Azathioprine and infliximab effectiveness in refractory Crohn’s disease (DC)

S300

Abstracts

AJG – Vol. 96, No. 9, Suppl., 2001

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Azathioprine and infliximab effectiveness in refractory Crohn’s disease (DC) Fernando Magro1, Mario Dinis-Ribeiro1, Nuno Mesquita1, Manuel Correia1 and Antonio Tome-Ribeiro1*. 1Gastrenterology, Hospital de S. Joa˜ o, Porto, Portugal.

Preoperative azathioprine/6-mercaptopurine use is not associated with increased complications following proctocolectomy and ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC) Uma Mahadevan MD1, Edward V Loftus MD2, William J Tremaine MD2, J ohn H Pemberton MD2, Scott W Harmsen MS2, Cathy D Schleck2, Alan D Zinsmeister PhD2 and William J Sandborn MD FACG2*. 1Gastroenterology, UCSF, San Francisco, CA; and 2 Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Purpose: Evaluation of AZA and Infliximab effectiveness in refractory CD. Methods: Two-hundred and fifty files of CD patients were analyzed. Forty-seven patients (19%), 19 (40%) males and 28 (60%) females, with a median age of 31 years (15–57), were treated with AZA (median dose ⫽ 2,27 mg/kg/day). Nineteen (40%) were also treated with infliximab (5mg/ kg). Effectiveness end-points assessed : remission, reduction in steroids dose, Bradshaw index, perianal disease activity index (PDAI); fistulae closure; and quality of life (IBDQL). Results: Table Conclusions: Azathioprine and infliximab were effective in remission induction in chronic active and penetrating refractory disease, with a significant steroids dose reduction and an improvement in patients quality of life. AZA Steroids-dependency Steroids dose after AZA (mg) Steroids reduction with AZA (mg) Perianal penetrating disease Remission PDAI reduction (median (m-M)) Fistulae closure IBDQL (median (m-M)) Chronic Active Disease Remission Bradshaw Index reduction (median (m-M)) IBDQL (median (m-M))

44% 10 (5–10) 15 (10–25) 41% 48%

15% 63%

Infliximab

80% 75% 3,5 (0–10) 25% 199 (89–224) 20% 73% 9 (5–15) 203 (142–207)

951 Multiple prothrombotic abnormalities in patients with inflammatory bowel disease (IBD) Fernando J Magro1, Mario J Dinis-Ribeiro1, Fernando Araujo2, M Fraga2, Nuno Mesquita1, Luis Cunha-Ribeiro2 and Antonio TomeRibeiro1*. 1Gastrenterology, Hospital de S.Joa˜ o, Porto, Portugal; and 2 Transfusion Medicine and Blood Bank, Hospital de S.Joa˜ o, Porto, Portugal. Purpose: To determine the prevalence of multiple prothrombotic abnormalities in IBD patients with active and inactive disease. Methods: Transversal study in 116 patients and 141 randomly assymptomatic blood donors. Coagulation factors assessed: Protein C, Protein S, Anti-thrombin III, homocystein, anti-cardiolipin antibodies (aCL IgG and IgM), Activated protein C resistance, Fibrinogen and Lupic anticoagulant. Genetic abnormalities of Factor V Leiden, Prothrombin 20210 variant, MTHFR C677T, ACE, PAI and Factor XIII were determined. Results: Patients had a higher prevalence of single prothrombotic abnormalities: 35 vs 19% (p ⬍ 0,001). Abnormalities with statistically significant differences were protein S (4 vs 0%), aCL IgG (8 vs 0%) and fibrinogen (28 vs 2%). The mutated allele frequency was statistically different (median ⫽ 3 in IBD patients vs 0, p ⬍ 0,001), although the prevalence of high risk mutations was similar. Fourty four percent of IBD patients had two or more prothrombotic alterations (vs 8%; p ⫽ 0,021). Disease activity (19%) was not related to prothrombotic alterations prevalence. Conclusions: Multiple prothrombotic abnormalities were more frequent in IBD patients, independently of disease activity, and could explain a hypercoagulate status in these patients.

Purpose: To determine whether patients receiving azathioprine (AZA) or 6-mercaptopurine (6-MP) within 7 days of colectomy and IPAA have higher rates of short-term complications (within 30 days) than patients who did not receive AZA/6MP. Methods: 216 unselected patients who underwent IPAA between 19971999 were identified. 7 patients were disqualified for prior colectomy. The medical records of the remaining 209 patients were reviewed to determine demographics, body mass index (BMI), extent and duration of UC, dose and duration of AZA/6-MP, dose and duration of steroids, albumin, and Truelove/Witts score. Short-term complications of mortality, anastomotic leak, wound dehiscence, pelvic sepsis, perianal fistula/abscess, anastomotic stricture, small bowel obstruction (SBO), and infections (urosepsis, pneumonia, bacteremia) were identified. Immunosuppressive use was coded as none, AZA/6-MP within one week of surgery or cyclosporine(CSA)/ methotrexate(MTX) within one month of surgery. A logistic regression analysis assessed the association between these variables and postoperative complications. Results: Table. All patients had 30-day follow-up. There were no deaths. Complications occurred in 49/151 (32%) patients in the no immunosuppressives group, in 12/46(26%)patients with recent use of AZA/6-MP, and in 4/12(33%) patients on CSA/MTX (p ⫽ 0.75). No significant associations with individual types of complications were detected. IV or oral steroids ⱖ 40 mg (p ⬍ 0.01) and severe or fulminant disease by Truelove/Witts Criteria (p ⫽ .0094) were associated with a higher complication rate. Patient age, extent of disease, albumin level, and BMI were not significantly associated with greater complications. Conclusions: Complications after IPAA for ulcerative colitis are associated with use of high dose steroids and severity of disease but not with the use of AZA/6MP. N Median Age Male:Female Indication Median Duration UC Extent UC Truelove Witts Criteria Steroids Preoperatively

209 36 [8–68] 120:89 Refractory 172; Dysplasia 36 5 years [1–34] 11 proctitis; 41 left sided; 157 pancolitis 70 mild; 75 Moderate; 56 Severe; 8 fulminant 39 IV, 115 PO, 55 none

953 Safety of selective cyclooxygenase-2 inhibitors (COX2-I) in inflammatory bowel disease (IBD) Uma Mahadevan MD1, Edward V Loftus MD2, William J Tremaine MD2 and William J Sandborn MD FACG2*. 1Division of Gastroenterology, UCSF, San Francisco, CA; and 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. Purpose: Nonsteroidal antiinflammatory drugs (NSAIDS) are relatively contraindicated in patients with IBD for fear of disease aggravation. This recommendation is based on uncontrolled and inconsistent data. COX-2I have fewer gastrointestinal side effects than traditional NSAIDS in nonIBD patients. We report the safety of COX-2I in IBD. Methods: Patients with Crohns disease (CD), ulcerative colitis (UC), or pouchitis (PS) who used celecoxib or rofecoxib were identified from computerized prescription records of 4 physicians at one institution. A retrospective chart review was conducted to determine disease type, duration, and extent. Concomitant medications, past NSAID use, indication for