P340 Serum albumin and C-reactive protein week 2/week 0 ratio after anti-TNF therapy best predict both short- and long-term clinical outcomes in anti-TNF-naïve ulcerative colitis patients

• Published in: Journal of Crohn's and colitis 2018-01, Vol.12 (supplement_1), p.S273-S274
• Main Authors: Lee, S -H, Chang, K, Song, E M, Hwang, S W, Park, S H, Yang, D -H, Byeon, J -S, Myung, S -J, Yang, S -K, Ye, B D
• Format: Article
• Language: English
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjx180.467

Abstract Background The aim of this study was to investigate the predictors of short- and long-term clinical response to the first anti-TNF therapy in moderate to severe ulcerative colitis (UC) patients who were naïve to anti-TNFs. Methods A total of 218 UC patients who were treated with infliximab (n = 188) or adalimumab (n = 30) between December 2006 and November 2016 in Asan Medical Center, Korea (male, 61.5%, median age at diagnosis of UC, 36.5 years old [range, 14.3–71.5], and median duration of follow-up, 27.6 months [range, 0.92–82.3]) were retrospectively analysed. Independent predictors of primary non-response (PNR) to anti-TNFs were identified using logistic regression analysis. Cumulative hazards of poor long-term outcomes (colectomy, anti-TNF failure, or anti-TNF discontinuation) were estimated by the Kaplan–Meier method and were compared between groups divided by predictors using the log-rank test. Results Forty-seven patients (21.6%) showed PNR. In multivariate analysis, serum albumin W2/W0 ratio less than 1.029 (adjusted OR [aOR] 3.29, 95% confidence interval [CI] 1.59–7.04), C-reactive protein (CRP) W2/W0 ratio greater than 0.517 (aOR 3.53, 95% CI 1.62–8.24), severe disease (baseline Mayo score > 10) at starting anti-TNFs (aOR 3.84, 95% CI 1.67–9.05), and combined CMV colitis within 3 months (aOR 2.70, 95% CI 1.32–5.68) were significant predictors of PNR. Comparison between two cumulative hazard curves regarding long-term outcomes showed significant differences between groups divided by serum albumin W2/W0 ratio cut-off level (1.029 for predicting PNR); colectomy (p = 0.00086), discontinuation of anti-TNFs (p = 0.01), and anti-TNF failure (p = 0.00016). Analogously, comparison between two cumulative hazard curves regarding long-term outcomes showed significant differences between groups divided by serum CRP W2/W0 ratio cut-off level (0.517 for predicting PNR); discontinuation of anti-TNFs (p = 0.0073) and anti-TNF failure (p = 0.0066). Figure 1. Comparison between two cumulative hazard curves regarding long-term outcomes between groups divided by serum albumin W2/W0 ratio cut-off level and groups divided by CRP W2/W0 ratio cut-off level. *W2 = week 2; W0 = week 0. Conclusions The week 2/week 0 ratios of serum albumin and CRP after anti-TNF initiation are significant novel predictors of both short- and long-term clinical outcomes in anti-TNF-naïve, moderate to severe UC patients.