Sa1893 Predictive Factors of Response to Intravenous Cyclosporine in Severe Ulcerative Colitis: Development of a Novel Calculation Formula for Earlier Clinical Decision-Making

Background & Aims: It has been shown that infliximab (IFX) has short-term protective effect against postoperative recurrence in patients with Crohn's disease (CD), suggesting the role "reset" therapy for aggressive CD.However, long-term effect of IFX in postoperative CD remains to be elucidated.We aimed to investigate long-term effect of scheduled IFX against postoperative recurrence of intestinal lesions in patients with CD.Methods: Postoperative clinical course of 37 patients with CD, who underwent intraoperative enteroscopy (IOE) and ileocolonic resection, was retrospectively investigated.In each patient, endoscopic/ radiographic findings after surgery were reviewed.Recurrence at the anastomotic site was defined by an endoscopic score >i2 of Rutgeerts' score or by depiction of small barium flecks indicating erosion or ulceration, thickened mucosal folds, or intestinal narrowing under double-contrast barium enteroclysis.Recurrence outside the anastomotic site was regarded to be positive when active inflammatory lesions were endoscopically or radiographically detected in the intestinal segment where preceding IOE had not identified any active lesion.Age, disease duration, history of intestinal resection, disease type, extent of disease, perianal disease, active inflammatory lesions under IOE, smoking habit, and postoperative treatments were also reviewed.Results: 19 of 37 patients were treated by scheduled IFX (5mg/kg, every 8 weeks).17 patients (46%) showed postoperative recurrence.Time interval between surgery and confirmation of recurrence was 26.9±18.7 months.3 of 17 patients with recurrence were under IFX.Active inflammatory lesions were detected in the anastomotic region in 10 patients, outside the anastomotic region in 5, and both in 2. Univariate analysis revealed that history of intestinal resection (Log-rank test: p=0.047), penetrating disease (p=0.01),current smoking habit (p=0.039) and ileocolonic anastomosis (p=0.046) were more frequent in patients with recurrence than in those without.In addition, recurrence was less frequent in patients with IFX than in those without (p=0.014).Multivariate analysis revealed that patients treated with IFX were less likely to recur (Cox proportional hazards model: OR=0.08, 95% CI 0.009-0.43),while patients with history of intestinal resection had an increased risk of recurrence (OR=9.97,95% CI; 1.71-98.1).Stratified analyses revealed that in patients treated by IFX, recurrence was less frequent in patients with concomitant immunomodulators than in those without, although the difference did not reach a statistical significance (0% vs. 21%, p=0.11).Conclusions: Scheduled IFX treatment after intestinal resection can exert a longer prophylactic effect in postoperative CD.Intensive postoperative treatment seems to be necessary for patients who require repeated surgery.