P421 Effects of combination therapy in inflammatory bowel disease: how long should we keep concomitant immunomodulators?
J. C. Silva*1, A. P. Silva1, A. Rodrigues1, C. Fernandes1, A. Ponte1, J. Rodrigues1, M. Sousa1, A. C. Gomes1, J. Carvalho1
1Centro Hospitalar Vila Nova de Gaia/Espinho, Gastroenterology, Vila Nova de Gaia, Portugal
Combination therapy (CT) in inflammatory bowel disease (IBD) is considered to be superior to monotherapy. Reduction of biological immunogenicity is believed to be an advantage, especially in the first 6 months. Nonetheless CT may increase the risk of neoplasia and infection. The aim of this study was to evaluate the benefits of CT beyond 6 months.
Retrospective cohort-study, which included all IBD patients who underwent treatment with anti-TNF between 2003–2017 in our unit. Inclusion criteria: IBD patients submitted to CT (anti-TNF+immunomodulator) for at least 3 months. Patients who lost follow-up were excluded. Patients were divided in 2 groups, based on CT duration (≤6 months and >6 months). The main outcomes include time to biologic treatment failure (defined as need to dose increase, switch biologic or surgery) and immunomodulator-related adverse events. Long-term clinical remission (CR) as well as deep remission (DR) were the secondary outcomes. DR was defined as CR (as described in medical records), endoscopic remission (absence of ulcers and erosions in endoscopy) and in ileal Crohn’s disease as absence of radiologic activity.
136 patients were included, 90 of which underwent CT. Most patients had Crohn’s disease (90%). Mean age was 38.3 years (SD 12.5) and 56% were females (
There was no additional benefit in maintaining combination therapy beyond 6 months. Considering the long-time risks, namely infections and neoplasia, it is reasonable to consider that combined therapy for 6-months may be as effective as concomitant therapy for longer periods.