P626 Histological improvement after induction therapy with infliximab provide prolonged clinical remission during maintenance therapy in children with Crohn disease.
M. Dadalski*1, E. Szymanska2, W. Grajkowska3, J. Kierkus4
1The Children's Memorial Health Institute, Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, Warsaw, Poland, 2The Children's Memorial Health Institute, Paediatrics, Warsaw, Poland, 3Children's Memorial Health Institute, Pathology, Warsaw, Poland, 4Children's Memorial Health Institute, Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, Warsaw, Poland
Recently, so-called "deep remission" has become a conceptual, more "extended" goal that contribute to achievement of long-term clinical remission and may even alter the long-term natural history of the disease in selected patients. Since data on that issue are limited, especially in pediatric population, the aim of this study was to assess impact of histological healing during biological therapy for maintenance of Crohn disease (CD) remission.
33 patients aged 16,7 ± 4 years with moderate to severely active CD who had clinical response following induction therapy with infliximab (IFX) and continued with maintenance therapy during 1 year were included into the study. Colonoscopy and gastroscopy with samples collection were performed in all patients at baseline (week 0), after three injections of IFX (week 10), and after 1 year of maintenance therapy with IFX. Histological changes were evaluated with numerical scoring system (0-no inflamation; 1-nonactive inflamation; 2-cript distortion, abscesses; 3-active inflammation, ulcerations). Histological scorings at week 0 and week 10 were compared between 2 subgroups: patients with remission at week 52 present (n=26) vs. patients with no remission (n=7). Discriminant ability was assessed with ROC curve analysis.
Neither histological scoring at week 0 nor at week 10 did not differ significantly between subgroup with remission at week 52 present vs. subgroup with no remission, whereas difference between scoring at week 0 and at week 10 was significantly higher in subgroup with remission. Area under ROC curve for this parameter (scoring week 0 - scoring week 10) was 0,76 and optimum cut-off point greater or equal 2 discriminate subgroups with sensivity 0,62 and specifity 1.
Histological improvement after induction therapy with at least 2 points provides prolonged clinical remission, whereas 40% patients with less histological improvement have CD flare during maintenance therapy with IFX.