🫀 Advanced therapies in Middle Eastern IBD: real-world effectiveness snapshot

🔥 Main in 3 points

• Real-world studies confirm effectiveness for advanced therapies (anti-TNFs, vedolizumab, ustekinumab, risankizumab, tofacitinib) in Middle Eastern IBD patients.
• Vedolizumab achieved 89.3% remission with intensified dosing in advanced-therapy–experienced UC.
• Ustekinumab and risankizumab show promising results, particularly in anti-TNF–refractory settings.

🧪 Context

Systematic review of 23 real-world evidence studies (n>10 each) across Middle Eastern countries, covering UC and CD, with focus on biologics and small molecules. Heterogeneous designs and outcomes, but narrative synthesis highlights remission rates and head-to-head comparisons where available.

📍 Practical significance

• For advanced therapy-experienced UC, consider vedolizumab with intensified dosing for high remission potential.
• Explore ustekinumab and risankizumab especially in anti-TNF–refractory cases; monitor evolving regional protocols.
• High variability and limited methodological uniformity; multidisciplinary input and regional data registries needed for clinical guideline development.

🔗 PubMed | Full text – BMJ Open Gastroenterology

⚠️ Safety signal: Acute tubulointerstitial nephritis (TIN) linked to vedolizumab in VEO-IBD

🧪 Context

Case report: 11-year-old girl with very early onset UC, steroid- and anti-TNF–refractory, on vedolizumab for 1 year. Developed fever, nausea, raised creatinine, and persistent sterile leukocyturia. MRI and renal biopsy revealed acute TIN, likely vedolizumab-related. Renal function normalised after steroids and vedolizumab pause; maintenance resumed with pre-medication.

📊 Numbers

Single case; persistent sterile leukocyturia for 8–10 months prior; normalization with intervention and histological resolution on follow-up.

📍 Actions

• Be alert for persistent sterile leukocyturia or declining renal function in vedolizumab-treated paediatric IBD, especially VEO-IBD.
• Early urinalysis and renal function monitoring if symptoms arise.
• Consider temporary discontinuation and corticosteroid therapy for acute TIN; re-initiation of vedolizumab may be feasible with caution and steroid cover.

🔗 PubMed | Full text – Frontiers in Immunology

🧪 Ulcerative colitis and neurofibromatosis type 1: rare overlap—why it matters

What was studied

Case report and literature review: Elderly male with coexisting UC and neurofibromatosis type 1 (NF1), presenting with steroid-dependent UC and extensive neurofibromas.

📈 Key results

Remission achieved with corticosteroids, vedolizumab, and traditional Chinese medicine (SFEC). Colonic ulcers and polypoid lesions associated with both UC and neurofibromas; mast cells implicated in pathology. Highlights clinical and histological overlap.

📍 What this changes in practice

• Be vigilant for rare comorbidities like NF1 in UC patients—diagnosis may require combined GI, dermatological, and pathology input.
• Vedolizumab contributed to remission in steroid-dependent UC with complex comorbidities.
• Consider wider differential diagnoses, especially when concurrent GI and skin findings are present.

🔗 PubMed | Full text – Frontiers in Medicine