P385 Predictors of tissue healing in ulcerative colitis patients treated with anti-TNF
N. Viazis*1, M. Giakoumis1, G. Bamias2, D. Goukos2, T. Koukouratos1, J. Anastasiou1, K. Katopodi1, S. Ladas2, D. Karamanolis1
1Evangelismos Hospital, Gastroenterology Department, Athens, Greece, 2Kapodistrian University of Athens, Laikon Hospital, Academic Department of Gastroenterology, Athens, Greece
Assessment of tissue healing has become of paramount importance in patients treated for inflammatory bowel disease; therefore, the aim of our study was to prospectively identify, at diagnosis, factors predictive of mucosal healing in ulcerative colitis patients treated with anti-TNF.
All ulcerative colitis patients with corticosteroid resistant or corticosteroid dependent disease, necessitating anti-TNF therapy, according to the physician’s judgement, based on the current ECCO guidelines were considered for entry into the study. Endoscopy (ileocolonoscopy) was performed at baseline (i.e. before anti-TNF administration) and at 12 months after the start of therapy, whilst biopsies from the affected colon were collected. At the same time periods the disease activity was documented as well. Infliximab was administered at 5 mg/Kg body weight at 0, 2, and 6 weeks and thereafter, every 2 months for the follow-up period of 1 year. Adalimumab was administered at a dose of 160mg at week 0, 80 mg at week 2, 40 mg at week 4 and 40 mg every other week thereafter. Clinical, as well as immunological, markers with predictive value for mucosal healing at 1 year were sought at the intestinal and systematic level. Precisely, mucosal expression of T helper (Th) cell subsets defining transcription factors was measured by real-time RT-PCR, whereas measurement of soluble cytokine proteins in the serum of patients was done with ELISA. At the end of the follow-up period, mucosal healing was defined as Mayo score of 0.
From May 2012 until September 2014, 12 patients with ulcerative colitis (pancolitis = 8; left-sided colitis = 4) were started on anti-TNF therapy in the participating centres (infliximab = 9; adalimumab = 3). Amongst these patients, 5 achieved complete mucosal healing (Mayo score 0) at the end of the 1-year follow-up period (41.7%), whereas the remaining 7 showed partial or no mucosal healing (58.3%). The only clinical predictor of complete mucosal healing was concomitant immunomodulator use at the start of anti-TNF therapy (mucosal healing, 4 patients on azathioprine vs 1; no mucosal healing, 1 patient on azathioprine vs 6, p = 0.02). Further, responders had significantly lower baseline expression of the transcription factor T-bet that defines type 1 (Th-1) adaptive immunological responses (p < 0.05). Finally, responders had significantly lower baseline serum concentration of IL-6 (p < 0.05).
Immunomodulator use, lower baseline mucosal expression of T-bet, and lower baseline serum concentration of IL-6 appear to be predictors of mucosal healing in ulcerative colitis patients treated with anti-TNF.