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severe ulcerative colitis
S218 co-morbidities, disease severity, surgical operations, gender, steroid therapy and treatment response were related to VTE. Results: 2668/3049 (87.5%) patients were given prophylactic heparin. 66/3049 (2.2%) patients experienced VTE during their admission. The rate of VTE amongst heparinised patients, 2.2% (59/2668), did not differ significantly when compared to a rate of 1.8% (7/381) within the population who didn’t receive prophylaxis (p < 0.8). VTE was associated with surgery: 39.4% (26/66) of patients with VTE underwent surgery compared with surgery in 26.2% (781/2983) without VTE (P < 0.02). Of these 26 surgical patients within the VTE population, 4 of these patients’ VTE were post-operative. When patients undergoing elective surgery are excluded VTE is associated with co-morbidity: 46.0% (23/50) of the VTE population compared to 32.4% (810/2504) in the nonVTE population (p < 0.03). There was no association of VTE with disease severity or the use of steroids. Conclusions: Although there was no difference in the frequency of VTE in patients given or not given heparin the numbers of VTE within this group are small. This analysis does however demonstrate that patients with co-morbidity and those undergoing surgery are at higher risk of VTE. Additional measures to prevent VTE should be considered in these patients such as a combination of heparin and compression stockings. All IBD patients admitted to hospital should continue to receive prophylactic subcutaneous heparin. P519 Efficacy of Adalimumab in children and adolescents with moderate/ severe ulcerative colitis E. Volonaki1 *, M. Martins1 , L. Cococcioni1 , M. Malamisura1 , N. Shah1 , K. Lindley1 , F. Kiparissi1 , M. Elawad1 . 1 Great Ormond Street Hospital, Paediatric Gastroenterology, London, United Kingdom Background: Adalimumab is licensed for treating moderately to severely active ulcerative colitis (UC) in adults whose condition has responded inadequately to conventional therapy, but data on its role in paediatric UC are lacking. The aim of our study was to evaluate the efficacy of Adalimumab used as indicated above in children and adolescents treated in a single tertiary UK centre. Methods: All patients with UC who received Adalimumab between April 2008 and October 2012 in our hospital were identified. Clinical response and long term outcomes were assessed. Results: Ten patients (7 females) with median age 14 years (6.8y-16.6y) at the time of first Adalimumab injection were included in our study, with median follow up 1.9 years (1y3y). All patients had failed Infliximab after 6.5 months median duration of treatment (2 24 months). Three patients (3/10, 30%) showed sustained clinical response to Adalimumab with histological evidence of mucosal healing (follow up 16, 22 and 24months respectively). All three received concurrent treatment with Azathioprine or Methotrexate and one of them was successfully weaned off Adalimumab after 21 months, without relapse to date. For the remaining 7 patients, medical treatment was escalated with other immunosuppressive agents, with 4 of them ending up with colectomy (4/10, 40%). Conclusions: Adalimumab was efficacious in 30% of children and adolescents with moderate/ severe ulcerative colitis who failed Infliximab and should therefore be considered as treatment option in refractory disease in this age group.
Poster presentations P520 Efficacy and safety of leucocytapheresis for active inflammatory bowel disease during pregnancy: therapeutic outcomes in four pregnant cases H. Kinoshita1 *, R. Kunisaki1 , S. Tomohiko1 , H. Kimura1 , S. Maeda2 . 1 Yokohama City University Medical Center, Inflammatory Bowel Disease Center, Yokohama, Japan, 2 Yokohama City University, Department of Gastroenterology, Yokohama, Japan Background: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), affects patients who are in their reproductive age. The benefits of maintaining remission before and during pregnancy overweigh the risks of disease flare-ups and associated adverse effects of drug-based medications on the pregnancy outcome. Although most of the medications used to treat IBD appear to be safe during gestation, patients and their partners are still concerned about the influences of medications on fertility and pregnancy. Therapeutic leucocytapheresis is an alternative to conventional drug therapy. Here we report 4 cases of pregnant IBD patients safely treated with either leucocytapheresis (LCAP) or granulocyte/monocyte apheresis (GMA). Methods: Four pregnant IBD patients, three with UC and one with CD, were treated with therapeutic leucocytapheresis. One patient with UC was treated with LCAP and the other three were treated with GMA. One patient had contraindication to corticosteroids and the other three had corticosteroid refractory IBD. Anticoagulation during the procedure was achieved with heparin in three patients, and with nafamostat mesylate in one patient (LCAP). Results: All four patients responded to therapeutic leucocytapheresis. Two of the three patients with UC achieved steroid free remission before the delivery. Steroid dose was tapered to 5 mg/day in the other patient with UC. In the only CD patient, the symptoms improved, but were not sustained. All three patients with UC delivered healthy babies via uncomplicated vaginal delivery. In the patient with persistently active CD, delivery was carried out by caesarean section at week 36 due to non-reassuring foetal status and the birth weight was 1534g. No adverse effect related to therapeutic leucocytapheresis was observed in these four cases. Conclusions: In these 4 cases, therapeutic leucocytapheresis was safe and was associated with remission in all three cases with active UC. Additionally, with therapeutic leucocytapheresis, corticosteroid sparing is possible, which is highly desirable in pregnant cases. Regarding CD, we believe a study in larger cohort of pregnant patients is warranted for assessing the efficacy of this non-pharmacologic intervention in this clinical setting. P521 Efficacy and safety of adalimumab in children with Crohn’s disease previously treated with infliximab A. Jacob1 *, M. Fumery2 , J. Salleron3 , L. Michaud1 , C. Spyckerelle4 , J.-F. Colombel5 , C. Gower-Rousseau6 , D. Turck1 . 1 University Hospital, Pediatric Unit, Lille, France, 2 Amiens University and Hospital, Gastroenterology, Amiens, France, 3 University Hospital EA 2694, Biostatistics, Lille, France, 4 St Vincent Hospital, Paediatric Unit, Lille, France, 5 University Hospital, Gastroenterology, Lille, France, 6 University Hospital, Epidemiology EA 2694, Lille, France Background: Adalimumab (ADA) is effective in the treatment of Crohn’s disease (CD) in children naive to infliximab (IFX) [1]. The objective of this study was to evaluate the effectiveness and safety of ADA in children with CD refractory or intolerant to IFX. Methods: This retrospective study included all children with CD from a paediatric-onset population-based cohort who received
Poster presentations P520 Efficacy and safety of leucocytapheresis for active inflammatory bowel disease during pregnancy: therapeutic outcomes in four pregnant cases H. Kinoshita1 *, R. Kunisaki1 , S. Tomohiko1 , H. Kimura1 , S. Maeda2 . 1 Yokohama City University Medical Center, Inflammatory Bowel Disease Center, Yokohama, Japan, 2 Yokohama City University, Department of Gastroenterology, Yokohama, Japan Background: Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), affects patients who are in their reproductive age. The benefits of maintaining remission before and during pregnancy overweigh the risks of disease flare-ups and associated adverse effects of drug-based medications on the pregnancy outcome. Although most of the medications used to treat IBD appear to be safe during gestation, patients and their partners are still concerned about the influences of medications on fertility and pregnancy. Therapeutic leucocytapheresis is an alternative to conventional drug therapy. Here we report 4 cases of pregnant IBD patients safely treated with either leucocytapheresis (LCAP) or granulocyte/monocyte apheresis (GMA). Methods: Four pregnant IBD patients, three with UC and one with CD, were treated with therapeutic leucocytapheresis. One patient with UC was treated with LCAP and the other three were treated with GMA. One patient had contraindication to corticosteroids and the other three had corticosteroid refractory IBD. Anticoagulation during the procedure was achieved with heparin in three patients, and with nafamostat mesylate in one patient (LCAP). Results: All four patients responded to therapeutic leucocytapheresis. Two of the three patients with UC achieved steroid free remission before the delivery. Steroid dose was tapered to 5 mg/day in the other patient with UC. In the only CD patient, the symptoms improved, but were not sustained. All three patients with UC delivered healthy babies via uncomplicated vaginal delivery. In the patient with persistently active CD, delivery was carried out by caesarean section at week 36 due to non-reassuring foetal status and the birth weight was 1534g. No adverse effect related to therapeutic leucocytapheresis was observed in these four cases. Conclusions: In these 4 cases, therapeutic leucocytapheresis was safe and was associated with remission in all three cases with active UC. Additionally, with therapeutic leucocytapheresis, corticosteroid sparing is possible, which is highly desirable in pregnant cases. Regarding CD, we believe a study in larger cohort of pregnant patients is warranted for assessing the efficacy of this non-pharmacologic intervention in this clinical setting. P521 Efficacy and safety of adalimumab in children with Crohn’s disease previously treated with infliximab A. Jacob1 *, M. Fumery2 , J. Salleron3 , L. Michaud1 , C. Spyckerelle4 , J.-F. Colombel5 , C. Gower-Rousseau6 , D. Turck1 . 1 University Hospital, Pediatric Unit, Lille, France, 2 Amiens University and Hospital, Gastroenterology, Amiens, France, 3 University Hospital EA 2694, Biostatistics, Lille, France, 4 St Vincent Hospital, Paediatric Unit, Lille, France, 5 University Hospital, Gastroenterology, Lille, France, 6 University Hospital, Epidemiology EA 2694, Lille, France Background: Adalimumab (ADA) is effective in the treatment of Crohn’s disease (CD) in children naive to infliximab (IFX) [1]. The objective of this study was to evaluate the effectiveness and safety of ADA in children with CD refractory or intolerant to IFX. Methods: This retrospective study included all children with CD from a paediatric-onset population-based cohort who received