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P215. Biologic therapy versus conventional therapies in a series of Crohn's disease patients: A pair-matched study

V. Criscuoli, F. Mocciaro, A. Orlando, L. Oliva, G. Rizzuto, M. Cottone

DiBiMis, Division of Internal Medicine “Villa Sofia-V. Cervello” Hospital, Palermo University, Palermo, Italy

Aims: The clinical course of Crohn's disease (CD) changes over time, from ever-relapsing cases to a quiescent course with remission for several years. Widespread use of immunosuppressant drugs and the advent of biological treatment has had a significant impact in the management and clinical course of CD, leading to an improved quality of life, fewer clinical recurrence and reduction of corticosteroid use.

Materials and Methods: The aim of this matched pair study is to assess the long term clinical efficacy and safety of infliximab therapy compared to conventional immunosuppressive treatment. A cohort of CD patients, including infliximab-treated (CD-IFX) and immunosuppressant-treated CD controls (CD-C) studied from 1999 to 2008, was followed-up, in our tertiary referral centre, in order to evaluate: overall clinical benefit, clinical recurrence, disease complications (strictures, new fistulas, abscesses/severe infections), needing for surgery, neoplasia development, and mortality. Cases and controls were matched for: sex, age, CD duration, and follow-up. The indication for Infliximab and immunosuppressive treatment was moderate to severe CD refractory/steroid dependent luminal not fistulising disease. The patients in the case group were intolerant or never treated with immunosuppressant.

Results: We considered a total of 184 CD patients: 69 CD-IFX and 115 CD-C. The number of patients with colonic involvement was higher in CD-IFX group than in CD controls (p = 0.01). At the end of the follow-up (median 74.6 months, range 12–300) the overall clinical benefit was similar in both groups (CD-IFX 82.6% vs CD-C 89.5%, p = ns). Clinical recurrence (at least 1 per year) was higher in CD-IFX (69.5%) than control group (46.1%) [OR 2.67, p = 0.002; 95% CI 1.42–5.02] however with a shorter mean time of maintenance treatment in the first group than controls (14 vs 39 months, p < 0.001). Twenty-one (CD-IFX) vs 37 (CD-C) patients experienced a disease complication (p = ns). Rate of surgery was similar among the 2 groups (23.1% vs 21.7%, p = ns). Not difference concerning neoplasia development and mortality rate were observed (p = ns).

Conclusion: Our results show no differences between infliximab and immunosuppressant-control group concerning clinical benefit, disease complications, needing for surgery, neoplasia development, and mortality. Patients treated with infliximab experienced more clinical recurrence than controls likely due to a shorter period of treatment than immunosuppressant control group.