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P487. Factors influencing recurrence following suspension of biological treatment. Importance of mucosal healing

V. Ciria, P. Silva, E. Leo, C. Trigo, M.D. De la Cruz, J.M. Herrera, J.L. Márquez, Hospital Virgen del Rocío, Gastroenterology, Sevilla, Spain

Background

Monoclonal anti-TNF antibodies have demonstrated effectiveness in the induction and maintenance of remission of inflammatory bowel disease (IBD); However still is not well established when suspend treatment and its possible consequences.

Objectives: To know the evolution in the long term in our series of patients with IBD after the suspension of biological treatment with check endoscopic mucosal healing (EMH) or achieve clinical remission (CR) and identify possible factors associated with the risk of relapse.

Methods

Retrospective study of 34 patients in treatment with anti-TNF that suspended treatment for prolonged CR - at least 1 year - (n = 8) or proven EMH (n = 26).

Baseline descriptive analyses of demographic and phenotypic characteristics and time evolution of IBD, type of biological, use concomitant immunosuppressants (IS). Also analyzing biological treatment time and the reason for their suspension; as well as endoscopic findings, value of CRP and other inflammatory reactants and levels of calprotectin in time to remove them.

Results

Twenty-four patients had Crohn's disease (CD) with predominance of inflammatory pattern (58%) and ileocolic extension (75%), only 3 with previous surgical procedures. Most were males (74%), with a mean age at diagnosis of 27 years (SD = 13.6). The main indication of antiTNF treatment was the dependence on corticosteroids (59%), mostly with failure to IS, followed by the refractory to corticosteroids (21%). The most widely used biological was Infliximab (79%). After suspend anti-TNF, by EMH (76%) or CR (24%) and after a median follow-up of 20 months (DS=12.9) there is clinical recurrence in 35% of patients.

There were no relationship of the risk of recurrence after the suspension with the factors analyzed, noting only a trend to increased risk of recurrence among patients with Crohn's disease (CD) with inflammatory pattern respect to aggressive patterns (50% vs 10%, P = 0.07), being similar among patients with CD and Ulcerative Colitis (33% vs 40%, P = 0.71) and independent of that check EMH or not (42%, 13%, P = 0.21). In patients where withdrew without checking for EMH, the inflammatory parameters (Hb, leukocytes, CRP, calprotectin) were normal (or only 1 altered) in 7 patients (87%). In those who are confirmed EMH only 2 (12%) presented more than 2 parameters altered and none recurred.

Conclusion

Approximately 35% of patients with IBD in our series who were treated for at least 1 year with anti-TNF suffered a relapse during the first year after the discontinuation of treatment. The presence of EMH predicts a good evolution after the withdrawal, but the negativity of the biological parameters of inflammation, possibly, reflects the presence of mucosal healing without checking, since the risk of relapse is similar.