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* = Presenting author

P541 Long-term colectomy rates in patients with Ulcerative Colitis treated with Infliximab: A single Canadian tertiary care centre's experience

M. Cooray*1, A. Meadley2, S. Halder3

1McMaster University, Gastroenterology, Burlington, Canada, 2McMaster University, Department of Internal Medicine, Hamilton, Canada, 3McMaster University, Gastroenterology, Hamilton, Canada

Background

In the era prior to the introduction of biologic agents for the treatment of Ulcerative Colitis, rates of colectomy were estimated to be 20%(1). More recent evidence suggests that the risk of surgery at 1, 5, and 10 years after diagnosis was 4.9%, 11.6% and 15.6% respectively(2). Infliximab has shown to decrease early colectomy rates in Ulcerative Colitis(3), however its effects on long-term colectomy rates are unclear.

Infliximab for the treatment of Ulcerative Colitis was approved in Canada in 2005. Data up to 2010 have reported a colectomy rate of 9% in the post-Infliximab era(4). However the majority of this data was collected between 2008 and 2010 and data beyond this in Canada has been limited.

Our aim was to assess the long-term rates of colectomy at our institution in patients treated with Infliximab for Ulcerative Colitis.

Methods

Medical records of patients with a diagnosis of Ulcerative Colitis on Infliximab were retrospectively reviewed. Inclusion criteria consisted of Infliximab initiation between January 2005 and January 2012. Charts were reviewed to January 2014 for study outcomes. 18 of 22 gastroenterologists practicing at McMaster University provided consent to review patients charts. 76 patient charts were eligible for review, although 10 patients were excluded.

Baseline demographic information was collected in addition to pre and post-Infliximab data. Our primary outcome was a colectomy. Although primarily descriptive data was obtained, eligible information was statistically analyzed using a t-test.

Results

Of the 66 eligible patients, 31 were female and 35 male. The mean age at diagnosis was 27.2 (95 % CI 23.73-30.60). The mean number of months from diagnosis to the initiation of Infliximab and the mean duration of Infliximab treatment was 66.6 (95% CI 47.14-85.99) and 46.2 (95% CI 39.85 to 52.58) respectively. A total of 9 patients required a colectomy, however only 7 (colectomy rate 10.6%) were for refractory ulcerative colitis. The mean number of months from the initiation of Infliximab to colectomy was 10.7 (95% CI 4.14 to 17.29). The mean duration of disease prior to starting Infliximab between the colectomy and non-colectomy groups were 9.4 and 72.2 months respectively (p=0.046). The mean number of hospitalizations prior to and on Infliximab were 1.1 and 0.4 respectively (p<0.001).

Conclusion

Our findings suggest comparable long-term rates of colectomy to the current literature. An aggressive phenotype may explain the failure of Infliximab and the need for a colectomy earlier in the course of disease. Unfortunately the small number of patients in our study limit our ability to make any strong inferences although our data is reassuring on the long-term effectiveness of Infliximab in Ulcerative Colitis.