P402. Normalized wall thickness at MRE predicts clinical remission in Crohn's disease after infliximab discontinuation: a 5 years follow-up
M.L. Annunziata1, L.G. Papparella1, I. Sansoni2, P. Balestrieri1, M. Cicala1, 1Campus Bio Medico, Gastroenterology, Rome, Italy, 2Campus Bio Medico, Radiology, Roma, Italy
Mucosal healing (MH) after cessation of anti-TNFalfa therapy has been associated with improved clinical outcomes in Crohn's disease (CD), although it cannot predict healing of the entire intestinal wall. Magnetic Resonance Enterography (MRE) demonstrates to correlate with clinical and endoscopic disease activity in CD. AIM: to investigate the role of MRE in predicting clinical outcome at 5 years following Infliximab (IFX) discontinuation in ileal CD patients.
Clinical data from 90 CD patients treated with IFX from June 2005 were retrospectively analyzed. Out of 90 patients, 16 ileal CD patients, treated with IFX until deep remission and C-reactive protein (CRP) <5 were obtained and who performed both ileo-colonoscopy and MRE examination at the time of anti-TNFalfa discontinuation, entered the study. Cumulative probability to be in clinical remission was estimated using a Kaplan–Meier method. Factors independently associated with clinical relapse (MH, wall thickness at MRE, smoke habits, gender, number of infusions) were analyzed using a Cox proportional hazards model.
All patients were treated for a mean value of infusions of 22 (range 13–36). At the time of IFX discontinuation, 8 (50%) patients had MH at colonoscopy, 6 (37.5%) had normalized wall thickness (NWT) at MRE and 4 (25%) had both MH and NWT. Median follow-up was 37 months (range 11–60). Ten (62.5%) of 16 patients experienced clinical relapse during the 5-year follow-up period. Median time to relapse was 36 and 25 months for patients with and without MH at colonoscopy at the time of IFX discontinuation, respectively (p = 0.8). Of the 10 patients with clinical relapse, four patients had achieved MH but not NWT at MRE and 4 patients with both MH and NWT at MRE were still in remission at 5 years. Univariate analysis showed that patients who relapsed still presented wall thickening at MRE (9 vs. 1, P = 0.015) although the logistic regression did not confirmed this finding. None of the other risk factors was independently associated with clinical remission at 5 years in the multivariate model (P = 0.14). The cumulative probability of relapse-free survival was 0.34, while the probability, in those patients having NWT at MRE, was 0.83 at 60 months.
This is the first study that specifically investigates the role of MRE as a potential tool in predicting clinical relapse after anti-TNFalfa discontinuation. In this retrospective analysis, normalization of WT was able to predict clinical remission after discontinuation of IFX therapy at the 5-year follow-up. Moreover, MH alone, without a concomitant normalization of WT at MRE, seems not to correlate with improved clinical outcomes in the long term.