NASHVILLE, TENNESSEE — Exercise has a long history in multiple sclerosis (MS). In 1838, the Scottish physician John Abercrombie reported that a patient with “a diminution of muscular power,” who could walk but only unsteadily, decided after various failed treatments like “evacuations and spare diet” to try “violent exercise.” He walked 5-6 miles on a warm evening, as quickly as he was able, and returned home “much fatigued, and considerably heated. Next morning he had severe pains in the calves of his legs, but his other complaints were much diminished, and in a few days disappeared. He has ever since enjoyed good health,” Dr. Abercrombie was quoted in Multiple Sclerosis: The History of a Disease by T. Jock Murray.

The first randomized, controlled trial of an exercise intervention for MS didn’t appear in the literature until 1988, but more than 200 have been published in the years since, according to Robert Motl, PhD, who spoke about exercise interventions for MS at the annual meeting of the Consortium of Multiple Sclerosis Centers.

NASHVILLE, TENNESSEE — Exercise has a long history in multiple sclerosis (MS). In 1838, the Scottish physician John Abercrombie reported that a patient with “a diminution of muscular power,” who could walk but only unsteadily, decided after various failed treatments like “evacuations and spare diet” to try “violent exercise.” He walked 5-6 miles on a warm evening, as quickly as he was able, and returned home “much fatigued, and considerably heated. Next morning he had severe pains in the calves of his legs, but his other complaints were much diminished, and in a few days disappeared. He has ever since enjoyed good health,” Dr. Abercrombie was quoted in Multiple Sclerosis: The History of a Disease by T. Jock Murray.

The first randomized, controlled trial of an exercise intervention for MS didn’t appear in the literature until 1988, but more than 200 have been published in the years since, according to Robert Motl, PhD, who spoke about exercise interventions for MS at the annual meeting of the Consortium of Multiple Sclerosis Centers.

NASHVILLE, TENNESSEE — Exercise has a long history in multiple sclerosis (MS). In 1838, the Scottish physician John Abercrombie reported that a patient with “a diminution of muscular power,” who could walk but only unsteadily, decided after various failed treatments like “evacuations and spare diet” to try “violent exercise.” He walked 5-6 miles on a warm evening, as quickly as he was able, and returned home “much fatigued, and considerably heated. Next morning he had severe pains in the calves of his legs, but his other complaints were much diminished, and in a few days disappeared. He has ever since enjoyed good health,” Dr. Abercrombie was quoted in Multiple Sclerosis: The History of a Disease by T. Jock Murray.

The first randomized, controlled trial of an exercise intervention for MS didn’t appear in the literature until 1988, but more than 200 have been published in the years since, according to Robert Motl, PhD, who spoke about exercise interventions for MS at the annual meeting of the Consortium of Multiple Sclerosis Centers.

The ethical imperative in healthcare necessitates equitable delivery of care to all individuals, regardless of their socio-economic status or insurance coverage. This principle is rooted in the concept of justice and is crucial to achieving health equity.

As gastroenterologists, despite our various practice settings, we have seen the harmful effects of economic and social disparities on health outcomes. We must therefore ensure that we acknowledge the existence of these disparities, and then begin to provide a framework that allows us to ethically and successfully navigate these complexities for our patients and our affiliated structures.

RaShun Focus Minded Photo

The following cases illustrate the complexities and ethical dilemmas that gastroenterology and hepatology healthcare professionals encounter in delivering care within the traditional healthcare system.

• Case 1: A 44-year-old male presents to the hospital with intermittent rectal bleeding every few weeks without associated abdominal pain or weight loss and not associated with straining. He has bowel movements every 2-3 days. There is no family history of underlying gastrointestinal disease or associated neoplasm. He is accompanied at the time of the interview by his coworker who offered to drive him to the hospital as he is having personal car trouble. Physical examination reveals normal hemodynamics, abdomen is benign, a digital rectal exam reveals small internal hemorrhoids without pain. Hemoglobin is 10, MCV 85. There is scant blood on the glove. He is uninsured. A GI consult is placed to determine the disposition of the patient. The resident on service suggests outpatient follow-up given low risk of clinical deterioration.
• Case 2: A 28-year-old woman postpartum 6 weeks presents in the office with a history of ulcerative colitis which was diagnosed 2 years prior. She was initially placed on steroid therapy. She underwent a colonoscopy at the time of her diagnosis and was following with a gastroenterologist at which time she was found to have moderate left-sided disease with a modified Mayo score of 9. She complains of urgency and rectal bleeding. She saw a gastroenterologist during her pregnancy and was placed on oral mesalamine, which she remains on at the time of evaluation. Once her physical examination is completed and laboratory values are reviewed, you begin to discuss advanced therapies including biologics as she has failed conventional therapies.
• Case 3: You receive a phone call from an outside hospital about a potential transfer for a 46-year-old male who is an immigrant of unknown citizenship status with fulminant liver failure. He meets all criteria including encephalopathy and coagulopathy. He drinks only socially. His secondary liver workup for extensive disease including ceruloplasmin remains pending. Viral hepatology serologies and autoimmune serologies are negative.

Challenges to the Delivery of Equitable Care

These cases underscore the challenges of delivering equitable care within a system that often fails to address the social determinants of health (SDOH). The disparity in the evaluation and treatment of patients based on insurance status not only affects patient outcomes, but also emphasizes the ethical dilemma of balancing cost with population health management.

Ironwood Pharmaceuticals

The introduction of measures SDOH-1 and SDOH-2 by the Centers for Medicare & Medicaid Services in the 2023 IPPS Final Rule is a step towards requiring hospitals to systematically collect patient-level SDOH data, aiming to establish meaningful collaborations between healthcare providers and community-based organizations for whole-person care.¹ The primary goal is to allow ecosystems to collect patient-level social risk factors followed by the creation of meaningful collaboration between healthcare providers and the community-based organizations.

The office settings may or may not implement the SDOH and the current electronic medical record systems. However, from a social history standpoint and certainly from a decision standpoint, the impact of SDOH is realized in all settings.
 

Interplay of SDOH and Ethical Considerations

The recognition of social determinants of health is crucial for ethical healthcare delivery. In the first case, considering the patient’s identified social determinants of health — including lack of insurance and transportation, combined with the rising incidence of colorectal cancer in individuals under 55 — an argument could be made for admitting the patient under observation for inpatient colonoscopy.

Data have shown disparities in treatment and referrals in emergency care setting for Black patients with rectal bleeding.² It is imperative that we recognize these existing disparities in diagnosis and outcomes, along with determining SDOH to appropriately come to a final disposition. This approach aligns with the principle of justice and the imperative to deliver equitable care.

In the third case study, we have a patient facing the life-or-death situation of fulminant liver failure. He requires an expeditious decision to be made about transfer candidacy for liver transplant evaluation by the hepatology team.
 

Impact of Insurance Status on Healthcare Access

Insurance status significantly influences access to healthcare and disparities in treatment outcomes. As seen in case 2 and case 3, our therapies often hinge upon access.

In the inflammatory bowel disease (IBD) case, the therapy that we will choose for our IBD patient may be more influenced by access than efficacy. In a national sample of children with Crohn’s disease, publicly insured children were more likely to receive a biologic within 18 months of diagnosis compared to children with private insurance.³ This would suggest that those with private insurance perhaps experience increased barriers.

In the IBD case that we presented here, we do have a publicly insured woman who will face a potential loss of her Medicaid coverage. Our therapeutic decision will therefore not just rely on risk stratification and individualized approach, but rather the programs that are put in place by our pharmaceutical partners to support a future self-pay patient. This may or may not be favorable to her outcome. This discrepancy points to systemic inequalities in healthcare access and the need for policies that ensure equitable treatment for all, regardless of insurance status.
 

Conclusion

The delivery of care in healthcare is an ethical imperative that demands equity and justice. The cases discussed above illustrate the complex interplay between socioeconomic factors, insurance status, and the ethical challenges in providing equitable care.

Systematic efforts to address social determinants of health, as mandated by recent CMS measures, along with a commitment to ethical principles, are essential steps toward reducing disparities and ensuring that all individuals receive the care they need. As healthcare expenditures continue to rise, particularly in areas like gastrointestinal health, addressing these ethical and systemic challenges becomes even more critical for the sustainability of the healthcare system and the well-being of the population it serves.

Gastrointestinal healthcare expenditures totaled $119.6 billion in 2018. Annually there were more than 36.8 million ambulatory visits for GI symptoms and 43.4 million ambulatory visits with primary GI diagnosis.⁴ The use of higher-acuity settings and lack of continuity of care, and the under-recognition and lack of longitudinal framework to follow those families at risk continue to compromise our healthcare system. We must begin to create a framework to provide equitable care for which the cornerstone should be those identified social determinants of health.

Dr. McCutchen is a gastroenterologist at United Digestive, Atlanta, Georgia. She is vice chair of the AGA Research Foundation. Dr. Boules is vice president of global medical and scientific affairs at Ironwood Pharmaceuticals, Cleveland, Ohio.

References

1. www.govinfo.gov/content/pkg/FR-2022-08-10/pdf/2022-16472.pdf.

2. Shields HM et al. Disparities in evaluation of patients with rectal bleeding 40 years and older. Clin Gastroenterol Hepatol. 2014 Apr. doi: 10.1016/j.cgh.2013.07.008.

3. Quiros JA et al. Insurance type influences access to biologics and healthcare utilization in pediatric Crohn’s disease. Crohns Colitis 360. 2021 Aug. doi: 10.1093/crocol/otab057.

4. Peery AF et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology. 2022 Feb. doi: 10.1053/j.gastro.2021.10.017.

The ethical imperative in healthcare necessitates equitable delivery of care to all individuals, regardless of their socio-economic status or insurance coverage. This principle is rooted in the concept of justice and is crucial to achieving health equity.

As gastroenterologists, despite our various practice settings, we have seen the harmful effects of economic and social disparities on health outcomes. We must therefore ensure that we acknowledge the existence of these disparities, and then begin to provide a framework that allows us to ethically and successfully navigate these complexities for our patients and our affiliated structures.

RaShun Focus Minded Photo

The following cases illustrate the complexities and ethical dilemmas that gastroenterology and hepatology healthcare professionals encounter in delivering care within the traditional healthcare system.

• Case 1: A 44-year-old male presents to the hospital with intermittent rectal bleeding every few weeks without associated abdominal pain or weight loss and not associated with straining. He has bowel movements every 2-3 days. There is no family history of underlying gastrointestinal disease or associated neoplasm. He is accompanied at the time of the interview by his coworker who offered to drive him to the hospital as he is having personal car trouble. Physical examination reveals normal hemodynamics, abdomen is benign, a digital rectal exam reveals small internal hemorrhoids without pain. Hemoglobin is 10, MCV 85. There is scant blood on the glove. He is uninsured. A GI consult is placed to determine the disposition of the patient. The resident on service suggests outpatient follow-up given low risk of clinical deterioration.
• Case 2: A 28-year-old woman postpartum 6 weeks presents in the office with a history of ulcerative colitis which was diagnosed 2 years prior. She was initially placed on steroid therapy. She underwent a colonoscopy at the time of her diagnosis and was following with a gastroenterologist at which time she was found to have moderate left-sided disease with a modified Mayo score of 9. She complains of urgency and rectal bleeding. She saw a gastroenterologist during her pregnancy and was placed on oral mesalamine, which she remains on at the time of evaluation. Once her physical examination is completed and laboratory values are reviewed, you begin to discuss advanced therapies including biologics as she has failed conventional therapies.
• Case 3: You receive a phone call from an outside hospital about a potential transfer for a 46-year-old male who is an immigrant of unknown citizenship status with fulminant liver failure. He meets all criteria including encephalopathy and coagulopathy. He drinks only socially. His secondary liver workup for extensive disease including ceruloplasmin remains pending. Viral hepatology serologies and autoimmune serologies are negative.

Challenges to the Delivery of Equitable Care

These cases underscore the challenges of delivering equitable care within a system that often fails to address the social determinants of health (SDOH). The disparity in the evaluation and treatment of patients based on insurance status not only affects patient outcomes, but also emphasizes the ethical dilemma of balancing cost with population health management.

Ironwood Pharmaceuticals

The introduction of measures SDOH-1 and SDOH-2 by the Centers for Medicare & Medicaid Services in the 2023 IPPS Final Rule is a step towards requiring hospitals to systematically collect patient-level SDOH data, aiming to establish meaningful collaborations between healthcare providers and community-based organizations for whole-person care.¹ The primary goal is to allow ecosystems to collect patient-level social risk factors followed by the creation of meaningful collaboration between healthcare providers and the community-based organizations.

The office settings may or may not implement the SDOH and the current electronic medical record systems. However, from a social history standpoint and certainly from a decision standpoint, the impact of SDOH is realized in all settings.
 

Interplay of SDOH and Ethical Considerations

The recognition of social determinants of health is crucial for ethical healthcare delivery. In the first case, considering the patient’s identified social determinants of health — including lack of insurance and transportation, combined with the rising incidence of colorectal cancer in individuals under 55 — an argument could be made for admitting the patient under observation for inpatient colonoscopy.

Data have shown disparities in treatment and referrals in emergency care setting for Black patients with rectal bleeding.² It is imperative that we recognize these existing disparities in diagnosis and outcomes, along with determining SDOH to appropriately come to a final disposition. This approach aligns with the principle of justice and the imperative to deliver equitable care.

In the third case study, we have a patient facing the life-or-death situation of fulminant liver failure. He requires an expeditious decision to be made about transfer candidacy for liver transplant evaluation by the hepatology team.
 

Impact of Insurance Status on Healthcare Access

Insurance status significantly influences access to healthcare and disparities in treatment outcomes. As seen in case 2 and case 3, our therapies often hinge upon access.

In the inflammatory bowel disease (IBD) case, the therapy that we will choose for our IBD patient may be more influenced by access than efficacy. In a national sample of children with Crohn’s disease, publicly insured children were more likely to receive a biologic within 18 months of diagnosis compared to children with private insurance.³ This would suggest that those with private insurance perhaps experience increased barriers.

In the IBD case that we presented here, we do have a publicly insured woman who will face a potential loss of her Medicaid coverage. Our therapeutic decision will therefore not just rely on risk stratification and individualized approach, but rather the programs that are put in place by our pharmaceutical partners to support a future self-pay patient. This may or may not be favorable to her outcome. This discrepancy points to systemic inequalities in healthcare access and the need for policies that ensure equitable treatment for all, regardless of insurance status.
 

Conclusion

The delivery of care in healthcare is an ethical imperative that demands equity and justice. The cases discussed above illustrate the complex interplay between socioeconomic factors, insurance status, and the ethical challenges in providing equitable care.

Systematic efforts to address social determinants of health, as mandated by recent CMS measures, along with a commitment to ethical principles, are essential steps toward reducing disparities and ensuring that all individuals receive the care they need. As healthcare expenditures continue to rise, particularly in areas like gastrointestinal health, addressing these ethical and systemic challenges becomes even more critical for the sustainability of the healthcare system and the well-being of the population it serves.

Gastrointestinal healthcare expenditures totaled $119.6 billion in 2018. Annually there were more than 36.8 million ambulatory visits for GI symptoms and 43.4 million ambulatory visits with primary GI diagnosis.⁴ The use of higher-acuity settings and lack of continuity of care, and the under-recognition and lack of longitudinal framework to follow those families at risk continue to compromise our healthcare system. We must begin to create a framework to provide equitable care for which the cornerstone should be those identified social determinants of health.

Dr. McCutchen is a gastroenterologist at United Digestive, Atlanta, Georgia. She is vice chair of the AGA Research Foundation. Dr. Boules is vice president of global medical and scientific affairs at Ironwood Pharmaceuticals, Cleveland, Ohio.

References

1. www.govinfo.gov/content/pkg/FR-2022-08-10/pdf/2022-16472.pdf.

2. Shields HM et al. Disparities in evaluation of patients with rectal bleeding 40 years and older. Clin Gastroenterol Hepatol. 2014 Apr. doi: 10.1016/j.cgh.2013.07.008.

3. Quiros JA et al. Insurance type influences access to biologics and healthcare utilization in pediatric Crohn’s disease. Crohns Colitis 360. 2021 Aug. doi: 10.1093/crocol/otab057.

4. Peery AF et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology. 2022 Feb. doi: 10.1053/j.gastro.2021.10.017.

The ethical imperative in healthcare necessitates equitable delivery of care to all individuals, regardless of their socio-economic status or insurance coverage. This principle is rooted in the concept of justice and is crucial to achieving health equity.

As gastroenterologists, despite our various practice settings, we have seen the harmful effects of economic and social disparities on health outcomes. We must therefore ensure that we acknowledge the existence of these disparities, and then begin to provide a framework that allows us to ethically and successfully navigate these complexities for our patients and our affiliated structures.

RaShun Focus Minded Photo

The following cases illustrate the complexities and ethical dilemmas that gastroenterology and hepatology healthcare professionals encounter in delivering care within the traditional healthcare system.

• Case 1: A 44-year-old male presents to the hospital with intermittent rectal bleeding every few weeks without associated abdominal pain or weight loss and not associated with straining. He has bowel movements every 2-3 days. There is no family history of underlying gastrointestinal disease or associated neoplasm. He is accompanied at the time of the interview by his coworker who offered to drive him to the hospital as he is having personal car trouble. Physical examination reveals normal hemodynamics, abdomen is benign, a digital rectal exam reveals small internal hemorrhoids without pain. Hemoglobin is 10, MCV 85. There is scant blood on the glove. He is uninsured. A GI consult is placed to determine the disposition of the patient. The resident on service suggests outpatient follow-up given low risk of clinical deterioration.
• Case 2: A 28-year-old woman postpartum 6 weeks presents in the office with a history of ulcerative colitis which was diagnosed 2 years prior. She was initially placed on steroid therapy. She underwent a colonoscopy at the time of her diagnosis and was following with a gastroenterologist at which time she was found to have moderate left-sided disease with a modified Mayo score of 9. She complains of urgency and rectal bleeding. She saw a gastroenterologist during her pregnancy and was placed on oral mesalamine, which she remains on at the time of evaluation. Once her physical examination is completed and laboratory values are reviewed, you begin to discuss advanced therapies including biologics as she has failed conventional therapies.
• Case 3: You receive a phone call from an outside hospital about a potential transfer for a 46-year-old male who is an immigrant of unknown citizenship status with fulminant liver failure. He meets all criteria including encephalopathy and coagulopathy. He drinks only socially. His secondary liver workup for extensive disease including ceruloplasmin remains pending. Viral hepatology serologies and autoimmune serologies are negative.

Challenges to the Delivery of Equitable Care

These cases underscore the challenges of delivering equitable care within a system that often fails to address the social determinants of health (SDOH). The disparity in the evaluation and treatment of patients based on insurance status not only affects patient outcomes, but also emphasizes the ethical dilemma of balancing cost with population health management.

Ironwood Pharmaceuticals

The introduction of measures SDOH-1 and SDOH-2 by the Centers for Medicare & Medicaid Services in the 2023 IPPS Final Rule is a step towards requiring hospitals to systematically collect patient-level SDOH data, aiming to establish meaningful collaborations between healthcare providers and community-based organizations for whole-person care.¹ The primary goal is to allow ecosystems to collect patient-level social risk factors followed by the creation of meaningful collaboration between healthcare providers and the community-based organizations.

The office settings may or may not implement the SDOH and the current electronic medical record systems. However, from a social history standpoint and certainly from a decision standpoint, the impact of SDOH is realized in all settings.
 

Interplay of SDOH and Ethical Considerations

The recognition of social determinants of health is crucial for ethical healthcare delivery. In the first case, considering the patient’s identified social determinants of health — including lack of insurance and transportation, combined with the rising incidence of colorectal cancer in individuals under 55 — an argument could be made for admitting the patient under observation for inpatient colonoscopy.

Data have shown disparities in treatment and referrals in emergency care setting for Black patients with rectal bleeding.² It is imperative that we recognize these existing disparities in diagnosis and outcomes, along with determining SDOH to appropriately come to a final disposition. This approach aligns with the principle of justice and the imperative to deliver equitable care.

In the third case study, we have a patient facing the life-or-death situation of fulminant liver failure. He requires an expeditious decision to be made about transfer candidacy for liver transplant evaluation by the hepatology team.
 

Impact of Insurance Status on Healthcare Access

Insurance status significantly influences access to healthcare and disparities in treatment outcomes. As seen in case 2 and case 3, our therapies often hinge upon access.

In the inflammatory bowel disease (IBD) case, the therapy that we will choose for our IBD patient may be more influenced by access than efficacy. In a national sample of children with Crohn’s disease, publicly insured children were more likely to receive a biologic within 18 months of diagnosis compared to children with private insurance.³ This would suggest that those with private insurance perhaps experience increased barriers.

In the IBD case that we presented here, we do have a publicly insured woman who will face a potential loss of her Medicaid coverage. Our therapeutic decision will therefore not just rely on risk stratification and individualized approach, but rather the programs that are put in place by our pharmaceutical partners to support a future self-pay patient. This may or may not be favorable to her outcome. This discrepancy points to systemic inequalities in healthcare access and the need for policies that ensure equitable treatment for all, regardless of insurance status.
 

Conclusion

The delivery of care in healthcare is an ethical imperative that demands equity and justice. The cases discussed above illustrate the complex interplay between socioeconomic factors, insurance status, and the ethical challenges in providing equitable care.

Systematic efforts to address social determinants of health, as mandated by recent CMS measures, along with a commitment to ethical principles, are essential steps toward reducing disparities and ensuring that all individuals receive the care they need. As healthcare expenditures continue to rise, particularly in areas like gastrointestinal health, addressing these ethical and systemic challenges becomes even more critical for the sustainability of the healthcare system and the well-being of the population it serves.

Gastrointestinal healthcare expenditures totaled $119.6 billion in 2018. Annually there were more than 36.8 million ambulatory visits for GI symptoms and 43.4 million ambulatory visits with primary GI diagnosis.⁴ The use of higher-acuity settings and lack of continuity of care, and the under-recognition and lack of longitudinal framework to follow those families at risk continue to compromise our healthcare system. We must begin to create a framework to provide equitable care for which the cornerstone should be those identified social determinants of health.

Dr. McCutchen is a gastroenterologist at United Digestive, Atlanta, Georgia. She is vice chair of the AGA Research Foundation. Dr. Boules is vice president of global medical and scientific affairs at Ironwood Pharmaceuticals, Cleveland, Ohio.

References

1. www.govinfo.gov/content/pkg/FR-2022-08-10/pdf/2022-16472.pdf.

2. Shields HM et al. Disparities in evaluation of patients with rectal bleeding 40 years and older. Clin Gastroenterol Hepatol. 2014 Apr. doi: 10.1016/j.cgh.2013.07.008.

3. Quiros JA et al. Insurance type influences access to biologics and healthcare utilization in pediatric Crohn’s disease. Crohns Colitis 360. 2021 Aug. doi: 10.1093/crocol/otab057.

4. Peery AF et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology. 2022 Feb. doi: 10.1053/j.gastro.2021.10.017.

The American Gastroenterological Association (AGA) is proud to announce that it has selected 79 recipients to receive research funding through the annual AGA Research Foundation Awards Program. The program serves as a catalyst for discovery and career growth among the most promising researchers in gastroenterology and hepatology.

“This year’s awardees are an exceptional group of investigators who are committed to furthering patient care through research,” said Michael Camilleri, MD, AGAF, chair, AGA Research Foundation. “The AGA Research Foundation is proud to fund these investigators and their ongoing efforts to advance GI research at a critical time in their careers. We believe the Foundation’s investment will ultimately enable new discoveries in gastroenterology and hepatology that will benefit patients.”

Treatment options for digestive diseases begin with vigorous research. The AGA Research Foundation supports medical investigators as they advance our understanding of gastrointestinal and liver conditions. Here are this year’s award recipients:
 

RESEARCH SCHOLAR AWARDS

AGA Research Scholar Award 

• Karen Jane Dunbar, PhD, Columbia University, New York, New York
• Aaron Hecht, MD, PhD, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
• Sarah Maxwell, MD, University of California, San Francisco
• Chung Sang Tse, MD, University of Pennsylvania, Philadelphia, Pennsylvania
• Jason (Yanjia) Zhang, MD, PhD, Boston Children’s Hospital, Massachusetts

AGA-Bristol Myers Squibb Research Scholar Award in Inflammatory Bowel Disease

• Joseph R. Burclaff, PhD, University of North Carolina at Chapel Hill

SPECIALTY AWARDS

AGA-Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer

• Swathi Eluri, MD, MSCR, Mayo Clinic, Rochester, Minnesota

AGA-R. Robert & Sally Funderburg Research Award in Gastric Cancer

• Jianwen Que, MD, PhD, Columbia University, New York, New York

AGA-Pfizer Fellowship-to-Faculty Transition Award

• Lianna Wood, MD, PhD, Boston Children’s Hospital, Massachusetts

AGA-Ironwood Fellowship-to-Faculty Transition Award

• ZeNan Li Chang, MD, PhD, Washington University School of Medicine, St. Louis, Missouri

PILOT AWARDS

AGA Pilot Research Award

• Linda C. Cummings, MD, MS, University Hospitals Cleveland Medical Center, Cleveland, Ohio
• Pooja Mehta, MD, MSCS, University of Colorado Denver
• Guilherme Piovezani Ramos, MD, Boston Children’s Hospital
• Simon Schwoerer, PhD, University of Chicago, Illinois
• Yankai Wen, PhD, University of Texas Health Science Center at Houston

AGA-Pfizer Pilot Research Award in Non-Alcoholic Steatohepatitis

• Alice Cheng, PhD, Stanford University, California
• Petra Hirsova, PhD, PharmD, Mayo Clinic, Rochester, Minnesota
• Sarah Maxwell, MD, University of California, San Francisco

AGA-Pfizer Pilot Research Award in Inflammatory Bowel Disease

• David Boone, PhD, Indiana University, Indianapolis, Indiana
• Sara Chloe Di Rienzi, PhD, Baylor College of Medicine, Houston, Texas
• Jared Andrew Sninsky, MD, MSCR, Baylor College of Medicine, Houston, Texas

UNDERGRADUATE RESEARCH AWARDS

AGA-Aman Armaan Ahmed Family Surf for Success Program

• Eli Burstein, Yeshiva University, New York, New York
• Chloe Carlisle, University of Florida, Gainesville, Florida
• Adna Hassan, University of Minnesota Rochester
• Nicole Rodriguez Hilario, Barry University, Miami, Florida
• Maryam Jimoh, College of Wooster, Wooster, Ohio
• Viktoriya Kalinina, Brandeis University, Waltham, Massachusetts

AGA-Dr. Harvey Young Education & Development Foundation’s Young Guts Scholar Program

• Rafaella Lavalle Lacerda de Almeida, Michigan State University, East Lansing, Michigan
• Lara Cheesman, John’s Hopkins University School of Medicine, Baltimore, Maryland
• Cass Condray, University of Oklahoma, Norman, Oklahoma
• Daniel Juarez, Columbia University, New York, New York
• Jason Lin, University of Michigan, Ann Arbor, Michigan
• Riya Malhotra, Case Western Reserve University, Cleveland, Ohio
• Brian Nguyen, Brown University, Providence, Rhode Island
• Mahmoud (Moudy) Salem, Stony Brook University, Stony Brook, New York

ABSTRACT AWARDS

AGA Fellow Abstract of the Year Award

• Andrea Tou, MD Children’s Hospital of Philadelphia, Pennsylvania

AGA Fellow Abstract Awards

• Manik Aggarwal, MBBS, Mayo Clinic, Rochester, Minnesota
• Kole Buckley, PhD, University of Pennsylvania, Philadelphia, Pennsylvania
• Jane Ha, MD, Massachusetts General Hospital, Boston, Massachusetts
• Brent Hiramoto, MD, Brigham and Women’s Hospital, Boston, Massachusetts
• Md Obaidul Islam, PhD, University of Miami, Coral Gables, Florida
• Kanak Kennedy, MD, MPH, Children’s Hospital of Philadelphia, Pennsylvania
• Hanseul Kim, PhD, MS, Massachusetts General Hospital, Boston, Massachusetts
• Chiraag Kulkarni, MD, Stanford University, Stanford, California
• Su-Hyung Lee, PhD, DVM, Vanderbilt University Medical Center, Nashville, Tennessee
• Caroline Muiler, PhD, Yale School of Medicine, New Haven, Connecticut
• Sarah Najjar, PhD, New York University, New York, New York
• Ronaldo Panganiban, MD, PhD Penn State Hershey Medical Center, Hershey, Pennsylvania
• Perseus Patel, MD, Stanford University, California
• Hassan Sinan, MD, Johns Hopkins University, Baltimore, Maryland
• Patricia Snarski, PhD, Tulane University, New Orleans, Louisiana
• Fernando Vicentini, PhD, MS, McMaster University, Hamilton, Ontario, Canada
• Remington Winter, MD, University of Manitoba – Health Sciences Centre, Winnipeg, Manitoba, Canada
• Tiaosi Xing, PhD, MBBS, MS, Penn State College of Medicine, Hershey, Pennsylvania

AGA Student Abstract of the Year Award

• Jazmyne Jackson, Temple University, Philadelphia, Pennsylvania

AGA Student Abstract Award

• Valentina Alvarez, University of Washington School of Medicine, Seattle, Washington
• Yasaman Bahojb Habibyan, MS, University of Calgary, Alberta, Canada
• Tessa Herman, MD, University of Minnesota, Minneapolis-Saint Paul, Minnesota
• Jason Jin, Yale School of Medicine, New Haven, Connecticut
• Frederikke Larsen, Western University, London, Ontario, Canada
• Kara McNamara, Vanderbilt University, Nashville, Tennessee
• Julia Sessions, MD, University of Virginia, Charlottesville, Virginia
• Scott Silvey, MS, Virginia Commonwealth University, Richmond, Virginia
• Vijaya Sundaram, Marshall University School of Medicine, Huntington, West Virginia
• Kafayat Yusuf, MS, University of Kansas Medical Center, Kansas City, Kansas

AGA–Eric Esrailian Student Abstract Prize

• Brent Gawey, MD, MS, Mayo Clinic, Rochester, Minnesota
• Fei Li, MBBS, MS, University of Michigan, Ann Arbor, Michigan
• Emily Wong, University of Toronto, Ontario, Canada
• Jordan Woodard, MD, Prisma Health – Upstate, Greenville, South Carolina

AGA–Radhika Srinivasan Student Abstract Prize

• Raz Abdulqadir, MS, Penn State College of Medicine, Hershey, Pennsylvania
• Rebecca Ekeanyanwu, MHS, Meharry Medical College, Nashville, Tennessee
• Jared Morris, MD, University of Manitoba, Winnipeg City, Manitoba, Canada
• Rachel Stubler, Medical University of South Carolina, Charleston, South Carolina

AGA Abstract Award for Health Disparities Research

• Saqr Alsakarneh, MD University of Missouri-Kansas City
• Marco Noriega, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts
• Temitope Olasehinde, MD, University Hospitals/Case Western Reserve University, Cleveland, Ohio
• Gabrielle Waclawik, MD, MPH, University of Wisconsin, Madison, Wisconsin

AGA-Moti L. & Kamla Rustgi International Travel Award

• W. Keith Tan, MBChB, University of Cambridge, Cambridge, England
• Elsa van Liere, MD Amsterdam Universitair Medische Centra, Amsterdam, Netherlands

The American Gastroenterological Association (AGA) is proud to announce that it has selected 79 recipients to receive research funding through the annual AGA Research Foundation Awards Program. The program serves as a catalyst for discovery and career growth among the most promising researchers in gastroenterology and hepatology.

“This year’s awardees are an exceptional group of investigators who are committed to furthering patient care through research,” said Michael Camilleri, MD, AGAF, chair, AGA Research Foundation. “The AGA Research Foundation is proud to fund these investigators and their ongoing efforts to advance GI research at a critical time in their careers. We believe the Foundation’s investment will ultimately enable new discoveries in gastroenterology and hepatology that will benefit patients.”

Treatment options for digestive diseases begin with vigorous research. The AGA Research Foundation supports medical investigators as they advance our understanding of gastrointestinal and liver conditions. Here are this year’s award recipients:
 

RESEARCH SCHOLAR AWARDS

AGA Research Scholar Award 

• Karen Jane Dunbar, PhD, Columbia University, New York, New York
• Aaron Hecht, MD, PhD, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
• Sarah Maxwell, MD, University of California, San Francisco
• Chung Sang Tse, MD, University of Pennsylvania, Philadelphia, Pennsylvania
• Jason (Yanjia) Zhang, MD, PhD, Boston Children’s Hospital, Massachusetts

AGA-Bristol Myers Squibb Research Scholar Award in Inflammatory Bowel Disease

• Joseph R. Burclaff, PhD, University of North Carolina at Chapel Hill

SPECIALTY AWARDS

AGA-Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer

• Swathi Eluri, MD, MSCR, Mayo Clinic, Rochester, Minnesota

AGA-R. Robert & Sally Funderburg Research Award in Gastric Cancer

• Jianwen Que, MD, PhD, Columbia University, New York, New York

AGA-Pfizer Fellowship-to-Faculty Transition Award

• Lianna Wood, MD, PhD, Boston Children’s Hospital, Massachusetts

AGA-Ironwood Fellowship-to-Faculty Transition Award

• ZeNan Li Chang, MD, PhD, Washington University School of Medicine, St. Louis, Missouri

PILOT AWARDS

AGA Pilot Research Award

• Linda C. Cummings, MD, MS, University Hospitals Cleveland Medical Center, Cleveland, Ohio
• Pooja Mehta, MD, MSCS, University of Colorado Denver
• Guilherme Piovezani Ramos, MD, Boston Children’s Hospital
• Simon Schwoerer, PhD, University of Chicago, Illinois
• Yankai Wen, PhD, University of Texas Health Science Center at Houston

AGA-Pfizer Pilot Research Award in Non-Alcoholic Steatohepatitis

• Alice Cheng, PhD, Stanford University, California
• Petra Hirsova, PhD, PharmD, Mayo Clinic, Rochester, Minnesota
• Sarah Maxwell, MD, University of California, San Francisco

AGA-Pfizer Pilot Research Award in Inflammatory Bowel Disease

• David Boone, PhD, Indiana University, Indianapolis, Indiana
• Sara Chloe Di Rienzi, PhD, Baylor College of Medicine, Houston, Texas
• Jared Andrew Sninsky, MD, MSCR, Baylor College of Medicine, Houston, Texas

UNDERGRADUATE RESEARCH AWARDS

AGA-Aman Armaan Ahmed Family Surf for Success Program

• Eli Burstein, Yeshiva University, New York, New York
• Chloe Carlisle, University of Florida, Gainesville, Florida
• Adna Hassan, University of Minnesota Rochester
• Nicole Rodriguez Hilario, Barry University, Miami, Florida
• Maryam Jimoh, College of Wooster, Wooster, Ohio
• Viktoriya Kalinina, Brandeis University, Waltham, Massachusetts

AGA-Dr. Harvey Young Education & Development Foundation’s Young Guts Scholar Program

• Rafaella Lavalle Lacerda de Almeida, Michigan State University, East Lansing, Michigan
• Lara Cheesman, John’s Hopkins University School of Medicine, Baltimore, Maryland
• Cass Condray, University of Oklahoma, Norman, Oklahoma
• Daniel Juarez, Columbia University, New York, New York
• Jason Lin, University of Michigan, Ann Arbor, Michigan
• Riya Malhotra, Case Western Reserve University, Cleveland, Ohio
• Brian Nguyen, Brown University, Providence, Rhode Island
• Mahmoud (Moudy) Salem, Stony Brook University, Stony Brook, New York

ABSTRACT AWARDS

AGA Fellow Abstract of the Year Award

• Andrea Tou, MD Children’s Hospital of Philadelphia, Pennsylvania

AGA Fellow Abstract Awards

• Manik Aggarwal, MBBS, Mayo Clinic, Rochester, Minnesota
• Kole Buckley, PhD, University of Pennsylvania, Philadelphia, Pennsylvania
• Jane Ha, MD, Massachusetts General Hospital, Boston, Massachusetts
• Brent Hiramoto, MD, Brigham and Women’s Hospital, Boston, Massachusetts
• Md Obaidul Islam, PhD, University of Miami, Coral Gables, Florida
• Kanak Kennedy, MD, MPH, Children’s Hospital of Philadelphia, Pennsylvania
• Hanseul Kim, PhD, MS, Massachusetts General Hospital, Boston, Massachusetts
• Chiraag Kulkarni, MD, Stanford University, Stanford, California
• Su-Hyung Lee, PhD, DVM, Vanderbilt University Medical Center, Nashville, Tennessee
• Caroline Muiler, PhD, Yale School of Medicine, New Haven, Connecticut
• Sarah Najjar, PhD, New York University, New York, New York
• Ronaldo Panganiban, MD, PhD Penn State Hershey Medical Center, Hershey, Pennsylvania
• Perseus Patel, MD, Stanford University, California
• Hassan Sinan, MD, Johns Hopkins University, Baltimore, Maryland
• Patricia Snarski, PhD, Tulane University, New Orleans, Louisiana
• Fernando Vicentini, PhD, MS, McMaster University, Hamilton, Ontario, Canada
• Remington Winter, MD, University of Manitoba – Health Sciences Centre, Winnipeg, Manitoba, Canada
• Tiaosi Xing, PhD, MBBS, MS, Penn State College of Medicine, Hershey, Pennsylvania

AGA Student Abstract of the Year Award

• Jazmyne Jackson, Temple University, Philadelphia, Pennsylvania

AGA Student Abstract Award

• Valentina Alvarez, University of Washington School of Medicine, Seattle, Washington
• Yasaman Bahojb Habibyan, MS, University of Calgary, Alberta, Canada
• Tessa Herman, MD, University of Minnesota, Minneapolis-Saint Paul, Minnesota
• Jason Jin, Yale School of Medicine, New Haven, Connecticut
• Frederikke Larsen, Western University, London, Ontario, Canada
• Kara McNamara, Vanderbilt University, Nashville, Tennessee
• Julia Sessions, MD, University of Virginia, Charlottesville, Virginia
• Scott Silvey, MS, Virginia Commonwealth University, Richmond, Virginia
• Vijaya Sundaram, Marshall University School of Medicine, Huntington, West Virginia
• Kafayat Yusuf, MS, University of Kansas Medical Center, Kansas City, Kansas

AGA–Eric Esrailian Student Abstract Prize

• Brent Gawey, MD, MS, Mayo Clinic, Rochester, Minnesota
• Fei Li, MBBS, MS, University of Michigan, Ann Arbor, Michigan
• Emily Wong, University of Toronto, Ontario, Canada
• Jordan Woodard, MD, Prisma Health – Upstate, Greenville, South Carolina

AGA–Radhika Srinivasan Student Abstract Prize

• Raz Abdulqadir, MS, Penn State College of Medicine, Hershey, Pennsylvania
• Rebecca Ekeanyanwu, MHS, Meharry Medical College, Nashville, Tennessee
• Jared Morris, MD, University of Manitoba, Winnipeg City, Manitoba, Canada
• Rachel Stubler, Medical University of South Carolina, Charleston, South Carolina

AGA Abstract Award for Health Disparities Research

• Saqr Alsakarneh, MD University of Missouri-Kansas City
• Marco Noriega, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts
• Temitope Olasehinde, MD, University Hospitals/Case Western Reserve University, Cleveland, Ohio
• Gabrielle Waclawik, MD, MPH, University of Wisconsin, Madison, Wisconsin

AGA-Moti L. & Kamla Rustgi International Travel Award

• W. Keith Tan, MBChB, University of Cambridge, Cambridge, England
• Elsa van Liere, MD Amsterdam Universitair Medische Centra, Amsterdam, Netherlands

The American Gastroenterological Association (AGA) is proud to announce that it has selected 79 recipients to receive research funding through the annual AGA Research Foundation Awards Program. The program serves as a catalyst for discovery and career growth among the most promising researchers in gastroenterology and hepatology.

“This year’s awardees are an exceptional group of investigators who are committed to furthering patient care through research,” said Michael Camilleri, MD, AGAF, chair, AGA Research Foundation. “The AGA Research Foundation is proud to fund these investigators and their ongoing efforts to advance GI research at a critical time in their careers. We believe the Foundation’s investment will ultimately enable new discoveries in gastroenterology and hepatology that will benefit patients.”

Treatment options for digestive diseases begin with vigorous research. The AGA Research Foundation supports medical investigators as they advance our understanding of gastrointestinal and liver conditions. Here are this year’s award recipients:
 

RESEARCH SCHOLAR AWARDS

AGA Research Scholar Award 

• Karen Jane Dunbar, PhD, Columbia University, New York, New York
• Aaron Hecht, MD, PhD, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
• Sarah Maxwell, MD, University of California, San Francisco
• Chung Sang Tse, MD, University of Pennsylvania, Philadelphia, Pennsylvania
• Jason (Yanjia) Zhang, MD, PhD, Boston Children’s Hospital, Massachusetts

AGA-Bristol Myers Squibb Research Scholar Award in Inflammatory Bowel Disease

• Joseph R. Burclaff, PhD, University of North Carolina at Chapel Hill

SPECIALTY AWARDS

AGA-Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer

• Swathi Eluri, MD, MSCR, Mayo Clinic, Rochester, Minnesota

AGA-R. Robert & Sally Funderburg Research Award in Gastric Cancer

• Jianwen Que, MD, PhD, Columbia University, New York, New York

AGA-Pfizer Fellowship-to-Faculty Transition Award

• Lianna Wood, MD, PhD, Boston Children’s Hospital, Massachusetts

AGA-Ironwood Fellowship-to-Faculty Transition Award

• ZeNan Li Chang, MD, PhD, Washington University School of Medicine, St. Louis, Missouri

PILOT AWARDS

AGA Pilot Research Award

• Linda C. Cummings, MD, MS, University Hospitals Cleveland Medical Center, Cleveland, Ohio
• Pooja Mehta, MD, MSCS, University of Colorado Denver
• Guilherme Piovezani Ramos, MD, Boston Children’s Hospital
• Simon Schwoerer, PhD, University of Chicago, Illinois
• Yankai Wen, PhD, University of Texas Health Science Center at Houston

AGA-Pfizer Pilot Research Award in Non-Alcoholic Steatohepatitis

• Alice Cheng, PhD, Stanford University, California
• Petra Hirsova, PhD, PharmD, Mayo Clinic, Rochester, Minnesota
• Sarah Maxwell, MD, University of California, San Francisco

AGA-Pfizer Pilot Research Award in Inflammatory Bowel Disease

• David Boone, PhD, Indiana University, Indianapolis, Indiana
• Sara Chloe Di Rienzi, PhD, Baylor College of Medicine, Houston, Texas
• Jared Andrew Sninsky, MD, MSCR, Baylor College of Medicine, Houston, Texas

UNDERGRADUATE RESEARCH AWARDS

AGA-Aman Armaan Ahmed Family Surf for Success Program

• Eli Burstein, Yeshiva University, New York, New York
• Chloe Carlisle, University of Florida, Gainesville, Florida
• Adna Hassan, University of Minnesota Rochester
• Nicole Rodriguez Hilario, Barry University, Miami, Florida
• Maryam Jimoh, College of Wooster, Wooster, Ohio
• Viktoriya Kalinina, Brandeis University, Waltham, Massachusetts

AGA-Dr. Harvey Young Education & Development Foundation’s Young Guts Scholar Program

• Rafaella Lavalle Lacerda de Almeida, Michigan State University, East Lansing, Michigan
• Lara Cheesman, John’s Hopkins University School of Medicine, Baltimore, Maryland
• Cass Condray, University of Oklahoma, Norman, Oklahoma
• Daniel Juarez, Columbia University, New York, New York
• Jason Lin, University of Michigan, Ann Arbor, Michigan
• Riya Malhotra, Case Western Reserve University, Cleveland, Ohio
• Brian Nguyen, Brown University, Providence, Rhode Island
• Mahmoud (Moudy) Salem, Stony Brook University, Stony Brook, New York

ABSTRACT AWARDS

AGA Fellow Abstract of the Year Award

• Andrea Tou, MD Children’s Hospital of Philadelphia, Pennsylvania

AGA Fellow Abstract Awards

• Manik Aggarwal, MBBS, Mayo Clinic, Rochester, Minnesota
• Kole Buckley, PhD, University of Pennsylvania, Philadelphia, Pennsylvania
• Jane Ha, MD, Massachusetts General Hospital, Boston, Massachusetts
• Brent Hiramoto, MD, Brigham and Women’s Hospital, Boston, Massachusetts
• Md Obaidul Islam, PhD, University of Miami, Coral Gables, Florida
• Kanak Kennedy, MD, MPH, Children’s Hospital of Philadelphia, Pennsylvania
• Hanseul Kim, PhD, MS, Massachusetts General Hospital, Boston, Massachusetts
• Chiraag Kulkarni, MD, Stanford University, Stanford, California
• Su-Hyung Lee, PhD, DVM, Vanderbilt University Medical Center, Nashville, Tennessee
• Caroline Muiler, PhD, Yale School of Medicine, New Haven, Connecticut
• Sarah Najjar, PhD, New York University, New York, New York
• Ronaldo Panganiban, MD, PhD Penn State Hershey Medical Center, Hershey, Pennsylvania
• Perseus Patel, MD, Stanford University, California
• Hassan Sinan, MD, Johns Hopkins University, Baltimore, Maryland
• Patricia Snarski, PhD, Tulane University, New Orleans, Louisiana
• Fernando Vicentini, PhD, MS, McMaster University, Hamilton, Ontario, Canada
• Remington Winter, MD, University of Manitoba – Health Sciences Centre, Winnipeg, Manitoba, Canada
• Tiaosi Xing, PhD, MBBS, MS, Penn State College of Medicine, Hershey, Pennsylvania

AGA Student Abstract of the Year Award

• Jazmyne Jackson, Temple University, Philadelphia, Pennsylvania

AGA Student Abstract Award

• Valentina Alvarez, University of Washington School of Medicine, Seattle, Washington
• Yasaman Bahojb Habibyan, MS, University of Calgary, Alberta, Canada
• Tessa Herman, MD, University of Minnesota, Minneapolis-Saint Paul, Minnesota
• Jason Jin, Yale School of Medicine, New Haven, Connecticut
• Frederikke Larsen, Western University, London, Ontario, Canada
• Kara McNamara, Vanderbilt University, Nashville, Tennessee
• Julia Sessions, MD, University of Virginia, Charlottesville, Virginia
• Scott Silvey, MS, Virginia Commonwealth University, Richmond, Virginia
• Vijaya Sundaram, Marshall University School of Medicine, Huntington, West Virginia
• Kafayat Yusuf, MS, University of Kansas Medical Center, Kansas City, Kansas

AGA–Eric Esrailian Student Abstract Prize

• Brent Gawey, MD, MS, Mayo Clinic, Rochester, Minnesota
• Fei Li, MBBS, MS, University of Michigan, Ann Arbor, Michigan
• Emily Wong, University of Toronto, Ontario, Canada
• Jordan Woodard, MD, Prisma Health – Upstate, Greenville, South Carolina

AGA–Radhika Srinivasan Student Abstract Prize

• Raz Abdulqadir, MS, Penn State College of Medicine, Hershey, Pennsylvania
• Rebecca Ekeanyanwu, MHS, Meharry Medical College, Nashville, Tennessee
• Jared Morris, MD, University of Manitoba, Winnipeg City, Manitoba, Canada
• Rachel Stubler, Medical University of South Carolina, Charleston, South Carolina

AGA Abstract Award for Health Disparities Research

• Saqr Alsakarneh, MD University of Missouri-Kansas City
• Marco Noriega, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts
• Temitope Olasehinde, MD, University Hospitals/Case Western Reserve University, Cleveland, Ohio
• Gabrielle Waclawik, MD, MPH, University of Wisconsin, Madison, Wisconsin

AGA-Moti L. & Kamla Rustgi International Travel Award

• W. Keith Tan, MBChB, University of Cambridge, Cambridge, England
• Elsa van Liere, MD Amsterdam Universitair Medische Centra, Amsterdam, Netherlands

The Fibrosis-4 (FIB-4) index shows high discordance with liver stiffness measurement (LSM) via transient elastography, suggesting that many patients are misclassified, potentially impacting clinical decisions, according to investigators.

These findings call for a cautious interpretation of low-risk FIB-4 results among patients at greatest risk of misclassification, and/or use of alternative assessment strategies, reported Mazen Noureddin, MD, MHSc, of Houston Methodist Hospital, and coauthors.

Houston Methodist Hospital

“Currently, the AGA/AASLD Pathways recommends identifying patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD), then using sequential testing with FIB-4 followed by FibroScan to risk-stratify patients,” the investigators wrote in Clinical Gastroenterology and Hepatology.

Yet the performance of the FIB-4 index in this context remains unclear.

“Previous studies have shown FIB-4 to have low accuracy for screening liver fibrosis, especially among obese and diabetic patients,” the investigators wrote. “Thus, there is a concern that classifying patients with FIB-4 can lead to misclassification and missed diagnosis.”

To explore this concern, Dr. Noureddin and colleagues turned to data from the 2017-2020 National Health and Nutrition Examination Surveys, including 5285 subjects at risk for MASLD. Exclusions were made for those with excessive alcohol intake or other liver diseases, resulting in a final cohort of 3741 individuals.

All subjects were classified as low-, indeterminate-, or high-risk for advanced liver fibrosis based on FIB-4 scores. These scores were then compared with liver stiffness measurements (LSM) obtained through transient elastography (FibroScan).

Out of 2776 subjects classified as low-risk by FIB-4, 277 (10%) were reclassified as higher risk by LSM, including 75 (2.7%) who were found to be at high risk. Out of 879 subjects with indeterminate FIB-4 scores, 37 (4.2%) were at high risk according to LSM. Finally, among the 86 subjects classified as high risk by FIB-4, 68 (79.1%) were reclassified as lower risk by LSM, including 54 (62.8%) who were deemed low risk.

Subjects misclassified as low risk by FIB-4 were typically older and had higher waist circumferences, body mass indices, glycohemoglobin A1c levels, fasting glucose levels, liver enzyme levels, diastolic blood pressures, controlled attenuation parameter scores, white blood cell counts, and alkaline phosphatase levels, but lower high-density lipoprotein and albumin levels (all P less than .05). They were also more likely to have prediabetes or diabetes.

“[I]t is important to acknowledge that 10% of the subjects were misclassified as low risk by FIB-4,” Dr. Noureddin and colleagues wrote, including 2.7% of patients who were actually high risk. “This misclassification of high-risk patients can lead to missed diagnoses, delaying crucial medical treatments or lifestyle interventions.”

They therefore suggested cautious interpretation of low-risk FIB-4 results among patients with factors predicting misclassification, or even use of alternative diagnostic strategies.

“Some possible alternatives to FIB-4 include new serum tests such NIS-2+, MASEF, SAFE score, and machine learning methods,” Dr. Noureddin and colleagues wrote. “However, additional confirmatory and cost-effective studies are required to validate the effectiveness of these tests, including studies conducted on the general population.”

The investigators disclosed relationships with AbbVie, Corcept, Galectin, and others.

The Fibrosis-4 (FIB-4) index shows high discordance with liver stiffness measurement (LSM) via transient elastography, suggesting that many patients are misclassified, potentially impacting clinical decisions, according to investigators.

These findings call for a cautious interpretation of low-risk FIB-4 results among patients at greatest risk of misclassification, and/or use of alternative assessment strategies, reported Mazen Noureddin, MD, MHSc, of Houston Methodist Hospital, and coauthors.

Houston Methodist Hospital

“Currently, the AGA/AASLD Pathways recommends identifying patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD), then using sequential testing with FIB-4 followed by FibroScan to risk-stratify patients,” the investigators wrote in Clinical Gastroenterology and Hepatology.

Yet the performance of the FIB-4 index in this context remains unclear.

“Previous studies have shown FIB-4 to have low accuracy for screening liver fibrosis, especially among obese and diabetic patients,” the investigators wrote. “Thus, there is a concern that classifying patients with FIB-4 can lead to misclassification and missed diagnosis.”

To explore this concern, Dr. Noureddin and colleagues turned to data from the 2017-2020 National Health and Nutrition Examination Surveys, including 5285 subjects at risk for MASLD. Exclusions were made for those with excessive alcohol intake or other liver diseases, resulting in a final cohort of 3741 individuals.

All subjects were classified as low-, indeterminate-, or high-risk for advanced liver fibrosis based on FIB-4 scores. These scores were then compared with liver stiffness measurements (LSM) obtained through transient elastography (FibroScan).

Out of 2776 subjects classified as low-risk by FIB-4, 277 (10%) were reclassified as higher risk by LSM, including 75 (2.7%) who were found to be at high risk. Out of 879 subjects with indeterminate FIB-4 scores, 37 (4.2%) were at high risk according to LSM. Finally, among the 86 subjects classified as high risk by FIB-4, 68 (79.1%) were reclassified as lower risk by LSM, including 54 (62.8%) who were deemed low risk.

Subjects misclassified as low risk by FIB-4 were typically older and had higher waist circumferences, body mass indices, glycohemoglobin A1c levels, fasting glucose levels, liver enzyme levels, diastolic blood pressures, controlled attenuation parameter scores, white blood cell counts, and alkaline phosphatase levels, but lower high-density lipoprotein and albumin levels (all P less than .05). They were also more likely to have prediabetes or diabetes.

“[I]t is important to acknowledge that 10% of the subjects were misclassified as low risk by FIB-4,” Dr. Noureddin and colleagues wrote, including 2.7% of patients who were actually high risk. “This misclassification of high-risk patients can lead to missed diagnoses, delaying crucial medical treatments or lifestyle interventions.”

They therefore suggested cautious interpretation of low-risk FIB-4 results among patients with factors predicting misclassification, or even use of alternative diagnostic strategies.

“Some possible alternatives to FIB-4 include new serum tests such NIS-2+, MASEF, SAFE score, and machine learning methods,” Dr. Noureddin and colleagues wrote. “However, additional confirmatory and cost-effective studies are required to validate the effectiveness of these tests, including studies conducted on the general population.”

The investigators disclosed relationships with AbbVie, Corcept, Galectin, and others.

The Fibrosis-4 (FIB-4) index shows high discordance with liver stiffness measurement (LSM) via transient elastography, suggesting that many patients are misclassified, potentially impacting clinical decisions, according to investigators.

These findings call for a cautious interpretation of low-risk FIB-4 results among patients at greatest risk of misclassification, and/or use of alternative assessment strategies, reported Mazen Noureddin, MD, MHSc, of Houston Methodist Hospital, and coauthors.

Houston Methodist Hospital

“Currently, the AGA/AASLD Pathways recommends identifying patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD), then using sequential testing with FIB-4 followed by FibroScan to risk-stratify patients,” the investigators wrote in Clinical Gastroenterology and Hepatology.

Yet the performance of the FIB-4 index in this context remains unclear.

“Previous studies have shown FIB-4 to have low accuracy for screening liver fibrosis, especially among obese and diabetic patients,” the investigators wrote. “Thus, there is a concern that classifying patients with FIB-4 can lead to misclassification and missed diagnosis.”

To explore this concern, Dr. Noureddin and colleagues turned to data from the 2017-2020 National Health and Nutrition Examination Surveys, including 5285 subjects at risk for MASLD. Exclusions were made for those with excessive alcohol intake or other liver diseases, resulting in a final cohort of 3741 individuals.

All subjects were classified as low-, indeterminate-, or high-risk for advanced liver fibrosis based on FIB-4 scores. These scores were then compared with liver stiffness measurements (LSM) obtained through transient elastography (FibroScan).

Out of 2776 subjects classified as low-risk by FIB-4, 277 (10%) were reclassified as higher risk by LSM, including 75 (2.7%) who were found to be at high risk. Out of 879 subjects with indeterminate FIB-4 scores, 37 (4.2%) were at high risk according to LSM. Finally, among the 86 subjects classified as high risk by FIB-4, 68 (79.1%) were reclassified as lower risk by LSM, including 54 (62.8%) who were deemed low risk.

Subjects misclassified as low risk by FIB-4 were typically older and had higher waist circumferences, body mass indices, glycohemoglobin A1c levels, fasting glucose levels, liver enzyme levels, diastolic blood pressures, controlled attenuation parameter scores, white blood cell counts, and alkaline phosphatase levels, but lower high-density lipoprotein and albumin levels (all P less than .05). They were also more likely to have prediabetes or diabetes.

“[I]t is important to acknowledge that 10% of the subjects were misclassified as low risk by FIB-4,” Dr. Noureddin and colleagues wrote, including 2.7% of patients who were actually high risk. “This misclassification of high-risk patients can lead to missed diagnoses, delaying crucial medical treatments or lifestyle interventions.”

They therefore suggested cautious interpretation of low-risk FIB-4 results among patients with factors predicting misclassification, or even use of alternative diagnostic strategies.

“Some possible alternatives to FIB-4 include new serum tests such NIS-2+, MASEF, SAFE score, and machine learning methods,” Dr. Noureddin and colleagues wrote. “However, additional confirmatory and cost-effective studies are required to validate the effectiveness of these tests, including studies conducted on the general population.”

The investigators disclosed relationships with AbbVie, Corcept, Galectin, and others.

Maria T. Abreu, MD, AGAF, has been inducted as the 119th president of the AGA Institute. She currently serves as the Martin Kalser Endowed Chair of Gastroenterology; professor of medicine, microbiology, and immunology; and director of the Crohn’s and Colitis Center at the University of Miami. Dr. Abreu is the fifth woman to lead AGA as president.

Born in New York and raised in New Jersey, Dr. Abreu grew up surrounded by a strong, tight-knit Cuban community. Her family moved to Miami when she was in the ninth grade. She later entered the 6-year medical program at the University of Miami, which was the beginning of her unparalleled academic and professional excellence in medicine.

University of Miami

Dr. Abreu is a leader in inflammatory bowel disease patient care, and she was honored by the prestigious Sherman Prize in 2019. Her service to AGA is lengthy and begins when she took on the role of fellow representative for the research grant committee. She has since sat on both the government advocacy and diversity committees. She also served as the chair of the Immunology, Microbiology and Inflammatory Bowel Diseases Section of the AGA Council, and later as chair of the full AGA Council. While chair she developed a more streamlined in-person planning committee meeting to better organize DDW.

When asked about goals for her presidency, Dr. Abreu wants to make DDW a better experience for the modern gastroenterologist. This includes finding that perfect balance between digesting the latest education and science with networking and socializing. She plans to collaborate with the presidents of the other societies to make this come to fruition.

Perhaps the area that Dr. Abreu is most passionate about is welcoming and fostering the growth of women in gastroenterology. She wants to support women who want to succeed in academics and in practice, who want ergonomics to match their work needs, and who want to have families.

“Maria is the ultimate ‘triple threat’: master scientist, master clinician, and devoted mentor. She has not only been a major player advancing knowledge in IBD, but also motivating and pushing others to develop successful careers,” said Andres Yarur, MD, AGAF, associate professor of medicine at Cedars-Sinai Medical Center. “Her work, brilliance, passion, and charm inspire all of us and will continue to inspire many generations to come.”

Maria T. Abreu, MD, AGAF, has been inducted as the 119th president of the AGA Institute. She currently serves as the Martin Kalser Endowed Chair of Gastroenterology; professor of medicine, microbiology, and immunology; and director of the Crohn’s and Colitis Center at the University of Miami. Dr. Abreu is the fifth woman to lead AGA as president.

Born in New York and raised in New Jersey, Dr. Abreu grew up surrounded by a strong, tight-knit Cuban community. Her family moved to Miami when she was in the ninth grade. She later entered the 6-year medical program at the University of Miami, which was the beginning of her unparalleled academic and professional excellence in medicine.

University of Miami

Dr. Abreu is a leader in inflammatory bowel disease patient care, and she was honored by the prestigious Sherman Prize in 2019. Her service to AGA is lengthy and begins when she took on the role of fellow representative for the research grant committee. She has since sat on both the government advocacy and diversity committees. She also served as the chair of the Immunology, Microbiology and Inflammatory Bowel Diseases Section of the AGA Council, and later as chair of the full AGA Council. While chair she developed a more streamlined in-person planning committee meeting to better organize DDW.

When asked about goals for her presidency, Dr. Abreu wants to make DDW a better experience for the modern gastroenterologist. This includes finding that perfect balance between digesting the latest education and science with networking and socializing. She plans to collaborate with the presidents of the other societies to make this come to fruition.

Perhaps the area that Dr. Abreu is most passionate about is welcoming and fostering the growth of women in gastroenterology. She wants to support women who want to succeed in academics and in practice, who want ergonomics to match their work needs, and who want to have families.

“Maria is the ultimate ‘triple threat’: master scientist, master clinician, and devoted mentor. She has not only been a major player advancing knowledge in IBD, but also motivating and pushing others to develop successful careers,” said Andres Yarur, MD, AGAF, associate professor of medicine at Cedars-Sinai Medical Center. “Her work, brilliance, passion, and charm inspire all of us and will continue to inspire many generations to come.”

Maria T. Abreu, MD, AGAF, has been inducted as the 119th president of the AGA Institute. She currently serves as the Martin Kalser Endowed Chair of Gastroenterology; professor of medicine, microbiology, and immunology; and director of the Crohn’s and Colitis Center at the University of Miami. Dr. Abreu is the fifth woman to lead AGA as president.

Born in New York and raised in New Jersey, Dr. Abreu grew up surrounded by a strong, tight-knit Cuban community. Her family moved to Miami when she was in the ninth grade. She later entered the 6-year medical program at the University of Miami, which was the beginning of her unparalleled academic and professional excellence in medicine.

University of Miami

Dr. Abreu is a leader in inflammatory bowel disease patient care, and she was honored by the prestigious Sherman Prize in 2019. Her service to AGA is lengthy and begins when she took on the role of fellow representative for the research grant committee. She has since sat on both the government advocacy and diversity committees. She also served as the chair of the Immunology, Microbiology and Inflammatory Bowel Diseases Section of the AGA Council, and later as chair of the full AGA Council. While chair she developed a more streamlined in-person planning committee meeting to better organize DDW.

When asked about goals for her presidency, Dr. Abreu wants to make DDW a better experience for the modern gastroenterologist. This includes finding that perfect balance between digesting the latest education and science with networking and socializing. She plans to collaborate with the presidents of the other societies to make this come to fruition.

Perhaps the area that Dr. Abreu is most passionate about is welcoming and fostering the growth of women in gastroenterology. She wants to support women who want to succeed in academics and in practice, who want ergonomics to match their work needs, and who want to have families.

“Maria is the ultimate ‘triple threat’: master scientist, master clinician, and devoted mentor. She has not only been a major player advancing knowledge in IBD, but also motivating and pushing others to develop successful careers,” said Andres Yarur, MD, AGAF, associate professor of medicine at Cedars-Sinai Medical Center. “Her work, brilliance, passion, and charm inspire all of us and will continue to inspire many generations to come.”

TOPLINE:

Some vulnerable older patients with untreated metastatic pancreatic cancer can benefit from chemotherapy, but only if they can tolerate enough cycles of treatment, according to results of the randomized phase 2 GIANT study.

METHODOLOGY:

Pancreatic cancer is most often diagnosed in adults aged 65 years or older. Providing cancer treatment for this older, often vulnerable, population comes with significant challenges and can lead to worse survival.

To examine real-world outcomes of older adults with untreated metastatic pancreatic cancer, researchers recruited patients aged 70 years or older and performed a geriatric assessment to identify comorbidities, cognitive issues, and other geriatric abnormalities.

Those who were deemed “fit” (ie, with no geriatric abnormalities) were assigned to receive off-study standard-of-care treatment, whereas those classified as “frail” (ie, with severe abnormalities) received off-study supportive care.

The remaining 176 “vulnerable” patients with mild to moderate geriatric abnormalities completed a geriatric and quality-of-life assessment and were then randomly assigned to receive either dose-reduced 5-fluorouracil (5-FU), leucovorin plus liposomal irinotecan (n = 88) or modified gemcitabine plus nab-paclitaxel (n = 88) every 2 weeks. Ultimately, 79 patients started the 5-FU combination and 75 received gemcitabine plus nab-paclitaxel. Patients were assessed every 8 weeks until disease progression or intolerance.

Overall, patients had a median age of 77 years; 61.9% were aged 75 years or older. About half were female, and 81.5% were White. The majority (87.5%) had a performance status of 0 or 1.

TAKEAWAY:

• Median overall survival was 4.7 months in the gemcitabine plus nab-paclitaxel arm and 4.4 months in the 5-FU combination group, with no significant survival difference observed between the two arms (P = .72).
• When the overall survival analysis was restricted to patients who received at least 4 weeks, or two cycles, of treatment (about 62% of patients), the median overall survival across the two treatment arms reached 8.0 months, in line with expectations for these regimens.
• Patient stratification revealed that those with a performance status of 2 had significantly worse overall survival than those with a status of 0: 1.4 months vs 6.9 months, respectively (hazard ratio [HR], 2.77; P < .001). A similar divide was seen when patients were stratified by physical/functional status and well-being. Age, however, did not significantly influence the results.
• Overall, more than half of patients experienced grade 3 or higher adverse events. Just over 38% of patients received only one to three cycles of therapy, whereas 26% remained on treatment for 12 or more cycles. The adverse event rates were similar between the two regimens, but the toxicity profile was slightly different — the researchers, for instance, observed more peripheral neuropathy with gemcitabine plus nab-paclitaxel and more diarrhea in the 5-FU combination arm.

IN PRACTICE:

• Overall, the “survival outcomes among vulnerable older patients were lower than expected, with high percentage of patients not able to start treatment, or complete one month of therapy due to clinical deterioration,” said study presenter Efrat Dotan, MD, chief, Division of Gastrointestinal Medical Oncology, Fox Chase Cancer Center, Philadelphia. 
• “For vulnerable older adults who can tolerate treatment, these two regimens provide clinicians with options for tailoring therapy based on toxicity profile,” Dr. Dotan added. But “tools are needed to better identify patients who can benefit from treatment.”
• The results underline the need to perform geriatric assessments, as opposed to merely looking at performance status, commented David F. Chang, PhD, MS, MBBS, professor of Surgical Oncology, University of Glasgow, Scotland, who was not involved in the study. 

SOURCE:

The research, presented at the 2024 annual meeting of the American Society of Clinical Oncology, was funded by the National Cancer Institute and the Eastern Cooperative Oncology Group.

LIMITATIONS:

Dr. Chang noted that the study did not reveal which treatment regimen was more effective.

DISCLOSURES:

Dr. Dotan declared relationships with Agenus, Amgen, G1 Therapeutics, Incyte, Olympus, and Taiho Pharmaceutical and institutional relationships with Dragonfly Therapeutics, Gilead Sciences, Ipsen, Kinnate Biopharma, Leap Therapeutics, Lilly, Lutris, NGM Biopharmaceuticals, Relay Therapeutics, and Zymeworks. Dr. Chang declared relationships with Immodulon Therapeutics and Mylan and institutional relationships with AstraZeneca, BMS GmbH & Co. KG, Immodulon Therapeutics, and Merck.

A version of this article appeared on Medscape.com.

TOPLINE:

Some vulnerable older patients with untreated metastatic pancreatic cancer can benefit from chemotherapy, but only if they can tolerate enough cycles of treatment, according to results of the randomized phase 2 GIANT study.

METHODOLOGY:

Pancreatic cancer is most often diagnosed in adults aged 65 years or older. Providing cancer treatment for this older, often vulnerable, population comes with significant challenges and can lead to worse survival.

To examine real-world outcomes of older adults with untreated metastatic pancreatic cancer, researchers recruited patients aged 70 years or older and performed a geriatric assessment to identify comorbidities, cognitive issues, and other geriatric abnormalities.

Those who were deemed “fit” (ie, with no geriatric abnormalities) were assigned to receive off-study standard-of-care treatment, whereas those classified as “frail” (ie, with severe abnormalities) received off-study supportive care.

The remaining 176 “vulnerable” patients with mild to moderate geriatric abnormalities completed a geriatric and quality-of-life assessment and were then randomly assigned to receive either dose-reduced 5-fluorouracil (5-FU), leucovorin plus liposomal irinotecan (n = 88) or modified gemcitabine plus nab-paclitaxel (n = 88) every 2 weeks. Ultimately, 79 patients started the 5-FU combination and 75 received gemcitabine plus nab-paclitaxel. Patients were assessed every 8 weeks until disease progression or intolerance.

Overall, patients had a median age of 77 years; 61.9% were aged 75 years or older. About half were female, and 81.5% were White. The majority (87.5%) had a performance status of 0 or 1.

TAKEAWAY:

• Median overall survival was 4.7 months in the gemcitabine plus nab-paclitaxel arm and 4.4 months in the 5-FU combination group, with no significant survival difference observed between the two arms (P = .72).
• When the overall survival analysis was restricted to patients who received at least 4 weeks, or two cycles, of treatment (about 62% of patients), the median overall survival across the two treatment arms reached 8.0 months, in line with expectations for these regimens.
• Patient stratification revealed that those with a performance status of 2 had significantly worse overall survival than those with a status of 0: 1.4 months vs 6.9 months, respectively (hazard ratio [HR], 2.77; P < .001). A similar divide was seen when patients were stratified by physical/functional status and well-being. Age, however, did not significantly influence the results.
• Overall, more than half of patients experienced grade 3 or higher adverse events. Just over 38% of patients received only one to three cycles of therapy, whereas 26% remained on treatment for 12 or more cycles. The adverse event rates were similar between the two regimens, but the toxicity profile was slightly different — the researchers, for instance, observed more peripheral neuropathy with gemcitabine plus nab-paclitaxel and more diarrhea in the 5-FU combination arm.

IN PRACTICE:

• Overall, the “survival outcomes among vulnerable older patients were lower than expected, with high percentage of patients not able to start treatment, or complete one month of therapy due to clinical deterioration,” said study presenter Efrat Dotan, MD, chief, Division of Gastrointestinal Medical Oncology, Fox Chase Cancer Center, Philadelphia. 
• “For vulnerable older adults who can tolerate treatment, these two regimens provide clinicians with options for tailoring therapy based on toxicity profile,” Dr. Dotan added. But “tools are needed to better identify patients who can benefit from treatment.”
• The results underline the need to perform geriatric assessments, as opposed to merely looking at performance status, commented David F. Chang, PhD, MS, MBBS, professor of Surgical Oncology, University of Glasgow, Scotland, who was not involved in the study. 

SOURCE:

The research, presented at the 2024 annual meeting of the American Society of Clinical Oncology, was funded by the National Cancer Institute and the Eastern Cooperative Oncology Group.

LIMITATIONS:

Dr. Chang noted that the study did not reveal which treatment regimen was more effective.

DISCLOSURES:

Dr. Dotan declared relationships with Agenus, Amgen, G1 Therapeutics, Incyte, Olympus, and Taiho Pharmaceutical and institutional relationships with Dragonfly Therapeutics, Gilead Sciences, Ipsen, Kinnate Biopharma, Leap Therapeutics, Lilly, Lutris, NGM Biopharmaceuticals, Relay Therapeutics, and Zymeworks. Dr. Chang declared relationships with Immodulon Therapeutics and Mylan and institutional relationships with AstraZeneca, BMS GmbH & Co. KG, Immodulon Therapeutics, and Merck.

A version of this article appeared on Medscape.com.

TOPLINE:

Some vulnerable older patients with untreated metastatic pancreatic cancer can benefit from chemotherapy, but only if they can tolerate enough cycles of treatment, according to results of the randomized phase 2 GIANT study.

METHODOLOGY:

Pancreatic cancer is most often diagnosed in adults aged 65 years or older. Providing cancer treatment for this older, often vulnerable, population comes with significant challenges and can lead to worse survival.

To examine real-world outcomes of older adults with untreated metastatic pancreatic cancer, researchers recruited patients aged 70 years or older and performed a geriatric assessment to identify comorbidities, cognitive issues, and other geriatric abnormalities.

Those who were deemed “fit” (ie, with no geriatric abnormalities) were assigned to receive off-study standard-of-care treatment, whereas those classified as “frail” (ie, with severe abnormalities) received off-study supportive care.

The remaining 176 “vulnerable” patients with mild to moderate geriatric abnormalities completed a geriatric and quality-of-life assessment and were then randomly assigned to receive either dose-reduced 5-fluorouracil (5-FU), leucovorin plus liposomal irinotecan (n = 88) or modified gemcitabine plus nab-paclitaxel (n = 88) every 2 weeks. Ultimately, 79 patients started the 5-FU combination and 75 received gemcitabine plus nab-paclitaxel. Patients were assessed every 8 weeks until disease progression or intolerance.

Overall, patients had a median age of 77 years; 61.9% were aged 75 years or older. About half were female, and 81.5% were White. The majority (87.5%) had a performance status of 0 or 1.

TAKEAWAY:

• Median overall survival was 4.7 months in the gemcitabine plus nab-paclitaxel arm and 4.4 months in the 5-FU combination group, with no significant survival difference observed between the two arms (P = .72).
• When the overall survival analysis was restricted to patients who received at least 4 weeks, or two cycles, of treatment (about 62% of patients), the median overall survival across the two treatment arms reached 8.0 months, in line with expectations for these regimens.
• Patient stratification revealed that those with a performance status of 2 had significantly worse overall survival than those with a status of 0: 1.4 months vs 6.9 months, respectively (hazard ratio [HR], 2.77; P < .001). A similar divide was seen when patients were stratified by physical/functional status and well-being. Age, however, did not significantly influence the results.
• Overall, more than half of patients experienced grade 3 or higher adverse events. Just over 38% of patients received only one to three cycles of therapy, whereas 26% remained on treatment for 12 or more cycles. The adverse event rates were similar between the two regimens, but the toxicity profile was slightly different — the researchers, for instance, observed more peripheral neuropathy with gemcitabine plus nab-paclitaxel and more diarrhea in the 5-FU combination arm.

IN PRACTICE:

• Overall, the “survival outcomes among vulnerable older patients were lower than expected, with high percentage of patients not able to start treatment, or complete one month of therapy due to clinical deterioration,” said study presenter Efrat Dotan, MD, chief, Division of Gastrointestinal Medical Oncology, Fox Chase Cancer Center, Philadelphia. 
• “For vulnerable older adults who can tolerate treatment, these two regimens provide clinicians with options for tailoring therapy based on toxicity profile,” Dr. Dotan added. But “tools are needed to better identify patients who can benefit from treatment.”
• The results underline the need to perform geriatric assessments, as opposed to merely looking at performance status, commented David F. Chang, PhD, MS, MBBS, professor of Surgical Oncology, University of Glasgow, Scotland, who was not involved in the study. 

SOURCE:

The research, presented at the 2024 annual meeting of the American Society of Clinical Oncology, was funded by the National Cancer Institute and the Eastern Cooperative Oncology Group.

LIMITATIONS:

Dr. Chang noted that the study did not reveal which treatment regimen was more effective.

DISCLOSURES:

Dr. Dotan declared relationships with Agenus, Amgen, G1 Therapeutics, Incyte, Olympus, and Taiho Pharmaceutical and institutional relationships with Dragonfly Therapeutics, Gilead Sciences, Ipsen, Kinnate Biopharma, Leap Therapeutics, Lilly, Lutris, NGM Biopharmaceuticals, Relay Therapeutics, and Zymeworks. Dr. Chang declared relationships with Immodulon Therapeutics and Mylan and institutional relationships with AstraZeneca, BMS GmbH & Co. KG, Immodulon Therapeutics, and Merck.

A version of this article appeared on Medscape.com.

Vaccination against human papillomavirus (HPV) is an effective way to prevent HPV infection and cancers typically caused by HPV, including cervical cancer and head and neck cancers, new research showed.

The analysis, featured at a press briefing ahead of the presentation at the American Society of Clinical Oncology (ASCO) 2024 annual meeting, notably found that men who received the HPV vaccine had a 56% lower risk for head and neck cancers.

“We’ve known for a long time that having the HPV vaccine can prevent the development of HPV infection, yes, but importantly, cancer,” primarily cervical cancer, said briefing moderator and ASCO president Lynn Schuchter, MD, Abramson Cancer Center, University of Pennsylvania, Philadelphia. “This is a really important study that extends the information about the impact.”

Using the US TriNetX database, lead investigator Jefferson DeKloe, BS, a research fellow with Thomas Jefferson University, Philadelphia, and colleagues created a matched cohort of 760,540 HPV-vaccinated and unvaccinated men and 945,999 HPV-vaccinated and unvaccinated women.

HPV-vaccinated men had a 54% lower risk for all HPV-related cancers (odds ratio [OR], 0.46; P < .001) and a 56% lower risk for head and neck cancers (OR, 0.44; P < .001) than unvaccinated men. There were not enough cases of anal and penile cancers for analysis.

HPV-vaccinated women had a 27% lower risk for all HPV-related cancers (OR, 0.73; P < .05), a 54% lower risk for cervical cancer (OR, 0.46; P < .05), and a 33% lower risk for head and neck cancers (OR, 0.67; 95% CI, 0.42-1.08) than HPV-unvaccinated women, but this finding was not significant. There were not enough cases of anal cancers for analysis, and the odds of developing vulvar or vaginal cancer was not significantly different in HPV-vaccinated vs unvaccinated women.

Vaccinated women, however, were less likely than unvaccinated women to develop high-grade squamous intraepithelial lesions (OR, 0.44), cervical carcinoma in situ (OR, 0.42), or abnormal Pap findings (OR, 0.87), and were less likely to undergo cone biopsy and loop electrosurgical excision (OR, 0.45).

“This study really highlights the importance of getting the HPV vaccine,” Dr. Schuchter said at the briefing.

“HPV vaccination is cancer prevention,” Glenn Hanna, MD, with Dana-Farber Cancer Institute, Boston, said in an ASCO statement.

Still, HPV vaccination rates in the United States remain relatively low. According to the National Cancer Institute, in 2022, only about 58% of adolescents aged 13-15 years had received two or three doses of HPV vaccine as recommended.

“The goal,” Dr. Schuchter said at the briefing, “is that younger girls and young boys get vaccinated to prevent development of HPV infection, and that should decrease the risk of cancer, which is what we’ve seen.”

Mr. DeKloe agreed and highlighted the importance of improving vaccination rates. “Identifying effective interventions that increase HPV vaccination rates is critical in reducing undue cancer burden in the United States,” Mr. DeKloe said in a statement.

The study had no funding source. Mr. DeKloe had no relevant disclosures. Dr. Hanna has disclosed relationships with Bicara Therapeutics, Bristol Myers Squibb, Coherus BioSciences, and others. Dr. Schuchter had no relevant disclosures.

A version of this article appeared on Medscape.com .

Vaccination against human papillomavirus (HPV) is an effective way to prevent HPV infection and cancers typically caused by HPV, including cervical cancer and head and neck cancers, new research showed.

The analysis, featured at a press briefing ahead of the presentation at the American Society of Clinical Oncology (ASCO) 2024 annual meeting, notably found that men who received the HPV vaccine had a 56% lower risk for head and neck cancers.

“We’ve known for a long time that having the HPV vaccine can prevent the development of HPV infection, yes, but importantly, cancer,” primarily cervical cancer, said briefing moderator and ASCO president Lynn Schuchter, MD, Abramson Cancer Center, University of Pennsylvania, Philadelphia. “This is a really important study that extends the information about the impact.”

Using the US TriNetX database, lead investigator Jefferson DeKloe, BS, a research fellow with Thomas Jefferson University, Philadelphia, and colleagues created a matched cohort of 760,540 HPV-vaccinated and unvaccinated men and 945,999 HPV-vaccinated and unvaccinated women.

HPV-vaccinated men had a 54% lower risk for all HPV-related cancers (odds ratio [OR], 0.46; P < .001) and a 56% lower risk for head and neck cancers (OR, 0.44; P < .001) than unvaccinated men. There were not enough cases of anal and penile cancers for analysis.

HPV-vaccinated women had a 27% lower risk for all HPV-related cancers (OR, 0.73; P < .05), a 54% lower risk for cervical cancer (OR, 0.46; P < .05), and a 33% lower risk for head and neck cancers (OR, 0.67; 95% CI, 0.42-1.08) than HPV-unvaccinated women, but this finding was not significant. There were not enough cases of anal cancers for analysis, and the odds of developing vulvar or vaginal cancer was not significantly different in HPV-vaccinated vs unvaccinated women.

Vaccinated women, however, were less likely than unvaccinated women to develop high-grade squamous intraepithelial lesions (OR, 0.44), cervical carcinoma in situ (OR, 0.42), or abnormal Pap findings (OR, 0.87), and were less likely to undergo cone biopsy and loop electrosurgical excision (OR, 0.45).

“This study really highlights the importance of getting the HPV vaccine,” Dr. Schuchter said at the briefing.

“HPV vaccination is cancer prevention,” Glenn Hanna, MD, with Dana-Farber Cancer Institute, Boston, said in an ASCO statement.

Still, HPV vaccination rates in the United States remain relatively low. According to the National Cancer Institute, in 2022, only about 58% of adolescents aged 13-15 years had received two or three doses of HPV vaccine as recommended.

“The goal,” Dr. Schuchter said at the briefing, “is that younger girls and young boys get vaccinated to prevent development of HPV infection, and that should decrease the risk of cancer, which is what we’ve seen.”

Mr. DeKloe agreed and highlighted the importance of improving vaccination rates. “Identifying effective interventions that increase HPV vaccination rates is critical in reducing undue cancer burden in the United States,” Mr. DeKloe said in a statement.

The study had no funding source. Mr. DeKloe had no relevant disclosures. Dr. Hanna has disclosed relationships with Bicara Therapeutics, Bristol Myers Squibb, Coherus BioSciences, and others. Dr. Schuchter had no relevant disclosures.

A version of this article appeared on Medscape.com .

Vaccination against human papillomavirus (HPV) is an effective way to prevent HPV infection and cancers typically caused by HPV, including cervical cancer and head and neck cancers, new research showed.

The analysis, featured at a press briefing ahead of the presentation at the American Society of Clinical Oncology (ASCO) 2024 annual meeting, notably found that men who received the HPV vaccine had a 56% lower risk for head and neck cancers.

“We’ve known for a long time that having the HPV vaccine can prevent the development of HPV infection, yes, but importantly, cancer,” primarily cervical cancer, said briefing moderator and ASCO president Lynn Schuchter, MD, Abramson Cancer Center, University of Pennsylvania, Philadelphia. “This is a really important study that extends the information about the impact.”

Using the US TriNetX database, lead investigator Jefferson DeKloe, BS, a research fellow with Thomas Jefferson University, Philadelphia, and colleagues created a matched cohort of 760,540 HPV-vaccinated and unvaccinated men and 945,999 HPV-vaccinated and unvaccinated women.

HPV-vaccinated men had a 54% lower risk for all HPV-related cancers (odds ratio [OR], 0.46; P < .001) and a 56% lower risk for head and neck cancers (OR, 0.44; P < .001) than unvaccinated men. There were not enough cases of anal and penile cancers for analysis.

HPV-vaccinated women had a 27% lower risk for all HPV-related cancers (OR, 0.73; P < .05), a 54% lower risk for cervical cancer (OR, 0.46; P < .05), and a 33% lower risk for head and neck cancers (OR, 0.67; 95% CI, 0.42-1.08) than HPV-unvaccinated women, but this finding was not significant. There were not enough cases of anal cancers for analysis, and the odds of developing vulvar or vaginal cancer was not significantly different in HPV-vaccinated vs unvaccinated women.

Vaccinated women, however, were less likely than unvaccinated women to develop high-grade squamous intraepithelial lesions (OR, 0.44), cervical carcinoma in situ (OR, 0.42), or abnormal Pap findings (OR, 0.87), and were less likely to undergo cone biopsy and loop electrosurgical excision (OR, 0.45).

“This study really highlights the importance of getting the HPV vaccine,” Dr. Schuchter said at the briefing.

“HPV vaccination is cancer prevention,” Glenn Hanna, MD, with Dana-Farber Cancer Institute, Boston, said in an ASCO statement.

Still, HPV vaccination rates in the United States remain relatively low. According to the National Cancer Institute, in 2022, only about 58% of adolescents aged 13-15 years had received two or three doses of HPV vaccine as recommended.

“The goal,” Dr. Schuchter said at the briefing, “is that younger girls and young boys get vaccinated to prevent development of HPV infection, and that should decrease the risk of cancer, which is what we’ve seen.”

Mr. DeKloe agreed and highlighted the importance of improving vaccination rates. “Identifying effective interventions that increase HPV vaccination rates is critical in reducing undue cancer burden in the United States,” Mr. DeKloe said in a statement.

The study had no funding source. Mr. DeKloe had no relevant disclosures. Dr. Hanna has disclosed relationships with Bicara Therapeutics, Bristol Myers Squibb, Coherus BioSciences, and others. Dr. Schuchter had no relevant disclosures.

A version of this article appeared on Medscape.com .

The European Alliance of Associations for Rheumatology (EULAR) 2024 European Congress of Rheumatology annual meeting is about to take place in Vienna, Austria. From June 12 to 15, some of the world’s leading researchers and clinicians will convene to present and learn about data on some of the new and innovative treatments for people with rheumatic and musculoskeletal diseases (RMDs) as well as to discuss how to use and optimize existing approaches. 

Ahead of the Congress, this news organization asked the Congress Committee’s Scientific Programme Chair Caroline Ospelt, MD, PhD, and Abstract Chair Christian Dejaco, MD, PhD, MBA, to discuss some of their highlights of this year’s meeting.
 

From Bench to Bedside

“For me, the beauty at EULAR is really that you have the latest on basic research, how this can be translated in clinical trials, and then the last step would be how EULAR recommends it to be used in clinical practice,” Dr. Ospelt, professor of experimental rheumatology at University Hospital Zurich, said in an interview.  

University Hospital Zurich

“So, if you go to EULAR continuously, you can actually follow the whole story of how novelty comes into clinical practice,” she added. 

In a separate interview, Dr. Dejaco, a consultant rheumatologist and associate professor at the Medical University of Graz in Austria, said: “There are several new drug trials that are going to be presented.” 

One of his highlights on the use of new drugs for the treatment of giant cell arteritis will be the phase 3 SELECT-GCA trial of the Janus kinase (JAK) inhibitor upadacitinib (LBA0001).

“It’s a trial that hopefully will lead to the approval of this drug in this indication,” Dr. Dejaco said.

EULAR

Late-Breaking Abstracts

Dr. Ospelt noted: “We had a lot of good late-breaking abstracts this year.” 

Some of these include: 

• Real-world data on the comparative effectiveness of five different classes of drugs used to treat psoriatic arthritis (PsA; LBA0002) 
• The 16-week results of a phase 2b/3 study with the novel interleukin (IL)–17A inhibitor izokibep in people with PsA (LBA0005)
• Data from the COSPIRIT-JIA trial on the efficacy and safety of ixekizumab (Taltz) in juvenile idiopathic arthritis (LBA0009)
• Phase 2 data on the safety and efficacy of the CD38-targeting monoclonal antibody daratumumab in systemic lupus erythematosus (LBA0007)
• Results of the phase 2 DAHLIAS study of the anti–neonatal Fc receptor monoclonal antibody nipocalimab in people with primary Sjögren disease (LBA0010) 
• Safety and immunogenicity data from a phase 1 study of an active anti–IL-6 immunotherapy in people with knee osteoarthritis (LBA0011)

The latter is “really interesting,” Dr. Ospelt said. As of now, there is no approved treatment for osteoarthritis, and there is no immunotherapy, “so this would be the first.” 

But it’s not just the late-breaker abstracts to look out for. Dr. Dejaco highlighted two abstracts that will be presented during the Abstract Plenary: 

• A phase 3 study of a new selective JAK1 inhibitor, SHR0302, in rheumatoid arthritis (OP0037)
• A multi-omics analysis and targeted gene-editing study in people with , which causes inflammatory and hematologic changes (OP0073)

Of the latter, he said, “this disease is still incompletely understood, and this abstract really helps to better understand the mechanisms underlying this disease.”
 

One to Watch: CAR T-Cell Therapy 

Dr. Ospelt said that the scientific program is about 80% clinical and 20% basic science overall. However, more sessions are being held jointly because data are starting to move from the bench to bedside. 

One of the basic science areas that has had “a real buzz” around it and is now producing results in the clinic is the use of chimeric antigen receptor (CAR) T cells. In one of the first, and perhaps aptly titled What Is New, or WIN, sessions of the congress, Georg Schett, MD, vice president of research at Friedrich-Alexander-Universität Erlangen-Nüremberg in Germany, will discuss the use of CAR T-cell therapy for inflammatory RMDs. There are also multiple abstract presentations on this topic. 

In-depth tissue analysis and prediction of treatment response is another interesting approach, Dr. Ospelt said. “I think that’s the way to go, that we come from the blood, we go into the tissue.” A “very nice” example of this approach will be presented during the Abstract Plenary session on Wednesday, June 12, looking at how synovial tissue macrophages may be able to give information on likely treatment response in treatment-naive rheumatoid arthritis (OP0062). There are also some further findings related to the tissue biopsy–driven treatment trial R4RA that are being presented at the meeting (OP0218, OP0242, and POS0351).
 

EULAR Highlighted Sessions

Among the highlighted sessions on the EULAR 2024 website is one on axial involvement in PsA and spondyloarthritis (SpA). 

“Axial involvement in psoriatic arthritis and peripheral involvement in axial spondyloarthritis is quite a hot topic at the moment,” Dr. Ospelt said. There are lots of questions: “How connected are they? How different are they? Do we need different treatment for axial involvement compared to peripheral involvement?” 

Another EULAR highlighted session is the 75th anniversary of glucocorticoid treatment, during which Past President of EULAR and Emeritus Professor of Rheumatology Josef S. Smolen, MD, will overview the “past, present, and future” of glucocorticoids in RMDs. Consultant rheumatologist Frank Buttgereit, MD, from the German Rheumatism Research Center in Berlin, will discuss the practicalities of using these drugs in clinical practice.

Dr. Dejaco noted: “Glucocorticoids have been one of the most important treatments for a very long time, and they’re still the most important treatment for the acute treatment of systemic inflammatory diseases.”

For a long time, there was no alternative to using steroids, he added, but steroid-sparing options now exist, and there will be data presented on a new type of drug that could potentially be used to control cortisol levels in the body (OP0335).
 

Recommendations and More

Dr. Ospelt and Dr. Dejaco both pointed out other sessions that are likely to be very popular, such as the first and second EULAR Recommendations sessions, a session on rheumatoid arthritis prevention, as well as the many presentations and sessions on digital health and nonpharmacologic interventions such as exercise. 

With over 5242 submitted abstracts, there is going to be no shortage of data being presented at EULAR 2024. Alongside the traditional abstract submission categories, this year there is a new clinical case reports category. 

“We had about 578 submissions for that category,” Dr. Dejaco said. There were 3315 abstracts submitted for the clinical research category, 812 for the basic and translational research category, 283 from health professionals in rheumatology, 152 from patient groups, and 102 in the field of pediatric rheumatology.
 

Join in On-Site, Watch on Demand 

EULAR 2024 reverts to an on-site–only meeting this year. Some of the more lighthearted yet educational elements of the program for those attending include the second edition of the EMEUNET Rheumatology Quiz and, new for this year, two escape rooms. These rooms will provide an interactive experience where small teams will have to solve rheumatologic conundrums in order to escape the room within the hour, Dr. Dejaco explained. There will also be a morning run on Friday, June 14. “It’s not a race, it’s simply to meet and run together,” Dr. Dejaco said. 

But if you cannot make the congress in person, the EULAR 2024 Livestream will be broadcasting throughout the congress. Anyone registered by June 30 will have on-demand access to the recorded content from June 17 until December 31, 2024. 

Abstracts for the meeting will be published as a supplement to Annals of the Rheumatic Diseases, the official journal of EULAR. 

Dr. Ospelt reported no relevant financial relationships. Dr. Dejaco has received consulting/speaker fees from AbbVie, Eli Lilly, Janssen, Sparrow, Novartis, Pfizer, Roche, Galapagos, and Sanofi.

A version of this article appeared on Medscape.com.

The European Alliance of Associations for Rheumatology (EULAR) 2024 European Congress of Rheumatology annual meeting is about to take place in Vienna, Austria. From June 12 to 15, some of the world’s leading researchers and clinicians will convene to present and learn about data on some of the new and innovative treatments for people with rheumatic and musculoskeletal diseases (RMDs) as well as to discuss how to use and optimize existing approaches. 

Ahead of the Congress, this news organization asked the Congress Committee’s Scientific Programme Chair Caroline Ospelt, MD, PhD, and Abstract Chair Christian Dejaco, MD, PhD, MBA, to discuss some of their highlights of this year’s meeting.
 

From Bench to Bedside

“For me, the beauty at EULAR is really that you have the latest on basic research, how this can be translated in clinical trials, and then the last step would be how EULAR recommends it to be used in clinical practice,” Dr. Ospelt, professor of experimental rheumatology at University Hospital Zurich, said in an interview.  

University Hospital Zurich

“So, if you go to EULAR continuously, you can actually follow the whole story of how novelty comes into clinical practice,” she added. 

In a separate interview, Dr. Dejaco, a consultant rheumatologist and associate professor at the Medical University of Graz in Austria, said: “There are several new drug trials that are going to be presented.” 

One of his highlights on the use of new drugs for the treatment of giant cell arteritis will be the phase 3 SELECT-GCA trial of the Janus kinase (JAK) inhibitor upadacitinib (LBA0001).

“It’s a trial that hopefully will lead to the approval of this drug in this indication,” Dr. Dejaco said.

EULAR

Late-Breaking Abstracts

Dr. Ospelt noted: “We had a lot of good late-breaking abstracts this year.” 

Some of these include: 

• Real-world data on the comparative effectiveness of five different classes of drugs used to treat psoriatic arthritis (PsA; LBA0002) 
• The 16-week results of a phase 2b/3 study with the novel interleukin (IL)–17A inhibitor izokibep in people with PsA (LBA0005)
• Data from the COSPIRIT-JIA trial on the efficacy and safety of ixekizumab (Taltz) in juvenile idiopathic arthritis (LBA0009)
• Phase 2 data on the safety and efficacy of the CD38-targeting monoclonal antibody daratumumab in systemic lupus erythematosus (LBA0007)
• Results of the phase 2 DAHLIAS study of the anti–neonatal Fc receptor monoclonal antibody nipocalimab in people with primary Sjögren disease (LBA0010) 
• Safety and immunogenicity data from a phase 1 study of an active anti–IL-6 immunotherapy in people with knee osteoarthritis (LBA0011)

The latter is “really interesting,” Dr. Ospelt said. As of now, there is no approved treatment for osteoarthritis, and there is no immunotherapy, “so this would be the first.” 

But it’s not just the late-breaker abstracts to look out for. Dr. Dejaco highlighted two abstracts that will be presented during the Abstract Plenary: 

• A phase 3 study of a new selective JAK1 inhibitor, SHR0302, in rheumatoid arthritis (OP0037)
• A multi-omics analysis and targeted gene-editing study in people with , which causes inflammatory and hematologic changes (OP0073)

Of the latter, he said, “this disease is still incompletely understood, and this abstract really helps to better understand the mechanisms underlying this disease.”
 

One to Watch: CAR T-Cell Therapy 

Dr. Ospelt said that the scientific program is about 80% clinical and 20% basic science overall. However, more sessions are being held jointly because data are starting to move from the bench to bedside. 

One of the basic science areas that has had “a real buzz” around it and is now producing results in the clinic is the use of chimeric antigen receptor (CAR) T cells. In one of the first, and perhaps aptly titled What Is New, or WIN, sessions of the congress, Georg Schett, MD, vice president of research at Friedrich-Alexander-Universität Erlangen-Nüremberg in Germany, will discuss the use of CAR T-cell therapy for inflammatory RMDs. There are also multiple abstract presentations on this topic. 

In-depth tissue analysis and prediction of treatment response is another interesting approach, Dr. Ospelt said. “I think that’s the way to go, that we come from the blood, we go into the tissue.” A “very nice” example of this approach will be presented during the Abstract Plenary session on Wednesday, June 12, looking at how synovial tissue macrophages may be able to give information on likely treatment response in treatment-naive rheumatoid arthritis (OP0062). There are also some further findings related to the tissue biopsy–driven treatment trial R4RA that are being presented at the meeting (OP0218, OP0242, and POS0351).
 

EULAR Highlighted Sessions

Among the highlighted sessions on the EULAR 2024 website is one on axial involvement in PsA and spondyloarthritis (SpA). 

“Axial involvement in psoriatic arthritis and peripheral involvement in axial spondyloarthritis is quite a hot topic at the moment,” Dr. Ospelt said. There are lots of questions: “How connected are they? How different are they? Do we need different treatment for axial involvement compared to peripheral involvement?” 

Another EULAR highlighted session is the 75th anniversary of glucocorticoid treatment, during which Past President of EULAR and Emeritus Professor of Rheumatology Josef S. Smolen, MD, will overview the “past, present, and future” of glucocorticoids in RMDs. Consultant rheumatologist Frank Buttgereit, MD, from the German Rheumatism Research Center in Berlin, will discuss the practicalities of using these drugs in clinical practice.

Dr. Dejaco noted: “Glucocorticoids have been one of the most important treatments for a very long time, and they’re still the most important treatment for the acute treatment of systemic inflammatory diseases.”

For a long time, there was no alternative to using steroids, he added, but steroid-sparing options now exist, and there will be data presented on a new type of drug that could potentially be used to control cortisol levels in the body (OP0335).
 

Recommendations and More

Dr. Ospelt and Dr. Dejaco both pointed out other sessions that are likely to be very popular, such as the first and second EULAR Recommendations sessions, a session on rheumatoid arthritis prevention, as well as the many presentations and sessions on digital health and nonpharmacologic interventions such as exercise. 

With over 5242 submitted abstracts, there is going to be no shortage of data being presented at EULAR 2024. Alongside the traditional abstract submission categories, this year there is a new clinical case reports category. 

“We had about 578 submissions for that category,” Dr. Dejaco said. There were 3315 abstracts submitted for the clinical research category, 812 for the basic and translational research category, 283 from health professionals in rheumatology, 152 from patient groups, and 102 in the field of pediatric rheumatology.
 

Join in On-Site, Watch on Demand 

EULAR 2024 reverts to an on-site–only meeting this year. Some of the more lighthearted yet educational elements of the program for those attending include the second edition of the EMEUNET Rheumatology Quiz and, new for this year, two escape rooms. These rooms will provide an interactive experience where small teams will have to solve rheumatologic conundrums in order to escape the room within the hour, Dr. Dejaco explained. There will also be a morning run on Friday, June 14. “It’s not a race, it’s simply to meet and run together,” Dr. Dejaco said. 

But if you cannot make the congress in person, the EULAR 2024 Livestream will be broadcasting throughout the congress. Anyone registered by June 30 will have on-demand access to the recorded content from June 17 until December 31, 2024. 

Abstracts for the meeting will be published as a supplement to Annals of the Rheumatic Diseases, the official journal of EULAR. 

Dr. Ospelt reported no relevant financial relationships. Dr. Dejaco has received consulting/speaker fees from AbbVie, Eli Lilly, Janssen, Sparrow, Novartis, Pfizer, Roche, Galapagos, and Sanofi.

A version of this article appeared on Medscape.com.

The European Alliance of Associations for Rheumatology (EULAR) 2024 European Congress of Rheumatology annual meeting is about to take place in Vienna, Austria. From June 12 to 15, some of the world’s leading researchers and clinicians will convene to present and learn about data on some of the new and innovative treatments for people with rheumatic and musculoskeletal diseases (RMDs) as well as to discuss how to use and optimize existing approaches. 

Ahead of the Congress, this news organization asked the Congress Committee’s Scientific Programme Chair Caroline Ospelt, MD, PhD, and Abstract Chair Christian Dejaco, MD, PhD, MBA, to discuss some of their highlights of this year’s meeting.
 

From Bench to Bedside

“For me, the beauty at EULAR is really that you have the latest on basic research, how this can be translated in clinical trials, and then the last step would be how EULAR recommends it to be used in clinical practice,” Dr. Ospelt, professor of experimental rheumatology at University Hospital Zurich, said in an interview.  

University Hospital Zurich

“So, if you go to EULAR continuously, you can actually follow the whole story of how novelty comes into clinical practice,” she added. 

In a separate interview, Dr. Dejaco, a consultant rheumatologist and associate professor at the Medical University of Graz in Austria, said: “There are several new drug trials that are going to be presented.” 

One of his highlights on the use of new drugs for the treatment of giant cell arteritis will be the phase 3 SELECT-GCA trial of the Janus kinase (JAK) inhibitor upadacitinib (LBA0001).

“It’s a trial that hopefully will lead to the approval of this drug in this indication,” Dr. Dejaco said.

EULAR

Late-Breaking Abstracts

Dr. Ospelt noted: “We had a lot of good late-breaking abstracts this year.” 

Some of these include: 

• Real-world data on the comparative effectiveness of five different classes of drugs used to treat psoriatic arthritis (PsA; LBA0002) 
• The 16-week results of a phase 2b/3 study with the novel interleukin (IL)–17A inhibitor izokibep in people with PsA (LBA0005)
• Data from the COSPIRIT-JIA trial on the efficacy and safety of ixekizumab (Taltz) in juvenile idiopathic arthritis (LBA0009)
• Phase 2 data on the safety and efficacy of the CD38-targeting monoclonal antibody daratumumab in systemic lupus erythematosus (LBA0007)
• Results of the phase 2 DAHLIAS study of the anti–neonatal Fc receptor monoclonal antibody nipocalimab in people with primary Sjögren disease (LBA0010) 
• Safety and immunogenicity data from a phase 1 study of an active anti–IL-6 immunotherapy in people with knee osteoarthritis (LBA0011)

The latter is “really interesting,” Dr. Ospelt said. As of now, there is no approved treatment for osteoarthritis, and there is no immunotherapy, “so this would be the first.” 

But it’s not just the late-breaker abstracts to look out for. Dr. Dejaco highlighted two abstracts that will be presented during the Abstract Plenary: 

• A phase 3 study of a new selective JAK1 inhibitor, SHR0302, in rheumatoid arthritis (OP0037)
• A multi-omics analysis and targeted gene-editing study in people with , which causes inflammatory and hematologic changes (OP0073)

Of the latter, he said, “this disease is still incompletely understood, and this abstract really helps to better understand the mechanisms underlying this disease.”
 

One to Watch: CAR T-Cell Therapy 

Dr. Ospelt said that the scientific program is about 80% clinical and 20% basic science overall. However, more sessions are being held jointly because data are starting to move from the bench to bedside. 

One of the basic science areas that has had “a real buzz” around it and is now producing results in the clinic is the use of chimeric antigen receptor (CAR) T cells. In one of the first, and perhaps aptly titled What Is New, or WIN, sessions of the congress, Georg Schett, MD, vice president of research at Friedrich-Alexander-Universität Erlangen-Nüremberg in Germany, will discuss the use of CAR T-cell therapy for inflammatory RMDs. There are also multiple abstract presentations on this topic. 

In-depth tissue analysis and prediction of treatment response is another interesting approach, Dr. Ospelt said. “I think that’s the way to go, that we come from the blood, we go into the tissue.” A “very nice” example of this approach will be presented during the Abstract Plenary session on Wednesday, June 12, looking at how synovial tissue macrophages may be able to give information on likely treatment response in treatment-naive rheumatoid arthritis (OP0062). There are also some further findings related to the tissue biopsy–driven treatment trial R4RA that are being presented at the meeting (OP0218, OP0242, and POS0351).
 

EULAR Highlighted Sessions

Among the highlighted sessions on the EULAR 2024 website is one on axial involvement in PsA and spondyloarthritis (SpA). 

“Axial involvement in psoriatic arthritis and peripheral involvement in axial spondyloarthritis is quite a hot topic at the moment,” Dr. Ospelt said. There are lots of questions: “How connected are they? How different are they? Do we need different treatment for axial involvement compared to peripheral involvement?” 

Another EULAR highlighted session is the 75th anniversary of glucocorticoid treatment, during which Past President of EULAR and Emeritus Professor of Rheumatology Josef S. Smolen, MD, will overview the “past, present, and future” of glucocorticoids in RMDs. Consultant rheumatologist Frank Buttgereit, MD, from the German Rheumatism Research Center in Berlin, will discuss the practicalities of using these drugs in clinical practice.

Dr. Dejaco noted: “Glucocorticoids have been one of the most important treatments for a very long time, and they’re still the most important treatment for the acute treatment of systemic inflammatory diseases.”

For a long time, there was no alternative to using steroids, he added, but steroid-sparing options now exist, and there will be data presented on a new type of drug that could potentially be used to control cortisol levels in the body (OP0335).
 

Recommendations and More

Dr. Ospelt and Dr. Dejaco both pointed out other sessions that are likely to be very popular, such as the first and second EULAR Recommendations sessions, a session on rheumatoid arthritis prevention, as well as the many presentations and sessions on digital health and nonpharmacologic interventions such as exercise. 

With over 5242 submitted abstracts, there is going to be no shortage of data being presented at EULAR 2024. Alongside the traditional abstract submission categories, this year there is a new clinical case reports category. 

“We had about 578 submissions for that category,” Dr. Dejaco said. There were 3315 abstracts submitted for the clinical research category, 812 for the basic and translational research category, 283 from health professionals in rheumatology, 152 from patient groups, and 102 in the field of pediatric rheumatology.
 

Join in On-Site, Watch on Demand 

EULAR 2024 reverts to an on-site–only meeting this year. Some of the more lighthearted yet educational elements of the program for those attending include the second edition of the EMEUNET Rheumatology Quiz and, new for this year, two escape rooms. These rooms will provide an interactive experience where small teams will have to solve rheumatologic conundrums in order to escape the room within the hour, Dr. Dejaco explained. There will also be a morning run on Friday, June 14. “It’s not a race, it’s simply to meet and run together,” Dr. Dejaco said. 

But if you cannot make the congress in person, the EULAR 2024 Livestream will be broadcasting throughout the congress. Anyone registered by June 30 will have on-demand access to the recorded content from June 17 until December 31, 2024. 

Abstracts for the meeting will be published as a supplement to Annals of the Rheumatic Diseases, the official journal of EULAR. 

Dr. Ospelt reported no relevant financial relationships. Dr. Dejaco has received consulting/speaker fees from AbbVie, Eli Lilly, Janssen, Sparrow, Novartis, Pfizer, Roche, Galapagos, and Sanofi.

A version of this article appeared on Medscape.com.

Autonomous artificial intelligence (AI) can achieve similar accuracy to AI-assisted humans (AI-H) in the optical diagnosis of diminutive colorectal polyps, while providing greater alignment with pathology-based surveillance intervals, based on a randomized controlled trial.

These findings suggest that autonomous AI may one day replace histologic assessment of diminutive polyps, reported lead author Roupen Djinbachian, MD, of the Montreal University Hospital Research Center, Montreal, Quebec, Canada, and colleagues.Optical diagnosis of diminutive colorectal polyps has been proposed as a cost-effective alternative to histologic diagnosis, but its implementation in general clinical practice has been hindered by endoscopists’ concerns about incorrect diagnoses, the investigators wrote in Gastroenterology.“AI-based systems (CADx) have been proposed as a solution to these barriers to implementation, with studies showing high adherence to Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) thresholds when using AI-H,” they wrote. “However, the efficacy and safety of autonomous AI-based diagnostic platforms have not yet been evaluated.”

To address this knowledge gap, Dr. Djinbachian and colleagues conducted a randomized controlled noninferiority trial involving 467 patients, all of whom underwent elective colonoscopies at a single academic institution.

Participants were randomly assigned to one of two groups. The first group received an optical diagnosis of diminutive (1-5 mm) colorectal polyps using an autonomous AI-based CADx system without any human input. The second group had diagnoses performed by endoscopists who used AI-H to make their optical diagnoses.

The primary outcome was the accuracy of optical diagnosis compared with the gold standard of histologic evaluation. Secondarily, the investigators explored associations between pathology-based surveillance intervals and various measures of accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

The results showed that the accuracy of optical diagnosis for diminutive polyps was similar between the two groups, supporting noninferiority. Autonomous AI achieved an accuracy rate of 77.2%, while the AI-H group had an accuracy of 72.1%, which was not statistically significant (P = .86).

But when it came to pathology-based surveillance intervals, autonomous AI showed a clear advantage; the autonomous AI system achieved a 91.5% agreement rate, compared with 82.1% for the AI-H group (P = .016).

“These findings indicate that autonomous AI not only matches but also surpasses AI-H in accuracy for determining surveillance intervals,” the investigators wrote, noting that this finding highlights the “complexities of human interaction with AI modules where human intervention could lead to worse outcomes.”

Further analysis revealed that the sensitivity of autonomous AI for identifying adenomas was 84.8%, slightly higher than the 83.6% sensitivity of the AI-H group. Specificity was 64.4% for autonomous AI vs 63.8% for AI-H. While PPV was higher in the autonomous AI group (85.6%), compared with the AI-H group (78.6%), NPV was lower for autonomous AI than AI-H (63.0% vs 71.0%).

Dr. Djinbachian and colleagues suggested that future research should focus on larger, multicenter trials to validate these findings and further explore the integration of autonomous AI systems in clinical practice. They also noted that improving AI algorithms to accurately diagnose sessile serrated lesions could enhance the overall effectiveness of AI-based optical diagnosis.

“The performance of autonomous AI in accurately diagnosing diminutive polyps and determining appropriate surveillance intervals suggests that it could play a crucial role in streamlining colorectal cancer screening processes, reducing the burden on pathologists, and potentially lowering healthcare costs,” the investigators concluded.The study was supported by Fujifilm, which had no role in the study design or data analysis. Dr. von Renteln reported additional research funding from Vantage and Fujifilm.

Autonomous artificial intelligence (AI) can achieve similar accuracy to AI-assisted humans (AI-H) in the optical diagnosis of diminutive colorectal polyps, while providing greater alignment with pathology-based surveillance intervals, based on a randomized controlled trial.

These findings suggest that autonomous AI may one day replace histologic assessment of diminutive polyps, reported lead author Roupen Djinbachian, MD, of the Montreal University Hospital Research Center, Montreal, Quebec, Canada, and colleagues.Optical diagnosis of diminutive colorectal polyps has been proposed as a cost-effective alternative to histologic diagnosis, but its implementation in general clinical practice has been hindered by endoscopists’ concerns about incorrect diagnoses, the investigators wrote in Gastroenterology.“AI-based systems (CADx) have been proposed as a solution to these barriers to implementation, with studies showing high adherence to Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) thresholds when using AI-H,” they wrote. “However, the efficacy and safety of autonomous AI-based diagnostic platforms have not yet been evaluated.”

To address this knowledge gap, Dr. Djinbachian and colleagues conducted a randomized controlled noninferiority trial involving 467 patients, all of whom underwent elective colonoscopies at a single academic institution.

Participants were randomly assigned to one of two groups. The first group received an optical diagnosis of diminutive (1-5 mm) colorectal polyps using an autonomous AI-based CADx system without any human input. The second group had diagnoses performed by endoscopists who used AI-H to make their optical diagnoses.

The primary outcome was the accuracy of optical diagnosis compared with the gold standard of histologic evaluation. Secondarily, the investigators explored associations between pathology-based surveillance intervals and various measures of accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

The results showed that the accuracy of optical diagnosis for diminutive polyps was similar between the two groups, supporting noninferiority. Autonomous AI achieved an accuracy rate of 77.2%, while the AI-H group had an accuracy of 72.1%, which was not statistically significant (P = .86).

But when it came to pathology-based surveillance intervals, autonomous AI showed a clear advantage; the autonomous AI system achieved a 91.5% agreement rate, compared with 82.1% for the AI-H group (P = .016).

“These findings indicate that autonomous AI not only matches but also surpasses AI-H in accuracy for determining surveillance intervals,” the investigators wrote, noting that this finding highlights the “complexities of human interaction with AI modules where human intervention could lead to worse outcomes.”

Further analysis revealed that the sensitivity of autonomous AI for identifying adenomas was 84.8%, slightly higher than the 83.6% sensitivity of the AI-H group. Specificity was 64.4% for autonomous AI vs 63.8% for AI-H. While PPV was higher in the autonomous AI group (85.6%), compared with the AI-H group (78.6%), NPV was lower for autonomous AI than AI-H (63.0% vs 71.0%).

Dr. Djinbachian and colleagues suggested that future research should focus on larger, multicenter trials to validate these findings and further explore the integration of autonomous AI systems in clinical practice. They also noted that improving AI algorithms to accurately diagnose sessile serrated lesions could enhance the overall effectiveness of AI-based optical diagnosis.

“The performance of autonomous AI in accurately diagnosing diminutive polyps and determining appropriate surveillance intervals suggests that it could play a crucial role in streamlining colorectal cancer screening processes, reducing the burden on pathologists, and potentially lowering healthcare costs,” the investigators concluded.The study was supported by Fujifilm, which had no role in the study design or data analysis. Dr. von Renteln reported additional research funding from Vantage and Fujifilm.

Autonomous artificial intelligence (AI) can achieve similar accuracy to AI-assisted humans (AI-H) in the optical diagnosis of diminutive colorectal polyps, while providing greater alignment with pathology-based surveillance intervals, based on a randomized controlled trial.

These findings suggest that autonomous AI may one day replace histologic assessment of diminutive polyps, reported lead author Roupen Djinbachian, MD, of the Montreal University Hospital Research Center, Montreal, Quebec, Canada, and colleagues.Optical diagnosis of diminutive colorectal polyps has been proposed as a cost-effective alternative to histologic diagnosis, but its implementation in general clinical practice has been hindered by endoscopists’ concerns about incorrect diagnoses, the investigators wrote in Gastroenterology.“AI-based systems (CADx) have been proposed as a solution to these barriers to implementation, with studies showing high adherence to Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) thresholds when using AI-H,” they wrote. “However, the efficacy and safety of autonomous AI-based diagnostic platforms have not yet been evaluated.”

To address this knowledge gap, Dr. Djinbachian and colleagues conducted a randomized controlled noninferiority trial involving 467 patients, all of whom underwent elective colonoscopies at a single academic institution.

Participants were randomly assigned to one of two groups. The first group received an optical diagnosis of diminutive (1-5 mm) colorectal polyps using an autonomous AI-based CADx system without any human input. The second group had diagnoses performed by endoscopists who used AI-H to make their optical diagnoses.

The primary outcome was the accuracy of optical diagnosis compared with the gold standard of histologic evaluation. Secondarily, the investigators explored associations between pathology-based surveillance intervals and various measures of accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

The results showed that the accuracy of optical diagnosis for diminutive polyps was similar between the two groups, supporting noninferiority. Autonomous AI achieved an accuracy rate of 77.2%, while the AI-H group had an accuracy of 72.1%, which was not statistically significant (P = .86).

But when it came to pathology-based surveillance intervals, autonomous AI showed a clear advantage; the autonomous AI system achieved a 91.5% agreement rate, compared with 82.1% for the AI-H group (P = .016).

“These findings indicate that autonomous AI not only matches but also surpasses AI-H in accuracy for determining surveillance intervals,” the investigators wrote, noting that this finding highlights the “complexities of human interaction with AI modules where human intervention could lead to worse outcomes.”

Further analysis revealed that the sensitivity of autonomous AI for identifying adenomas was 84.8%, slightly higher than the 83.6% sensitivity of the AI-H group. Specificity was 64.4% for autonomous AI vs 63.8% for AI-H. While PPV was higher in the autonomous AI group (85.6%), compared with the AI-H group (78.6%), NPV was lower for autonomous AI than AI-H (63.0% vs 71.0%).

Dr. Djinbachian and colleagues suggested that future research should focus on larger, multicenter trials to validate these findings and further explore the integration of autonomous AI systems in clinical practice. They also noted that improving AI algorithms to accurately diagnose sessile serrated lesions could enhance the overall effectiveness of AI-based optical diagnosis.

“The performance of autonomous AI in accurately diagnosing diminutive polyps and determining appropriate surveillance intervals suggests that it could play a crucial role in streamlining colorectal cancer screening processes, reducing the burden on pathologists, and potentially lowering healthcare costs,” the investigators concluded.The study was supported by Fujifilm, which had no role in the study design or data analysis. Dr. von Renteln reported additional research funding from Vantage and Fujifilm.

Highlights in ulcerative colitis (UC) and Crohn's disease (CD) from Digestive Disease Week® (DDW) 2024 are reported on by Dr. Andres Yarur from Cedars Sinai Medical Center in Los Angeles.

Dr. Yarur opens by discussing two phase 3 studies focused on risankizumab (RZB), which is currently approved for treatment of CD and has shown efficacy in UC. The first showed an induction period extended from 12 to 24 weeks resulted in clinical response in more than half of patients with UC.

The second study compared maintenance therapy with RZB to ustekinumab in patients with CD and found that RZB resulted in a higher rate of remission.

Dr. Yarur next looks at a study that explored use of darvadstrocel, an allogeneic stem cell therapy, in a subset of patients with CD and complex perianal fistulas. The disappointing results of the ADMIRE-CD II trial showed no benefit over placebo.

Patients hospitalized with UC, a population with few therapeutic options, were the focus of the next study. The TRIUMPH study explored use of the Janus kinase inhibitor tofacitinib for these patients and found that clinical response was achieved by 58.3% of them by day 7.

The final study addressed a clinical challenge: devising the optimal vaccination strategy for patients on immunosuppressive or anti–tumor necrosis factor therapies. Dr. Yarur reports that the study found an intensified pneumococcal vaccine regimen was more immunogenic and provided immunity for a longer duration than did the standard regimen.

--

Andres J. Yarur, MD, Associate Professor of Medicine, Cedars Sinai Medical Center, Los Angeles, California

Andres J. Yarur, MD, has disclosed the following relevant financial relationships:

Serve(d) as a consultant for: Takeda; Pfizer; Arena; AbbVie; Bristol Myers Squibb; Boehringer Ingelheim; Celltrion

Highlights in ulcerative colitis (UC) and Crohn's disease (CD) from Digestive Disease Week® (DDW) 2024 are reported on by Dr. Andres Yarur from Cedars Sinai Medical Center in Los Angeles.

Dr. Yarur opens by discussing two phase 3 studies focused on risankizumab (RZB), which is currently approved for treatment of CD and has shown efficacy in UC. The first showed an induction period extended from 12 to 24 weeks resulted in clinical response in more than half of patients with UC.

The second study compared maintenance therapy with RZB to ustekinumab in patients with CD and found that RZB resulted in a higher rate of remission.

Dr. Yarur next looks at a study that explored use of darvadstrocel, an allogeneic stem cell therapy, in a subset of patients with CD and complex perianal fistulas. The disappointing results of the ADMIRE-CD II trial showed no benefit over placebo.

Patients hospitalized with UC, a population with few therapeutic options, were the focus of the next study. The TRIUMPH study explored use of the Janus kinase inhibitor tofacitinib for these patients and found that clinical response was achieved by 58.3% of them by day 7.

The final study addressed a clinical challenge: devising the optimal vaccination strategy for patients on immunosuppressive or anti–tumor necrosis factor therapies. Dr. Yarur reports that the study found an intensified pneumococcal vaccine regimen was more immunogenic and provided immunity for a longer duration than did the standard regimen.

--

Andres J. Yarur, MD, Associate Professor of Medicine, Cedars Sinai Medical Center, Los Angeles, California

Andres J. Yarur, MD, has disclosed the following relevant financial relationships:

Serve(d) as a consultant for: Takeda; Pfizer; Arena; AbbVie; Bristol Myers Squibb; Boehringer Ingelheim; Celltrion

Highlights in ulcerative colitis (UC) and Crohn's disease (CD) from Digestive Disease Week® (DDW) 2024 are reported on by Dr. Andres Yarur from Cedars Sinai Medical Center in Los Angeles.

Dr. Yarur opens by discussing two phase 3 studies focused on risankizumab (RZB), which is currently approved for treatment of CD and has shown efficacy in UC. The first showed an induction period extended from 12 to 24 weeks resulted in clinical response in more than half of patients with UC.

The second study compared maintenance therapy with RZB to ustekinumab in patients with CD and found that RZB resulted in a higher rate of remission.

Dr. Yarur next looks at a study that explored use of darvadstrocel, an allogeneic stem cell therapy, in a subset of patients with CD and complex perianal fistulas. The disappointing results of the ADMIRE-CD II trial showed no benefit over placebo.

Patients hospitalized with UC, a population with few therapeutic options, were the focus of the next study. The TRIUMPH study explored use of the Janus kinase inhibitor tofacitinib for these patients and found that clinical response was achieved by 58.3% of them by day 7.

The final study addressed a clinical challenge: devising the optimal vaccination strategy for patients on immunosuppressive or anti–tumor necrosis factor therapies. Dr. Yarur reports that the study found an intensified pneumococcal vaccine regimen was more immunogenic and provided immunity for a longer duration than did the standard regimen.

--

Andres J. Yarur, MD, Associate Professor of Medicine, Cedars Sinai Medical Center, Los Angeles, California

Andres J. Yarur, MD, has disclosed the following relevant financial relationships:

Serve(d) as a consultant for: Takeda; Pfizer; Arena; AbbVie; Bristol Myers Squibb; Boehringer Ingelheim; Celltrion