P290 Therapeutic requirements in patients with Ulcerative Proctitis. Is it necessary immunosuppressive therapy in these patients?
Ferreiro Iglesias, R.(1);Porto Silva, M.S.(1);Marín, S.(2);Casanova, M.J.(3);Mañosa, M.(4);González-Muñoza, C.(5);de Francisco, R.(6);Caballol, B.(7);Arias, L.(8);Piqueras, M.(9);Zabana , Y.(10);Rivero, M.(11);Calvet, X.(12);Mesonero, F.(13);Varela Trastoy, P.(14);Busta Nistal, R.(15);Gomez Perosanz, R.(16);Vega, P.(17);Gonzalez Vivo, M.(18);Iborra, M.(19);Jimenez Marquez, L.(20);Madero, L.(21);Rodríguez-Lago, I.(22);Rodriguez Gonzalez , M.(23);Vera, I.(24);Ponferrada Diaz, A.(25);Vela, M.(26);Torrealba, L.(27);Van Domselaar, M.(28);Iglesias , E.(2);P. Gisbert, J.(3);Calafat, M.(4);García-Planella, E.(5);Perez-Martinez, I.(6);Ricart, E.(7);Sicilia , B.(8);Mena, R.(9);Nieto, L.(1);Domenech, E.(4);Barreiro-de Acosta, M.(1);
(1)Hospital Clinico Universitario de Santiago. Fundación Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, Gastroenterology Department, Santiago, Spain;(2)UCO/IMIBIC/Hospital Universitario Reina Sofía, Digestive System Service, Córdoba, Spain;(3)Hospital Universitario de La Princesa- Instituto de Investigación Sanitaria Princesa IIS-IP and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHD, Gastroenterology, Madrid, Spain;(4)Hospital Universitari Germans Trias i Pujol. Badalona.Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHD, Gastroenterology and Hepatology Department, Badalona, Spain;(5)Hospital Sant Creu I Sant Pau, Gastroenterology and Hepatology Department., Barcelona, Spain;(6)Hospital Universitario Central de Asturias, Gastroenterology Department, Oviedo, Spain;(7)IDIBAPS- CIBER-EHD- Hospital Clínic, Servei de Gastroenterologia- Barcelona- Spain, Barcelona, Spain;(8)Hospital Universitario de Burgos, Gastroenterology Department, Burgos, Spain;(9)Consorci Sanitari de Terrassa CST, Gastroenterology Department, Barcelona, Spain;(10)Hospital Mútua de Terrassa HMT. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd., Gastroenterology Department, Barcelona, Spain;(11)Hospital Universitario Marqués de Valdecilla Instituto de Investigación Marqués de Valdecilla IDIVAL, Gastroenterology Department, Santander, Spain;(12)Corporació Sanitària Universitaria Parc Taulí. Universistat Autònoma de Barcelona. CIBEREHD. Instituto de Salud Carlos III. Madrid-, Sabadell Department de Medicina, Sabadell, Spain;(13)Hospital Universitario Ramón y Cajal, Gastroenterology Department, Madrid, Spain;(14)Hospital Universitario de Cabueñes, Gastroenterology Department, Gijon, Spain;(15)Hospital Clínico Universitario de Valladolid, Gastroenterology Department, Valladolid, Spain;(16)Hospital Universitario Fundación Alcorcón, Gastroenterology Department, Madrid, Spain;(17)Hospital Clinico Universitario de Ourense, Gastroenterology Department, Gastroenterology Department, Spain;(18)Hospital del Mar- Barcelona. IMIM Hospital del Mar Medical Research Institute, Servei de Digestiu, Barcelona, Spain;(19)Hospital Universitario y Politécnico La Fe de Valencia, Gastroenterology Department, Valencia, Spain;(20)Hospital Universitario de Fuenlabrada, Gastroenterology Department, Madrid, Spain;(21)Hospital General Universitario de Alicante, Gastroenterology Department, Alicante, Spain;(22)Hospital Universitario de Galdakao- Biocruces Bizkaia Health Research Institute- Galdakao, Gastroenterology Department, Bilbao, Spain;(23)Hospital de Ciudad Real, Gastroenterology Department., Ciudad Real, Spain;(24)Hospital Universitario Puerta de Hierro, Gastroenterology Department, Madrid, Spain;(25)Hospital Universitario Infanta Leonor, Gastroenterology Department, Madrid, Spain;(26)Hospital Nuestra señora de la Candelaria, Gastroenterology Department, Tenerife, Spain;(27)Hospital Dr. Josep Treuta-, Gastroenterology Department, Girona, Spain;(28)Hospital Universitario de Torrejón, Gastroenterology Department, Madrid, Spain; Consortium of the ENEIDA Project of GETECCU
Background
Ulcerative proctitis may have a mild and less aggressive course, although evidence is scarce because these patients are excluded from participation in randomized controlled clinical trials. The aim is to identify clinical characteristics and complications associated with ulcerative proctitis refractory to conventional therapy.
Methods
Patients included in the prospectively maintained ENEIDA registry from GETECCU with ulcerative proctitis were included. Socio-demographic data were evaluated. We defined ulcerative proctitis based on ECCO guidelines and immunosuppression as the use of immunomodulators and/or biologics. Logistic regression was used to identify the independent factors associated with immunosuppressive therapy among the different socio-demographic data.
Results
From a total of 34.716 patients with ulcerative colitis, 6281 (18%) patients with ulcerative proctitis were identified. Mean age was 53 ±15 years and mean duration of illness was 12 ± 9 years. Surgery was necessary only in 2% of patients, 31 (0.5%) panprotocolectomy or subtotal colectomy. The clinical characteristics of the patients with and without immunosupressive therapy are summarized at table 1. A total of 3691 patients received oral 5-ASA (58.8%) and 4652 (74.1%) topic 5ASA. 636 (10.1%) were refractory to 5-ASA and corticosteroids, necessitating immunosuppression: 459 patients with azathioprine (7%), 28 with 6-mercaptopurine (0.4%), 49 with methothrexate (0.8%), 191 with infliximab (9%), 125 with adalimumab (2%), 50 with golimumab (0.8%), 57 with vedolizumab (0.9%), 6 with ustekinumab (0.1%) and 3 with tofacitinib (0.0). 316 (5%) patients needed one biologic therapy, 95 (1.5%) needed 2 biologics and 40 (0.6%) at least three different biologics. Longer duration of illness and use of corticosteroids were associated with higher risk of immunosuppression.
Table 1. Characteristics of the study population.
| Total (%) | Immunosuppressive therapy (%) | No immunosuppressive therapy (%) | |
| Sex (male) | 45.1 | 47 | 44.8 |
| Family background | 10.9 | 14.3 | 10.5 |
| Smoking habit | 10.1 | 9.7 | 10.1 |
| Perianal disease | 3.2 | 7.7 | 2.7 |
| Extraintestinal manifestations | 8.5 | 22.6 | 6.9 |
| Colonic tumors | 0.2 | 0.2 | 0.2 |
| Diabetes type 1 | 0.3 | 0.3 | 0.3 |
| Celiac disease | 0.6 | 0.8 | 0.5 |
| Hospitalizations | 3.2 | 9.7 | 2.4 |
| Autoimmune thyroiditis | 1.1 | 0.9 | 1.2 |
| Surgery | 2 | 1.3 | 8 |
Conclusion
Good clinical outcomes were recorded in ulcerative proctitis, with only 10% of patients treated with immunosuppression therapy. The risk factors of immunosuppression were longer duration of illness and use of corticosteroids.