Lena W.Y. Thin

• Bachelor of Medicine
• Gastroenterologist at Government of Western Australia

Introduction Several studies have demonstrated that switching stable patients with inflammatory bowel disease (IBD) from originator to biosimilar infliximab is noninferior to continuing originator infliximab. However, “real‐world” data comparing long‐term outcomes between switch and nonswitch cohorts is lacking. This study aimed to address this gap...

Background Acute Severe Ulcerative Colitis (ASUC) is a medical emergency, with limited therapeutic options available for medical management. Tofacitinib and Upadacitinib are novel Janus Kinase inhibitors (JAKi), with proven efficacy for ulcerative colitis (UC). This study aimed to examine the outcomes of patients treated with JAKi for ASUC in a rea...

Background and Aim: Ileocolic resections (ICR) are the most commonly performed resections for Crohn’s disease (CD). There is ongoing debate about the impact of anastomotic technique on the risk of post operative recurrence (POR). Historical control groups have often been used for statis-tical comparison, usually with temporal bias. The aims of this...

Background An inverse relationship exists between inflammation and testosterone concentrations in non–inflammatory bowel disease (IBD) immune conditions but has not been objectively explored in the IBD male population. We aimed to characterize the distribution of testosterone concentrations in a cohort of males with IBD and identify any relationshi...

Introduction A substantial proportion of patients with inflammatory bowel disease (IBD) on intravenous infliximab require dose intensification. Accessing additional intravenous infliximab is labour-intensive and expensive, depending on insurance and pharmaceutical reimbursement. Observational data suggest that subcutaneous infliximab may offer a co...

Background: Endoscopic balloon dilatation (EBD) is an alternative therapy to avoid or delay surgery in stricturing Crohn’s disease (CD); however, certain factors determining outcomes remain poorly defined, and conflicting evidence exists in current studies. In one of the largest cohorts to date, we assess outcomes following EBD for stricturing CD f...

Background Anti-IL12/23 agents have shown greater durability in response compared with anti-TNFα agents. Data on the association between body composition or body mass index (BMI) and Ustekinumab’s (Ust) therapeutic response is limited. We aimed to evaluate the impact of body composition on time to failing standard doses of Ust in Crohn’s disease (C...

Background Upadacitinib (UPA), an oral Janus kinase inhibitor approved for the treatment of moderately to severely active Crohn’s disease (CD), has demonstrated the ability to provide rapid symptom relief within the first week of induction treatment in patients with CD.1 As symptomatic remission is critical for patients, this phase 3 post hoc analy...

Background Risk factors for colectomy following an episode of acute severe ulcerative colitis (ASUC) have been well studied, but data examining the early complications following an episode is limited. Objectives We aimed to evaluate the prevalence and risk factors for medical and surgical complications within 90 days of an ASUC admission and deter...

Background & aims: The QUASAR Phase 2b Induction Study evaluated the efficacy and safety of guselkumab, an interleukin-23p19 subunit antagonist, in patients with moderately to severely active ulcerative colitis (UC) with prior inadequate response and/or intolerance to corticosteroids, immunosuppressants, or advanced therapy. Methods: In this dou...

Background Chromoendoscopy is preferred over high-definition white light endoscopy (HDWLE) for dysplasia surveillance in inflammatory bowel disease (IBD) patients, but is more time-consuming to perform and real-world evidence is limited. The prevalence of sessile serrated lesions (SSLs) in IBD patients is also unknown. Objective To determine the y...

Background Loss of response (LOR) to anti-TNFα therapy in inflammatory bowel disease (IBD) is common and biologic therapies such as anti-IL12/23 agents have shown greater durability in efficacy. Anti-TNFα LOR is increased in higher body mass index (BMI) patients however the evidence for the association between body composition or BMI and Ustekinuma...

Background Upadacitinib (UPA), an oral, selective JAK inhibitor demonstrated superior efficacy for clinical remission compared with placebo (PBO) and an acceptable safety profile in patients with moderately to severely active Crohn’s disease (CD) in 2 phase 3 induction trials, U-EXCEL (NCT03345849) and U-EXCEED (NCT03345836).1-2 There remains an un...

Background Ustekinumab (UST) is a monoclonal antibody targeting IL-12 and IL-23 through their shared p40 subunit. This study aimed to determine the clinical outcomes after UST treatment in Crohn’s disease (CD) patients in a real-world setting, and to investigate the association of clinical outcomes with IL-12, IL-23 and UST levels. Methods A multi...

Background Switching patients with inflammatory bowel disease (IBD) from originator to biosimilar infliximab has been demonstrated to be non-inferior to continuing originator infliximab by several studies. However, data comparing treatment outcomes beyond 12-months across switch and non-switch cohorts specific to IBD patients remains comparatively...

Background Gastrointestinal ultrasound (GIUS) can accurately assess disease activity in atients with ulcerative colitis (UC). The aim of this study was to determine the accuracy of GIUS in predicting IV corticosteroid (CS) failure in patients with Acute Severe Ulcerative Colitis (ASUC) and the requirement for rescue therapy. Methods We conducted a...

Background and Aim: Ustekinumab (UST) is a monoclonal antibody targeting IL-12 and IL-23 through their shared p40 subunit. Although UST was approved for the treatment of moderate to severe Crohn's disease (CD) in Australia in September 2017, there are limited data investigating its utility in real-world clinical practice. Further, there are no pros...

Background Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. In an earlier phase 2 induction study, etrolizumab significantly improved clinical remission relative to placebo in patients with moderately to severely active ulcerative colitis. The HIBISCUS studies aimed to compare the efficacy and safety of etrolizumab to adalimumab...

Background Etrolizumab is a gut-targeted, anti-β7 integrin, monoclonal antibody. In an earlier phase 2 induction study, etrolizumab significantly improved clinical remission compared with placebo in patients with moderately to severely active ulcerative colitis. We aimed to evaluate the efficacy and safety of etrolizumab in patients with moderately...

In reply: We thank Lim and colleagues for their insightful comments regarding the use biosimilar medicines in Australia; their letter highlights some pertinent issues. Firstly, we agree that uptake of biosimilar medications in Australia has been slower than expected owing to several factors, including those elucidated in the letter by Lim et al....

Background and Aim: Inflammatory bowel disease (IBD) imposes a significant burden on an individual’s quality of life and the health care system. Most patients use dietary modifications to manage their symptoms, despite limited research to support these changes. A Westernized diet has been associated with increased IBD risk and relapse. There are em...

Background & aims: Higher anti-tumour necrosis factor-α drug levels are associated with improved clinical healing of Crohn's perianal fistulas. It is unclear whether this leads to improved healing on radiological assessment. We aimed to evaluate the association between anti-tumour necrosis factor-α drug levels and radiological outcomes in perianal...

Background Higher anti-tumour necrosis factor-α (TNF) drug levels are associated with improved clinical fistula healing and closure in perianal fistulising Crohn’s disease (pfCD). It is hypothesised that higher drug levels will lead to improved healing on magnetic resonance imaging (MRI); but this is yet to be established. This study evaluated the...

LINKED CONTENT This article is linked to Trystram et al paper. To view this article, visit https://doi.org/10.1111/apt.16312

Objective: To examine whether non-medical switching of patients with inflammatory bowel disease (IBD) from originator infliximab to a biosimilar (CT-P13, Inflectra) is safe and clinically non-inferior to continued treatment with originator infliximab. Design: Prospective, open label, multicentre, parallel cohort, non-inferiority study in seven Aus...

Objective: To examine whether non-medical switching of patients with inflammatory bowel disease (IBD) from originator infliximab to a biosimilar (CT-P13, Inflectra) is safe and clinically non-inferior to continued treatment with originator infliximab. Design: Prospective, open label, multicentre, parallel cohort, non-inferiority study in seven Aus...

Introduction: A high body mass index is known to adversely affect antitumor necrosis factor-alpha trough levels and secondary loss of response (SLOR) in patients with Crohn's disease. We hypothesize that high levels of adiposity negatively affect these outcomes and aimed to determine if this relationship exists. Methods: We performed a retrospec...

Background: Vedolizumab (VDZ), a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis (UC) patients. Aim: To assess the efficacy and safety of VDZ in the real-world management of UC in a large multicenter cohort involving two countries and to identify pr...

Background and AimSeveral risk factors affecting post-operative recurrence in Crohn’s disease patients have been studied, and of these, the role of the anastomosis remains contentious. We aimed to compare the risk of developing early post-operative endoscopic recurrence (EPER), in resections that had an end-to-end anastomosis (ETEA) to a side-to-si...

Background A high body mass index (BMI) is known to adversely affect anti-TNFα trough levels and secondary loss of response (SLOR); however, the literature is scarce in defining what aspect of body mass determine these outcomes. We hypothesise that a large visceral fat area is associated with a lower anti-TNFα level and a higher rate of SLOR. Our a...

Background Stricturing Crohn’s disease (CD) is associated with significant morbidity and high rates of surgery with anastomotic strictures commonly occurring after surgery. Endoscopic balloon dilatation (EBD) may avoid or delay operative management of strictures. Methods A retrospective audit of CD patients undergoing EBD was conducted at 11 hospi...

Background: Vedolizumab (VDZ), an α4β7 anti-integrin antibody, is efficacious in the induction and maintenance of remission in ulcerative colitis (UC) and Crohn's disease (CD). In the GEMINI long-term safety study, enrolled patients received 4-weekly VDZ. Upon completion, patients were switched to 8-weekly VDZ in Australia. The clinical success ra...

Background In GEMINI 1, UC response to vedolizumab (VDZ) was 47% at Week 6 and 42% by Week 52. Our aim was to assess real-life outcomes for VDZ in UC. Methods Data collected at 12 Australian (Aus), 1 UK and 2 Hong Kong (HK) centres, assessed response to VDZ at 3, 6, and 12 months using the Mayo Clinic Score (MCS, Aus/HK) or SCCAI and UCEIS (UK)....

Background Early postoperative endoscopic recurrence (EPER)within the first year after a Crohn’s disease (CD) resection can be as high as 90%. Established risk factors include smoking, previous resections, perforating disease, extent of resection and the presence of myenteric plexitis. Equivocal data exist, however, on the impact that the type of s...

Background Up to 5% of inflammatory bowel disease (IBD) patients are thought to have clinically significant liver disease due to multifactorial causes, however, this figure may be an underestimate due to reliance on abnormal liver tests (LTs) and/or liver biopsies. Aims Our aim was to evaluate the prevalence of clinically significant liver disease...

Background: Patients with inflammatory bowel disease who are refractory to standard therapies frequently require surgery. The long-term efficacy of tacrolimus in patients who fail standard immunosuppressive and antitumor necrosis factor α therapy is unknown. Methods: Thirty-five patients (11 Crohn's disease and 24 ulcerative colitis) with medica...

Since first described in the mid 1990s, there has been burgeoning literature on IgG4-related sclerosing disease. The number of sites that may be involved is ever increasing, with the pancreas, salivary glands, and lymph nodes being the most commonly affected organs. There are no well-documented cases arising in the gastrointestinal tract. In this r...

  Hepatic epithelioid haemangioendothelioma (HEH) is a rare, low grade malignant neoplasm of endothelial origin which is difficult to diagnose and has a variable outcome. We review five HEH cases from our centre with the aim of identifying clinical predictors of outcome and various therapeutic options.   A search was made on the WA Liver Transplant...

Acute graft-versus-host disease following orthotopic liver transplantation is a rare but feared complication arising in 1% to 2% of cases with a dismal prognosis. It most often presents as fever, rash, and diarrhea with or without pancytopenia. Patients die from complications of marrow failure such as sepsis or bleeding. Because of its low incidenc...

Sir, Endometriosis is a common condition in women and intestinal involvement occurs in up to 37% of patients. Malignant transformation, however, is rare and is documented in only 1% of cases. Although several case reports and small series have emerged during the past decade, there is still little experience with malignant change in intestinal endom...