Qazi Corner, Edition 3: Upadacitinib, Smoking Cessation, FIT Screening, and More

Taha Qazi, MD

It is my pleasure to introduce the third edition of the Qazi Corner. In this edition, we hope to present research of trainees at the Cleveland Clinic along with a recent analysis of the data from randomized, placebo-controlled trial of upadacitinib in Crohn’s disease, highlighted by a review of this pivotal trial from Ravi Shah, MD.

This edition also includes new data on the role of bariatric surgery in pancreatic adenocarcinoma; a meta-analysis on the role of stool-based DNA testing; and the detection of sessile serrated polyps. Lastly, Susha Abushamma, MD, reports of an office-based intervention for counseling on smoking cessation using the electronic health record.

Abushamma, a current advanced inflammatory bowel disease fellow at the Cleveland Clinic, received the American Gastroenterology Association Fellow Abstract Award for her fellow-directed quality improvement project, evaluating the role of an electronic health record (EHR)-assisted tobacco treatment model (ELEVATE) in smoking cessation for our outpatient gastroenterology clinic. Despite most physicians reporting that they discussed smoking cessation at clinic visit, less than half of physicians truly assessed patients’ willingness to quit or provide counseling. A lack of a systematic program was cited as a major barrier, and through the implementation of the ELEVATE module, Abushamma was able to see significant improvement in the proportion of patients receiving smoking cessation training. The program highlights a strategy which can be utilized and build into the electronic medical record to promote smoking cessation in patients.

Fecal immunochemical test (FIT) and FIT-DNA test are stool-based tests that are recommended by all gastroenterology societies and United States Preventative Services Taskforce (USPSTF) for average-risk colorectal cancer (CRC) screening. The proposed goal of stool testing is the utility of a non-invasive, inexpensive strategy to identify early-stage colon cancer, as well as to identify benign precursors to colorectal cancer. Although most colorectal cancers are derived from benign adenomas, sessile serrated polyps represent an alternative pathway for malignant transformation. The ability of FIT and FIT-DNA testing to identify sessile serrated polyps is not established. Rajat Garg, MD, reports his recent systematic review and meta-analysis which was presented at Digestive Disease Week (DDW) 2023 as an oral poster, assessing the role of stool-based testing on sessile serrated polyp detection.

Obesity is a known risk factor for the development of pancreatic ductal adenocarcinoma, the third leading cause of cancer-associated mortality in the United States. Conflicting data current exists on the role of bariatric surgery in reducing the risk of pancreatic ductal adenocarcinoma. Also in this edition, Stephen Firkins, MD, presents his work, which was also selected for an oral poster presentation at DDW 2023, on the potential effects of bariatric surgery in reducing the relative risk of pancreatic adenocarcinoma.

Lastly, Shah returns to review the recent data from the induction trials using upadacitinib, a selective JAK-1 antagonist, and a novel oral therapy for the management of Crohn’s disease. In a pair of phase 3 induction studies as well as a maintenance trial, upadacitinib at a dose of 45 mg for 12 weeks induction, and upadcitinib 30 mg and 15 mg were able to meet the primary endpoint of clinical remission as well as the secondary endpoint of endoscopic response at a higher rate than placebo. The medication offers a new opportunity for the management of Crohn’s disease, especially in patients with refractory disease, using an entirely oral agent.