P101 - Azathioprine-associated lymphopenia in IBD – are our patients in danger? A prospective multi-centre study

Abstract

s of the 4th Congress of ECCO the European Crohn’s and Colitis Organisation S51 P101 Azathioprine-associated lymphopenia in IBD are our patients in danger? A prospective multi-centre study A. Al-Rifai1, N. Prasad1 *, E. Shuttleworth2, A. Robinson2, S. Campbell1. 1Manchester Royal Infirmary, Manchester, United Kingdom, 2Salford Royal Hospital, Manchester, United Kingdom Introduction: Azathioprine (AZA) is frequently used to manage IBD patients and opportunistic infections are well documented in long-term use. Amongst non-HIV patients on immunosuppressants for other conditions, there are reports of lymphopenia (LP) related infections. LP is a recognised effect of treatment with AZA but LP related complications in IBD patients have not been widely reported. This raises the question of whether antibiotic prophylaxis is indicated for IBD patients on immunomodulators. However, there is no consensus on how to manage LP in this group. Aims: To assess the incidence of LP and any related complications in a cohort of IBD patients started on AZA. Methods: This is a prospective observational study of all patients started on AZA between 1/8/2007 and 30/9/2008 in two tertiary gastroenterology units in the UK. Data was collected on demographics, diagnosis, disease anatomy, LP episodes, relapses and concurrent therapy. LP was defined as 3 and the need for corticosteroids or anti-TNF therapy. Results: The median duration of follow-up was 51 months (10 142). Eighteen patients (12%) had a clinical recurrence within the first year following surgery before a colonoscopy was performed; 90 patients (Group C) had a systematic colonoscopy within the year following surgery (median time: 7 months, 2 13) and in 82 of them (91%), treatment was tailored according to the severity of endoscopic recurrence; 42 patients (Group NC) did not have endoscopic evaluation (8 patients declined and in 34 patients, colonoscopy was not performed in time). At time of surgery, there was no difference between Group C and Group NC except that surgery was more often curative in Group C (96%) than in Group NC (83%; p = 0.02). Time to clinical recurrence was shorter in Group NC than in Group C, with probabilities of clinical recurrence of 31% and 52% at 3 and 5 years in Group NC, and of 21% and 26% respectively in Group C (p = 0.01; logrank test). In multivariate analysis (Cox model), the following factors were associated with a higher risk of clinical recurrence: Group NC, presence of extraintestinal manifestations, and non penetrating disease behaviour. Conclusion: In our experience, the majority of patients accepts to have a colonoscopy within the year following surgery for decision of a tailored treatment. This strategy reduced clinical recurrence rate by 50% compared to absence of colonoscopy, but 12% of patients had an early recurrence before colonoscopy. P103 Mesenchymal stem cells administered via novel selective mesenteric artery cannulation for the treatment of severe refractory Crohn’s disease L. Dinesen1 *, A. Wang1, F. Vianello2, P. Tait3, E. Leen3, J. Davis2, F. Dazzi2, S. Ghosh1. 1Dept of Gastroenterology, Hammersmith Hospital, Imperial College London, United Kingdom, 2Dept of Haematology, Hammersmith Hospital, Imperial College London, United Kingdom, 3Dept of Imaging, Hammersmith Hospital, Imperial College London, United Kingdom Background: Mesenchymal stem cells (MSC) are a population of stromal origin that, in adult life, resides primarily in the bone marrow. MSC have the ability to self-renew and differentiate into tissues of mesodermal origin and produce a potent immunosuppressive effect. Recent results from multicentre clinical trials have described the successful use of MSC in severe graft-versus-host disease (GvHD), in which 60% of patients obtained complete durable remission with no toxicity. We tested their therapeutic potential in a patient with refractory Crohn’s disease. We administered MSC for the first time via selective mesenteric artery cannulation to ensure that the cells reached their target. Method: A 35 year old gentleman with severe refractory fistulizing Crohn’s disease failing all conventional therapies, biological therapies and surgical defunctioning ileostomy received mesenchymal stem cells from a haplo-identical donor, after informed consent. MSC were injected after by gest on July 1, 2016 http://eccoxfordjournals.org/ D ow nladed from