P376 Mucosal healing in IBD: Therapy maintenance or de-escalation therapeutic approach in patients achieving mucosal healing
G. Costantino*1, L. Amato1, A. Sitibondo1, A. Alibrandi2, W. Fries1
1University, Dept. of Clinical and Experimental Medicine, Messina, Italy, 2University, Dept. of Economical, Financial, Social, Environmental, Statistical and Territorial Sciences, Messina, Italy
Mucosal Healing (MH) has become an important therapeutic goal in Crohn’s Disease (CD) and Ulcerative Colitis (UC), but only few data concerning therapeutic management of patients after achievement of MH are available.
Aim: to evaluate differences in clinical relapse after achieving MH in patients who continued therapy with immunosuppressors (IMM) such as Thiopurines-Methotrexate and/or biologics (BIO) administered before achieving this goal and in patients who stopped/reduced therapy with IMM/BIO (de-escalation therapy). Moreover, we analyzed for potential predictive biomarkers of clinical relapse.
80 pts with inflammatory bowel diseases (IBD) with endoscopically confirmed MH were retrospectively analyzed (49 UC and 31 CD; 40 male). We assessed therapies before and after MH, smoking status and the following blood tests at baseline and at 6, 12 and 18 months: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Hemoglobin (Hb), white blood cells (WBC) and neutrophil count (NBC). Data are mean values ± SD. Analysis was performed with the Wilcoxon test and logistic regression.
mean age was 42.3 ± 15.8 yrs. Median follow-up time was 29 months (range 3-120). The Results showed that neither de-escalation therapy (p=n.s.) nor smoking status (p=n.s.) influenced clinical relapse (26,6 ± 19.5 months) in the whole cohort. We found same Results in both subgroups, UC and CD. Significant variations of the examined variables were registered for CRP (p=.019) and ESR (p=.001) from baseline to month 18 in CD patients. In UC patients ESR (p= .013), WBC (p= .039), NBC (p= .048) but not CRP (p=n.s.) variations from baseline to month 18 were significant as clinical relapse predictors.
In patients achieving MH de-escalation of immunosuppressant/biologic therapy does not influence time to clinical relapse in patients with IBD. But this approach may reduce potential side effects and is cost-effective.