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  1. Article: De-escalation of Therapy for Patients With Inflammatory Bowel Disease.

    Ungaro, Ryan C

    Gastroenterology & hepatology

    2022  Volume 18, Issue 4, Page(s) 213–215

    Language English
    Publishing date 2022-04-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2386402-3
    ISSN 1554-7914
    ISSN 1554-7914
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  2. Article: Managing IBD in the COVID-19 era.

    Scalzo, Nicholas / Ungaro, Ryan C

    Therapeutic advances in gastroenterology

    2023  Volume 16, Page(s) 17562848231176450

    Abstract: Over the last 2 years the lives of millions have changed because of the emergence of Coronavirus disease 2019 (COVID-19). Patients living with inflammatory bowel disease (IBD) represent a sizable population with their own sets of challenges to providers ... ...

    Abstract Over the last 2 years the lives of millions have changed because of the emergence of Coronavirus disease 2019 (COVID-19). Patients living with inflammatory bowel disease (IBD) represent a sizable population with their own sets of challenges to providers in the wake of so much uncertainty. The Centers for Disease Control considers immunocompromised individuals at higher risk of infection and complications from COVID-19. Early in the pandemic, the specific risks for IBD patients were unclear as guidance was based on expert opinion regarding the management of IBD during a COVID-19 era. Fortunately, after considerable work in the field, the overwhelming evidence suggests that IBD patients as a whole do not appear to be at increased risk for more severe disease from COVID-19. Certain risk factors such as age, steroids, comorbidities, combination immunomodulatory therapy, and IBD disease activity have been associated with worse outcomes. Most IBD medications are low risk, with the exception of immunomodulator monotherapy and combination therapy with thiopurine and anti-TNF. Vaccination remains safe and effective for all IBD patients, although additional booster doses may be necessary, particularly in patients taking anti-TNF agents.
    Language English
    Publishing date 2023-06-15
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2440710-0
    ISSN 1756-2848 ; 1756-283X
    ISSN (online) 1756-2848
    ISSN 1756-283X
    DOI 10.1177/17562848231176450
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  3. Article ; Online: Treat to target with ustekinumab for Crohn's disease.

    Ungaro, Ryan C / Colombel, Jean-Frederic

    The lancet. Gastroenterology & hepatology

    2022  Volume 7, Issue 4, Page(s) 276–277

    MeSH term(s) Crohn Disease/drug therapy ; Humans ; Remission Induction ; Ustekinumab/therapeutic use
    Chemical Substances Ustekinumab (FU77B4U5Z0)
    Language English
    Publishing date 2022-02-01
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Comment
    ISSN 2468-1253
    ISSN (online) 2468-1253
    DOI 10.1016/S2468-1253(22)00019-X
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  4. Article ; Online: Reappraisal of Coronavirus Disease 2019 Risk for Patients With Inflammatory Bowel Disease: Withdrawal of the British Society of Gastroenterology Inflammatory Bowel Disease Risk Grid.

    Ungaro, Ryan C / Kappelman, Michael D

    Gastroenterology

    2022  Volume 164, Issue 1, Page(s) 2–4

    MeSH term(s) Humans ; Gastroenterology ; COVID-19 ; Inflammatory Bowel Diseases/diagnosis
    Language English
    Publishing date 2022-09-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80112-4
    ISSN 1528-0012 ; 0016-5085
    ISSN (online) 1528-0012
    ISSN 0016-5085
    DOI 10.1053/j.gastro.2022.09.015
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  5. Article ; Online: Besting the Biologics: Vancomycin Monotherapy for Ulcerative Colitis Management in Patients with Primary Sclerosing Cholangitis.

    Ahmed, Taqwa / Kayal, Maia / Hashem, Dana / Ungaro, Ryan C

    Digestive diseases and sciences

    2023  Volume 68, Issue 4, Page(s) 1118–1120

    MeSH term(s) Humans ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/diagnosis ; Colitis, Ulcerative/drug therapy ; Vancomycin/therapeutic use ; Cholangitis, Sclerosing/complications ; Cholangitis, Sclerosing/drug therapy ; Biological Products/therapeutic use
    Chemical Substances Vancomycin (6Q205EH1VU) ; Biological Products
    Language English
    Publishing date 2023-03-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-023-07826-3
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  6. Article ; Online: Racial Difference in Efficacy of Golimumab in Ulcerative Colitis.

    Greywoode, Ruby / Petralia, Francesca / Ullman, Thomas A / Frederic Colombel, Jean / Ungaro, Ryan C

    Inflammatory bowel diseases

    2024  Volume 29, Issue 6, Page(s) 843–849

    Abstract: Background: Observational studies have described racial differences in inflammatory bowel disease (IBD) genetics, clinical manifestations, and outcomes. Whether race impacts response to biologics in IBD is unclear. We conducted a post hoc analysis of ... ...

    Abstract Background: Observational studies have described racial differences in inflammatory bowel disease (IBD) genetics, clinical manifestations, and outcomes. Whether race impacts response to biologics in IBD is unclear. We conducted a post hoc analysis of phase 2 and 3 randomized clinical trials in ulcerative colitis to evaluate the effect of race on response to golimumab.
    Methods: We analyzed pooled individual-level data from induction and maintenance trials of golimumab through the Yale Open Data Access Project. The primary outcome was clinical response. Secondary outcomes were clinical remission and endoscopic healing. Multivariable logistic regression was performed comparing White vs racial minority groups (Asian, Black, or other race), adjusting for potential confounders.
    Results: There were 1006 participants in the induction (18% racial minority) and 783 participants in the maintenance (17% racial minority) trials. Compared with White participants, participants from racial minority groups had significantly lower clinical response (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.28-0.66), clinical remission (aOR, 0.41; 95% CI, 0.22-0.77), and endoscopic healing (aOR, 0.48; 95% CI, 0.31-0.74) at week 6. Participants from racial minority groups also had significantly lower clinical remission (aOR, 0.46; 95% CI, 0.28-0.74) and endoscopic healing (aOR, 0.63; 95% CI, 0.41-0.96) at week 30. There were no racial differences in placebo response rates.
    Conclusions: Ulcerative colitis participants from racial minority groups were less likely to achieve clinical response, clinical remission, and endoscopic healing with golimumab compared with White participants in induction and maintenance trials. Further studies are needed to understand the impact of race on therapeutic response in IBD.
    MeSH term(s) Humans ; Antibodies, Monoclonal/therapeutic use ; Colitis, Ulcerative/drug therapy ; Inflammatory Bowel Diseases/drug therapy ; Remission Induction
    Chemical Substances Antibodies, Monoclonal ; golimumab (91X1KLU43E)
    Language English
    Publishing date 2024-02-05
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 1340971-2
    ISSN 1536-4844 ; 1078-0998
    ISSN (online) 1536-4844
    ISSN 1078-0998
    DOI 10.1093/ibd/izac161
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  7. Article ; Online: Is Prevention the Best Way to Modify Inflammatory Bowel Disease? How Close Are We?

    Torres, Joana / Ungaro, Ryan C / Colombel, Jean-Frédéric

    Gastroenterology

    2022  Volume 162, Issue 5, Page(s) 1452–1455

    Abstract: Despite improved therapeutic strategies and expanding therapeutic targets, inflammatory bowel disease remains a disabling disease with potential to progress and lead to irreversible complications. Increased evidence supports the concept of a preclinical ... ...

    Abstract Despite improved therapeutic strategies and expanding therapeutic targets, inflammatory bowel disease remains a disabling disease with potential to progress and lead to irreversible complications. Increased evidence supports the concept of a preclinical phase in inflammatory bowel disease, preceding clinical diagnosis, during which immune and inflammatory pathways are already altered. As knowledge about this prediagnosis period expands, it unlocks the possibility of disease prediction and ambition for disease prevention and interception. Targeting the early pathogenic events that promote the development of inflammatory bowel disease could prevent or attenuate disease onset and offer a true opportunity for disease modification.
    MeSH term(s) Chronic Disease ; Colitis/complications ; Humans ; Inflammatory Bowel Diseases/complications ; Inflammatory Bowel Diseases/diagnosis ; Inflammatory Bowel Diseases/therapy
    Language English
    Publishing date 2022-01-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80112-4
    ISSN 1528-0012 ; 0016-5085
    ISSN (online) 1528-0012
    ISSN 0016-5085
    DOI 10.1053/j.gastro.2021.07.051
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  8. Article ; Online: Second-Line Biologic Therapy Following Tumor Necrosis Factor Antagonist Failure: A Real-World Propensity Score-Weighted Analysis.

    Ibing, Susanne / Cho, Judy H / Böttinger, Erwin P / Ungaro, Ryan C

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

    2023  Volume 21, Issue 10, Page(s) 2629–2638

    Abstract: Background& aims: Tumor necrosis factor (TNF) antagonists often are used as first-line medications to treat moderate to severe inflammatory bowel disease (IBD), but many patients do not achieve or maintain response. Our aim was to compare the ... ...

    Abstract Background& aims: Tumor necrosis factor (TNF) antagonists often are used as first-line medications to treat moderate to severe inflammatory bowel disease (IBD), but many patients do not achieve or maintain response. Our aim was to compare the effectiveness of second-line treatments (ustekinumab, vedolizumab, or a second TNF antagonist) after TNF antagonist exposure in patients with Crohn's disease (CD) and ulcerative colitis (UC) from 2 electronic health records-based cohorts.
    Methods: We identified patients with prior TNF antagonist exposure who switched to a different biologic in the Mount Sinai Health System (MSHS) electronic health records (CD, n = 527; UC, n = 165) and the Study of a Prospective Adult Research Cohort (SPARC) from the Inflammatory Bowel Disease Plexus Program of the Crohn's & Colitis Foundation (CD, n = 412; UC, n = 129). Treatment failure was defined as the composite of any IBD-related surgery, IBD-related hospitalization, new prescription of oral/intravenous corticosteroids, or need to switch to a third biologic agent. Time-to-event analysis was conducted with inverse probability of treatment-weighted data.
    Results: Overall, treatment failure occurred in 85% of MSHS and 72% of SPARC CD patients. In SPARC, the likelihood of treatment failure was significantly lower with ustekinumab compared with vedolizumab as second-line treatment (adjusted hazard ratio, 0.66; 95% CI, 0.54-0.82; P < .001), a trend confirmed in MSHS (adjusted hazard ratio, 0.89; 95% CI, 0.77-1.04; P = .15). In both cohorts, the superiority of ustekinumab compared with vedolizumab was shown when considering treatment failure as prescription of steroids or a third biologic agent. In UC, no differences between second-line treatment groups were identified.
    Conclusions: In 2 independent real-world cohort settings, second-line therapy in CD with ustekinumab after TNF antagonist treatment failure was associated with a lower likelihood of treatment failure than second-line vedolizumab.
    MeSH term(s) Adult ; Humans ; Tumor Necrosis Factor Inhibitors/therapeutic use ; Ustekinumab/therapeutic use ; Propensity Score ; Prospective Studies ; Crohn Disease/drug therapy ; Colitis, Ulcerative/drug therapy ; Inflammatory Bowel Diseases/drug therapy ; Biological Factors/therapeutic use ; Biological Therapy ; Treatment Outcome ; Tumor Necrosis Factor-alpha
    Chemical Substances Tumor Necrosis Factor Inhibitors ; Ustekinumab (FU77B4U5Z0) ; Biological Factors ; Tumor Necrosis Factor-alpha
    Language English
    Publishing date 2023-02-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2119789-1
    ISSN 1542-7714 ; 1542-3565
    ISSN (online) 1542-7714
    ISSN 1542-3565
    DOI 10.1016/j.cgh.2023.01.038
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  9. Article: Effectiveness and Safety of COVID-19 Vaccines in Patients With Inflammatory Bowel Disease.

    Spiera, Emily / Ungaro, Ryan C / Kornbluth, Asher

    Gastroenterology & hepatology

    2022  Volume 18, Issue 3, Page(s) 145–155

    Abstract: Vaccines against SARS-CoV-2 are important for protection from COVID-19; however, patients with immune-mediated conditions and patients taking immunosuppressive medications, including patients with inflammatory bowel disease (IBD), were excluded from ... ...

    Abstract Vaccines against SARS-CoV-2 are important for protection from COVID-19; however, patients with immune-mediated conditions and patients taking immunosuppressive medications, including patients with inflammatory bowel disease (IBD), were excluded from studies demonstrating the safety and efficacy of these vaccines. This article provides an overview of the research and recommendations currently published on vaccines against COVID-19 in adult populations with IBD, including studies evaluating effects of commonly used medications. COVID-19 vaccines are strongly recommended for patients with IBD. Messenger RNA (mRNA) and adenovirus vector vaccines are safe in patients with IBD, and reports of severe reactions or IBD flares are rare. Studies assessing antibody response, T-cell immunity, and real-world experience demonstrate positive outcomes for mRNA and adenovirus vector vaccines in patients with IBD, although mRNA vaccines may have a slight advantage. Studies assessing inactive COVID-19 vaccines are still needed. Immunosuppressive therapies used in IBD, especially tumor necrosis factor antagonists, combination therapy, and corticosteroids, may reduce antibody responses and durability, but the impact on infection, hospitalizations, and death requires further evaluation. Educating patients with this evidence-based information will likely help to reduce concerns and vaccine hesitancy.
    Language English
    Publishing date 2022-04-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2386402-3
    ISSN 1554-7914
    ISSN 1554-7914
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  10. Article ; Online: Ultraprocessed Foods and the Risk of Inflammatory Bowel Disease: Is it Time to Modify Diet?

    Allin, Kristine H / Ungaro, Ryan C / Agrawal, Manasi

    Gastroenterology

    2021  Volume 162, Issue 2, Page(s) 652–654

    Language English
    Publishing date 2021-09-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80112-4
    ISSN 1528-0012 ; 0016-5085
    ISSN (online) 1528-0012
    ISSN 0016-5085
    DOI 10.1053/j.gastro.2021.09.053
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