P621 Faecal calprotectin after the induction of anti-TNF therapy predicts mucosal healing in patients with ulcerative colitis: A prospective single-centre study

Abstract

Background: In the last few years, adalimumab (ADA) and golimumab (GOL) have been developed as a therapeutic option for ulcerative colitis (UC). Infliximab (IFX) remains the gold standard therapy for severe UC. Mucosal healing (MH) is emerging as primary goal of anti-TNF therapy in UC. Limited data are known about potential early predictors of MH, especially regarding ADA and GOL. Method(s): A prospective observational study was carried out among the patients with moderate-severe UC who started treatment with IFX, ADA and GOL in monotherapy between January and September 2016 at our centre. The basal therapy with mesalamine was maintained stable during the follow-up period (1 year). Primary non-responder was excluded. Partial Mayo score (PMS), C-reactive protein (CRP) and faecal calprotectin (FC) were assessed before treatment and every 8 weeks during the follow-up. All the patients underwent colonoscopy at baseline and at the end of follow-up or in case of discontinuation of therapy due to loss of response (LOR) or side effects (SE). MH was defined as a Mayo Endoscopic Score <2), a normal CRP value (<0.5 mg/dl), and a value of FC <150 mg/kg (chosen on the basis of previous studies1,2) were evaluated as potential predictors of MH. Statistical analysis was carried out using Fisher's test for categorical variables. Result(s): Forty-seven patients were enrolled, 21 treated with IFX, 12 with ADA, and 14 with GOL. LOR was observed in 18 patients (38%), 3 patients (6%) experienced SE. Twenty-six (55%) patients maintained the therapy until the end of follow-up, 16 of them (62%) showed MH. Overall, 18 of 47 (38%) patients showed MH. A significant correlation between MH and FC <150 mg/kg at Week 8 (p < 0.001) was observed in patients treated with IFX, ADA or GOL evaluated globally, while no correlation was observed between MH and PMS or CRP at the same time point. (Table presented) Same results are achieved considering only the subcutaneous drugs (ADA and GOL) or IFX singularly. Moreover, MH was correlated with FC levels at Week 16 and at Week 24, while PMS and CRP showed a significant correlation with MH only at Week 24. Conclusion(s): Our results showed that an early drop of FC levels is a good predictor of MH at 1 year in UC patients treated with IFX, ADA or GOL. Therefore, FC could be used as a reliable tool for an early optimisation of anti-TNF treatment in UC patients in order to reach the correct therapeutic target.