P0437 Positive anti-Saccharomyces cerevisiae antibodies do not affect clinical outcomes in pediatric patients with Crohn’s disease treated with anti-TNF therapy

Abstract

Listen

Translate article

Abstract Background Anti-Saccharomyces cerevisiae antibodies (ASCA) have been associated with a more aggressive Crohn’s disease (CD) phenotype. However, the effect of ASCA serology on the response to biologic therapy, specifically in children on anti-TNF therapy, is unknown. Our goal was to assess whether ASCA levels are associated with clinical outcomes in pediatric CD patients treated with anti-TNF antibodies. Methods A single center retrospective study. Demographic, clinical and laboratory data were collected from pediatric CD patients (aged 2.2-17.9 years) treated with anti-TNF therapy, who were tested for IgG ASCA levels upon diagnosis, between 2010-2023. The cut-off value for a positive ASCA result was defined as 30 EU/mL. Clinical outcomes included durability of anti-TNF therapy, corticosteroid-free survival (CSFS) at week 52 of therapy, IBD-associated hospitalizations and IBD related surgery. Results One hundred seventy-two patients with CD (69 ,39% females) with a median age at diagnosis of 13.5 (11.1-15.4) years were included. Ninety-two (52%) patients had positive ASCA (> 30 EU/mL). ASCA positivity was associated with female sex (p=0.02) and ileocolonic disease location at diagnosis (p=0.02). Sixty-six (37%) patients were treated with infliximab and 111 (63%) with adalimumab. The median time of follow-up in our cohort was 115 (65-174) weeks. Time to discontinuation of anti-TNF was comparable between patients with ASCA positive and negative levels (97.8% vs. 97.4% and 89.3% vs. 87.4% at 1 and 3 years, respectively). In addition, time to IBD-associated hospitalization and surgery were also similar. Interestingly, patients with positive ASCA achieved CSFR more often, compared to patients with ASCA negative (P=0.04). Sub-analysis of patients with high ASCA values, the top 20%, (>80 EU/mL) demonstrated significantly longer durability of anti-TNF, compared to the patients with lower ASCA levels (<80 EU/mL,p= 0.02). Conclusion ASCA positivity is not associated with worse outcomes in pediatric patients with CD treated with TNF antagonists.