P481 Efficacy of the sequential use of a second biologic agent for Crohn’s disease treatment in a non-academic tertiary centre
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
One-third of Crohn’s disease (CD) patients, treated with anti-TNF agents do not respond to the drug (primary failure), and a relevant proportion from those who respond experiences loss of response (secondary failure) or intolerance over time. The aim was to investigate the efficacy of the sequential use of a second biologic agent after failing or developing intolerance to an anti-TNF drug as well as identify predictors of treatment failure.
Retrospective cohort-study, which included all CD patients who started anti-TNF between 2003–2017. The main outcome was the efficacy of a second biologic agent, measured by 12-week clinical remission (CR), 1-year CR and 1-year endoscopic (ER). When endoscopy could not adequately evaluate inflammation (small bowel CD), resolution of inflammation as assessed by cross-sectional imaging. Secondary outcomes includes identification of predictors to second-line biologic agents failure, time to treatment failure (defined as need to dose increase, switch biologic or surgery). Deep remission (DR) was defined as CR (as described in medical records), ER (absence of ulcers and erosions in endoscopy) and in ileal Crohn’s disease as absence of radiologic activity.
118 patients were included. Mean age was 39.8 years (SD 12.4) and 53.4% were females (
Sequential use of a second biologic agent failed in more than one third of patients, nonetheless clinical remission at 50 weeks was obtained in most patients. Younger age at diagnosis and surgery for perianal disease are potential predictors of failure of a second biologic agent.