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P548 Anti-TNF monotherapy for Crohn’s disease: a 13-year multicentre experience

L. Peyrin-Biroulet1, J. Salleron2, J. Filippi*3, C. Reenaers4, O. Antunes3, V. Filipe1, E. Louis4, X. Hébuterne3, X. Roblin5

1Nancy University Hospital, Université de Lorraine, Nancy 1, Inserm U954 and Department of Gastroenterology, Vandoeuvre-lès-Nancy, France, 2Institut de Cancérologie de Lorraine, Department of biostatistics, Vandoeuvre les Nancy, France, 3Archet 2 Hospital, University of Nice, Gastroenterology and Nutrition Department, Nice, France, 4University of Liège, Gastroenterology Department, Liège, Belgium, 5University hospital of Saint-Etienne, Inserm, CIC1408, Gastroenterology Department, Saint-Etienne, France

Background

Anti-tumour necrosis factor (TNF) therapy in combination with thiopurine is the most effective strategy for Crohn’s disease, but it raises safety concerns.

Methods

In a retrospective multicentre study, we investigated long-term outcome of patients starting anti-TNF monotherapy for Crohn’s disease and investigated whether introducing an immunomodulator in patients losing response to anti-TNF monotherapy is effective for resetting immunogenicity.

Results

In total, 350 adult patients with Crohn’s disease received either infliximab (n = 178, 51%) or adalimumab (n = 172, 49%) monotherapy. Mean duration of follow-up was 42 months. An immunomodulator was initiated in 53 patients (15%). At last follow-up, 73.1% (n = 38) of the 53 patients were in clinical remission. Multivariate analysis identified anti-TNF type (higher need for starting immunomodulator for infliximab than for adalimumab; p = 0.0058) and first- versus second-/third-/fourth-line anti-TNF therapy (p = 0.014) as predictors of immunomodulator initiation. Amongst the 18 patients with available data, the introduction of an immunomodulator was able to restore infliximab trough level within the therapeutic range and to induce clinical remission in 10 patients (55%). Cumulative probability of remaining on anti-TNF therapy was 57.9% at 5 years amongst the 297 patients not starting an immunomodulator during follow-up.

Conclusion

An immunomodulator was initiated in 15% of patients with Crohn’s disease starting anti-TNF monotherapy. Independent predictors of immunomodulator initiation were infliximab use and second-/third-/fourth-line anti-TNF therapy. Resetting immunogenicity with an immunomodulator was effective in half of patients in a sub-study. Persistence of anti-TNF treatment at 5 years was observed half of the 297 patients not starting an immumodulator in a real-life setting.