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P393 Outcome of treat to target strategy in paediatric patients with Crohn’s disease and ulcerative colitis on infliximab

D. Yerlioglu*1, L. Cococcioni1, A. ElZein1, S. Sider1, S. Chadokufa1, R. Buckingham1, N. Shah1, A. Ocholi1, O. Borrelli1, F. Kiparissi1

1Great Ormond Street Hospital, Gastroenterology, London, UK

Background

Treat to target strategy has been proposed in adult IBD to improve Quality of Life, symptoms and to treat inflammation. There are little data in the paediatric population for this approach. The aim of this study was to look if set goals (reduced PCDAI/PUCAI and Mayo/SES-CD) were achieved.

Methods

We conducted a retrospective analysis of children with IBD who received Infliximab (IFX) in our institution. Data were collected to evaluate mucosal healing for UC from colonoscopy results, using Mayo Scoring and for CD using SES-CD. We also compared These data with activity scores (PUCAI and PCDAI), CRP and Faecal Calprotectin, (FC).

Results

A total of 61 patients were identified, 46 (Group 1) with Crohn’s disease (CD), 15 (Group 2) with ulcerative colitis (UC); Male n = 38, age range 3–15 years, median 10 years. Group 1: there were 46 patients, male n = 26, age range 0–15 years, median 9 years. SES-CD was assessed in all patients pre-treatment with IFX, median score was 3 with a range from 0 to 8; In 36 patients, 1 year after treatment SES-CD score dropped to a median of 1 with a range between 0 and 7. Pre-treatment median FC (n = 37) was 2282 mg/kg with a range of 133–6000 mg/kg and post-treatment FC was (n = 39) 105 mg/kg with a range of 15–6000 mg/kg. Median CRP pre-commencing (n = 42) was 12 mg/l with a range of 5–167 mg/l. Post-treatment (n = 42) the median was 5 mg/l with a range of 0.6–67 mg/l. The 1-year follow-up PCDAI was 78% (PCDAI <10). Group 2, 15 children were identified, male n = 13, age range 4–13 years, median 10 years. Mayo pre-commencing (n = 15) median was 2, range 1–3, post (n = 10) was median of 1 with range of 0–3. FC pre-commencing (n = 13) median was 1032 mg/kg with a range of 23–3000 mg/kg and was decreased to 69 mg/kg with a range of 15–1852 mg/kg (n = 14).

CRP pre-commencing median (n = 15) was 6 mg/l with a range of 5–19 mg/l and after (n = 15) it was 5 mg/l with a range of 5–8 mg/l. PUCAI was found to be <10 after 1 year of follow-up in 60% of the children with UC.

Conclusion

Our data suggest that set goals were achieved in CD with a decrease of SES-CD and in UC a decrease of the Mayo scoring with an improvement of PCDAI and PUCAI. We suggest that Paediatric patients get targets set at the beginning of their treatment and assess outcomes at set times.