P305. Predictive factors of one-year mucosal healing in a cohort of ulcerative colitis patients in treatment with infliximab
G. Andrisani1, A. Armuzzi2, C. Felice3, M. Marzo4, G. Mocci5, D. Pugliese6, I. De Vitis3, L. Guidi7, G.L. Rapaccini8, A. Papa6
1Catholic University of Rome, Internal Medicine Department/Gastroenterology Division, Rome, Italy; 2Complesso Integrato Columbus, Gastroenterology Unit, Rome, Italy; 3Università Cattolica Del Sacro Cuore, Complesso integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy; 4Complesso Integrato Columbus, Medicina Interna e Gastroenterologia, Rome, Italy; 5Catholic University of Rome, Internal Medicine Gastroenterology, Rome, Italy; 6Catholic University of Rome, Internal Medicine and Gastroenterology Complesso Integrato Columbus, Rome, Italy; 7Università Cattolica Del Sacro Cuore, O.U. Gastroenterology Columbus, Rome, Italy; 8Catholic University of Rome, Complesso Integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy
Background: Recent studies have shown that in patients with ulcerative colitis (UC) the mucosal healing (MH) is a reliable marker of response to biological therapy with important prognostic implications, including long-term remission and colectomy-rate. However, the factors that determine the achievement of the MH in UC patients treated with the anti-TNF‑α agent infliximab (IFX) are poorly defined. The aim of this study was to assess in a cohort of consecutive patients with UC treated with IFX the factors associated with the achievement of MH after one-year of therapy.
Methods: All consecutive patients with UC treated for one-year with scheduled infusions of IFX and who underwent colonoscopy before starting therapy and after one year (±3 months) were enrolled in the study. To assess the endoscopic activity of disease was used the Mayo score. MH was defined as a Mayo score of 0 or 1. Clinical features of each patients and the concomitant therapies assumed by the patients were recorded at baseline and after one-year. Changes in the dosage of the drugs (or the reduction in the interval time between two consecutive infusions of IFX) or the introduction of immunosuppressors during the study period were also recorded.
Results: Thirty-five patients were included in the study overall (mean age 43.9±15.2 years, 22 females (62.8%). Twenty patients (57%) were treated with IFX for steroid-dependence, 10 (28.5%) for refractoriness to steroids, 5 for extra-intestinal manifestations. Nineteen patients (54%) reached MH at one-year. At univariate analysis discontinuation of steroids (p = 0.02), the concomitant use of immunosuppressors (p = 0.05) and CRP-levels ≥5 mg/L (p = 0.05) at baseline were associated with MH. At multivariate analysis only steroids discontinuation (p = 0.05) was significantly associated with MH at one-year.
Conclusions: The results of the present study show that in a population of UC patients the discontinuation of steroids is significantly associated with MH after one year of treatment with IFX. However, confirmation of this outcome needs more studies on large populations of patients with UC in treatment with IFX.