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P507 Efficacy of Infliximab after failure of subcutaneous anti-TNF agents in patients with moderate-to-severe ulcerative colitis

N. Viazis*1, E. Tsoukali1, M. Galanopoulos1, C. Pontas1, G. Karampekos1, G. Filippidis1, O. Giouleme2, G. Theocharis3, M. Tzouvala4, E. Archavlis1, A. Christidou1, G. J. Mantzaris1

1Evangelismos Hospital, Gastroenterology Department, Athens, Greece, 22nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokrateion Hospital, Gastroenterology – Hepatology Department, Thessaloniki, Greece, 3University Hospital of Patras, Gastroenterology Department, Patras, Greece, 4Nikaia General Hospital, Gastroenterology Department, Athens, Greece

Background

To assess the efficacy of intravenously administered infliximab in patients with moderate to severe ulcerative colitis (UC) who have failed therapy with subcutaneously administered adalimumab or golimumab.

Methods

Retrospective analysis of prospectively collected data of all anti-TNF naive UC patients who received adalimumab or golimumab for the treatment of moderate to severe UC in the participating tertiary referral centres. Patients who showed primary non-response or secondary loss of response to the subcutaneously administered anti-TNF were scheduled to receive intravenously administered anti-TNF (infliximab). Primary non-response was defined as failure to achieve a clear improvement in symptoms and a drop in CRP, if elevated at baseline, at Week 6 through Week 14. Secondary loss of response was defined as reappearance of symptoms and re-elevation of CRP at any time period after the first 14 weeks of anti-TNF therapy. Clinical response to infliximab was subsequently assessed at Week 14 and was defined as a decrease in the total Mayo score of at least 3 points and at least 30% per cent from baseline. Finally, clinical remission, defined as Mayo score of ≤ 2 with no individual sub-score > 1, was assessed at Week 54.

Results

From September 2015 till September 2017, 58 anti-TNF naive ulcerative colitis patients (males=31, females = 27; E1=1, E2=32, E3=25, median age=40.6 years, median disease duration=38.6 months) were started on adalimumab (n = 38) or golimumab (n = 20) because of moderate–severe disease. From these patients, 21 (36.2%) were primary non responders (adalimumab = 13, golimumab = 8), while 8 more (13.7%) showed secondary loss of response (adalimumab = 7, golimumab =1). Therefore, 29 patients were started on infliximab, because of failure of subcutaneously administered anti-TNF. At Week 14, 18 patients showed clinical response (62.1%), while at Week 54, 14 patients were on clinical remission (48.3%).

Conclusion

UC patients with moderate to severe disease that are anti-TNF naive can be successfully treated with intravenously administered anti-TNF after failure of anti-TNF administered subcutaneously.