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P604. Adalimumab for the treatment of post-operative recurrence of Crohn's disease. A single centre experience

C. Praticò1, F. Rizzello1, A. Calafiore1, C. Calabrese1, G. Poggioli2, S. Laureti2, M. Campieri1, P. Gionchetti1, 1Bologna, Clinical Medicine, Bologna, Italy, 2Bologna, General Surgery, Bologna, Italy

Background

Crohn's disease commonly recurs after intestinal resection. Growing evidences suggest that infliximab and adalimumab are effective to prevent post operative Crohn's recurrence. We investigated the efficacy of adalimumab for inducing mucosal healing in patients with endoscopic recurrence of Crohn's disease after intestinal resection.

Methods

Twenty-four patients who had endoscopic early severe relapse (evaluated 12 months after an ileo-cecal or ileo-colic anastomotic “curative” resection) were treated with adalimumab. Severe endoscopic relapse was defined as a grade greater than i2 in the Rutgeerts post-operative score or as a presence of deep colonic mucosal lesions. Adalimumab treatment was started with induction regimen 160/80 mg and followed by maintenance regimen with 40 mg every other week. Mucosal healing was evaluated after 1 year of treatment and defined as i0, while improvement as 1-point reduction in the Rutgeerts score. Colonic mucosal lesions were classified as deep or superficial; mucosal healing was defined as absence of any mucosal lesions and improvement as reduction of the ulcers severity (from deep to superficial).

Results

Out of 24 patients with post-operative endoscopic recurrence [M/F: 10/14; mean age 35.7 years (16–58); median disease duration 11 years (2–21); disease location before surgery: 7 ileal, 15 ileo-colonic, 2 colonic; numbers of surgeries: 19 had 1 surgery, 3 had 2 surgeries, 2 had 3 surgeries] 19 had an ileal recurrence (median Rutgeerts Score 3; range 2–4) while 5 a colonic one. At week 52, in the subgroup of patients with ileal recurrence, mucosal healing was observed in 9 patients (47.4%), 3 patients (15.8%) had endoscopic improvement, 7 patients (36.8%) didn't have endoscopic improvement. Among the 5 patients with colonic recurrence, 3 (60%) achieved mucosal healing, 1 (20%) improved endoscopically and 1 (20%) didn't respond endoscopically. At the end of the study, 12 patients were in remission (Harvey Bradshaw Index [HBI] lower than 4), 7 patients had mild activity (mean HBI: 6) and 5 patients had a moderate-severe clinical relapse.

Conclusion

Adalimumab seems to be effective to induce mucosal healing in post operative endoscopic relapse. However one third of patients did not have any improvement. This may suggest that an early treatment with adalimumab could improve its efficacy.