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P495. Efficacy of switching to infliximab in Crohn's disease patients with loss of response to adalimumab

H. Peeters1, E. Louis2, F. Baert3, O. Dewit4, J.-C. Coche5, M. Ferrante6, G. Lambrecht7, A. Colard2, A. Van Gossum8, P. Bossuyt9, T. Moreels10, M. De Vos11, 1Hospital AZ Sint-Lucas, Gastroenterology, Gent, Belgium, 2CHU de Liege, Gastroenterologie, Liege, Belgium, 3AZ Delta Roeselare Menen, Gastroenterology, Roeselare, Belgium, 4UCL St-Luc, Gastroenterology, Brussels, Belgium, 5Clinique Saint-Pierre, Gastroenterology, Ottignies, Belgium, 6University Hospital Gasthuisberg, Gastroenterology, Leuven, Belgium, 7AZ Damiaan, Gastroenterology, Oostende, Belgium, 8Hôpital Erasme ULB, Gastroenterology, Brussels, Belgium, 9Imelda Hospital, Gastroenterology, Bonheiden, Belgium, 10University Hospital Antwerpen (UZA), Gastroenterology, Antwerpen, Belgium, 11Gent University Hospital, Gastroenterology, Gent, Belgium

Background

In case of loss of response to adalimumab (ADA), switching to infliximab (IFX) is routinely done in patients with Crohn's disease (CD). Nevertheless, data on the efficacy of this strategy are scarce.

Methods

A prospective, observational, multicenter study was performed to evaluate the efficacy of IFX after loss of response to ADA in CD. Loss of response to ADA was defined as CDAI ≥220 in combination with CRP ≥5 mg/L or endoscopic or radiological evidence of disease activity and after at least 4 weeks of weekly injections of ADA. The primary efficacy variable was clinical remission at week 10 (CDAI ≤150). Other efficacy variables were clinical response and strong clinical response (respectively 70 and 100 point drop in CDAI) at week 10. Clinical remission and response were also evaluated after 26 and 52 weeks. Therapy adjustments and safety data were recorded. Ethics committee approval was obtained.

Results

22 CD patients were included at 11 BIRD centers (Belgian IBD Research and Development Group). Mean age was 36 years (19–69 y), M/F ratio was 5/17, mean disease duration was 7.3 years (1–33 y) and mean duration of ADA therapy was 24 months (6–60m). In 2 patients no CDAI score was recorded at week 10. At week 10 10/20 patients (50%) were in clinical remission. Clinical response and strong clinical response was seen in respectively 12/20 (60%) and 10/20 (50%) patients. At week 26 the clinical remission rate was 5/16 (31%), clinical response 11/16 (69%) and strong clinical response 6/16 (38%). The mean CDAI dropped from 289 (226–413) at baseline to 172 (0–371) at week 10 and 163 (0–399) at week 26. The mean CRP level dropped from 70 mg/L at baseline to 26 mg/L at week 10 and 29 mg/L at week 26. Ten patients needed IFX therapy optimization (interval shortening), 6 patients needed an intermittent course of steroids. In 2 patients immunomodulator therapy was changed. In none of the patients IFX therapy was cessated during the first 26 weeks. There were no infusion reactions. Data on sustained remission and response at week 52 are still being collected.

Conclusion

Switching from adalimumab to infliximab can be useful in patients with loss of response to adalimumab. Predictive factors of remission and response are currently under investigation.