P278. Impact of mucosal healing on long-term outcomes in ulcerative colitis treated with infliximab: A multicenter experience

D. Laharie1, J. Filippi2, X. Roblin3, S. Nancey4, J.‑B. Chevaux5, X. Hebuterne2, M. Capdepont1, L. Peyrin-Biroulet6

1Hôpital Haut-Lévêque, Service Gastroenterologie, Pessac, France; 2Archet 2 Hospital, Department of Gastroenterology, Nice, France; 3University of Saint Etienne, Gastroenterology, Saint Etienne, France; 4AP‑HL, Gastroenterologie, Lyon, France; 5University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France; 6University Hospital of Nancy, Hepato-Gastroenterology, Vandoeuvre-Lès-Nancy, France

Background: Mucosal healing (MH) is a major therapeutic goal in ulcerative colitis (UC) and can be achieved with infliximab (IFX). The impact of MH on long-term outcomes in patients treated with IFX for UC is unknown.

Methods: All consecutive patients with refractory UC receiving maintenance treatment with IFX in five French referral centers were analysed retrospectively if an endoscopic evaluation was performed between 6 and 52 weeks after IFX initiation. According to their Mayo endoscopic subscore after starting IFX, patients were categorized into MH (subscore: 0–1) and no MH (2–3). Outcome measures were colectomy-free survival and IFX failure defined by drug withdrawal and/or the need for a second-line therapy.

Results: Of the 63 patients (30 women; median age: 38 years, range: 19–70) 30 (48%) achieved MH. The median follow-up duration was 27 (3–79) months. Colectomy-free survival rates at 12, 24 and 36 months were respectively 100%, 96% and 96% in patients with MH, while these figures were respectively 80%, 65% et 65% in those without MH (P = 0.004). By multivariate analysis, MH was the sole prognostic factor associated colectomy-free survival, with an odds ratio of 18.01 (95%CI: 1.58–204.92). Survival without IFX failure rates at 12, 24 and 36 months were respectively 76%, 69% and 64% in patients with MH, while these figures were respectively 44%, 25% et 21% in those without MH (P = 0.003).

Conclusions: Patients with refractory UC who achieved MH after IFX initiation had better long-term outcomes, with significantly less colectomy and less IFX failure.