{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T06:28:18Z","timestamp":1782887298983,"version":"3.54.5"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100011684","name":"Crohn\u2019s and Colitis Foundation","doi-asserted-by":"crossref","award":["#1298119"],"award-info":[{"award-number":["#1298119"]}],"id":[{"id":"10.13039\/100011684","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"NIDDK","doi-asserted-by":"publisher","award":["R01DK13593701A1"],"award-info":[{"award-number":["R01DK13593701A1"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Despite regulatory mandates for advanced therapy (AT) washout periods of up to 5 drug half-lives before enrolling patients in inflammatory bowel disease (IBD) trials, the evidence base for these requirements is largely empirical, and whether shorter intervals independently increase the risk of serious infections in real-world practice remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the OptumLabs Data Warehouse, we identified adult patients with IBD who initiated a new AT (tumor necrosis factor antagonists, vedolizumab, interleukin (IL)-12\/23 or IL-23 antagonists, or Janus kinase inhibitors) between 2018 and 2023 using a class-specific new-user design. We examined whether exposure to AT within the preceding 12 months (vs no exposure to AT within that window) and timing of discontinuation (\u22641 month, 1-&amp;lt;3 months, or 3-12 months) were associated with risk of serious infections using multivariable Cox proportional hazards regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 21\u2009564 AT initiators (47\u2009\u00b1\u200918 years; 52% female; 57% Crohn\u2019s disease), 7490 (34.7%) had AT exposure within the preceding 12 months. Over a mean follow-up of 1.6\u2009\u00b1\u20090.9 y, 1955 (9.1%) experienced a serious infection. Prior AT exposure was associated with higher infection risk (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.07-1.33), consistent in inverse probability of treatment-weighted analyses (HR, 1.20 [1.06-1.37]). Among patients with prior exposure, timing of discontinuation was not associated with infection risk (HR, 1.17 [0.95-1.43] for \u22641 month vs 3-12 months; HR, 1.01 [0.83-1.22] for 1-&amp;lt;3 months), with no dose\u2013response relationship on continuous modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>AT exposure within the preceding 12 months is associated with modestly higher risk of serious infection after initiating a new AT in IBD, but timing of discontinuation does not independently influence this risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjag095","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:32:02Z","timestamp":1781613122000},"source":"Crossref","is-referenced-by-count":0,"title":["Prior exposure to advanced therapy and timing of discontinuation and risk of serious infections in patients with inflammatory bowel disease initiating a new advanced therapy"],"prefix":"10.1093","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2935-6778","authenticated-orcid":false,"given":"Virginia","family":"Solitano","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, Universit\u00e0 Vita-Salute San Raffaele , Milan,","place":["Italy"]},{"name":"Department of Epidemiology and Biostatistics, Western University , London, Ontario,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4502-5717","authenticated-orcid":false,"given":"Dhruv","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Hospital , New Delhi,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchen","family":"Qi","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego , La Jolla, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar B","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, University of California San Diego , La Jolla, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5158-2321","authenticated-orcid":false,"given":"Marianne","family":"Hup\u00e9","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Western University , London, Ontario,","place":["Canada"]},{"name":"Universite\u2019 Grenoble Alpes\/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes\/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209 , Grenoble,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudheer K","family":"Vuyyuru","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Western University , London, Ontario,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L","family":"Silverman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Arizona , Scottsdale, AZ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronghui","family":"Xu","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego , La Jolla, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane W","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Western University , London, Ontario,","place":["Canada"]},{"name":"London Health Sciences Centre Research Institute , London, Ontario,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Ol\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet , Stockholm,","place":["Sweden"]},{"name":"Department of Pediatric Gastroenterology and Nutrition, Sachs\u2019 Children and Youth Hospital , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwin N","family":"Ananthakrishnan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-0033","authenticated-orcid":false,"given":"Vipul","family":"Jairath","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Western University , London, Ontario,","place":["Canada"]},{"name":"Division of Gastroenterology, Western University , London, Ontario,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddharth","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Arizona , Scottsdale, AZ,","place":["United 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