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, C Bellanger APHP, Le Kremlin Bicetre, France Search for other works by this author on: Oxford Academic L Beaugerie Saint Antoine, Paris, France Search for other works by this author on: Oxford Academic A Amiot Henri Mondor 94, Henri Mondor, France Search for other works by this author on: Oxford Academic S Tezenas du Montcel Pitié-Salpétrière, Paris, France Search for other works by this author on: Oxford Academic C Duvoux Henri Mondor 94, Henri Mondor, France Search for other works by this author on: Oxford Academic D Samuel Paul Brousse, Villejuif, France Search for other works by this author on: Oxford Academic F Carbonnel APHP, Le Kremlin Bicetre, France Search for other works by this author on: Oxford Academic
Journal of Crohn's and Colitis, Volume 12, Issue supplement_1, February 2018, Pages S343–S344, https://doi.org/10.1093/ecco-jcc/jjx180.601
Published:
16 January 2018
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C Bellanger, L Beaugerie, A Amiot, S Tezenas du Montcel, C Duvoux, D Samuel, F Carbonnel, P474 Efficacy and safety of anti-TNF and vedolizumab in liver transplant recipients with inflammatory bowel disease (IBD), Journal of Crohn's and Colitis, Volume 12, Issue supplement_1, February 2018, Pages S343–S344, https://doi.org/10.1093/ecco-jcc/jjx180.601
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Abstract
Background
The aim of this study was to evaluate the efficacy and safety of anti-TNFs and Vedolizumab in liver transplant recipients with IBD.
Methods
We reviewed the medical records of consecutive liver transplant recipients with IBD, who had been treated with anti-TNFs and/or Vedolizumab at four academic French centres. Response and remission at Weeks 4–8 and 48–52 were assessed by Mayo, Harvey-Bradshaw, and Pouch Disease Activity Index scores. Mucosal healing was defined as disappearance of endoscopic signs of activity. Infectious risk was estimated by incidence and time to first infection, both before and after biologics.
Results
We studied 20 consecutive patients (14 men, median age 35 (20–61) years at biotherapy introduction: 7 CD, 11 UC, 2 chronic pouchitis). Main liver transplantation indications were primary sclerosing cholangitis (13/20) and overlap syndrome (2/20). The majority of patients had a combination of Tacrolimus (100%), an anti-metabolite and low dose of corticosteroids. They received 20 lines of anti-TNF (16 in first line) and 8 lines of Vedolizumab (4 in first line). Median time between liver transplantation and introduction of biologics was 73.5 months (12–287). The average duration of each line of biologics was 12 months (0–48). The table summarises efficacy of biologics.
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Anti-TNF n = 20 (71.4%) | Vedolizumab n = 8 (28.5%) | Total n = 28 | |
---|---|---|---|
Response Weeks 4–8 | 13/20 (65) | 6/8 (75) | 19/28 (67.9) |
Remission Weeks 4–8 | 11/20 (55) | 5/8 (62.5) | 16/28 (57.1) |
Response Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Remission Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Mucosal healing Weeks 48–52 | 5/20 (25) | 2/7 (28.5) | 7/27 (25.9) |
Anti-TNF n = 20 (71.4%) | Vedolizumab n = 8 (28.5%) | Total n = 28 | |
---|---|---|---|
Response Weeks 4–8 | 13/20 (65) | 6/8 (75) | 19/28 (67.9) |
Remission Weeks 4–8 | 11/20 (55) | 5/8 (62.5) | 16/28 (57.1) |
Response Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Remission Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Mucosal healing Weeks 48–52 | 5/20 (25) | 2/7 (28.5) | 7/27 (25.9) |
Open in new tab
Anti-TNF n = 20 (71.4%) | Vedolizumab n = 8 (28.5%) | Total n = 28 | |
---|---|---|---|
Response Weeks 4–8 | 13/20 (65) | 6/8 (75) | 19/28 (67.9) |
Remission Weeks 4–8 | 11/20 (55) | 5/8 (62.5) | 16/28 (57.1) |
Response Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Remission Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Mucosal healing Weeks 48–52 | 5/20 (25) | 2/7 (28.5) | 7/27 (25.9) |
Anti-TNF n = 20 (71.4%) | Vedolizumab n = 8 (28.5%) | Total n = 28 | |
---|---|---|---|
Response Weeks 4–8 | 13/20 (65) | 6/8 (75) | 19/28 (67.9) |
Remission Weeks 4–8 | 11/20 (55) | 5/8 (62.5) | 16/28 (57.1) |
Response Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Remission Weeks 48–52 | 11/20 (55) | 5/7 (71.4) | 16/27 (59.2) |
Mucosal healing Weeks 48–52 | 5/20 (25) | 2/7 (28.5) | 7/27 (25.9) |
Forty-nine infections were identified. All infections required hospitalisation, including three in intensive care, all treated with anti-TNF. No patient had died. Twenty-eight infections were observed in 11 patients (55%) before biologics and 21 infections in 7 patients (35%) during biologics. Before exposure to biologics, yearly incidence of infection was 0.36 ± 0.60; it was 46.38 ± 166 under anti-TNF and 0.09 ± 0.24 under Vedolizumab. Differences were not significant (p = 0.35). Median time to first infection was 53.5 months before biologics and 13 months under biologics (HR = 1.692, 95% CI 0.572–5.002).
Conclusions
Anti-TNFs and Vedolizumab induce and maintain clinical remission in approximately half of liver recipients with IBD. Severe infections are possible, particularly in patients treated with anti TNFs.
This content is only available as a PDF.
Copyright © 2018 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
Topic:
- tumor necrosis factors
- medical records
- adrenal corticosteroids
- inflammatory bowel disease
- endoscopy
- glucocorticoids
- biological products
- sclerosing cholangitis
- intensive care
- liver transplantation
- pouchitis
- safety
- infections
- liver
- mineralocorticoids
- mucous membrane
- tacrolimus
- overlap syndrome
- metabolites
- disease remission
- vedolizumab
Issue Section:
03. Poster presentations > c. Clinical: Therapy and observation
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