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P380 Comparison of mucosal healing through segments of ileocolonic Crohn’s disease treated with biologics

Temido, M.J.(1);Portela, F.(1);Lopes, S.(1);Mendes, S.(1);Ferreira, M.(1);Ferreira, M.(1);Figueiredo, P.(1);

(1)Centro Hospitalar e Universitário de Coimbra, Gastroenterology, Coimbra, Portugal

Background

Although major advances in Inflammatory bowel disease’s treatment have been observed, the response to the pharmacologic therapies is still unpredictable and highly variable. Mucosal healing (MH) is an important endpoint in Crohn’s disease patients undergoing biologic therapies as it improves outcomes. Nevertheless, endoscopic response is usually evaluated as a whole entity and not by intestinal segments. Moreover, to the best of our knowledge, it has never been assessed whether different plasmatic drug levels (PDL) of biologics result in different response rates by segments of disease. Taking all these considerations into account, this work aimed at assessing putative differences in MH between ileal and colonic disease.

Methods

Retrospective, single centre, cohort study of 131 consecutive patients undergoing biological therapies for Crohn’s disease. Patients included had at least six months of follow-up and an endoscopic evaluation before and after the initiation of biologic therapy. Clinical and endoscopic data were obtained at baseline and at the time of assessment of response. Potential prognostic factors included were: age at diagnosis, time from diagnosis at beginning of biologic agents, location and behaviour of disease, biologic agent taken, PDL and smoking. MH was defined as absence of ulcers in the previously affected segment.

Results

Mean age at diagnosis was 28±12.9 years (range 10-67years). 26.7% of patients had ileal disease and 34.5% only had colonic lesions. 61.83% of patients initiated infliximab and 29.8% started treatment with adalimumab. MH was present in 48.85% of patients. Rates of response were significantly different between ileal (48.9%) and colonic lesions (69.8%) both in the whole cohort and in patients with ileocolonic disease (54.9% and 74.5% respectively) (p<0.05). PDL were higher in the patients achieving response comparing subgroups of patients (responders versus non-responders) with ileal and colonic lesions (p<0.05). There were no significant differences in the PDL between ileal and colonic lesions achieving response. In the multivariate analysis, factors independently associated with higher rates of MH were PDL, location (ileum versus colon) of the affected areas and type of disease (ileal versus colonic versus ileocolonic) (p<0.05).

Conclusion

Rates of MH of ileal lesions are significantly different from colonic segments in Crohn’s Disease. This discrepancy appears not to be related to higher plasmatic concentrations of biologic agents.

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