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P194 Anti-TNFα treatment following surgical resection for Crohn's disease is effective despite previous pharmacodynamic failure

Assa A.*1, Bronsky J.2, Kolho K.-L.3, Zarubova K.4, de Meij T.5, Ledder O.6, Sladek M.7, van Biervliet S.8, Strisciuglio C.9, Shamir R.10

1Schneider Children's medical Center, Gastroenterology, Nutrition and Liver Diseases, Petach Tikva, Israel 2Charles University and University Hospital Motol, prague, Czech Republic 3University of Helsinki, Helsinki, Finland 4Charles University and University Hospital Motol, Prague, Czech Republic 5VU University Medical Center, Amsterdam, Netherlands 6Shaare Zedek Medical Center, Jerusalem, Israel 7Polish-American Children's Hospital, Krakow, Poland 8Ghent University Hospital, Ghent, Belgium 9University of Naples, Naples, Italy 10Schneider Children's medical Center, Petach Tikva, Israel


The outcome of crohn's disease (CD) patients who failed anti-TNFα therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNFα agent post operatively.


Pediatric CD patients who underwent intestinal resection and were treated with anti-TNFα agents post-operatively were assessed retrospectively. Patients were stratified to those with pre-operative anti-TNFα pharmacodynamic failure and those with no pre-operative anti-TNFα treatment.


A total of 61 children were included, 21 with pharmacodynamic failure and 40 controls. Median age at intestinal resection was 15 years with 28 (46%) females. The median time from intestinal resection to anti-TNFα initiation was 7 months (IQR 4–13 months). At the time of post-operative anti-TNFα initiation there were no differences in clinical, laboratory and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNFα treatment after 12 months and at the end of follow-up (1.7 years, IQR 1–2.9 years): 90.5% vs. 87.5% and 85.7% vs. 82.5% for pharmacodynamic failure patients and controls, respectively; p=0.8. No significant differences were observed at 14 weeks and 12 months of post-operative anti-TNFα treatment including endoscopic remission rate and fecal calprotectin. Both groups significantly improved all measures during post-operative anti-TNFα treatment.


Pediatric CD patients who failed anti-TNFα therapy despite adequate drug levels and underwent intestinal resection can be re-treated with the same agent for post-operative recurrence with high success rate similar to anti-TNFα naïve patients.