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P380 Comparative study of infliximab and adalimumab induction therapy for clinical remission and mucosal healing in paediatric patients with active Crohn’s disease

E. Szymanska*1, M. Dadalski2, S. Szymanska3, W. Grajkowska3, M. Pronicki3, K. Jaroslaw2

1Children’s Memorial Health Institute, Department of Paediatrics, Nutrition and Metabolic Disorders, Warsaw, Poland, 2Children’s Memorial Health Institute, Department of Gastroenterology, Hepatology and Feeding Disorders, Warsaw, Poland, 3Children’s Memorial Heath Institute, Department of Pathology, Warsaw, Poland

Background

Infliximab (IFX) and adalimumab (ADA) are considered to be equally effective in induction and maintenance of clinical remission and mucosal healing. Some data have shown positive outcomes with ADA as a second-line therapy in patients not responding or loosing response to IFX. The aim of this study was to compare clinical efficacy of both anti-TNF agents.

Methods

In total, 56 CD patients treated with IFX, and 23 children receiving ADA were included into the study. Endoscopy with sample collection was performed in all patients before and after 3 injections of anti-TNF agents. Clinical activity of the disease was assessed using the Paediatric Crohn’s Disease Activity Index (PCDAI), and the endoscopic activity was scored using the Simple Endoscopic Score (SES-CD). Histological changes were evaluated by a previously described numerical scoring system.

Results

Median baseline PCDAI scores and outcomes following induction therapy with IFX and ADA were as following; IFX = 55.0 (40.0–85.0) vs 7.5 (2.5–40.0)], ADA = 45.0 (30.0–65.0) vs 10.0 (0.0–15.0). Median baseline SES-CD scores and outcomes following induction therapy with INF and ADA were as following; IFX = 10.0 (0.0–32.0) vs 5.0 (0.0–23.0), ADA, 14.0 (6.0–27.0) vs 9.0 (0.0–27.0). Median baseline histological scores and outcomes following induction therapy with INF and ADA were as following; IFX = 5.5 (0.0–10.0) vs 4.0 (0.0–12.0), ADA = 5.7 (0.0–15.0) vs 4.0 (0.0–12.0). In 7/23 patients ADA was used as a second-line biologic agent. In this patients worse clinical response was observed. Median PCDAI scores following induction therapy with ADA in patients previously treated with IFX vs anti-TNF-naïve ones were as following: 17.5 (0.0–32.0) vs 15.0 (0.0–15.0).

Conclusion

Efficacy of IFX and ADA in induction of clinical remission and mucosal healing in Polish paediatric patients is comparative. Biologic agents are more effective in anti-TNF-alfa naïve patients.