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    Home > Active Ingredient News > Digestive System Information > CGC2021 Sino-Japanese Digestive Medicine Joint Exploration: To achieve standardized diagnosis and treatment of IBD, optimizing treatment strategies is the key

    CGC2021 Sino-Japanese Digestive Medicine Joint Exploration: To achieve standardized diagnosis and treatment of IBD, optimizing treatment strategies is the key

    • Last Update: 2022-01-10
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read and refer to the 7th China-Japan Digestive Medicine Exchange Forum, sharing the essence of relevant content of IBD standardized diagnosis and treatment
    .

    On December 16-18, 2021, the 21st National Digestive System Conference (CGC2021) of the Chinese Medical Branch hosted by the Chinese Society of Digestive Diseases was successfully held
    .

    This conference showcased China's academic progress in digestion clinical research, basic research, and new technology applications this year, and introduced new concepts and new developments in the current international digestive field
    .

    During the period, the 7th China-Japan Digestive Medicine Exchange Forum with the theme of "Gathering and Integrating, Energetic and New Realms" sponsored by the Takeda Medical Department gathered a number of top gastroenterology experts from China and Japan to build an academic foundation for the majority of digestive scholars.
    A platform for communication and exchange to promote the academic progress in the field of digestive medicine in China and Japan
    .

    In the "IBD Standardized Diagnosis and Treatment" section, Professor Kazuro Otsuka from Tokyo Medical and Dental University and Professor Gao Xiang from the Sixth Affiliated Hospital of Sun Yat-sen University respectively gave "Disease management and treatment of moderate to severe ulcerative colitis (UC) based on the national conditions of Japan" He shared his academic views on the topic of "Overall Planning and Optimizing Crohn's Disease (CD) Management Strategies".
    This article has compiled important academic information on standardized diagnosis and treatment of inflammatory bowel disease (IBD) for the reference of readers and friends
    .

    The 7th Sino-Japanese Digestive Medicine Exchange Forum, sharing the essence of IBD standardized diagnosis and treatment related content Part 1 Disease management and treatment of moderate to severe UC based on the national conditions of Japan 1.
    Disease characteristics of UC In the past 30 years, the number of UC patients in Japan has been increasing.
    In 2014, there were 181,560 UC patients registered and certified
    .

    UC is a chronic progressive disease.
    The clinical course of the patient during the 10 years after the onset of the disease is divided into 4 categories: 1) Initial high activity, and then weakened or relieved; 2) Initial low activity, then gradually aggravated; 3) Chronic persistent seizures; 4) Chronic intermittent seizures [1]
    .

    In addition, the risk of colorectal cancer in UC patients increases with the length of the disease [2]
    .

    2.
    The treatment strategy of UC For the treatment goal of IBD, the induction treatment stage is asymptomatic, the quality of life scale score is normal, and the maintenance treatment stage is no recurrence and no hospitalization
    .

    The treatment goals of UC continue to evolve, from Mayo score to UCEIS, histological healing, ultrastructural healing, and the ultimate goal is functional healing [3]
    .

    At present, UC treatment should follow the treatment strategy of Treat to Target, based on regular assessment of disease activity, combined with the patient's objective inflammatory activity indicators and biological indicators to adjust the follow-up treatment plan [4]
    .

    Figure 1 Target treatment strategy [4] Figure 2 UC treatment goals proposed by the 2021 STRIDE-II consensus [5] Current Japanese UC drugs are in addition to traditional drugs such as 5-aminosalicylic acid (5-ASA), steroids and immunomodulators , Biological preparations mainly include infliximab and its biological analogues, adalimumab, golimumab, usnuzumab, vedelizumab and tofacitib
    .

    The recently published 2020 evidence-based clinical practice guidelines for inflammatory bowel disease recommends treatment options for patients with different types of UC [6]
    .

    For hormone-dependent or refractory patients, you can choose to switch to biological agents
    .

    For patients with UC who use biological agents to induce remission, continue to use biological agents for maintenance treatment
    .

    3.
    Evaluation of the effectiveness of the treatment plan UC mainly involves mucosa, so mucosal healing is an important treatment goal of UC, and endoscopic evaluation must be performed
    .

    The most commonly used scoring systems are Mayo score [7] and UCEIS score [8]
    .

    Based on the full-automatic diagnosis system of cell endoscopy, the sensitivity, specificity and accuracy of the evaluation of histological inflammation using artificial intelligence (AI) technology are high, which are 74%, 97% and 91% respectively [9], which has a wide range of Application prospects
    .

    A prospective study found that, compared with expert evaluation, the accuracy of using deep neural networks to assess UC (DNUC) endoscopic remission was 90.
    1%, and the accuracy of predicting histological remission without mucosal biopsy was 92.
    9% [10]
    .

    In addition, biomarkers can also be used to evaluate the efficacy.
    Common biomarkers include acute inflammation marker C-reactive protein (CRP) and intestinal inflammation sensitive marker calprotectin (FC).
    FC and endoscopic mucosal manifestations have Good correlation
    .

    A recent new type of biomarker is leucine-rich alpha-2 glycoprotein (LRG), which can also predict clinical remission and mucosal healing, but its role in the precise pathophysiology of IBD has not been clear [11]
    .

    4.
    The effectiveness of vedelizumab vedelizumab is a humanized monoclonal antibody whose mechanism of action is to specifically antagonize α4β7 integrin and block α4β7 integrin and intestinal vascular endothelial cells The expressed mucosal address cell adhesion molecule 1 (MAdCAM-1) binds to prevent T lymphocytes from migrating from blood vessels to the intestinal mucosa, reducing local inflammation in the intestine
    .

    The GEMINI 1 study showed that [12], the clinical response rate and endoscopic remission rate at the 6th week of vedelizumab treatment were 47.
    1% and 40.
    9%, and the clinical remission rate at the 52nd week was 41.
    8%; The VARSITY study of Linibizumab and Adalimumab [13] showed that its clinical remission rate at 52 weeks (31.
    3% vs 22.
    5%, P=0.
    0061) and endoscopic remission rate (39.
    7% vs 27.
    7%, P=0.
    0005) ) And histological response rate (37.
    6% vs 19.
    9%, P<0.
    0001) were significantly better than adalimumab
    .

    A post-mortem analysis of a Japanese phase III study evaluated the efficacy of vedelizumab in inducing a rapid clinical response [14].
    In all patients and subgroups of untreated anti-TNF-α, veldrizumab was compared with placebo The proportion of patients with Mayo stool frequency (SF) score of 1 and rectal bleeding (RB) score of 0 was higher in the drug group
    .

    Part 2 Overall planning and optimization of CD management strategies 1.
    Optimizing the timing and goals of CD treatment According to the four stages of the epidemiological evolution of IBD, newly industrialized countries are in the stage of accelerating incidence [15]
    .

    A Chinese study on the characteristics and treatment results of CD in the real world in China showed that non-stenosis and non-penetrating (B1) accounted for the highest proportion (50%) of CD patients in China [16]
    .

    As the course of the disease increases, the proportion (%) of patients with stenosis (B2) or penetration (B3) increases with time [17]
    .

    CD is a chronic progressive disease that can cause cumulative structural damage.
    The focus of CD treatment strategies has changed from simple symptom control and improving quality of life to blocking disease progression to prevent intestinal injury and disability
    .

    Numerous research evidences show that early effective treatment during the window of treatment opportunity before complications (stenosis or penetration) in CD patients can slow the progression of the disease and prevent gastrointestinal damage [18]
    .

    The 2021 STRIDE-II consensus [5] puts forward new requirements for the treatment of CD.
    It is believed that the short-term treatment goals of CD are clinical response and clinical remission, and the medium-term treatment goals are normal CRP and fecal calprotectin falling to an acceptable range.
    The goal of treatment is mucosal healing, normalization of quality of life, and no disability.
    The treatment goal that can be considered is transmural healing
    .

    2.
    Optimizing treatment strategies under the "Golden Opportunity Window" A systematic review and meta-analysis results show that early use of biological agents is associated with a higher clinical remission rate and mucosal healing rate in adult CD patients (P<0.
    00001) [19]
    .

    The EVOLVE study suggests that patients with uncomplicated CD who are initially treated with biologics have a higher clinical response rate when using velizumab to treat patients with complex CD [20]
    .

    The clinical remission rate (38% vs 23%) and mucosal healing rate (29% vs 13%) of patients with a shorter course of disease (<2 years) compared with patients with a longer course of disease (>2 years) treated with veldrizumab [21]
    .

    A retrospective study aimed to compare the persistence of first-line treatment of CD with biologics with different mechanisms of action.
    The results showed that the first-line treatment of veldrizumab is more effective than infliximab, adalimumab, and usnuzumab.
    The persistence rate is higher (59.
    1% vs 58.
    0% vs 50.
    8% vs 57.
    6%) and longer (842 days vs 770 days vs 507 days vs 566 days) [22]
    .

    A simulation model study based on RWE aims to compare the effects of different orders of vedelizumab in the treatment of CD on the clinical outcome.
    The results show that the first-line treatment of vedelizumab is the best strategy in the treatment of CD [23]
    .

    3.
    China's single-center experience of vedelizumab in the treatment of CD.
    Professor Gao Xiang finally shared with us the single-center experience of using vedelizumab in the treatment of CD from Zhongshan Sixth Hospital.
    Early, uncomplicated, and safety requirements have special requirements.
    Patients with relative contraindications to infliximab are suitable for use of velizumab.
    Reasonable optimization before treatment and selection of appropriate synergistic treatment can make velizumab exert a better effect
    .

    In terms of efficacy evaluation, the clinical response should be evaluated during the induction period; inflammatory markers and endoscopic response should be evaluated in the mid-term; clinical and endoscopic remission should be evaluated at 1 year
    .

    The "golden window of opportunity" for CD is precious and short.
    Seizing the "golden window of opportunity" is the key to changing the long-term outcome of patients.
    For patients with early non-complex CD, the use of velizumab can effectively promote patients to achieve continuous clinical and clinical outcomes.
    Endoscopic and imaging relief; for patients with intractable and complex CD, based on its good efficacy and safety, early interventional therapy with veldrizumab can maximize the relief of intestinal inflammation in patients, and optimize patients to avoid surgery or pre-operation Create favorable conditions
    .

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    Approval number: VV-MEDMAT-59808 Approval date: December 2021 Statement:P535.
    Approval number: VV-MEDMAT-59808 Date of approval: December 2021 Statement:P535.
    Approval number: VV-MEDMAT-59808 Date of approval: December 2021 Statement:
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