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P700 The efficacy of colesevelam to treat bile acid malabsorption in Crohn's disease: data from TOPPIC trial

A. Devarakonda*1, I. Arnott2, J. Satsangi3

1The University of Edinburgh, Gastroenterology, Edinburgh, UK, 2Western General Hospital, Gastroenterology, Edinburgh, UK, 3University of Edinburgh, Edinburgh, UK

Background

Bile acid malabsorption (BAM) associated diarrhoea is a significant clinical issue in patients post ileocaecal resection secondary to Crohn's disease resulting in a reduced quality of life.

This study aimed to assess the efficacy of Colesevelam, as a useful symptomatic treatment for diarrhoea in these patients.

Methods

This is a post hoc analysis of the TOPPIC trial. The trial randomised 240 patients, 44 of these patients formed our study population based on the medications for our study. The four intervention groups we analysed are; Colesevelam alone (n = 17), Cholestyramine alone (n = 10), Loperamide alone (n = 12) and both Colesevelam and Loperamide (n = 5). A Wilcoxon Signed Rank Test was performed to analyse if there was a statistically significant difference between pre- and post-drug intervention in the following four outcomes; liquid stool frequency per week, CDAI value, IBDQ score and SF-36 score.

Results

Patients treated with Colesevelam monotherapy had a reduction in stool frequency from pre to post treatment: median = 33/week (IQR 45.5, 25.5) vs. median = 14/week, ( IQR 40, 5.5) ; p = 0.038. Similarly, Cholestyramine group had a reduction in stool frequency from median 17/week (IQR 32.25,10.25) vs. median 7.5/week, (IQR 12.75,4.25); p = 0.008. The other two groups were not associated with a reduction in stool frequency. Additionally, only the patients treated with Colesevelam monotherapy had a reduction in CDAI from pre to post treatment: median 213 (IQR 261, 8147) vs. median 118 (IQR 229.3, 60); p = 0.013. Finally, only Colesevelam monotherapy was associated with improvement in quality of life score, specifically the SF-36, from pre to post treatment: median 118 (IQR 122, 102.5) vs. median 121 (IQR 127.5, 118.5); p = 0.005.

Figure 1. (A–D) Graphs representing the change in liquid stool frequency per week pre- and post-treatment in four different medication groups.

Figure 2. (A–D) Graph representing the change in CDAI index pre and post treatment in four different medication groups.

Figure 3. (A–D) Graph representing the change in SF-36 score pre and post treatment in four different medication groups.

Conclusion

We have demonstrated that Colesevelam is an effective treatment for post-operative BAM in Crohn's disease. Both Colesevelam and Cholestyramine were associated with a reduction in stool frequency but only Colesevelam was associated with a reduction in CDAI and an improvement in quality of life.

References

1. Summers JA,Peacock J, Coker B. Multicentre prospective survey of SeHCAT provision and practice in the UK. BMJ Open Gastroenterol 2016; 3(1): e000091.