Mo1687 Oral Delivery of a New Class of Non-Antibody Protein Scaffold Nanofitins Targeting TNF-Alpha Shows a Strong Preventive and Curative Anti-Inflammatory Effect in Models of Inflammatory Bowel Diseases

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Background: Although worldwide data has clearly shown the persistent rise in paediatric inflammatory bowel disease (PIBD), trends in the incidence of early-onset PIBD (i.e. diagnosed before their 10th birthday; Paris A1a) are not yet clear. Recent administrative data suggests that A1a PIBD has shown a dramatic rise in recent years [1] , however robust population-based incidence data are lacking. We aimed to evaluate the incidence of PIBD A1a disease in Scotland across four decades using a complete national cohort study. Methods: National data from previously published incident cases of PIBD in Scotland during the periods 1981-1995 and 2003-2008 were examined to determine those diagnosed less than 10yrs of age; prospectively collected incident cases from 2009-2013 were also included. A1a cases were divided into two sub-groups for further analysis (0-5yrs and 6-9yrs at diagnosis). Incidence rates were calculated using publicly available population data from the Scottish government and trends across cohorts calculated using Poisson regression analysis. Results: A total of 402 A1a PIBD patients were identified during the study periods. There was a steady increase in incident cases across epochs: 39 (1981-1985), 54 (1986-1990), 63 (1991-1995), 112 (2003-2007) and 134 (2008-2013) cases respectively. The crude incidence of A1a PIBD rose from 1.2/100,000/yr (1981-1985) to 4.0/100,000/yr (2008-2013) (p<0.001). The crude incidence of those diagnosed at 0-5yrs of age rose from 0.7/100,000/yr (1981-1985) to 2.0/100,000/yr (2008-2013) (p=0.017) compared to an incidence of 2.0/100,000/yr (1981-1985) to 7.2/100,000/yr (2008-2013) (p<0.001) for those diagnosed at 6-9yrs of age. The incident rate ratio between the first and last epochs were 2.9 (95% CI 1.5-6.4) and 3.6 (95% CI 2.3-5.8) for the 0-5yr and the 6-9yr age group respectively, demonstrating a three-fold increase in both groups across the study period. Conclusions: Using population-based Scottish data from the previous four decades we have shown that early-onset PIBD (A1a) has shown a significant rise in incidence, with three-fold increases seen in both the very-early-onset (0-5yr) and 6-9yr age groups. Further examination of these young children, especially with regard to epigenetics and environmental exposures may provide clues to IBD aetiopathogenesis.