P212 - Infliximab as a treatment for ulcerative colitis – 3½ years experience in a district general hospital

S94 Results: two weeks later, we started azathioprine as maintenance therapy. Oral prednisone was tapered after 2 months, instead cyclosporine was tapered after 4 months and the patient was maintained on oral 5-ASA and azathioprine 2 mg/kg/day. Five years have elapsed and up to date MS and UC are well controlled by azathioprine and she has had no recurrence of both diseases confirmed by MRI and colonoscopy respectively. The patient EDSS still remains stable on 6.5 but she has regained urinary control. Conclusion: Patients with IBD have an increased risk for developing MS. In our patient MS preceded the development of UC by approximately 9 years. The progressive course of MS subsequently complicated with severe UC, shows that probably there are common genetic or environmental factors contributing to the development of these diseases, in their heterogeneous phenotypes, that have not been identified yet. P211 Efficacy of adalimumab in paediatric Crohn’s disease patients naive to other anti-TNF treatments J. Martín de Carpi1 *, N. Pociello2 , S. Pinillos1 , K. Ch´ avez1 , P. Vilar1 , V. Varea1 . 1 Hospital Sant Joan de D´ eu, Barcelona, Spain, 2 Hospital Arnau de Vilanova, Barcelona, Spain Background: Adalimumab is a fully-humanized anti-TNF a antibody that has showed its efficacy in Crohn’s disease (CD) adult patients. Its less immunogenic composition seems to be an important advantage compared to previous anti-TNF, mainly infliximab. Good response to adalimumab has been reported in patients naive to infliximab, in those in whom infliximab has shown no efficacy and in those intolerant or who have lost previous response to it. Although adalimumab has shown also its efficacy as second-line anti-TNF in small series of paediatric CD, data regarding its use in children naive to infliximab are lacking. Aim: To report our experience with adalimumab as first line anti-TNF treatment in paediatric CD. Patients and Methods: Three CD paediatric patients previously naive to infliximab have received adalimumab. Mean age at diagnosis: 13 years, 4 months. All the patients were started on exclusive enteral nutrition (EEN) with a polimeric diet for 8 weeks, combined with azathioprine at diagnosis. EEN was effective in all our patients, who entered in remission and were kept on maintenance treatment with AZA. Two patients presented with exacerbation of their clinical manifestations 5 months after finishing EEN. A top-down strategy was then decided, starting subcutaneous adalimumab at decreasing loading doses (160 mg and 80 mg two weeks after) and then 40 mg subsequently every two weeks, combined with AZA. The second patient relapsed after a one year-long maintained remission. He started a new regimen of EEN without showing efficacy. Adalimumab at 160 80 mg at induction and 40 mg every two weeks as maintenance, was started. Results. The three patients entered in remission after the first dose of adalimumab (mean previous PCDAI: 35, mean PCDAI after first dose: 4). In order to minimize possible risks of intensive immunomodulation, AZA was stopped after 4 months of combination therapy, without changes in the clinical situation of the patients. All the three patients remain in remission after 8 months of follow-up on monotherapy with adalimumab. Conclusion: Adalimumab has shown its efficacy in our paediatric CD patients naive to other anti-TNF drugs. The early introduction of anti-TNF antibodies in the treatment regimen of these patients (top-down strategy) could help to a better control of this chronic disease. Change to monotherapy after succesful combination therapy with AZA and adalimumab is a safe strategy that can help to minimize possible risks of intensive immunomodulation.

Poster Presentations P212 Infliximab as a treatment for ulcerative colitis 3 12 years experience in a district general hospital K. Taylor *, A.W. Harris. Kent & Sussex Hospital, Tunbridge Wells, United Kingdom Introduction: Ulcerative colitis (UC) is a chronic relapsing & remitting inflammatory disease characterised by colonic mucosal ulceration. Current medical therapy involves mesalazines, thiopurine analogues & steroids. Infliximab (IFX) a chimeric monoclonal antibody against tumour necrosis factor a is an established treatment for Crohn’s disease but its efficacy in UC is less clear. We report our experience with IFX in patients with moderate & acute severe UC since May 2005. Method: Retrospective analysis of case notes of all patients treated with IFX for biopsy-proven UC according to the ACT protocol [1]. Patient details: All patients treated with infliximab had moderate (14) or acute severe (2) UC. Prior treatment with thiopurines, mesalazines and steroids (and in 2 cases, iv ciclosporin) had failed to induce remission, or was stopped because of adverse reactions or intolerable side effects. All patients underwent a flexible sigmoidoscopy following induction treatment to assess mucosal healing before starting maintenance therapy. Results: 16 patients received IFX (8M; ages 18 69 yr). 15 patients completed induction phase (1 went for emergency colectomy after second dose of IFX). 3 patients failed to respond to induction treatment (persisting symptoms & active disease at endoscopy; underwent surgery). Of the remaining 12 patients, 11 remain in clinical and endoscopic remission & receive 8 weekly infusions of IFX (duration of treatment 6 40 months). All 5 patients who failed treatment (1 patient after 40 months treatment) underwent colectomy. Two patients required an increase in dose of IFX to 10 mg/kg after clinical relapse before returning to standard maintenance therapy; 1 of these relapsed again & had colectomy. None of the patients stopped treatment due to side-effects or adverse events. Conclusion: Our findings support the use of IFX in selected patients with moderate or acute severe UC in a DGH with 12 of 16 patients demonstrating clinical & endoscopic response for up to 40 months. Reference(s) [1] Rutgeerts P, Sandborn WJ, Feagan BG et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005; 353: 2462 76. P213 Concurrence of inflammatory bowel disease and multiple sclerosis in general population: frequency, phenotypes and clinical course G. Buzaglo, J. Salleron, C. Gower-Rousseau *, N. Waucquier, F. Gonzalez, G. Vernier-Massouille, A. Cortot, P. Vermersch, J.F. Colombel. CHRU Lille, Lille, France Aims: To report in general population of Northern France the frequency of the concurrence of inflammatory bowel disease (IBD) and multiple sclerosis (MS) and to describe their phenotypes at diagnosis and at maximal follow-up. Patients and Methods: In a retrospective study, concurrent cases of IBD and MS were identified through the crossing of EPIMAD Registry (incident population-based study on IBD) and the Northern Neurology Network. We compared the observed number of associated IBD/MS cases to expected number, using a prevalence of 120 for MS [1] and 336 for IBD [2]. IBD phenotype was classified according to Montreal. MS phenotype was classified in 3 forms: relapsing remitting (RR), secondary progressive (SP) and primary progressive (PP). MS disability was evaluated using Kurtzke Expanded Disability Status Scale