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P321. The one-year efficacy of infliximab does not depend on the timing of biological therapy in ulcerative colitis

T. Molnar1, A. Bálint1, T. Nyári2, K. Farkas1, R. Bor1, Z. Szepes1, F. Nagy1, P. Miheller3, Á. Csontos3, G. Horváth4, P.L. Lakatos5, P.A. Golovics5, K. Palatka6, T. Wittmann1, 1University of Szeged, First Department of Medicine, Szeged, Hungary, 2University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary, 3Semmelweis University, 2nd Department of Medicine, Budapest, Hungary, 4Semmelweis Health Center, Department of Gastroenterology, Miskolc, Hungary, 5Semmelweis University, First Department of Medicine, Budapest, Hungary, 6University of Debrecen, 2nd Department of Medicine, Debrecen, Hungary

Background

Infliximab is an effective therapeutic option in patients with refractory ulcerative colitis (UC). The optimal timing of infliximab therapy is still one the outstanding questions in the therapy of UC. The aim of our study was to assess whether there is an association between the one-year remission rates and the elapsed time between the diagnosis and the start of infliximab therapy.

Methods

116 UC patients treated with infliximab were enrolled in this prospective study. Every patient achieved response to the induction therapy at least [male/female: 64/52; mean age: 43 years (in range: 18–77 years)]. Clinical remission was defined as less than or equal to 2 points in partial Mayo (pMayo) score; response to infliximab was specified as decreasing 3 or more points. Mucosal healing was defined as endoscopic Mayo subscore of 0–1 points. Deep remission was determined as pMayo of 0–1 points and endoscopic Mayo subscore of 0 points at week 52. The time elapsed between the diagnosis and the first biological therapy was assessed in every patient, who was then categorized to groups according to the elapsed time (0–2 years, 2–5 years, 5–10 years etc). Data were collected from five Hungarian IBD centres.

Results

The mean elapsed time between the diagnosis and the start of biological therapy was 7 years. 50.4% of patients started infliximab therapy within 5 years after diagnosis. After induction with infliximab 65.6% of the enrolled patients achieved remission and 34.4% achieved response. After one-year treatment period, the remission and response rates remained 67.7% and 21.8%. 10.6% of patients showed loss of efficacy at one year infliximab therapy. 74.6% of subjects achieved clinical remission at week 14 and remained in remission at week 52. Complete mucosal healing was detected in 31.2% and deep remission in 13.9% of the patients at week 52. Response rates to infliximab therapy at one year were significantly lower compared to rates at week 14 (p = 0.029). The rate of response, remission and loss of efficacy did not depend on the elapsed time between the diagnosis and the start of biological therapy.

Conclusion

Our results did not reveal an association between the remission rates and the elapsed time between the diagnosis and the first biological therapy in UC.