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P173. Ehealth: Optimization of infliximab treatment and disease course via self-initiated web-based solution in Crohn's disease

N. Pedersen1, M. Ekjaer1, D. Ďuricová2, J. Burisch1, C. Dobrzanski1, N.N. Andersen1, F. Bendtsen3, I. Nordgaard-Larsen3, S. Leotta4, E. Langholz5, P. Munkholm1

1Herlev University Hospital, Copenhagen, Denmark; 2Charles University, Prague, Czech Republic; 3Hvidovre University Hospital, Copenhagen, Denmark; 4Helsingør Hospital, Copenhagen, Denmark; 5Gentofte Hospital, Copenhagen, Denmark

Background: Web-based treatment solutions can optimise 5-Aminosalicilic acid treatment efficacy in patients with ulcerative colitis and in chronic diseases such as asthma and insulin dependent diabetes. Infliximab maintenance therapy for Crohn's disease (CD) is labeled every 8 weeks (Q8), however not taking inter-patient variation or fluctuating disease activity into account.

Aim: To assess the efficacy and safety of a web-based treatment solution (Traffic Light) on the optimisation of infliximab maintenance treatment and disease control in CD patients.

Methods: CD patients in maintenance therapy with infliximab received 2.5 hours disease specific education and web training in the Patient Education Centre. Hereafter the patients were asked to enter disease activity Harvey-Bradshaw index (HBI), results from faecal calprotectin (FC) rapid test into a special developed web program (PM), once a week for a total of 52 weeks. The program automatically calculated the Inflammatory Burden (IB), a composite of subjective HBI and objective FC (CALPRO), and presented the results as a traffic light (green, yellow and red) (fig. 1). If the IB score was ≥6, the program recommended the patient to require infliximab infusion at the day care unit. However, the final decision was made by a consultant. The minimum allowed interval between treatments was Q4, while the maximum recommended interval was Q12.

Results: Twenty-seven consecutive CD patients (17 females), median age 38 years (range: 19–62) were included. Thirteen (48%) patients completed 52 weeks of follow-up, while 4 patients are still in treatment. Ten (37%) patients stopped prematurely due to loss of response (3), stable remission (5), pregnancy (1) and non-compliance (1). In total 123 infliximab infusions were given with a median interval of 9 weeks (Q9) (range: 4–18). Only 12 (10%) infusions were given at Q8 interval, 48 (39%) <Q8, while 73 (51%) >Q8. Regarding mean week interval of infliximab infusions per patient: 15 (56%) had more than 8 weeks interval, 5 (18%) had less than 8 weeks and only 7 (26%) had 8 weeks mean interval. Thirteen (48%) patients received concomitant immunosuppressive therapy with azathioprine/6-mercaptopurine (n = 10) and methotrexate (n = 3). One mild infusion reaction and 3 infections (folliculitis, influenza and C. difficile) were observed. Four patients underwent surgery: 2 bowel resections and 2 perianal surgeries (1 fistula, 1 abscess).

Conclusion: The web-based treatment program is a feasible concept for infliximab maintenance treatment in CD patients. By using the program, the infliximab treatment was individualized and optimized. By adjusting infusions to disease activity rather than following a constant interval costs may be reduced.

Figure 1. Traffic light, the Munkholm Inflammatory Burden (IB) Web score.