P678 Effect of accelerated infliximab induction on short-term outcomes of paediatric acute severe ulcerative colitis
M.B. Coronel-Arismendi, G. Pujol Muncunill, B. Minguez-Rodríguez, S. Feo-Ortego, L.N. Guevara-Caviedes, V. Vila-Miravet, F.J. Martin De Carpi
Hospital Sant Joan de Déu, Unit for the Comprehensive Care of Pediatric Inflammatory Bowel Disease, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Esplugues de Llobregat, Spain
Background
Due to a higher inflammatory burden and a rapid clearance of infliximab (IFX) in Acute Severe ulcerative colitis (ASUC), the accelerated IFX induction may be considered (IFX up to 10 mg/kg per dose, at week 0, 1 and 4–5) in those patients who need to start second-line treatment. The aim of our study is to describe the short-term outcomes of ASUC pediatric patients who have received an accelerated IFX induction regimen in our Unit.
Methods
In a retrospective study we collected data from patients with ASUC who received treatment with accelerated IFX induction. We analyzed demographic, clinical and analytical data as well as treatment adverse events from medical records. The short-term outcomes (at the end of the induction and at 3 months) were analyzed based in the Paediatric Ulcerative Activity Index (PUCAI)) and analytical parameters (haemoglobin, C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and albumin.
Results
Six patients with ASUC who received accelerated IFX induction were included (5 male; median age at diagnosis 10.5 years (IQR: 2–15); mean time from diagnosis to ASUC flare: 1.8 years (IQR: 0–9 years)). At disease onset, 5/6 patients presented with pancolonic involvement (E4) with an average PUCAI of 55 points. At ASUC flare all of them presented pancolonic involvement with a PUCAI over 65 points, 50% of them had anaemia, 66.6% elevation of inflammatory markers (CRP and/or ESR) and 50% hypoalbuminemia. The patients received an accelerated IFX induction with IFX at 10 mg/kg at 0, 1 and 4 - 5 weeks without adverse events. After accelerated IFX induction regimen 5/6 patients showed clinical response and normalisation of laboratory tests (haemoglobin, inflammatory markers and albumin). One patient presented treatment failure needing surgery (colectomy rate 16.6%). At 3 months follow-up, no new patients needed colectomy. One patient had an infusional reaction and was changed to Vedolizumab treatment maintaining remission, the other 4 patients were maintained on IFX treatment (1 clinical remission, 3 mild clinical activity). The overall colectomy rate after accelerated IFX induction remained in 16,6%.
Conclusion
In our cohort of ASUC patients treated with an accelerated IFX induction regimen we observed an 83.3% free colectomy rate at short-term, being this regimen a valid therapeutic option to avoid surgery. Prospective and comparative studies are needed to determine the efficacy of this strategy in reducing the colectomy rate, both in the short-and long-term follow-up.