Many patients with inflammatory bowel disease (IBD) are vitamin D deficient. The purpose of our study was to identify risk factors for vitamin D deficiency in IBD and to assess the impact of vitamin D repletion on disease activity and quality of life (QOL).

PURPOSE:Fifteen percent of incident Crohn's disease (CD) cases are diagnosed at older ages and demonstrate colonic location and inflammatory behavior. Serologic responses to gut microbial antigens are associated with specific phenotypes, and may differ by age at diagnosis. Our aim was to identify an association between age at diagnosis of CD and responses to gut microbial antigens. PATIENTS AND METHODS:Levels of anti-Saccharomyces cerevisiae antibodies (ASCA) immunoglobulins A and G (IgA and IgG), antibodies to Escherichia coli outer membrane porin-C (anti-Omp-C), antibodies to clostridial flagellin (anti-CBir-1), and perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) were compared in patients by age in three diagnosis groups: patients diagnosed at ages of <40, ≥40-59, and ≥60 years. For each antigen, patients with antibody levels in the first, second, third, and fourth quartile were assigned a score of 1, 2, 3, or 4, respectively. Individual scores were added to create a quartile sum score representing cumulative quantitative immune response. RESULTS:Eighteen, 17, and 12 patients were diagnosed at ages <40, 40-59, and ≥60 years, respectively. The majority (71%) had ileocolonic disease in the youngest group, compared to 36% in the oldest group (P=0.001). Mean ASCA IgA and IgG titers were increased in the youngest age group compared to the older groups (P=0.19 and P=0.13, respectively). Mean quartile sum scores for antibody levels were 7.2±2.8 in those patients diagnosed at ages <40 years, 4.9±2.9 in the 40-59-year-old age group, and 5.6±2.6 in the ≥60-year-old age group (P=0.06). CONCLUSION:A trend toward decreased cumulative immune responses to CD-associated gut antigens was observed in CD patients diagnosed at older ages compared to younger patients. Host responses to microbial antigens may be less important in older onset IBD and may contribute to the distinct phenotype in this group.

Background The existing literature on racial differences in Crohn’s disease (CD) activity and quality of life (QOL) is limited and extrapolated from surrogate measures. Aim The aim of our study was to compare objective markers of disease activity and QOL over time by race. Study A clinical data repository of inflammatory bowel disease (IBD) patients at University of Maryland, Baltimore IBD Program, was used. CD patients from 2004 to 2009 were included if they had greater than or equal to two clinic visits with disease activity and QOL scores during the study period. Differences in disease activity and QOL were compared by race over time. Results A total of 296 patients with CD met inclusion criteria; of these, 19 % (56/296) were African Americans (AA) and 81 % (240/296) were Caucasian. Baseline disease activity and QOL scores did not differ by race ( p > 0.05). Caucasians had a steady decline in disease activity and increase in QOL. AA experienced a similar pattern of change in disease activity and QOL scores over time; however, the declines were not statistically significant between groups. At each time point post-baseline, disease activity and QOL scores were similar between races. Conclusion We found that Caucasian and AA patients with CD had similar disease activity and QOL scores at initial presentation and over time. Thus, AA do not represent a more severe subgroup of CD patients to treat. These findings have important implications for clinicians that care for patients with CD.

Natalizumab, a humanized IgG4 monoclonal antibody that blocks the adhesion and subsequent migration of leukocytes into the gut by binding a 4 integrin, is FDA approved for treatment of moderate to severe Crohn’s disease. However due to the risk of progressive multifocal leukoencephalopathy (PML) associated with use of Natalizumab its use in clinical practice is limited to patients who fail the conventionally available medications specifically, one or more Anti-TNF agents. There are few publications on the use of natalizumab outside clinical trials. In this study we assessed the efficacy of Natalizumab in adults with refractory Crohn’s disease (CD) in a tertiary care center. Retrospective case analysis of CD patients treated with Natalizumab from 2008 to 2011 at a tertiary referral center identified using an IRB-approved clinical data repository. Patients were refractory to or intolerant of conventional medical therapy including at least one anti-TNF. Natalizumab (300 mg) was infused every 4 weeks. Treatment response was assessed by physician global assessment and the Harvey Bradshaw index. Quality of life was assessed with the Short Inflammatory Bowel Disease Questionnaire. Colonoscopy or capsule endoscopy was used at the discretion of the provider to assess for mucosal healing using the Froslie Simple Endoscopic Score. Ten patients received treatment with Natalizumab. Mean age at diagnosis was 23.6 ± 14.1 years. Eight patients were women. Median disease duration was 13 years (range, 4–20). Nine patients had ileocolonic and 1 patient had colonic disease location; 3 had upper tract disease and 6 had perianal disease. Disease phenotype was inflammatory in 3, stricturing in 3 and penetrating in 4 patients. Five patients had extraintestinal manifestations. Median duration of Natalizumab therapy was 5 months (range, 2–36). Four patients responded, 4 patients did not respond and 2 patients experienced severe acute infusion reactions requiring discontinuation of Natalizumab. Three patients underwent follow up endoscopy; 2 had mucosal healing and one had no improvement in endoscopic activity. Six patients were tested for JC virus antibody after initiating therapy. One patient was positive but continued Natalizumab because of the excellent response to therapy. Adverse events included Varicella-zoster requiring hospitalization, recurrent vaginal Candidiasis, worsening of CD (n = 2), nasopharyngitis, and headache (n = 3). No patients developed progression multifocal leukoencephalopathy. In a tertiary referral center, 40% of patients experience a durable clinical response to Natalizumab. Serious infusion reactions occurred in 20% necessitating drug withdrawal and 1 patient experienced a serious opportunistic infection. The lower response rate than observed in clinical trials should be interpreted with caution given the small sample size and the treatment refractory nature of the patient population. Further research is needed to detail the experience of Natalizumab in clinical practice.

Purpose: We assessed the efficacy of natalizumab in adults with refractory Crohn's disease (CD) in a tertiary care center. Methods: Retrospective case analysis of CD patients treated with natalizumab from 2008-2011 at a tertiary referral center identified using an IRB-approved clinical data repository. Patients were refractory to or intolerant of conventional medical therapy, including at least one anti-TNF. Natalizumab (300 mg) was infused every 4 weeks. Treatment response was assessed by physician global assessment and the Harvey Bradshaw index. Quality of life was assessed with the Short Inflammatory Bowel Disease Questionnaire. Colonoscopy or capsule endoscopy was used at the discretion of the provider to assess for mucosal healing using the Froslie Simple Endoscopic Score. Results: Ten patients received treatment with Natalizumab. Mean age at diagnosis was 23.6±14.1 years. Eight patients were women. Median disease duration was 13 years (range, 4-20). Nine patients had ileocolonic, and one patient had colonic disease location; three had upper tract disease, and six had perianal disease. Disease phenotype was inflammatory in three, stricturing in three, and penetrating in four patients. Five patients had extraintestinal manifestations. Median duration of natalizumab therapy was 33.5 months (range, 17-48). Four patients responded, four patients did not respond, and two patients experienced severe acute infusion reactions requiring discontinuation of natalizumab. Three patients underwent follow up endoscopy; two had mucosal healing, and one had no improvement in endoscopic activity. Six patients were tested for JC virus antibody after initiating therapy. One patient was positive, but continued natalizumab because of the excellent response to therapy. Adverse events included Varicella-zoster requiring hospitalization, recurrent vaginal candidiasis, worsening of CD (n=2), nasopharyngitis, and headache (n=3). No patients developed progression multifocal leukoencephalopathy. Conclusion: In a tertiary referral center, 40% of patients experience a durable clinical response to natalizumab. Serious infusion reactions occurred in 20%, necessitating drug withdrawal, and one patient experienced a serious opportunistic infection. The lower response rate than observed in clinical trials should be interpreted with caution, given the small sample size and the treatment refractory nature of the patient population. Further research is needed to detail the experience of natalizumab in clinical practice.

Purpose: Magnetic resonance imaging (MRI) is increasingly utilized for the identification of mucosal abnormality in small bowel (SB) Crohn's disease (CD). The aim of this study was to determine whether MR enterography (MRe) measures of disease are associated with endoscopic tissue inflammation and surgical histology at a tertiary care practice. Methods: CD patients who underwent diagnostic MRe at a tertiary referral center from January, 2008 to March, 2012 were included. All patients had an endoscopic evaluation and/or surgical resection within 6 months of imaging date. Two radiologists were blinded to the original MRe findings and colleagues' assessment. Consensus agreement was obtained. MRe indicators of inflammation included mucosal hyperenhancement (M_Hyp), mural thickening, intramural edema, and mesenteric edema. Surgical specimens were scored based on the degree of fibrosis. Mucosal disease was scored using the Froslie system. MRe measures of inflammation and fibrosis were compared to endoscopic mucosal disease and surgical fibrosis scores. Correlation of imaging and endoscopic findings of stenosis was performed. Results: One hundred five unique MRe studies in 98 CD patients met inclusion criteria. There were no significant differences in sex, race, smoking, presence of perianal disease, and age of diagnosis. Of those with marked M_Hyp on MRe (n=23), 70% had evidence of endoscopic active disease, whereas mild M_ Hyp and lack of M_Hyp was associated with active disease in 18 and 20% of cases, respectively (P≤0.02). A similar pattern was found when comparing MRe measures of intramural edema (59% positive association, P≤ 0.01) and mural thickening (55% with thickness >5 mm, P=0.06) with endoscopic disease, but not mesenteric edema (P=NS). The findings of prestenotic dilation, pseudosacculation, loop tethering, and intramural fat were not significantly associated with histologic fibrosis scores (P=NS). MRe accurately predicted endoscopic presence of stenosis (rho = 0.43, P<0.0001), namely of the terminal ileum. Conclusion: At a tertiary referral IBD center, we found that only certain MRe measures of SB inflammation are positively associated with active endoscopic disease such as marked mucosal hyperenhancement, intramural edema, and significant mural thickening. This association does not appear to hold true for MRe identification of fibrosis. Our study suggests that inflammation and fibrosis may coexist at varying degrees in CD patients and imaging alone is not adequate to categorize disease as active or inactive. Subtle mucosal changes may not be readily picked up on MR imaging. Therefore, direct mucosal visualization combined with MR imaging is a reasonable approach.

Background:Recent studies have demonstrated superior outcomes of early biologic therapy. Our purpose was to evaluate differences in disease course among patients in clinical practice treated with early biologic therapy compared with those receiving conventional Step Up therapy.Methods:Patients with Crohn's disease evaluated from July 2004 to November 2010 at a tertiary referral center were included. Demographic data were obtained from a prospectively maintained database. Patients were categorized into 1 of 2 groups: Early Bio group (with or without concomitant immune suppressants) or Step Up group (initial immune suppressants with or without escalation to biologic). Disease activity, quality of life, use of steroids, and number of hospitalizations, and surgeries were assessed.Results:Ninety-three patients with Crohn's disease met inclusion criteria: 39 (45%) in the Step Up group and 54 (58%) in the Early Bio group. There was no significant difference in demographic and clinical variables between groups. Mean Harvey-Bradshaw index and Short Inflammatory Bowel Disease Questionnaire scores at 3, 6, and 12 months were not different between groups. Response rates were higher in the Step Up group compared with the Early Bio group only at 3 months. Early Bio patients had a greater number of hospitalizations at 1 year (P = 0.04).Conclusions:In clinical practice, early biologic therapy did not improve disease activity or quality of life and did not decrease the need for steroids or surgeries 1 year after therapy. Our results suggest that clinical outcomes are not worsened using the conventional approach. Therefore, an accelerated Step Up approach for most patients seems reasonable.

Purpose: Data from the Social Security Administration show that 5% of patients with Crohn's disease (CD) will become permanently disabled as a result of their disease. The aim of this retrospective chart review study was to identify clinical factors associated with CD-related disability. Methods: Patients diagnosed with nonstricturing, nonpenetrating CD after 1998 were identified from the University of Maryland, Baltimore IBD Program clinical data repository. Data regarding demographics, disease-specific characteristics, and clinical course were collected from time of diagnosis to the last visit. Data regarding receipt of Social Security disability benefits were collected by patient self-report via questionnaire and telephone encounter. Characteristics of patients receiving disability were compared to those of patients not receiving disability using Student t-tests for continuous variables and Fisher's exact test for categorical variables. A logistic regression model that adjusted for patient characteristics was used to identify predictors of CD-related disability. Results: Of the 105 patients included in the study, 61% were women and 84% were white. The mean length of follow up was 4.8±3.3 years. Disease location at baseline was ileal, colonic, and ileocolonic in 28%, 24%, and 49% of patients, respectively. Thirty-six percent developed either stricturing or penetrating disease during the course of the study and 11% had perianal involvement within the first year of diagnosis. Fourteen (13%) patients reported CD-related disability. The mean time from diagnosis of CD to disability was 4.7±3.1 years. There were no significant differences in age at diagnosis, sex, race, baseline disease location or behavior, and type of drug therapy within the first year of diagnosis between disabled and nondisabled CD patients. Patients with disability were more likely to have perianal disease within the first year of diagnosis (33% vs. 8%, P=.01) and were more likely to be current smokers (53% vs. 21%, P=.03) than patients not on disability. The disability cohort had significantly higher annual rates of all-cause hospitalizations (0.74±0.65 vs. 0.36±0.61, P=.03) and CD-related hospitalizations, (0.62±0.61 vs. 0.30±0.59, P=.05) compared with the nondisabled group. In an adjusted analysis, perianal disease within the first year of diagnosis and current smoking status were found to be predictors associated with disability. Conclusion: CD-related disability was associated with perianal disease and smoking. Increased rates of hospitalizations were observed in disabled CD patients. Further research to determine whether early and aggressive medical therapy can prevent CD-related disability is indicated. Disclosure: Seema Patil - none. Ankur Rustgi - none. Joshua Watson - none. John Betteridge - none. Winnie Szeto - none. Nadia Cheevers - none. Mark Flasar - 2012's DDW (May 2012) - Advisory Board: Jansen, Prometheus Labs. Research Support: Abbott, Prometheus Labs. Martha Skup - Employee & Stockholder: Abbott. Mei Yang - Employee & Stockholder: Abbott. Jingdong Chao - Employee & Stockholder: Abbott. Parvez Mulani - Employee & Stockholder: Abbott. Raymond Cross - Consulting fee (Advisory Committees or Review Panels): Abbott; Consulting fee (Consulting): Abbott; Consulting fee (Grant/Research Support): Abbott, Centocor.

Adalimumab (Humira, AbbVie) has efficacy in treatment-naive and infliximab (Remicade, Janssen)-exposed patients with Crohn's disease (CD). An e-survey was sent to US gastroenterologists who were members of the American Gastroenterological Association. A total of 398 gastroenterologists (3%) completed the survey. Seventy-two percent prescribed adalimumab more than a few times yearly, 58% followed more than 50 patients with CD, and 15% followed 200 or more patients with CD. Ninety percent of gastroenterologists felt that adalimumab had a moderately significant positive impact on patient care. Eighty-two percent correctly identified the US Food and Drug Administration-approved adalimumab induction and maintenance regimens. These gastroenterologists were more likely to follow 200 or more patients with CD (P=.045) and prescribe adalimumab more than a few times per year (P=.037). Years in practice, practice setting, gender, and region did not impact prescribing. Correct dosing was associated with higher prescribing frequency (P=.014) and volume of patients with CD (P=.025). The frequency of adalimumab prescribing and volume of patients with CD were predictive of the total number of correct survey answers (P=.014 and P=.017, respectively). Only 50% of gastroenterologists always administered loading doses when switching to adalimumab from another anti-tumor necrosis factor (TNF) agent; 43.5% reported unclear loading efficacy and 24.3% reported infection concerns from excess anti-TNF as reasons. Eighteen percent of gastroenterologists reported that pharmacies had reduced their prescribed adalimumab doses. To our knowledge, this is the only study evaluating prescribing patterns of adalimumab in patients with CD in the United States. Our findings demonstrate that many gastroenterologists are not using optimal adalimumab dosing strategies, which may lead to a decreased rate of response in patients with CD. Further research is needed to confirm our findings and identify barriers to optimal adalimumab use by gastroenterologists for treatment of CD.

The three Food and Drug Administration (FDA)-approved anti-tumor necrosis factor drugs (anti-TNFs) for Crohn’s disease (CD) have not been directly compared.

Background: Diagnostic imaging is frequently used in Crohn's disease (CD) for diagnosis, evaluation of complications, and determination of response to treatment. Patients with CD are at risk for high radiation exposure in their lifetime. The aim of our study was to compare the effective dose of radiation in CD patients the year prior to and the year after initiation of anti-tumor necrosis factor (anti-TNF) agents or corticosteroids.Methods: We conducted a retrospective review of 99 CD patients initiated on anti-TNF therapy or corticosteroids between 2004 and 2009 in a tertiary care center.Results: Sixty-five patients were initiated on anti-TNF agents and 34 were initiated on corticosteroids. The anti-TNF cohort was significantly younger at diagnosis and at the time of initiation of anti-TNF or steroid therapy. The anti-TNF group had significantly more stricturing, penetrating, and perianal disease than the corticosteroid group. The anti-TNF cohort had a significant reduction in number of radiologic exams (5.5 vs. 3.7, P < 0.01) as well as a significant reduction in the cumulative radiation dose (28.1 vs. 15.0 mSv, P < 0.01) the year after initiation of therapy. This reduction was largely attributable to decreased use of computed tomography (CT) scans. In contrast, there was no significant change in radiation exposure in the corticosteroid cohort. Logistic regression analysis showed a strong trend toward higher exposure in patients with complicated disease behavior (stricturing or penetrating phenotype) (odds ratio [OR] 2.87, 95% confidence interval [CI] 0.98-8.38).Conclusions: Initiation of anti-TNF therapy for treatment of CD is associated with a significant reduction in diagnostic radiation exposure. Conversely, steroid treatment does not reduce diagnostic radiation exposure. (Inflamm Bowel Dis 2013;19:92-98)

Background: Outcomes are suboptimal in ulcerative colitis (UC). Telemedicine for UC is feasible and improves outcomes. Our goals were to evaluate a home telemanagement system for UC (UC HAT) on disease activity, quality of life (QoL), and adherence compared to best available care (BAC) in a randomized, controlled trial. Methods: Adults with UC were randomly assigned to receive UC HAT or BAC for 12 months. UC HAT recruits answered questions regarding disease activity, adherence, side effects, and measured their weight weekly. An educational curriculum was delivered after each session. Alerts and action plans were generated based on the results. BAC underwent routine follow‐up, received written action plans, and were given educational fact sheets. Seo Index scores, Inflammatory Bowel Disease Questionnaire (IBDQ) scores, and adherence rates were compared between UC HAT and BAC at 1 year. Results: Twenty‐five patients were randomized to UC HAT and 22 to BAC. After 12 months, 11 withdrew in UC HAT compared to 5 in BAC. Disease activity, QoL, and adherence were not different between groups at any timepoint postbaseline. Adjusted analyses of trial completers using all available data demonstrated decreased Seo Index (11.9 in UC HAT (P = 0.08) versus 1.2 in BAC (P = 0.84) and increased IBDQ scores (12.5 in UC HAT (P = 0.04) versus to −3.8 in BAC (P = 0.47) from baseline in UC HAT compared to BAC. Conclusions: UC HAT did not improve disease activity, QoL, or adherence compared to BAC after 1 year. After adjustment for baseline disease knowledge, UC HAT trial completers experienced significant gains in disease‐specific QoL from baseline compared to BAC trial completers. Our results suggest a potential benefit of UC HAT. Further research is indicated to determine if telemedicine improves outcomes in patients with IBD. (Inflamm Bowel Dis 2012;)

Purpose: Diagnostic imaging is used frequently in patients with Crohn's disease (CD); therefore, CD patients may be exposed to high amounts of radiation from diagnostic imaging in their lifetime. Frequent exposure to radiation increases the incidence of malignancy. The aim of this study was to identify demographic and disease-specific characteristics that are associated with higher diagnostic radiation exposure in patients with CD. Methods: 106 patients with CD who were initiated on anti-TNF or immunomodulator therapy with at least one year of follow-up between 2004 and 2008 were included. All radiologic studies done 1 year before and 1 year after initiation of immunomodulators or anti-TNF therapy were recorded. The cumulative effective dose of radiation over the 2 years was calculated using standardized effective doses. Demographics, disease phenotype, disease duration, and presence of extraintestinal manifestations of disease (EIM) were extracted from a preexisting clinical database. The cohort was divided into quartiles by effective dose of radiation. Logistic regression analysis was performed to identify associations between demographic and disease-specific variables and cumulative effective dose of diagnostic radiation ≥55 mSv (top quartile effective dose of radiation). Results: 86% of the patients were <40 years old at diagnosis. 68% were female. 79% were Caucasian. 32%, 54%, and 14% had ileal, ileocolonic, and colonic disease, respectively. 27%, 34%, and 39% had inflammatory, stricturing, and penetrating disease, respectively. 29% had perianal disease and 29% had EIM. 64% were treated with anti-TNF agents and 38% with immunomodulators. 55% of patients were diagnosed with CD for less than 10 years prior to the study. Exposure to diagnostic radiation did not differ by age, sex, race, age at diagnosis or duration of disease, smoking status, presence of upper tract or perianal disease, presence of EIM or type of medical therapy initiated. Obstructing or penetrating disease was associated with higher exposure to diagnostic radiation (OR 4.84, 95% CI 1.07 to 21.98). There was also a trend to higher radiation exposure in patients with ileal or ileocolonic compared to patients with colonic disease (OR 5.2, 95% CI 0.59 to 45.87). Conclusion: Obstructing and penetrating CD is associated with higher diagnostic radiation exposure compared to patients with inflammatory disease behavior. Ileal and ileocolonic disease location compared to colonic disease location is also likely associated with higher radiation exposure. The use of ionizing radiation in the diagnostic evaluation of CD, especially in patients with complicated disease behavior and small bowel disease, should be minimized in an effort to reduce their lifetime exposure to radiation.

Purpose: Diagnostic imaging is used frequently in patients with Crohn's disease (CD); therefore CD patients may be exposed to high amounts of radiation from diagnostic imaging in their lifetime. Frequent exposure to radiation increases the risk of malignancy. Tumor necrosis factor (TNF) antagonists are effective for treatment of CD and decrease health care utilization. The impact of anti-TNF therapy on radiation exposure has not been determined. Methods: 60 patients initiated on anti-TNF therapy with at least one year of follow up at a tertiary care referral center between 2004 and 2008 were included. All radiologic studies done 1 year before and 1 year after initiation of anti-TNF therapy were recorded. The annual cumulative effective dose of radiation was calculated using standardized effective doses. Demographics, disease phenotype, and extraintestinal manifestations of disease (EIM) were collected. Differences in the number of diagnostic tests and cumulative radiation dose used the year prior and year after anti-TNF were compared. Results: The mean age was 34.3+/-11.0 years. 62% were female. 79% were Caucasian and 20% were African-American. 22%, 14%, and 64% were current, former and never smokers respectively. 25%, 48%, 13%, and 12% had ileal, ileocolonic, colonic, and upper tract disease respectively. 24%, 36%, and 40% had inflammatory, stricturing, and penetrating disease respectively. 30% had perianal disease. 70% had EIM. 52% and 48% were treated with infliximab and adalimumab or certolizumab respectively. In the year prior to anti-TNF treatment, patients underwent 5.6+/-4.8 imaging tests compared to 4.0+/-7.9 the year after anti-TNF (p=0.0002). CT exams decreased from 3.2+/-2.8 the year prior to anti-TNF compared to 1.3+/-2.6 the year after (p<0.0001). Fluoroscopic exams decreased from 0.48+/-0.8 to 0.17+/-0.5 (p=0.01). Radiation dose decreased 17.6+/-25.4 mSv the year after anti-TNF therapy was initiated (p<0.0001). Radiation dose from CT decreased 16.5+/-22.1 mSv (p<0.0001). Patients with ileal and ileocolonic disease location had greater reductions in radiation exposure after anti-TNF therapy (data not shown). Conclusion: The number of diagnostic imaging tests and radiation dose is decreased the year after anti-TNF therapy is initiated. This is largely explained by decreased use of CT. It is likely that these differences are the result of improved disease activity and less complications of disease after anti-TNF use; however, it is possible that the results are biased as patients about to initiate anti-TNF therapy are more likely to undergo an extensive diagnostic evaluation. Further research is needed to confirm our results and to determine if the use of diagnostic imaging is decreased with prolonged follow up. Disclosure: Dr Cross-Consultant: Abbott Laboratories, Grant Support: Abbott Laboratories and Centocor, Inc.

Purpose: While tumor necrosis factor antagonists (anti-TNF) are effective for treatment of Crohn's disease (CD), data suggests possible differences in use across racial groups. One possible reason could be differential response to and tolerance of anti-TNF agents by race. The purpose of this study was to assess for differences in response to and tolerance of anti-TNF therapy by race. Methods: All CD patients who were initiated on anti-TNF therapy and had ≥ 1 year of follow up at a tertiary care referral center between 2004 and 2008 were indentified. Demography, Montreal classification, and extraintestinal manifestations (EIM) were collected. Physician global assessment of response, adverse drug reactions, steroid use, hospitalizations and surgeries were recorded at 3, 6, and 12 months after anti-TNF initiation and compared between Caucasian (W) and non-Caucasian (NW) patients. Results: 97 patients were analyzed; 77% (77) were Caucasian (W), 20% (19) African-American and 1% (1) Hispanic (combined as NW). 63% (61) were treated with infliximab, 30% (29) with adalimumab, and 7% (7) with certolizumab. There was no difference in age, gender, smoking status, presence of EIM, or disease location between W and NW. W had more B2 and B3 behavior (47% vs. 32% and 47% vs. 37%, respectively; p=0.08), but less perianal disease (30% vs. 60%, p=0.004) than NW. W had a higher complete response rate at 3 months; however there was no difference at other time points (see table). Overall prevalence of steroid use at 3, 6, and 12 months was 29%, 16% and 16% respectively without significant differences between W and NW. The overall rate of severe adverse drug reactions at 3, 6, and 12 months was 1%, 1%, and 0% without difference by race. The mean number and prevalence of hospitalizations in each group was not different at any time point. There was a trend toward a higher prevalence of surgery in W at 12 months (17% vs. 0%, p=0.08). Conclusion: Overall response to and tolerance of anti-TNF therapy over the first 12 months appeared similar between W and NW patients when therapy was started under the care of a tertiary referral CD practice. A trend to lower response at 3 months in NW compared to W did not persist at later months, while hospitalizations and surgeries were similar between W and NW. This suggests that differences in use of anti-TNF therapy should not be justified by possible differential response by race. Disclosure: Dr Patil - none Dr Ghazi - none Mr. Rustgi - none Dr Flasar - none Dr Cross - Consultant: Abbott, Grant Funding: Centocor, Abbott.Table 1