transplant preparation and administration, and safety aspects. The panel then voted on the statements following the Delphi process; the statements were reformulated and revoted until a consensus was reached. The manuscript was then reviewed by an infectiologist (the head of Lausanne's FMT centre). RESULTS: The established statements are summarised in the supplementary tables in the appendix to this paper. The working group hopes these will help standardise FMT practice in Switzerland and contribute to making faecal microbiota transplantation a safe and accessible treatment for patients with recurrent C. difficile infections and selected patients with ulcerative colitis, as well as other indications in the future.