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P464. Infliximab optimisation in ulcerative colitis: Intensificated and deintensificated patients clinical outcome

L. Fernández-Salazar1, J. Barrio2, J. Legido3, C. Muñoz4, G. González1, R. S-Ocaña2, F. Santos2, B. Velayos1, J.M. González1, 1Hospital Clínico Universitario, Gastroenterology, Valladolid. ACAD, Spain, 2Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain, 3Complejo Asistencial de Segovia, Gastroenterology, Segovia. ACAD, Spain, 4Hospital Virgen de la Salud, Gastroenterology, Toledo. ACAD, Spain

Background

An optimization of infliximab therapy for ulcerative colitis (UC) is often necessary to mantain response but safety and costs must also be considered. We want to evaluate the efficacy of intensification and the possibility of deintensification in UC patients treated with IFX.

Methods

We have reviewed the clinical outcome of UC patients with any intensification of IFX scheduled treatment (5 mg/kg q 8weeks) from four Spanish hospitals since 2003 to 2013.

Results

31 UC patients, 42% female, 35 (15–75) years old, E1 6%, E2 39%, E3 55%, received IFX because steroid resistance in 13%, intolerance/resistance to steroids or immunosuppressant agents in 61%, steroid dependence in 22% and pouchitis in 3%. 71% (22) also received thiopurines: 17 since more than 6 months before IFX induction, 3 since less than 6 months before induction, 2 after IFX induction. Thiopurine doses were 2.5 or 1.5 mg/kg (azathioprine or mercaptopurine) in 19 patients. 71% (22) patients received steroids during IFX induction. In 3 patients induction dose was increased to 10 mg/kg in the third infusion. Immunosuppressant agents were stopped in 5 patients 8 (3–15) months after IFX induction but were reinitiated later in one patient. Doubled dose (10 mg/kg) was used in 12 patients after 4 (0–11) months from induction, and 28 patients had a shortener dose interval (to 6 weeks) after 5 (0–30) months from induction. Both strategies were used in 9 patients. 12 patients had their IFX treatment deintensificated later, 5 received 5 mg/kg after 4 (2–13) months since intensification, 10 had their dose interval enlarged to 8 weeks after 13 (6–31) months since intensification, and 3 had both. Steroids were mantained or reintroduced in 35% (11/31) patients. IFX was stopped because loss of response in 8 patients and because adverse events in 3 (2 severe infections and 1 infusion reation). Rescue treatments used were steroids in 4 patients, adalimumab and colectomy in 3 each and leukocyto-apheresis in 2. Colectomy was finally needed in 19% (6) patients. 75% (9/12) of deintensificated patients receive scheduled IFX (5 mg/kg q 8weeks) after 8 (3–49) months since deintensification: 6 of them IFX+azathioprine, 1 IFX+azathioprine+steroids, 1 IFX+micofenolato and 1 IFX alone. 25% (3/12) of deintensificated patients were reintensificated later, one was finally switched to adalimumab, another one interrupted IFX because a pregnancy and went to leukocytoapheresis, and the third one was also treated with leukocyto-apheresis and had IFX stopped because of long remission.

Conclusion

Optimization of IFX treatment in UC is often needed in clinical practice even with a proper use of thipourines. Deintensification is often possible and seems to be safe as it does not increase the risk of a loss of response to IFX.