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P548. Deep remission: a recurrent feature in patients with Crohn's disease and long term biologic therapy

R. Vadan1, L. Gheorghe1, R. Cerban1, B. Cotruta1, L. Tugui1, I. Stanel1, C. Angelescu1, I. Bancila1, M. Diculescu1, C. Gheorghe1, 1Fundeni Clinical Institute, Gastroenterology and Hepatology Center, Bucharest, Romania

Background

The new therapeutic goal in patients with Crohn's disease (CD) is long term mucosal healing, due to its proven association with better outcome (better quality of life, fewer complications, less hospitalization). Not all CD patients treated with biologics achieve deep remission and in those patients that achieve it, it can be shortly lived. The aim of our study was to assess the frequency and durability of deep remission in CD patients on biological treatment in a clinical setting.

Methods

All CD patients treated with biologics in our department were followed prospectively. Demographical data (age, sex), disease characteristics (Montreal classification, time between diagnosis and start of biological therapy, previous surgeries), type of biologic therapy, other treatments, endoscopic findings were noted. All patients had ileocolonoscopy performed at 6–12 months interval. Deep remission was defined when both clinical (CDAI <150) and endoscopic (no ulcers) remissions were achieved.

Results

49 CD patients, mean age 37±13.06 (20–65) years were followed for a median of 38 (12–72) months. Localization of the disease was ileal in 12.24%, ileocolonic in 32.65% and colonic in 55.1% patients, with 26.53% having associated perianal fistulas. Mean time from diagnosis till biologic therapy was started was of 4.83±4.66 (0–18) years. The majority of patients (41) received Infliximab, the rest Adalimumab. Mean treatment time with biologics was 30.57±15.73 (12–72) months. During this time a mean number of 5.36 (2–11) ileocolonoscopies were performed per patient. Deep remission was achieved in 79.6% of cases after a mean of 8.23±7.52 (2–36) months and was sustained in 51.28% of cases. 48.71% of patients lost deep remission after a mean time of 12±6.48 (3–30) months. In 42.10% of cases (8 patients) after 8.25±3.1 months deep remission was induced again: in 5 cases with biologic dose escalation +/− immunosupressor, one with local budesonide treatment and in 2 cases (with clinical remission) spontaneous healing of ulcerations was observed at follow up ileocolonoscopies, without any therapeutic intervention.

Conclusion

In clinical setting deep remission can be achieved in a great proportion of patients after a variable time interval, sometimes over one year of biologic therapy. In patients with flares while on biologic treatment deep remission can be re induced with various therapeutic strategies. Our study showed that transitory, clinically silent, endoscopic relapse is possible during biologic maintenance therapy.