P546 Impact of mucosal healing on the clinical course in a cohort of paediatric patients affected by Crohn's Disease
F. Nuti, F. Viola, M. Aloi, F. Civitelli, S. Oliva, S. Cucchiara*
Sapienza, Rome, Pediatric Gastroenterology and Liver Unit, Rome, Italy
Crohn's disease (CD) is a chronic relapsing inflammatory condition of the gut that primarily affects young individuals, often leading to significant impairment of quality of life. The major objective of medical therapies in CD is the modification of the clinical course of the disease. Mucosal healing (MH) has recently arisen as a therapeutic goal able to predict sustained clinical remission.
Our aim was to evaluate the clinical outcome, after 2 years of follow-up (FU), of a cohort of pediatric CD patients according to the achievement of MH during maintenance therapy with anti-TNFalpha antibodies.
Pediatric CD pts starting infliximab (IFX) or adalimumab (ADA) from January 2009 were enrolled. All pts were naïve to biological therapies. An endoscopy was performed before starting biologics and after 12 months to evaluate MH. Clinical and endoscopic disease activity were assessed by Pediatric Crohn's Disease Activity Index (PCDAI) and Simple Endoscopic Score (SES CD) at time 0 (T0) and at the time of the endoscopic FU. A further 1-year clinical FU was performed to evaluate differences in relapse rates, surgical rates and corticosteroid (CS) need according to the achievement of MH at endoscopic FU
Thirty-seven patients were enrolled. At two years, 26 of 30 patients in maintenance treatment with anti-TNFalpha were in clinical remission, 4 were not; and the remaining 7 (22%) had stopped therapy for either surgery (4 pts) or loss of response (3 pts). All of the patients that had achieved a complete MH and 75% of those that had achieved a partial MH were in clinical remission at this further FU. Two pts that had obtained a complete MH and 4 of those that had obtained a partial MH needed a course of CS.
Kaplan Meier survival curves showed no statistical difference at two years from therapy introduction dividing patients according to treatment (ADA vs IFX) for risk of disease relapse
In pediatric Crohn's disease, biologics are effective in inducing clinical remission and in achieving MH. The achievement of MH appears able to predict a better clinical outcome at least in the short term. Larger studies will highlight the effect of MH on the long-term disease evolution.