Dimitrios Christodoulou

Background Ustekinumab and tofacitinib have recently been approved for the management of moderate to severe ulcerative colitis (UC). However, there is no evidence on how they should be positioned in the therapeutic algorithm. The aim of this study was to compare tofacitinib and ustekinumab as third‐line therapies in UC patients in whom anti‐TNF and vedolizumab had failed. Methods This was a multicenter retrospective observational study. The primary outcome was disease progression, defined as the need for steroids, therapy escalation, UC‐related hospitalization and/or surgery. Secondary outcomes were clinical remission, normalization of C‐reactive protein, endoscopic remission, treatment withdrawal, and adverse events. Results One‐hundred seventeen UC patients were included in the study and followed for a median time of 11.6 months (q 1 –q 3, 5.5–18.7). Overall, 65% of patients were treated with tofacitinib and 35% with ustekinumab. In the entire study cohort, 63 patients (54%) had disease progression during the follow‐up period. Treatment with ustekinumab predicted increased risk of disease progression compared to treatment with tofacitinib in Cox regression analysis (HR: 1.93 [95% CI: 1.06–3.50] p = 0.030). Twenty‐eight (68%) patients in the ustekinumab group and 35 (46%) in the tofacitinib group had disease progression over the follow‐up period (log‐rank test, p < 0.054). No significant differences were observed for the secondary outcomes. Six and 22 adverse events occurred in the ustekinumab and tofacitinib groups, respectively (15% vs. 31%, p = 0.11). Conclusions Tofacitinib was more efficacious in reducing disease progression than ustekinumab in this cohort of refractory UC patients. However, prospective head‐to‐head clinical trials are needed as to confirm these data.

Background and Aims Hepatitis D virus (HDV) underdiagnosis remains common. We assessed the HDV screening and prevalence rates in HBsAg‐positive patients seen at tertiary liver centres throughout Greece as well as factors affecting HDV diagnosis. Methods All adult HBsAg‐positive patients seen within the last 5 years were included. Non‐screened patients who visited or could be recalled to the clinics over a 6‐month period were prospectively tested for anti‐HDV. Results Of 5079 HBsAg‐positive patients, 53% had anti‐HDV screening (41% before and 12% after study initiation). Pre‐study (8%–88%) and total screening rates (14%–100%) varied widely among centres. Screening rates were associated with older age, known risk group, elevated ALT, centre location and size and period of first visit. Anti‐HDV prevalence was 5.8% without significant difference in patients screened before (6.1%) or after study initiation (4.7%, p = 0.240). Anti‐HDV positivity was associated with younger age, parenteral drug use, born abroad, advanced liver disease and centre location. Overall, HDV RNA detectability rate was 71.6% being more frequent in anti‐HDV‐positive patients with elevated ALT, advanced liver disease and hepatitis B therapy. Conclusions Anti‐HDV screening rates and recall capabilities vary widely among Greek liver clinics being higher in HBsAg‐positive patients of known risk group with active/advanced liver disease seen at smaller centres, while non‐medical factors are also important. Anti‐HDV prevalence varies throughout Greece being higher in patients born abroad with younger age, parenteral drug use and advanced liver disease. Viremia is more frequently but not exclusively detected in anti‐HDV‐positive patients with elevated ALT and advanced liver disease.