UEGJournal Abstracts 2021 - 521

IBD
P0430
AGE MAY NOT IMPACT BIOLOGIC TREATMENT FAILURE AT 12 MONTHS
FOR INFLAMMATORY BOWEL DISEASE: A REAL LIFE RETROSPECTIVE
SINGLE CENTRE COHORT STUDY
S. Sethi1, J. Patel1, J. Bruce2, D. Dhafer1
S. Verma1, A. Thompson1
H. Padmanabhan1
, M.J. Brookes1
1The Royal Wolverhampton NHS Trust, Gastroenterology,
Wolverhampton, United Kingdom, 2University of Birmingham,
Birmingham, United Kingdom
Contact E-Mail Address: jxb1196@student.bham.ac.uk
Introduction: Evidence of age-related treatment failure with biologics for
moderate-severe inflammatory bowel disease (IBD) is limited. Previous
studies have suggested a higher failure risk for Adults > 60 years, but research
is limited to anti-TNFα agents. Newer biologics are revolutionising
treatment for Adults with IBD, but to date treatment failure or intolerance
in the >60 age group is poorly understood.
Aims & Methods: RAB-IBD (Retrospective analysis of biologic treatment
failure in IBD) at The Royal Wolverhampton NHS Trust, is a real-life, longitudinal
retrospective single-centre study comparing failure rates for biologics/biosimilar
agents. These include anti-TNFα's (infliximab, adalimumab,
golimumab), integrin-inhibitors (vedolizumab), interleukins-inhibitors
(ustekinumab) and JAK-inhibitors (tofacitinib). The primary outcome
was to evaluate whether treatment failure at 12 months was impacted by
age (>60s versus <60s). The secondary outcomes were to analyse if failure
to complete 12 months of biologic therapy were a result of the; type of biologic
used, use of any concomitant drugs, patients being a primary nonresponder
or secondary non-responder, adverse effects/intolerance, or a
combination of other demographic factors. Treatment failure was defined
as failure to complete 12 months of biologics.
We identified a total of 632 patients from the Trust IBD database, who were
initiated on biologics from January 2015 to December 2019. Of which, 465
matched our inclusion and exclusion criteria. Baseline characteristics,
such as gender, biologic, type of IBD and number of biologics used previously,
were matched to produce two cohorts, each of 98 participants
comprising the 'over 60s' and 'under 60s'. Other measurements taken
at baseline of starting the therapy included use of concomitant therapy
and severity score. At 12 months, indices of flare severity (CRP and faecal
calprotectin) were looked at, as well as whether the biologic was discontinued
and assessing poor outcomes (adverse effects, hospitalisation or
need for emergency surgery.
Results: Adverse effects, hospitalisation and need for emergency
surgery was seen in 5.1% of under 60s (n=5) and 13.3% of over 60s
(n=13). There was no significant difference in the proportion of patients
who failed to complete 12 months of biologic treatment from the over
60s (n=20, 20.4%) versus the under 60s (n=12, 12.2%) (OR 1.838, p=0.126).
A larger proportion of biologic failure was seen in those on anti-TNFα
(n=21,18.1%) vs. non-anti-TNFα biologics (n=10,12.5%), but this was not
significant (OR 2.35, p=0.051). IBD type (Crohn's vs. Colitis) was not a predictor
of biological failure (OR 1.856, p=0.176), nor was previous biologic
use (OR 0.644, p=0.118); concomitant thiopurines/methotrexate (OR 0.46,
p=0.134); co-morbidities (OR 0.834, p=0.752); smoking status (OR 0.956,
p=0.888); severity score (OR 0.939, p=0.420); baseline CRP (OR 1.024,
p<=0.250); faecal calprotectin (OR 1.00, p=0.746). Comparing demographics,
the risk of biological failure at 12 months was greater in women than
in men (OR 2.5, p=0.023).
Conclusion: Age is not an independent predictor of pooled biological
failure at 12 months post-initiation. This finding may be factored in when
personalised treatment approaches are sought for patients in their over
60s who are not respondent to conventional therapy. The risk of biological
Vol. 9 | October 2021
, P. Nightingale2
, M. Suleman1
, S. Menon1
,
,
P0431
TASTY&HEALTHY IS A DIETARY APPROACH FOR INDUCING AND
MAINTAINING REMISSION IN CROHN'S DISEASE: A PROSPECTIVE
CASE SERIES
L. Plotkin1
, Y. Aharoni1
R. Lev-Zion1, O. Ledder1, R. Reifen2
, D. Fenster1, G. Focht1
, D. Turner1
, E. Orlanski-Meyer1
1Shaare Zedek Medical Center, The Juliet Keidan Institute of
Pediatric Gastroenterology and Nutrition, Jerusalem, Israel,
2
The Hebrew University of Jerusalem, The School of Nutritional
Sciences, Rehovot, Israel
Contact E-Mail Address: luba.paust@gmail.com
Introduction: Exclusive enteral nutrition (EEN) is highly effective in inducing
remission in Crohn's disease (CD), especially in children, but it is
challenging to implement. " Tasty&Healthy " (T&H) dietary approach is a
liberal diet that avoids pro-inflammatory ingredients. Allowed foods are
not structured and no liquid formula is needed. In this prospective pilot
case-series we aimed to explore the effectiveness of the T&H approach.
Aims & Methods: An eight-week T&H dietary intervention was offered to
children and young adults with mild-moderate CD or those in clinical remission
but with evidence of endoscopic inflammation.
Patients received dietary guidance by the study dietitian before and
throughout the 8-week intervention period. Nutritional and explicit clinical
data were collected at baseline, week 4, and week 8 with additional
weekly phone visits to ensure adherence. Fecal calprotectin (FC) was measured
using home kits at baseline (BL), weeks 2, 4, 6, and 8.
Results: Six patients were enrolled (mean age 15.4±4.9 years, age range
7-23 years, median disease duration 16.8 months [IQR 1.2-50.8], 50%
females, 3/6 patients received anti-TNF). One patient was withdrawn at
week 6 due to disease worsening and his data are imputed using last observation
carried forward approach. Except for one patient, FC improved
during the intervention and 2/6 patients normalized their FC levels to <150
μgr/gr (table 1). 5/6 patients were in clinical remission at week 8 as defined
by wPCDAI<12.5, including the two with low wPCDAI at baseline (table 1).
FC at
Patient Age
1
2
3
4
5
6
7.73
Baseline
(µgr/gr)
100
14.33 1192
16.73
14.91
22.84
16.65
272
362
234
938
FC at
week 2
(µgr/gr)
613
257
70
158
207
769
FC at
week 4
(µgr/gr)
592
1015
70
456
378
488
FC at
week 6
(µgr/gr)
203
361
539
435
416
484
average
FC week
8 (µgr/gr)
344
361
111
166.5
132
238
Wpcdai
baseline
20
15
20
15
7.5
Wpcdai
week 4
20
7.5
22.5
10
12.5
Table 1. FC (μg/g) and wPCDAI over 8 weeks of dietary intervention
Conclusion: The Tasty&Healthy dietary approach may be effective for inducing
clinical and endoscopic response in mild-moderate CD by avoiding
pro-inflammatory and processed ingredients. Two randomized controlled
trials are currently ongoing to assess the effectiveness of this approach.
Disclosure: Nothing to disclose.
Wpcdai
week 8
10
7.5
10
15
7.5
,
failure is higher in women at 12 months. However, more research is required
in a higher-powered study to investigate whether treatment failure
is influenced by various demographic factors and by biologic type.
Disclosure: No conflict of interest to disclose.
521
UEGJournal Abstracts 2021

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