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P677 Effect of late faecal loss of infliximab on treatment response of inflammatory bowel disease

F. AlborziAvanaki*1, H. Rezvan1, N. Ebrahimi Daryani1, N. Ale Taha1

1Tehran university ofMedical Sciences, Tehran, Iran, Islamic Republic of

Background

Anti TNF drugs are being used commonly in treatment of severe or non-responding cases of inflammatory bowel disease. Hence there are still some patients who are non-responder to these drugs or they lose their response throughout the course of treatment. Recently it has been proposed that loss of these drugs to the colonic lumen through the inflamed bowel may be responsible for the lack of response in the first 2 weeks of therapy. We evaluate the association of serum and faecal level of Anti TNF in patient treatment response.

Methods

In this cohort study 28 patient were included during June 2016 to June 2017 at Imam Khomeini Hospital. Serum and faecal infliximab level were measured by enzyme-linked immunosorbent assay. The severity of Crohn’s disease was assessed by Crohn's disease activity index (CDAI) and UC severity was determined by Montréal classification at initiation of therapy and then on Day 14 and Week 24 of therapy.

Results

There was significant difference between serum infliximab level on Day 14 and 96 in crohn's disease (p value: 0.03). But was not seen in ulcerative colitis patients (p value: 0.7).The mean serum infliximab level on Day 96 was 2.3 µg/ml and 5.2 µg/ml in non-responder and responder groups, respectively, and showed significant difference in both ulcerative colitis and Crohn's disease patients. The mean faecal infliximab level on Day 14 and 96 was 11 µg/ml and 5 µg/ml, respectively, and showed no significant difference between responder and non-responder groups. There was an insignificant indirect relationship between serum and faecal infliximab level in UC patients (R = 0.401, p = 0.175) whereas this relationship was directly insignificant in crohn disease (R = −0.411, p = 0.239). There was a significant direct relationship between faecal infliximab level and CRP on Day 96 (R = 0.839, p = 0.002).

Conclusion

We showed that faecal infliximab level other than the first days of treatment does not affect the treatment response. Although it was shown that increased faecal infliximab on first days of treatment is related to loss of response in UC patients, our study did not find significant relation in faecal infliximab with response to treatment on Week 24 in both crohn's and UC patients, but our results were matched with previous studies to show the relation of response with serum infliximab level. Decreased level CRP was related to increased level of faecal infliximab just in crohn's patients. Our study revealed that late faecal ant TNF concentration will not affect the treatment response and may not be a good predictor of response. Further studies will be needed to evaluate this relationship.