P194 Anti-TNFα treatment following surgical resection for Crohn's disease is effective despite previous pharmacodynamic failure

Abstract

Objectives and study: The outcome of crohn's disease (CD) patients who failed anti-TNFalpha therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNFalpha agent post operatively. Method(s): Pediatric CD patients who underwent intestinal resection and were treated with anti-TNFalpha agents post-operatively were assessed retrospectively. Patients were stratified to those with preoperative anti-TNFalpha pharmacodynamic failure and those with no pre-operative anti-TNFalpha treatment. Result(s): A total of 61 children were included, 21 with pharmacodynamic failure and 40 controls. Median age at intestinal resection was 15 years with 28 (46%) females. The median time from intestinal resection to anti-TNFalpha initiation was 7 months (IQR 4-13 months). At the time of postoperative anti-TNFalpha initiation there were no differences in clinical, laboratory and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNFalpha treatment after 12 months and at the end of follow-up (1.7 years, IQR 1-2.9 years): 90.5% vs. 87.5% and 85.7% vs. 82.5% for pharmacodynamic failure patients and controls, respectively; p=0.8. No significant differences were observed at 14 weeks and 12 months of postoperative anti-TNFalpha treatment including endoscopic remission rate and fecal calprotectin. Both groups significantly improved all measures during post-operative anti-TNFalpha treatment. Conclusion(s): Pediatric CD patients who failed anti-TNFalpha therapy despite adequate drug levels and underwent intestinal resection can be re-treated with the same agent for post-operative recurrence with high success rate similar to anti-TNFalpha naive patients.