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Poster presentations: Clinical: Therapy and Observation 2020

P619 Efficacy of zinc acetate hydrate administration for zinc deficiency in patients with inflammatory bowel disease: a multi-centre retrospective study

K. Sakurai1, T. Katsurada1, S. Otagiri1, K. Yamanashi1, K. Nagashima1, R. Onishi1, H. Nishimura2, T. Ito2, S. Furukawa2, A. Maemoto2, N. Sakamoto1

1Hokkaido University Hospital, Department of Gastroenterology, Sapporo City- Hokkaido, Japan, 2Sapporo Higashi Tokushukai Hospital, Inflammatory Bowel Disease Center, Sapporo City- Hokkaido, Japan

Background

Zinc deficiency is common in patients with inflammatory bowel disease (IBD), and the frequency is about 42.1% in Crohn’s disease (CD) and 38.5% in ulcerative colitis (UC). Patients with IBD with serum zinc deficiency are more likely to have adverse disease-specific outcomes. However, there are few studies about the effect of administering zinc preparations in IBD patients with zinc deficiency. The purpose of this study was to investigate the efficacy of zinc acetate hydrate (Nobelzin®︎) preparation for patients with IBD with zinc deficiency.

Methods

56 IBD patients who were treated with Nobelzin®︎ for zinc deficiency from March 2017 to November 2019 were analyzed. We conducted a multicenter retrospective observational study to investigate changes in serum zinc concentration or changes in disease activity before and after administration and their contributing factors.

Results

Among 56 cases, 4 cases were excluded due to self-interruption of internal use, and 52 cases (39 cases of CD, 13 cases of UC) were included. The median observation period was 27.5 (13–47) weeks, the median serum zinc concentration before administration was 58.5 (50.8–65.3) μg/dl, and the average of starting dose of Nobelzin®︎ was 67.8±31.1 mg/day. Nobelzin®︎ administration normalised serum zinc concentration(Zn ≥80 μg/dl) in 94.2 % (49/52) of patients. The median administration period required for normalisation of serum zinc concentration was 5 (3–8) weeks. In the group of CD patients who achieved zinc normalisation, the median CDAI score significantly improved after the normalisation from 171.5 to 129.5 (p < 0.001). Similarly, the partial Mayo score in the same group of UC significantly improved after the normalisation (p = 0.035). There were 77.6 % patients who did not have additional treatment without Nobelzin®︎ administration until zinc was normalised. In CD patients of this group, the median CDAI score significantly improved after the normalisation from 152 to 120 (p = 0.029). All 3 cases in which zinc normalisation was not achieved within the observation period were CD cases, and they had a history of multiple surgeries, changes in biologics, or a long medical history. In one patient, side effects of Nobelzin®︎ administration were observed and these were abdominal discomfort and nausea. During the observation period, serum copper concentration was measured in 27 patients after administration of Nobelzin®︎, and one patient presented with copper deficiency.

Conclusion

Our findings show that administration of zinc acetate hydrate preparations may be effective in improving zinc deficiency and contribute to improve disease activity in IBD patients with zinc deficiency.