The Best of IBD at UEGW (Crohn s)

Transcription

1 The Best of IBD at UEGW (Crohn s) Iyad Issa MD Head of Gastroenterology, Rafik Hariri Univ Hosp Adjunct Faculty, School of Medicine, Leb Univ Founding Faculty, School Of Medicine, Leb Am Univ 1

2 The Best of IBD at UEGW (CD) DIAGNOSIS 2

3 Hi Calprotectin in presence of normal Colono!! P1441 CALPROTECTIN PREDICTS RELAPSE OF IBD EVEN IN THE PRESENCE OF A NORMAL COLONOSCOPY AIMS & METHODS: Retrospective data was collected for consecutive patients with IBD on stable therapy undergoing colonoscopy for disease assessment. FCALP (ELISA) was collected as close as possible to the colonoscopy. When the appearance reported as normal --- patients F/U 12 months 83 patients Median calprotectinlevel in hi grp : 377 (UC) & 192 (CD) CD, 45% Remission Normal CALP High CALP CD 50% 88% UC, 55% UC 14% 66% CONCLUSION: Elevated levels of FCALP predict relapse even in the presence of a macroscopically normal colonoscopy. It may provide a cheaper and acceptable alternative to routine monitoring endoscopy in IBD

4 Does Calprotectinlevel rise in pregnancy?? P1449 PREGNANCY DOES NOT AFFECT FECAL CALPROTECTIN CONCENTRATIONS IN HEALTHY PREGNANT WOMEN AIMS & METHODS: The aim of this study was to determine fecal CP concentrations in healthy non-pregnant and pregnant women and in patients with IBD. Blood and stool samples were obtained from every patient to determine C- reactive protein (CRP) and fecal CP levels. Inactive IBD, 22% Active IBD, 39% Planning, 18% Pregnant, 20% 103 patients o Mean fecal CP and CRP levels were 32.4 mig/g and 6.5 mg/l in pregnant women. o Fecal CP sig higher in both active and inactive IBD compared to pregnant women (p<0.001, p=0.001) and also to those waiting for IVF (p<0.001, p=0.001). CONCLUSION: Since fecal CP levels did not change during pregnancy, it seems to be useful noninvasive diagnostic tool in pregnancy and maybe beneficial in the future for monitoring disease activity in pregnant patients suffering from IBD

5 Is there a way to check for fibrosis in IBD strictures?? P0300 ULTRASOUND BASED REAL TIME ELASTOGRAPHY RELIABLY IDENTIFIES FIBROTIC GUT TISSUE IN PATIENTS WITH STRICTURING CROHN S DISEASE (GUT-RTE) Real time ultrasound elasticity (RTE) imaging has not been systematically developed yet to evaluate the viscoelastic properties of the human gut in vivo. Prospective, controlled and partially blinded study unaffected and affected gut segments of 10 CD patient examined pre-, intra-and postoperatively with ultrasound including real time elastography(rte) to assess strain CONCLUSION: RTE allows bedside assessment of gut tissue mechanical properties in CD. 0 STRICTURE NONE RTE

6 Can we select patients for Rx with IFX?? P0314 MEAN PLATELET VOLUME AND NEUTROPHIL-TO LYMPHOCYTE RATIO AS NEW BIOMARKERS OF SUSTAINED RESPONSE TO INFLIXIMAB THERAPY IN CROHN S DISEASE PATIENTS The neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) may be used as cost-effective biomarkers of subclinical inflammation during 52-week IFX therapy in CD patients responding to induction treatment. AIMS & METHODS: NLR or MPV at baseline and pre-infusion at week 14 are good predictors of sustained response after week 14 in CD patients undergoing 52-week IFX therapy 30 adult patients with CD, who underwent a 52-week course of treatment with IFX and achieved response to induction treatment evaluated at week 14 were enrolled to the study.

7 Can we select patients for Rx with IFX?? RESULTS: Fifteen of CD patients (50%) have not reached full one year maintenance IFX treatment without loss of response Placebo CD Relapse Remission MPV NLR MPV Wk 14 NLR Wk 14 NLR Wk NLR < 3.7 & MPV > 10.3 at wk 14 predicts sustained response w 67% sensitivity and 80% specificity It can be suggested that NLR and MPV may serve as good predictors of sustained response to IFX maintenance treatment in CD patients.

8 Can we predict post-op recurrence in CD?? P0924 FACTORS AFFECTING THE INCIDENCE OF AN EARLY ENDOSCOPIC RECURRENCE AFTER ILEOCOLONIC RESECTION FOR CROHN S DISEASE: A MULTICENTRE STUDY AIMS & METHODS: Evaluate risk factors for an endoscopic recurrence after ileocolonic resection for CD for 12 months Retrospective, international multicentre study. 7 IBD referral centres from 3 countries (Japan, Brazil, Italy) 127 patients Endoscopic recurrence was defined as a Rutgeerts score of > i2. Recurrence Yes, 34% No steroids Previous steroids No, 66% Univariate analysis 27% 47% CONCLUSION: This study failed to find any significant factors associated with an endoscopic recurrence after ileocolonic resection for CD. However, prospective studies are necessary to precisely evaluate the impact of perioperative medications on an early endoscopic recurrence.

9 The Best of IBD at UEGW (CD) TREATMENT 9

10 Can we D/C AZA in CD patients on remission?? P0885 WITHDRAWAL OF AZATHIOPRINE IN PATIENTS WITH CROHN S DISEASE IN STABLE CLINICAL REMISSION: A DOUBLE-BLIND, PLACEBO-CONTROLLED 2 YEARS TRIAL AIMS & METHODS: Evaluate the efficacy of AZA therapy for more than 4 years to maintain clinical remission. R D B P C --- AZA withdrawal trial with a F/U period of 24 months. CDAI <150 at baseline. Randomized to continue on AZA (n=26) or switch to plb (n=26) The primary endpoint was time to clinical relapse during F/U. TIME TO CLINICAL RELAPSE Remission Plb AZA Plb AZA Plb, m AZA, m CONCLUSION: In patients with clinically inactive CD on maintenance therapy with AZA for > 4 years, D/C of AZA resulted in a numerically higher relapse rate compared to further Rx.

11 Is adding AZA helpful when failing IFX?? P1489 INTEREST OF COMBINATION THERAPY WITH IMMUNOSUPPRESSIVE TREATMENT IN IBD PATIENTS IN LOSS OF RESPONSE TO INFLIXIMAB AND EXHIBITING VERY HIGH ANTI-INFLIXIMAB ANTIBODY (ATI) LEVELS AIMS & METHODS: Prospective cohort of patients with IBD (15) All receiving IFX as monotherapy at the dose of 5mg/kg. Undetectable IFX levels and high levels of ATI (> 200 ng/ml) ELISA Fecal calprotectin > 450 mg/g of stools and/or endoscopic Mayo Score=2. IS was added to the prescription of IFX, for a minimum period of 6 months IFX level Pre-AZA Post-AZA ATI level Pre-AZA Post-AZA o 8 patients out of 15 exhibited IFX levels >1.5 mg/ml & ATI < 20ng/mL o 7 of the 13 patients in relapse on inclusion were in clinical remission at 6 months & normal fecal calprotectin values CONCLUSION: The addition of IS in patients relapsing during IFX treatment and having high ATI levels lead to remission in 54% of cases as evidenced by clinical, pharmacological and biomarker data.

12 Do biologics work on the long term for CD?? P0918 LONG TERM OUTCOMES OF ANTI-TNF THERAPY FOR FISTULISING PERIANAL CROHN S DISEASE AIMS & METHODS: Clinical and radiological outcomes of biological therapy on CD patients. 173 consecutive patients with Crohn s disease between 2005 and Median F/U of 52 months Demographics Both, 33% Setons 51% Thiopurines 58% ADA, 6% IFX, 61% Complex 68% Simple 32%

13 Do biologics work on the long term for CD?? Remission Response Relapse Clinical 12% 32% 74% Radiologic 5% 14% 68% Factors influencing the time to clinical response: Fistula duration (p=0.03) Concomitant use of immuno-modulators (p=0.02). CONCLUSION: ¾ of patients with fistulising perianal Crohn s disease had clinical response to biological therapy, whereas 2/3 had a radiological response.

14 Any difference between ADA & IFX for Rx of perianal CD?? AIMS & METHODS: Compare outcomes of CD patients with perianal fistulising disease Rxed with IFX or ADA. Retrospective medical record review. Fistulas assessed using MRI, and seton placement when appropriate. 36-month follow-up was performed. RESULTS: 20 CD patients were treated (9 with IFX and 11 with ADA). Seton placement was performed in 18 patients (8 in IFX and 10 in ADA group). ADA IFX Total Complete response 73% 75% 78% CONCLUSION: Efficacy of IFX and ADA was similar in treating perianal fistulising CD patients

15 Is monitoring vitals useful in IFX infusion?? P0338 MONITORING VITAL SIGNS DURING INFLIXIMAB INFUSION IS IT REALLY USEFUL? AIMS & METHODS: Usefulness of monitoring vital signs during IFX infusions. Jan 2013 to Dec 2013, each patient s HR, SBP, Temp and SpO2 were registered during Infliximab infusions. Acute adverse reactions were also recorded. No Rxn Rxn IFX INFUSIONS Rxn, 13, 2% Temp No Rxn, 580, 98% SpO2 sbp HR CONCLUSION: Scheduled monitoring of vitals during IFX infusions was unable to predict acute rxns or identify patients at increased risk of such rxns

16 Use IFX in setting of intra-abdominal abscess?? P0892 INTRA-ABDOMINAL ABSCESSES IN CROHN S DISEASE: OUTCOMES FOLLOWING INFLIXIMAB THERAPY AIMS & METHODS: Retrospective review records of all CD patients at Mount Sinai Medical Center in (NY), between 2000 and 2013, with an intraabdominal abscess treated with IFX to evaluate its safety and efficacy Phlegmo n, 4, 22% Abscess, 14, 78% ( RESULTS: All patients were treated with broad spectrum antibiotics. No complications following infliximab therapy. None required a surgical drainage 4 patients required abscess drainage by interventional radiology. CONCLUSION: Penetrating CD complicated by intra-abdominal abscess formation may be safely and effectively managed with a combination of antibiotics and IFX therapy without drainage. Prospective trials are required to confirm these findings.

17 ADA standard vs adjusted dosing in CD?? P0889 CLINICAL BENEFIT OF ADALIMUMAB DOSE ADJUSTMENT FOR PATIENTS WITH MODERATELY TO SEVERELY ACTIVE CROHN S DISEASE IN EXTEND AIMS & METHODS: The clinical outcomes of dose escalation in patients enrolled in the EXTEND trial are evaluated

18 ADA standard vs adjusted dosing in CD?? P0889 CLINICAL BENEFIT OF ADALIMUMAB DOSE ADJUSTMENT FOR PATIENTS WITH MODERATELY TO SEVERELY ACTIVE CROHN S DISEASE IN EXTEND 27 pts (42%) OL 64 pts DB EOW, 12, 44% EW, 15, 56% RESULTS: CONCLUSION: Escalation to weekly ADA dosing demonstrated clinical benefit in patients who met protocol criteria for dose escalation. No new safety risks were observed with EW ADA dosing.

19 The Best of IBD at UEGW (CD) Iyad Issa MD THANK YOU! 19