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P583 Outcome of treat to target strategy in paediatric patients with Crohn’s disease and ulcerative colitis on adalimumab

D. Yerlioglu*1, L. Cococcioni1, A. ElZein1, S. Chadokufa1, R. Buckingham1, S. Sider1, 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 Adalimumab (ADA) 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 24 patients were identified, 20 (Group 1) with Crohn’s disease (CD), 4 (Group 2) with ulcerative colitis (UC); Male n = 14, age range 2–13 years, median 9 years. Group 1: there were 20 patients, Male n = 13, age range 3–13 years, median 9 years. SES-CD was assessed in 9 patients pre-treatment with ADA, median score was 2.5 with a range from 0 to 8; In 10 patients 1 year after treatment SES-CD score dropped to a median of 1 with a range between 0 and 5. Pretreatment median FC (n = 15) was 574 mg/kg with a range of 66–6000 mg/kg and post treatment FC was (n = 18) 108 mg/kg with a range of 11–1491 mg/kg. Median CRP pre-commencing (n = 19) was 9 mg/l with a range of 5–166 mg/l. Post treatment (n = 19) the median was 5 mg/l with a range of 0.3–8 mg/l. 70% of patients had a drop of PCDAI to <10 at 1 year follow-up. Group2: 4 children were identified, Female n = 3, age range 2–10 years, median 5 years. Mayo pre commencing (n = 4) median was 2.5, range 1–3, post (n = 2) was median of 0.5 with range of 0–1. FC precommencing (n = 3) median was 1966 mg/kg with a range of 217–3000 mg/kg and was decreased to 15 mg/kg with a range of 15–1173 mg/kg (n = 14).

CRP precommencing median (n = 4) was 40 mg/l with a range of 8–81 mg/l and after (n = 4) it was 5 mg/l with a range of 2–6 mg/l. PUCAI was found to be <10 after 1 year of follow-up in 50% of the children with UC.

Conclusion

This study suggests that setting a target and monitoring SES-CD in CD and Mayo scoring in UC improves clinical outcomes (PCDAI and PUCAI), more in Crohn’s disease than Ulcerative colitis. Treat to target should become routine clinical management in paediatric IBD patients.