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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

9/ Bottom line

IUS finds subclinical inflammation, drives earlier treatment, reduces invasive tests & emissions.

📄 Full study: doi.org/10.1080/0036...

@yiyuantan.bsky.social @justinleongwh.bsky.social @tandfresearch.bsky.social

https://doi.org/10.1080/00365521.2025.2533338

t.co

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

8/ Limitations

Operator dependent
Limited for proximal small bowel / extramural complications
But as an alternative to endoscopy/MRE, it’s a game changer

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

7/ Cost & planet wins 🌱

💰 USD $92,069 saved
🌍 2,752 kg CO₂e cut (≈ driving 14,000 km less)
IUS isn’t just good medicine – it’s good climate action

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

6/ Impact on care

27% → treatment escalation
Discordant IUS findings → higher escalation (p=0.017)
60% avoided colonoscopy or MRE after IUS
That’s big for patients and endoscopy waitlists

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

5/ Our findings 😲

63% in clinical remission…
But only 32% in transmural remission on IUS
➡️ Almost HALF of “well” patients still had active disease

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

4/ Our prospective study

48 patients, 60 IUS assessments:
- CD: 57%
- UC: 43%
Compared clinical, biochemical & IUS findings
Tracked changes in management + avoided procedures (MRE/Colonoscopy)

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

3/ Why this matters:

Colonoscopy & MRE are gold standards but…
❌ Costly
❌ Long wait times
❌ Sedation/bowel prep
❌ CO₂e emissions up to 55 kg/procedure

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

2/ What is IUS?

No prep 🛑
No radiation ☢️
Point-of-care, takes minutes ⏱️
Sees transmural inflammation, not just mucosa
Minimal carbon footprint ♻️

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Malcolm Tan @ibdgastrodocsg.bsky.social · Aug 10

How intestinal ultrasound (IUS) changes IBD care – clinical impact, cost savings & greener healthcare

1/ #IBD is rising fast in SE Asia 📈
We need tools that are accurate, patient-friendly, and sustainable.
Our SGH pilot study shows #IntestinalUltrasound ticks all 3 boxes ✅

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

For gastroenterologists and IBD clinicians, TL1A blockade may represent the next chapter in mechanism-based IBD treatment.

@lancetgastrohep.bsky.social @robbrierley.bsky.social
#GISky #IBDSky #MedSky

Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

Takeaway:

Tulisokibart appears safe and potentially efficacious in CD patients with high prior biologic exposure.
Early signals of both anti-inflammatory and anti-fibrotic activity suggest a dual mechanism worth watching.

A phase 3 trial is underway. 🧪

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

Biomarker & histology insights:

- ↓ hsCRP & fecal calprotectin by Week 6
- ↓ Th1, Th17 cytokines (IL-17A, IL-22, IL-9)
- ↓ fibrotic gene expression (e.g., COL1A1, MMP3)
- Histologic remission (RHI <3) in 18%

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

Safety:

- AEs: 78% (mostly mild-moderate)
- SAEs: 15% (none drug-related)
- No deaths, no infusion reactions
- Most common AE: infection (45%), incl. COVID-19 (11%)

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

Primary efficacy results (Week 12):

- Endoscopic response (≥50% ↓ in SES-CD): 26.0%
vs historical placebo 12% (p=0.0023)
- Clinical remission (CDAI <150): 49.1%
vs historical placebo 16% (p<0.0001)

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

Trial design (N=55):

- Multicentre, open-label
- Moderate-to-severe CD
- IV tulisokibart: 1000 mg (Day 1), 500 mg (Weeks 2, 6, 10)
- Endoscopic response at Week 12 = primary endpoint
71% had prior biologic exposure; 35% had ≥3 agents

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

Why TL1A?

TL1A (TNFSF15) is a key driver of Th1/Th17-mediated inflammation and intestinal fibrosis—two critical components of CD pathogenesis.
Tulisokibart blocks TL1A from binding to its receptor DR3, dampening both inflammation and fibrotic signaling.

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 27

APOLLO-CD

A phase 2a induction trial of tulisokibart, an anti-TL1A monoclonal antibody, shows promising efficacy & safety in patients with moderate-to-severe Crohn’s disease (CD) refractory to prior therapies.

Key findings from the APOLLO-CD study:
[🔗https://doi.org/10.1016/S2468-1253(25)00071-8]

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 21

2025 guidelines for IBD from @amcollegegastro.bsky.social

Crohn's: journals.lww.com/ajg/fulltext...

UC: journals.lww.com/ajg/fulltext...

#IBDSky #MedSky #GISky

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 2

9/ Collaborate.
Oncologists + gastroenterologists should jointly manage ICI-colitis.
Steroid-sparing strategies are essential to keep patients on life-saving immunotherapy.

#GISky #OncoSky #MedSky

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 2

8/ Clinical takeaways for MDTs:

Don’t delay colonoscopy: endoscopic/histologic phenotyping matters.

- Consider early biologics for IBD-like or steroid-refractory cases.
- Faecal calprotectin is your friend.

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 2

7/ Poor prognosis:

- CD-like pattern → worse outcomes (HR 3.84)
- Microscopic colitis → better prognosis
- Total 12-mo mortality: 32%
-- Only 4 deaths were colitis-related
-- Majority due to cancer progression

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 2

6/ 12-month remission rate:

- Any clinical remission: 37%
- Steroid-free remission: only 16%
- 66% were still on therapy at 12 months.
🛑 ICI was stopped in 80% due to colitis — but discontinuation did NOT impact remission (P=0.48).

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 2

5/ Treatment snapshot:

- 1st-line: Systemic steroids (68%), oral budesonide, anti-diarrhoeals
- 2nd-line: Infliximab, vedolizumab
- Biologics were underused, colectomy was rare but real (1%).

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Malcolm Tan @ibdgastrodocsg.bsky.social · Jun 2

4/ Faecal calprotectin was significantly elevated in nearly all cases (median ~765 μg/g).
CRP? Mildly elevated.
➡️ Don’t underestimate colitis just because systemic markers look ‘okay’.

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