World Congress at ACG2017

Simultaneous Plenary Session 4C: IBD

76 - Biologic Therapy in Pediatric Inflammatory Bowel Disease: Can We Influence the Natural History of the Disease After Suspension of the Treatment? Preliminary Results

Wednesday, October 18
9:00 AM - 9:10 AM
Location: W414 (Level 4)



Category: IBD       

Federica Gaiani, MD1, Silvia De Bonis, MD2, Fabiola Fornaroli, MD2, Carmen Madia, MD2, Silvia Iuliano, MD2, Alessia Ghiselli, MD2, Barbara Bizzarri, MD2, Francesca Vincenzi, MD2, Gian Luigi de'Angelis, MD, PhD2
1University Hospital of Parma, Parma, Emilia-Romagna, Italy; 2University Hospital of Parma, Parma, Emilia-Romagna, Italy
Introduction: Biologic therapies have become the mainstays of treatment of Inflammatory Bowel Disease (IBD), as their efficacy and safety have been demonstrated both in the phase of induction and maintenance of remission, particularly in the achievement of “deep remission”. Nevertheless, data about advised timing of discontinuation of the therapy, natural history and the risk of relapse after suspension are lacking, especially in pediatric age. The aim of the study was to evaluate the follow up of a pediatric cohort after suspension of biologic therapy in terms of clinic and endoscopic remission.

Methods: Thirty four pediatric patients affected by IBD and treated with biologics were recruited at the Pediatric Clinic, University Hospital of Parma, between January 2014 and January 2017. Demographic and clinic data, characteristics of remission, timing of relapse, intra- and extraintestinal complications were collected at T0, after 1, 2 and 3 years after suspension of biologic therapy, focusing on clinic and endoscopic remission.

Results: Twenty-seven patients (79%) achieved clinic and endoscopic remission: 26 out of 27 patients (96%), after 1 year from the suspension, 17(63%) after 2 years, and 15(56%) after 3 years maintained both clinic and endoscopic remission. Seven patients (21%) achieved only clinic remission under treatment: 3(43%) maintained clinic remission with endoscopic activity; only 1 out of these 3 patients (33%) continued to be in clinic remission after 2 and 3 years from the suspension. None among age, sex, familiarity, type of IBD, clinical and endoscopic severity at diagnosis, localization, type of biologic, posology and duration of the therapy was associated with an augmented relapse rate. The presence of comorbidities, suspension of biologic therapy before reaching “deep remission” and the absence of immunomodulating therapy with azathioprine were positively associated with relapse.

Discussion: Accordingly with literature data, more than 50% (53%) of the patients in clinical and endoscopic remission relapse within 36 months of follow up. The present study confirms the importance of achieving clinic remission and mucosal healing before the suspension of the therapy. The patients who achieved the only clinical remission demonstrated an higher relapse rate (86%) after 3 years of follow up. An early and effective treatment using biologics with the top down approach, can positively influence the natural history of the disease, particularly the relapse rate.

Supported by Industry Grant: No


Clinic characteristics of patients


























































Clinic characteristics Percentage (%)

Sex: Male
       
Female



19
 15



56
44



Age at diagnosis (mean)


12.53y

/



Type of IBD: UC
 
                   CD


    7  
   27

21
79



Familiarity for IBD: yes 
                                no



3
31


           10
           90

Comorbidities: yes
                        no



7
27


           21
           79
 UC phenotype: proctitis
                         left colitis
                         extended colitis

1
2
4


           14
           29
           57
 CD phenotype: non-stricturing, non-penetrating
                         stricturing
                         penetrating
   23
    2
    2
           85
          7.5
          7.5
 Severity of  the disease (PUCAI or PCDAI): mild                                                                                                                             moderate
                                                                      severe
    9
   15
   10
           26
           44
           30
 Biologic therapy: Infliximab 
                             Adalimumab
   30
    4
           88
           12
 Therapeutic approach: step-up
                                      top-down
   21
   13
           62
           38

Clinic characteristics of patients































































Clinic characteristics Percentage (%)

Sex: Male


        Female

19


   15

56


           44

Age at diagnosis (mean)


12.53y

/



Type of IBD: UC


                     CD
    7
  
   27

21


           79

Familiarity for IBD: yes


                                no

3


   31
           10

           90

Comorbidities: yes


                         no

7


   27
           21

           79
 UC phenotype: proctitis

                          left colitis


                          extended colitis

1


2


    4
           14

29


           57
 CD phenotype: non-stricturing, non-penetrating

                          stricturing


                          penetrating


   23

2


    2
           85

7.5


           7.5
 Severity of  the disease (PUCAI or PCDAI): mild

                                                                      moderate


                                                                      severe
    9

15


   10
           26

44


           30
 Biologic therapy: Infliximab          
       
                             Adalimumab
   30

    4
           88

           12
 Therapeutic approach: step-up               
 
                                      top-down
   21

   13
           62

           38
     

Citation: . BIOLOGIC THERAPY IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: CAN WE INFLUENCE THE NATURAL HISTORY OF THE DISEASE AFTER SUSPENSION OF THE TREATMENT? PRELIMINARY RESULTS. Program No. 76. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Federica Gaiani

Dr
University Hospital of Parma
Parma, Emilia-Romagna, Italy

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