P284 Risk of colorectal neoplasia, colectomy and responsiveness to biologic therapy in patients with inflammatory bowel disease and concomitant primary sclerosing cholangitis: A systematic review

Abstract

Background: Primary sclerosing cholangitis (PSC) is a chronic immune-mediated liver disease commonly associated with inflammatory bowel disease (IBD) with the majority being diagnosed with ulcerative colitis (UC). Concomitant PSC with IBD can modify the risk of colorectal neoplasia (CRN) compared with those with IBD alone. However, the impact of PSC on clinical outcomes of IBD are unclear. Appropriate management for this patient group is not well adapted. Our aim was to perform a systematic review of all studies to further characterise the distinct risk of CRN in patients with concomitant PSC-IBD, risk of colectomy as well as response to biologic therapy. Method(s): A systematic review of studies assessing risk of primary outcomes was conducted. Searches for relevant English language studies from 2000 to September 2017, assessing primary outcomes comparing patient cohorts of PSC-IBD and IBD alone, were performed in MEDLINE, EMBASE and Cochrane Library according to PRISMA guidelines. Result(s): 10 studies were identified with risk of CRN in PSC-IBD, with 5 studies also reporting colectomy risk. Increased risk of CRN was shown in 9 of the 10 studies including 5 studies with PSC and associated UC, 1 study with associated Crohn's disease (CD) and 3 studies with an associated unspecified IBD (OR: 5.2 [95% CI: 1.7-15.6]-10.7 [95% CI: 3.7-31.3]). There were 2 studies that identified no increased risk of CRN in PSC-CD patients. The remaining study which included only PSC-CD patients, compared with patients with colonic CD alone found that the presence of PSC did not increase the risk of CRN (HR = 0.45, 95% CI: 0.18-1.13). Overall, a decreased risk of colectomy was found in 3 of the 5 studies (RR: 0.50-0.67). The data for response to biologic therapy in PSC-IBD patients are limited by cohort studies with significant heterogeneity. There were two studies reporting decreased efficacy of anti-TNF therapy in comparison to IBD alone (clinical response in 20% and 26.3% of patients respectively). Conversely, a cohort study demonstrated safety and efficacy in all 5 treated patients with co-morbid PSC-IBD while sustained clinical remission of PSC-IBD patients was shown in 2 case reports and 1 case series with clinical response in 6/7 patients in those receiving infliximab at 12 months. Conclusion(s): The risk of developing CRN in PSC-UC patients is higher while possibly being lower in PSC-CD patients. The risk of colectomy are not paralleled, perhaps due to vigilant colonic surveillance. Further characterisation is needed to better understand and manage these patients. This review also demonstrates the paucity of data regarding the utility of biologic therapy in PSC-IBD patients and represents a need for future studies regarding its role.