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P197. Predictors of clinical remission in ulcerative colitis patients treated with anti‑TNF: Results from a prospective study

A. Oussalah1, I. Aimone-Gastin2, S. Salignac3, C. Gurgul2, M.‑A. Bigard1, J.‑L. Guéant2, L. Peyrin-Biroulet1

1Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France; 2Inserm U954, Cellular and Molecular Pathology in Nutrition, Henri Poincaré University Nancy 1, and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France; 3Department of Haematobiology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France

Background: Achieving clinical remission is a major therapeutic goal in ulcerative colitis (UC). No studies have prospectively evaluated the biological predictors of clinical remission in UC patients treated with anti-TNF.

Methods: All consecutive UC patients from the Nancy IBD cohort and treated with anti‑TNF (infliximab or adalimumab) were included in the study. Each patient underwent complete blood count and biochemical blood tests including C‑reactive protein, albumin, and iron status markers (serum iron, ferritin, transferrin, and transferrin saturation coefficient). All data were collected prospectively in an electronic database and extracted for the purposes of the study using the GLIMS software. Disease activity was prospectively collected using the simple clinical colitis activity index (SCCAI). Clinical remission was defined as a SCCAI ≤2 [1]. In univariate analysis, the diagnostic performance of each biological marker was evaluated by receiver operating characteristic (ROC) analysis. Multivariate analysis was carried out using logistic regression (stepwise method). Before conducting regression analysis, colinearity testing was performed.

Results: Between January 11th 2011 and June 9th 2011, 169 UC-related hospitalizations were recorded. In multivariate logistic regression analysis, five biological variables were independently associated with clinical remission: CRP ≤1.5 mg/L (OR = 8.00, P = 0.0022), albumin >39.2 g/L (OR = 7.23, P = 0.0030), Ferritin >23.3 mg/L (OR = 10.64, P < 0.0001), plate­lets ≤302 G/L (OR = 50.24, P < 0.0001), and haemoglobin >12.9 g/dL (OR = 33.52, P < 0.0001). The multivariate model encompassing “platelets ≤302 G/L OR albumin >39.2 g/L” had the best performance for predicting clinical remission with a percentage of 89% of cases correctly classified and an area under the ROC curve 0.912 (95% CI, 0.843 to 0.958).

Conclusions: In UC patients treated with anti-TNF, the biological model combining “platelets ≤302 G/L OR albumin >39.2 g/L” reliably predicts clinical remission.

1. Higgins PD, Schwartz M, Mapili J, Krokos I, Leung J, Zimmermann EM (2005), Patient defined dichotomous end points for remission and clinical improvement in ulcerative colitis. Gut, 782–8.