P636 Long-term outcome of anti-tumour necrosis factor treatment in inflammatory bowel disease: A real-life observational study at Østfold Central Hospital, Norway

Abstract

Background: Anti-tumour necrosis factor (a-TNF) is an established treatment for moderate to severe Crohn disease (CD) and ulcerative colitis (UC). Treatment failure occurs frequently. Long-term observational studies are few and little is known about outcomes following discontinuation of a-TNF therapy. Method(s): A systematic review of medical records for the period 2001-2017 was performed, and data regarding sosio-demographic, clinical and therapeutical aspects were collected. Moreover, symptoms, calprotectin measurements, surgical procedures and use of concomitant medication before, during and after a-TNF were collected. Disease activity was classified as complete remission (CR) or partial response (PR) based on a composite assessment of symptoms, calprotectin values and results of additional endoscopy/radiology. Result(s): Two hundred and forty-two patients (male 56%) who started a-TNF therapy between 2001 and 2011 were included. In CD (n = 154), 51% had ileocolic affection, 53% luminal disease and 33% had undergone a prior intestinal resection. In UC (n = 88), 80% had a pancolitis. Initially n = 212 (88%) received infliximab and n = 30 (12%) adalimumab. Dose-escalation was performed in 35%. Fifty-three patients (22%) switched to another a-TNF due to treatment failure or intolerance. In UC, 32 (36%) had a colectomy, while 55 CD-patients (36%) had an intestinal resection during/following a-TNF therapy, of whom 43 were surgical naive before starting a-TNF. Malignant disease was diagnosed in 11 patients (5%) and mortality due to septicaemia occurred in four patients. One-year evaluation: CR was achieved in n = 106 (44%) and PR in n = 63 (26%), while n = 73 (30%) had no response/discontinued a-TNF therapy. Last evaluation on maintenance a-TNF (max 17 years observation; median 9 years): CR was achieved in n = 46 (19%); CD 26% and UC 7%, respectively. Evaluation of patients who had discontinued a-TNF (max 16 years observation; median 6 years): During the observation period, 170 of 242 (70%) had discontinued a-TNF therapy, of which treatment failure or severe side effects (36% vs. 26%) were the most frequent causes. Altogether CR was achieved in 62% of those patients who had stopped a-TNF. In CD, 12% had discontinued therapy due to clinical remission, while the comparable number in UC was 34%. Of those who had discontinued a-TNF due to clinical remission, 13 (27%) have re-started biological therapy. Conclusion(s): One out of five patients was in complete remission using the primary a-TNF drug 9 years after start of therapy. The efficacy was better in CD-patients, but more UC-patients had stopped a-TNF due to remission. One out of three patients had been operated, regardless of diagnosis.