P455 Need and predictors of colectomy for Ulcerative Colitis patients in the biologic therapy era. A real life experience in a tertiary referral center
N. Viazis*, J. Anastasiou, M. Giakoumis, M. Chanias, X. Tzannetakou, I. Internos, A. Tsigaridas, E. Anastasopoulos, D. Karamanolis
Evangelismos Hospital, Gastroenterology Department, Athens, Greece
Since its introduction on 2005, anti-TNF therapy has been increasingly used in patients with moderate or severe ulcerative colitis (UC) and the natural history of the disease has changed dramatically. With our study we aimed to examine how the colectomy rate has changed from the prebiologic to the biologic eras, while we tried to identify predictors of colectomy in these patients.
Adult patients with a diagnosis of ulcerative colitis who subsequently underwent an urgent or elective colectomy for medically refractory disease in our hospital between October 1998 and October 2014 were identified. We retrospectively analyzed data on patients with UC receiving infliximab, adalimumab and golimumab from October 2006 to October 2014 while the need for colectomy was also calculated and compared to the one observed between October 1998 to October 2006 when biologic therapy was not available.
From October 2006 to October 2014, 122 patients with ulcerative colitis were followed up in our Department. The mean age of this patients' group was 44 ± 15 years and 65 were males (53.27%), while 32 patients had pancolitis, 55 had left sided colitis and 35 had proctitis. Out of these patients, 46 received therapy with an anti-TNF agent (infliximab n=31, adalimumab n=10, golimumab = 5) because of steroid refractory (n=26, 56.52%) or steroid dependent disease and/or failure of immunomodulator therapy (n=20, 43.47%). Finally 11 patients have been subjected to colectomy (9.01%). As regards the period from October 1998 to October 2006, 77 UC patients were followed up in our Department. The mean age of this patients' group was 51 ± 19 years and 38 were males (49.35%), while 21 patients had pancolitis, 39 had left sided colitis and 17 had proctitis. From these patients 19 have been subjected to colectomy (24.67%). According to the statistical analysis high CRP values (CRP > 5mg/L) and severe endoscopic lesions at initial presentation (Mayo endoscopic score = 3) were associated with the risk of colectomy (Risk Ratio=1.95, 95%CI 1.15-4.02 and Risk Ratio=3.57, 95%CI 1.75-10.02, respectively).
The total incidence rate of colectomy for medically refractory ulcerative colitis has declined substantially since 2006, paralleling the increased use of anti-TNF therapy in this patient population. High CRP values and severe endoscopic lesions at initial presentation are associated with the risk of colectomy.