N023 Characterisation of IBD patients with multiple sclerosis at a large IBD unit

• Published in: Journal of Crohn's and colitis 2018-01, Vol.12 (supplement_1), p.S578-S578
• Main Authors: Breiteneicher, S, Török, H P, Mayerle, J, Beigel, F
• Format: Article
• Language: English
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjx180.1037

Abstract Background Targeting TNF-α is an important and effective therapeutic approach for patients with moderate-to-severe inflammatory bowel diseases (IBD). TNF-α antibodies have a favourable safety profile. However, known side effects of this treatment are for example allergic reactions and infections. Rare adverse events like central nervous system (CNS) demyelinating disorders (e.g. multiple sclerosis, optic neuritis) in association with TNF-α antibody (AB) therapy have been reported. In summary of this complex and important therapeutic area, we reviewed our patient collective of 1200 patients for known CNS diagnosis, e.g. multiple sclerosis (MS) independent of their IBD treatment. Methods All patients were recruited from our IBD outpatient clinic seen between June 2006 and October 2017. Only patient with MS and IBD diagnosis were included. The data were retrospectively collected by chart review and patients were split into 2 groups (CNS diagnosis without any TNF-alpha antibody treatment= cohort 1; and CNS diagnosis developed during TNF-alpha AB treatment=cohort 2). Data were analysed for age, age at diagnosis, sex, IBD diagnosis, Montreal Classification (Behaviour (B), Location (L)) and IBD family history with Student t-test and chi-square test. Results Overall, 13 patients with CNS diagnosis were included in this study. Six IBD patients were diagnosed with MS (cohort 1) without TNF-alpha AB treatment. Seven IBD patients were diagnosed during TNF-alpha AB treatment with MS (cohort 2). IBD diagnosis in cohort 1 was Crohns disease (CD) in 83.3 %, Ulcerative colitis (UC) in 16.7 %; and cohort 2 was CD in 57.1 % and UC in 42.9 %. Patients of cohort 2 were diagnosed significant early with IBD (p = 0.01; 16–53 years; SD 9.7 years) compared with cohort 1 (34–53 years; SD 7.3 years). The time between first Anti-TNF AB application and MS diagnosis differs about 12–109 months in cohort 2. Patients of this cohort reported more extraintestinal manifestations like arthralgia (p = 0.16; 85.7% vs. 50.0%) before MS diagnosis. Disease Behaviour (Montreal Classification) of cohort 2 patients was more severe (p = 0.19; B3 60.0%, B1 20.0%, B1p 20.0%) compared with cohort 1 (B2 40.0 %, B1 60.0%). In cohort 1 more patient had a family history of IBD than in cohort 2 (p = 0.20; 60.0% vs. 20.0%). Conclusions Despite the small sample size, in our cohort patients with MS developed during TNF-AB have a more severely IBD disease with a significant earlier onset of their symptom