P671 Natural history and clinical outcomes of patients with ulcerative colitis who are intolerant to 5-aminosalicylic acid agents: A multi-centre cohort study
A. Madarame1, H. Kinoshita1, T. Yamaguchi1, Y. Izumi1, Y. Nishikawa1, S. Shonai1, M. Tatsuno1, Y. Ishii1, K. Yaguchi1, Y. Nakamori1, A. Ikeda1, K. Araki1, A. Hirayama1, T. Ogashiwa1, A. Fuji1, R. Suzuki2, H. Kimura1, R. Kunisaki1
1Yokohama City University Medical Centre, Inflammatory Bowel Disease Centre, Yokohama, Japan, 2Kannai Suzuki Clinic, Inflammatory Bowel Disease Centre, Yokohama, Japan
Background
Five-aminosalicylic acid (5-ASA) compounds are used as the primary treatment for ulcerative colitis (UC); however, some patients are intolerant to this drug. There have been few studies on the natural history and clinical outcomes of 5-ASA intolerant patients. The aim of this study was to elucidate the clinical outcomes of 5-ASA intolerant patients in terms of colectomy, immunomodulator use, and biologic (anti-tumour necrosis factor (TNF) and Vedolizumab) therapy.
Methods
Data were obtained by a retrospective review of the charts of 2065 consecutive patients with UC who were treated with 5-ASA compounds at our tertiary referral inflammatory bowel disease (IBD) centre and a related IBD clinic from 2010 to 2020. Patients were considered to be intolerant to 5-ASA if they discontinued the drug because of any type of adverse effect. The cumulative rates of immunomodulator-, biologic- and colectomy-free survival rates in 5-ASA tolerant and intolerant patients were calculated using the Kaplan–Meier method. Additionally, Cox regression was used to analyse other factors besides 5-ASA intolerance contributing to clinical outcomes.
Results
Intolerance to 5-ASA was identified in 268 patients. The cumulative probability of colectomy within 10 years in 5-ASA intolerant patients was 23%, which is significantly higher than that in tolerant patients, 10% (log-rank test < 0.0001). Within 10 year, 63% of 5-ASA intolerant and 20% of tolerant patients received immunomodulators (log-rank test < 0.0001); and 37% of 5-ASA intolerant and 11% of tolerant patients received biologic therapy (log-rank test < 0.0001). Cox regression multivariate analysis identified that younger age, disease extent and 5-ASA intolerance were predictors of colectomy.
Conclusion
In this retrospective cohort study, 5-ASA intolerant patients had worse clinical outcomes than those who tolerated 5-ASA treatment. This is the first report on the long-term prognosis of 5-ASA intolerant patients.