P423 Evaluation and long-term benefit of mucosal healing in Crohn's disease patients treated with infliximab
L. Libier*1, M. Collins2, D. Koriche3, M. Nachury1, C. Gower-Rousseau4, P. Zerbib3, A. Cortot5, J.-F. Colombel6, P. Desreumaux1, G. Pineton de Chambrun7
1CHU de Lille, Department of Gastroenterology, Lille, France, 2APHP Paris Sud University , Gastroenterology, Le Kremlin Bicêtre, France, 3Lille University Hospital, Colorectal Surgery Department , Lille, France, 4Lille University Hospital, North of France University, Epidemiology, Lille, France, 5Lille University Hospital, North of France University, Gastroenterology, Lille, France, 6Mount Sinai Hospital, Gastroenterology, New-York, United States, 7Montpellier 1 University, Gastroenterology and Hepatology, Montpellier, France
For decades, the main therapeutic goal in Crohn's disease (CD) was clinical remission. Since the introduction of infliximab (IFX), mucosal healing (MH) was suggested as a new therapeutic goal in CD patients, but its long-term benefit on the natural history of CD is still debated. The aim of this study was to assess MH and to evaluate its effect on disease long-term outcome in CD patients treated with IFX.
In a single center observational retrospective study, we evaluated consecutive CD patients receiving IFX as maintenance therapy between 2007 and 2010 and presenting objective signs of intestinal inflammation before therapy. MH was evaluated on the report of the first endoscopy performed after IFX introduction and was defined as the absence of any ulceration. Clinical remission, defined by the referring physician assessment, was evaluated 3 to 6 months after IFX introduction. Hospitalizations, major abdominal surgeries and treatment modifications during the follow-up after IFX introduction were collected.
In our center, 153 CD patients received IFX between 2007 and 2010 with a median time between diagnosis and IFX introduction of 62 months (Q1-Q3: 18-152). The mean follow-up duration after IFX introduction was 42 ± 22 months. Seventy-four patients (48%) had a colonoscopy to evaluate MH within a mean delay of 26 ± 17 months after IFX introduction. In these patients, the rate of MH was 50%(37/74). Demographic and clinical characteristics before IFX introduction were similar between CD patients with or without MH. Clinical remission rates at 3 to 6 months after IFX introduction were also similar between patients with and without MH (59% vs. 57%, p=ns). Looking for long-term CD outcomes, patients with MH had fewer hospitalizations (13% vs. 38%, Log-rank p=0.002), fewer major abdominal surgeries (3% vs. 27%, Log-rank p=0.002) than patients without MH. Patients with MH had also fewer therapeutic modifications (24% vs. 51%, Log-rank p=0.027), fewer discontinuation of IFX for inefficacy or intolerance (11% vs. 43%, Log-rank p=0.008) and fewer switch for another anti-TNF agent (3% vs. 22%, Log-rank 0.013) compared to patients without MH. In multivariate analysis, absence of MH was associated to the risk of hospitalization (RR= 3.6; IC 1.2-11.2) and major abdominal surgery (RR=8.0; IC 95%: 1.5-43.5) for patients with CD during follow up.
In our cohort, MH was achieved in half of CD patients treated with IFX as maintenance therapy and was associated with less hospitalization, surgery, treatment modification and discontinuation of IFX. Results of this study suggested that MH should be considered as an important therapeutic goal for CD patients treated with IFX.