P341 Endoscopy Assessment at 1-year Identifies Long-term Responders to Thiopurines Maintenance Therapy in Patients with Crohn's Disease
Y. Qiu, R. Mao, B.-l. Chen, Y. He, Z.-r. Zeng, M.-h. Chen*
First Affiliated Hospital of Sun Yat-Sen University, Department of Gastroenterology, Guangzhou, China
When treating Crohn's disease (CD) with thiopurines, achievement of an objective response is essential. We aimed to determine the endoscopic responses of thiopurines monotherapy and to determine the minimal degree of mucosal improvement to alter outcomes of CD.
One-hundred and thirty CD patients with mucosal ulceration at baseline were included. The endpoints were endoscopic responses at two follow- endoscopies performed at 12 months (M12) and 36 month (M36) from the initiation of thiopurines.
At M12, mucosal healing (MH) and a positive response (PR) were documented in 38% and 46% of patients, respectively. At the second follow-, merely a further 14% (9/65) of patients on monotherapy had a PR and a total of 46% (30/65) presented with MH. In a logistic regression model, both a PR (P < 0.02) and MH (P < 0.001) at M12 were associated with response at M36 in patients continuing thiopurines treatment. MH at M12 was associated with outcomes of CD at M36, with an area under the Receiver Operator Characteristic curve of 0.54 for predicting clinical remission, 0.69 for hsCRP normalization, 0.69 for MH, and 0.74 for PR, respectively. A PR at M12, defined a decrease in endoscopic activity score by ≥*** 2 points from baseline, yielded similar Results.
Endoscopy at M12 can help to identify long-term responders to thiopurines monotherapy in active CD. A PR could represent the minimal clinically important improvement in endoscopic disease activity.