P461 Endoscopic features for loss of response in patients with Crohn’s disease who were treated with infliximab by top-down strategy
T. Miyazaki*1, K. Watanabe2, K. Kojima1, R. Koshiba1, K. Fujimoto1, T. Sato2, M. Kawai1, K. Kamikozuru1, T. Takagawa1, Y. Yokoyama2, N. Hida1, S. Nakamura1
1Hyogo College of Medicine, Inflammatory Bowel Disease, Nishinomiya, Japan, 2Hyogo College of Medicine, Intestinal Inflammation Research, Nishinomiya, Japan
The top-down strategy of treatment with anti-TNF agents showed the potentials for improved efficacy and outcomes in patients with Crohn’s disease (CD), especially those suspected to have a poor prognosis. However, few studies have evaluated clinical and endoscopic features associated with secondary loss of response (LOR) in CD cases treated with infliximab by the top-down strategy.
We treated 410 CD patients with infliximab (IFX) from December 2004 to May 2010 in our hospital. Among these CD cases treated with IFX, those receiving the top-down regimen were defined by a disease duration of less than 2 years, no treatment history of steroid/immunomodulator/biologics, and no history of surgery. Effectiveness of IFX was defined on the basis of a more than 70-point decrease in the Crohn’s disease activity index (CDAI). Endoscopic effectiveness was defined as a more than 50% decrease in the simple endoscopic score for Crohn’s disease (SES-CD). LOR was defined as a more than 50-point increase, requiring additional or increasing doses of concomitant therapy.
We retrospectively investigated 58 CD cases treated with infliximab by the top-down strategy. The cumulative remission rate was 86.1% at 1 year, 70.0 at 2 years and 61.0% at 4 years. The LOR group (
LOR occurrence rate in CD patients treated with IFX by the top-down strategy was similar to that in CD patients treated with IFX by the conventional strategy. The existence of an active lesion in the ileocaecum or distal colon, especially a highly active lesion (eg, longitudinal ulcer) in the distal colon, at baseline might predict LOR endoscopically.