P270 Maintenance of remission after prolonged therapy with Infliximab: a "real-life" experience from a single Italian centre in patients affected by Crohn's Disease and Ulcerative Colitis
L. Grossi*, M. Pagliaro, A.M. Di Tullio, R. Tavani, S. Cocciolillo, M. Di Berardino, A. Sepe, A.F. Ciccaglione, L. Marzio
G d'Annunzio University Chieti/Pescara - School of Gastroenterology - Fisiopatologia Digestiva Ospedale Spirito Santo Pescara, Dpt. of Medical Oral and Biotechnological Sciences, Pescara, Italy
The efficacy of anti-TNF alpha Infliximab (IFX) in the treatment of Crohn's Disease (CD) and Ulcerative Colitis (UC) is widely recognized. Guidelines are present worldwide on when and on which patients IFX therapy could be initiated, however less evidences are available regarding the exit strategies and the clinical outcome once stopped the drug. To date it has been claimed that after IFX discontinuation, about 50% of patients with CD show a relapse (Gastroenterology 2012, 142:63-70), but still little has been reported on patients with UC. Aim of this study has been therefore to analyze, in the "real-life" setting of our centre, the remission rate of a group of CD and UC patients undergoing prolonged therapy with Infliximab, during the follow-up after the interruption of the drug.
a prospective study on 37 patients (13 CD, 24 UC) in stable steroid-free remission after receiving scheduled Infliximab for a median time of 49 months (range 21-88) was conducted at the end of anti-TNF treatment. The steroid-free remission and the relapse rate were analysed up to 24 months following discontinuation of the drug.
after discontinuation of Infliximab, 11 out of 13 CD (84.7%) and 19 out of 24 UC (79.2%) were in complete steroid-free remission, identified as a CDAI <150 for CD and Mayo Score < 2 for UC. Two out of 13 CD patients (15.3%) and 5 out of 15 UC patients (20.8%) showed a clinical relapse. There was no statistical difference in the amount of relapse between CD and UC. No surgery was required in these patients. Re-treatment with IFX was scheduled and resulted effective in all the relapsers. Among the risk factors evaluated, history of disease at the beginning of IFX (>3 years) and the ileocolonic location of the disease seemed to play a major role in CD patients; female sex and left-side colitis seemed to represent predictive factors for relapse in UC.
: in our centre about 80% of patients with either UC and CD remained in remission up to 24 months after interruption of prolonged treatment with IFX, a percentage greater than reported in controlled studies. Although a longer follow-up and a larger population in this "real-life" setting is mandatory, in the meanwhile these Results not only confirm the efficacy and safety of Infliximab but also reinforce the hypothesis of a potential effect of the drug on the natural history of both CD and UC.