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P420. Parietal healing in patients with Crohn's disease on maintenance treatment with biologics

A. Rispo1, A. Testa1, M. Rea1, G.D. De Palma2, M. Diaferia1, D. Musto1, F. Sasso1, M. Tramontano1, N. Caporaso1, F. Castiglione1, 1University Federico II Of Naples, Gastroenterology, Naples, Italy, 2University Federico II Of Naples, Surgery and Advanced Technologies, Naples, Italy

Background

In the presence of steroid-dependency and prognostic factors of disabling disease such as perianal fistulising complications and extra-intestinal manifestations, Crohn's disease (CD) is usually treated with thiopurines and anti-TNF alpha agents. Mucosal healing (MH) is a crucial treatment end-point in CD patients, as it is a predictor of lower need for steroids, hospitalization and surgery in the long term. Nevertheless, data on parietal healing (PH) following treatment with traditional immunosuppressors and anti-TNF alpha agents are still lacking. This study aimed to explore the rate of PH in CD patients treated with biologics and immunosuppressors and its correlation with clinical remission (CR) and MH.

Methods

Between April 2008 and June 2012 we performed an observational longitudinal study evaluating PH, CR and MH in all CD patients attending our clinic who would complete 2 years of maintenance treatment with biologics or thiopurines in the course of the study. Steroid-free CR was defined in accordance with ECCO guidelines. MH was assessed using SES-CD, while PH was recorded using bowel sonography (BS). All patients underwent endoscopy and bowel sonography before starting treatment and 2 years later.

Results

The study included 66 CD patients treated with biologics and 67 patients receiving thiopurines. After 2 years of treatment, PH was present in 17 patients on biologics and only 3 patients treated with thiopurines (25% vs 4%; p < 0.01; O.R.=6.2). CR was achieved in 37 patients on biologics and in 34 patients on thiopurines (59.7% vs 53%; p = n.s.) while MH was more frequent in patients treated with anti-TNF alpha agents – even though this difference did not reach statistical significance (38% vs 25%; p = n.s.). The mean SES-CD score and the bowel wall thickness (BWT) measured through BS decreased significantly only in patients treated with biologics (SES-CD 11.1 vs 8.9 +2.7; p = 0.001; BWT at BS 6.0 vs 4.0 +0.9; p < 0.01).

Conclusion

Parietal healing can be achieved in approximately 25% of patients with Crohn's disease treated with anti-TNF alpha agents. Further studies are needed to define the potential role of parietal healing as long-term prognostic factor.