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P315 Remission induction therapy in patients with remitting-relapsing ulcerative colitis dependent and refractory to corticosteroids or intolerant to thiopurines

A. Yamada*, H. Iwashita, T. Sasaki, M. Katsumata, M. Miyamura, T. Arai, H. Kikuchi, R. Iwasa, R. Furukawa, K. Sono, A. Osamura, K. Nakamura, H. Aoki, Y. Yoshimatsu, Y. Tsuda, K. Takeuchi, N. Takada, Y. Suzuki

Toho University, Sakura Medical Centre, Division of Gastroenterology, Department of Internal Medicine, Sakura, Japan

Background

Ulcerative colitis (UC) is a chronic remitting-relapsing inflammatory bowel disease, requiring remission induction therapy during an active phase. Corticosteroid is often administered to achieve remission of moderate to severe UC, but UC in many patients may become refractory to corticosteroids at a subsequent remission induction therapy. This study was to investigate the success of remission induction therapy in patients with remitting-relapsing UC who were dependent and refractory to corticosteroids or intolerant to thiopurines.

Methods

In a retrospective single centre setting, from January 2008 to September 2014, 103 patients with remitting-relapsing UC dependent and refractory to corticosteroids or intolerant to thiopurines were monitored for the efficacy of remission induction therapy with corticosteroid (n=31), granulocyte/monocyte apheresis (GMA, n=44), tacrolimus (Tcl, n=13), and infliximab (IFX, n=15). Assessment of UC activity level was according to the Mayo clinical activity index (CAI); <3 meant remission, and a decrease of at least 30% in the CAI score meant significant response to therapy.

Results

Induction therapy sessions were 90 times in the steroid group, 75 times in the GMA group, 13 times in the Tcl group and 15 times in the IFX group. The average CAI before treatment was 6.91, 7.14, 8.60 and 8.67, respectively in the 4 groups. Remission induction rates were 8.88%, 22.3%, 15.4%, 0%, respectively in the 4 groups. In the same order, response rates were 33.3%, 60.3%, 30.8%, and 13.3%. The response and the remission induction rates for GMA were higher than for steroid (P=0.00045), Tcl (P=0.045) or IFX (P=0.00081).

Conclusion

In this setting of patients with remitting-relapsing UC and intolerant to thiopuries, the number of patients was not well balanced in the 4 groups for adequate statistical analyses. However, our observational judgment indicated that in this setting, IFX, corticosteroid and Tcl had very low efficacy. In contrast GMA appeared to be very much better than the other three interventions.