Effect Of anti-TNF Therapy Research Articles

Dynamics of serum levels of TNF-α in a longitudinal follow-up study in 98 patients with juvenile idiopathic arthritis treated with anti-TNF-α biological drugs

ObjectiveTo determine the dynamics of serum levels of TNF-α in patients with juvenile idiopathic arthritis (JIA) treated with anti-TNF-α biological drugs and investigate their association with the disease activity.MethodsWe conducted a single-centre, observational cohort study in 98 patients with JIA (30 boys, 68 girls, mean age 11.3 years) treated with anti-TNF-α biological drugs. Clinical examinations and laboratory assessments of serum levels of TNF-α were performed before starting therapy with biological drug and at 6-month intervals afterwards up to 2.5 years.ResultsThe analysis of serum levels of TNF-α in relation to the disease activity states showed the highest mean serum levels of TNF-α in patients on etanercept who had low disease activity states and in patients on adalimumab who had inactive disease. The correlation analysis in patients with JIA treated with etanercept or adalimumab showed a weak negative correlation between the serum levels of TNF-α and JADAS10 scores (p = 0.007), (r = − 0.177).ConclusionThe assessment of serum levels of TNF-α in children with JIA during treatment with etanercept or adalimumab is not a reliable biomarker of disease activity or immunological remission. Longitudinal measurement of TNF-α has no added clinical value in patients with JIA treated with anti-TNF-α biological drugs.Key Points• There is limited evidence regarding the effect of anti-TNF therapy on serum concentrations of TNF-α in patients with juvenile idiopathic arthritis• Our study showed an increase in the serum level of TNF-α after the initiation of therapy with either etanercept or adalimumab, which was more significant in patients with inactive or low disease activity• Serum TNF-α is most likely not biologically active during therapy with TNF-α inhibitors and therefore not a reliable biomarker of disease activity or immunological remission in patients with juvenile idiopathic arthritis

P365 Psoriasis in Inflammatory Bowel Disease: Comparison of Extraintestinal Manifestations and Effect of Anti-TNF Therapies

Abstract Background Psoriatic lesions may develop in inflammatory bowel disease (IBD) patients as an extraintestinal manifestation or an adverse effect of anti-TNF therapy. The aim of this study was to compare the clinical characteristics of IBD patients with psoriasis between extraintestinal manifestations and the effect of anti-TNF therapies. Methods In this cross-sectional study, data was identified between March 2019, and October 2022. Demographic and clinical data of patients with IBD were recorded at baseline and during follow-up. All patients were questioned for psoriasis, and the "onset of psoriasis" was recorded as before or after anti-TNF therapies. Results In our tertiary center, a total of 1125 IBD patients were identified through the database (543 with CD, 549 with UC, and 33 with IBD unclassified (IBDU)) and a 336 (29.9%) had an exposure to adalimumab, 322 (28.6%) to infliximab, and 27 (2.4%) to certolizumab. In our cohort, a total of 37 (3.3%) patients, suffered from psoriasis, in which 18 (48.6%) patients on anti-TNF therapy (7 adalimumab, 10 infliximab and 1 certolizumab) developed a drug-induced psoriasis, while 19 (51.4%) patients had psoriasis as an extraintestinal manifestation before the anti-TNF therapies. In patients with all psoriasis, 24 (%64.9) were female and 28 (75.7%) had CD. CD was statistically significantly more common in patients with psoriasis induced by anti-TNF therapy (17 (94.4%) vs. 11 (57.9%), p=0.019). Anti-TNF therapy induced psoriasis had statistically significantly longer disease duration than psoriasis as an extraintestinal manifestation group (11.5 vs 6 median years, respectively p=0.005), while other baseline characteristics such as age, sex, smoking status, family history of IBD, disease location, behavior, perianal disease, and other extraintestinal involvements were similar. At baseline, serum hemoglobin (13 vs. 12 mg/dL; p=0.069), albumin (4.2 vs.4.3 g/dL; p=0.505), partial MAYO score (6 vs 7 median score; p=0.247) and CDAI (360 vs. 320 median score; p=0.339) were all comparable between the two groups, respectively. Whereas baseline CRP level in extraintestinal manifestation group was significantly higher than anti-TNF therapy induced group (66 vs. 2.8 mg/L; p=0.003). Conclusion In this study, we found that up to 3.3% of all IBD patients had psoriasis; half of these cases were anti-TNF therapy induced psoriasis, and the rates of psoriasis in CD patients and female patients were greater than those in UC and male patients. Anti-TNF therapy induced psoriasis had a statistically significantly longer disease duration and lower baseline CRP in comparison to psoriasis as an extraintestinal manifestation.

Is there an optimal sequence of biologic therapies for inflammatory bowel disease?

Over the past two decades, 11 biologic agents have been approved for use in most countries for the treatment of moderate-to-severe inflammatory bowel disease (IBD). Antitumor necrosis factor α (anti-TNF) agents are commonly used as the first biologic in clinical practice, and nearly all pivotal studies of induction therapy enrolled patients with and without prior use of anti-TNF therapy. This narrative review presents a reasonable approach to devising treatment sequences, examining the magnitude of benefit for each drug versus placebo or active comparator and then considering how that benefit changes with prior anti-TNF treatment. Data from ULTRA 2, GEMINI 1, VARSITY, and True North in patients with ulcerative colitis indicate that induction adalimumab, vedolizumab, and ozanimod showed lower clinical remission rates after anti-TNF therapy, while UNIFI, OCTAVE 1&2, and U-ACHIEVE/U-ACCOMPLISH show ustekinumab, tofacitinib, and upadacitinib did not. In patients with Crohn's disease, endoscopic remission or mucosal healing after induction therapy rather than clinical remission as well as assessment of persistent endoscopic remission are good measures of long-term disease outcomes. Considering the drugs for which data on endoscopic remission rates are available, EXTEND and GEMINI 2&3 show adalimumab and vedolizumab with persistently lower endoscopic remission rates after prior anti-TNF therapy, while IM-UNIFI, SEAVUE, and FORTIFY show ustekinumab and risankizumab did not. Data from the multicenter retrospective EVOLVE study indicate that the effectiveness of anti-TNF therapy does not seem to be significantly impacted by prior vedolizumab therapy, and may further suggest the benefit of using vedolizumab as a first-line biologic. As adverse event rates remain low across all treatments, the magnitude of harm from untreated or poorly treated disease far outweighs harm from any individual therapy. Regardless of the treatment sequence, careful monitoring for early signs of treatment nonresponse and switching to another potentially highly active therapy are critical to effective management of IBD.

Effect of Anti-TNF Therapy on Mucosal Apoptosis Genes Expression in Crohn's Disease.

Crohn's disease (CD) is a chronic immune-mediated disorder for which there is not a fully effective treatment. Moreover, biological therapy with anti-tumor necrosis factor-α (anti-TNF-α) monoclonal antibodies leads to an effective response in only 60–70% of patients. Our previous data suggested that specific loci polymorphism of the TNFRSF1B, FCGR3A, IL1R, IL1B, and FAS genes could be a predictor of the primary non-response to anti-TNF therapy in CD patients. In this work, we propose to explain this hypothesis by functional analysis in colon biopsies and in a cell culture model. Using the RT-qPCR analysis, we estimated the FCGR3A, IL1R, TNFRSF1B, IL1B, FAS, and ADAM17 genes mRNA level in colon biopsies material from inflamed and non-inflamed tissue from 21 CD patients (14 responders and 7 non-responders to anti-TNF therapy) and 6 controls, as well as in vitro in a peripheral blood mononuclear cells (PBMCs) from 14 CD patients (seven responders and seven non-responders to anti-TNF therapy) and eight controls cultured for 72 h with 10 μg/ml of anti-TNF antibody. Our findings demonstrated a significant down-regulation of TNFRSF1B gene expression in non-responders both in inflamed and in non-inflamed colon tissue, while the expression of the FCGR3A and IL1B genes was significantly up-regulated in non-responders in the inflamed colon region. In vitro research results indicate that the anti-TNF drug induced a significant decrease in TNFRSF1B, FCGR3A, and FAS gene expression in non-responders. These results show that altered TNFRSF1B, FCGR3A, and IL1B genes expression can be a predictor of the primary non-response to anti-TNF therapy in CD patients.

Effects of anti-TNF therapy and immunomodulators on anxiety and depressive symptoms in patients with inflammatory bowel disease: a 5-year analysis.

Background and aims:Anxiety and depression are prevalent in patients with inflammatory bowel diseases (IBD), especially during IBD flares. IBD therapies can profoundly affect the mood of patients with IBD. We aimed to determine the long-term impact of anti-tumor necrosis factor (anti-TNF) and immunomodulators (IM) on anxiety and depressive symptoms in IBD patients.Methods:We compared three treatment groups with IM only (group A), anti-TNF ± IM (group B) and no such therapy (group C). Patients completed the hospital anxiety and depression scale (HADS) at 1 year, 3 years, and 5 years after start of treatment.Results:In total, 581 patients with IBD (42.9% Crohn’s disease, 57.1% ulcerative colitis/IBD unclassified) participated in this study. Effects of treatment were analyzed in a mixed effects model, with and without correction for confounders. Compared with group C, group B showed a significant treatment-related improvement in both anxiety and depressive symptoms within the first 2.5 years and also thereafter. Group A showed a significant long-term improvement of anxiety and both short-term and long-term improvement in depressive symptoms. The significance of these results was maintained after correction for confounders, including corticosteroid treatment. Additionally, both groups A and B showed a significant decrease in disease activity in the first 2.5 years after start of treatment and also thereafter. Anti-TNF and IM treatment were associated with a similarly significant decrease in anxiety and depressive symptoms over an observation period of up to 5 years.Conclusion:Besides a clear benefit for disease activity, anti-TNF and IM apparently improve the mood of patients with IBD.

Anti-TNF agents and potential effects on male fertility: are men being counseled?

BackgroundAdult men with autoimmune conditions are commonly prescribed anti-tumor necrosis factor (anti-TNF) agents; however, there is a paucity of quality evidence as to their effect on male fertility (e.g. semen parameters and sperm quality). Our objective was to determine if men with autoimmune conditions are being counseled regarding the unknown reproductive effects of anti-TNF agents prior to initiation of therapy.MethodsA retrospective analysis of 1010 male patients age 18–45 who were prescribed an anti-TNF agent were assessed for (1) receipt of counseling regarding potential reproductive effects; (2) screening for anatomic or laboratory abnormalities associated with infertility; (3) election for sperm cryopreservation.ResultsOnly 10.3% of men received counseling, and this was not associated with age (p = 0.77). Those who received counseling were significantly more likely to have a genitourinary exam performed, be assessed for presence of a varicocele, be asked about or endorse low libido or erectile dysfunction, have a testosterone, LH, FSH, or prolactin level checked, and have a semen analysis performed (all, p < 0.0001). Rates of sperm cryopreservation were low, but statistically higher in men who received counseling (5.77% (+) counseling, 1.10% (−) counseling) (p = 0.002).ConclusionsThe limited current literature lacks a consensus regarding the short- and long-term male reproductive effects of anti-TNF therapy. Despite this lack of clarity, rates of pre-initiation counseling were low. Rates of sperm cryopreservation, while improved in the counseled group remained low, suggesting prescribing physicians may be unaware of this option for patients.

Prevalence of Metabolic Syndrome Among Patients with Psoriasis Treated with TNF Inhibitors and the Effects of Anti-TNF Therapy on Their Lipid Profile: A Prospective Cohort Study.

Background: Tumor necrosis factor (TNF) is an important inflammatory cytokine in the pathogenesis of psoriasis and metabolic syndrome (MS). Patients with psoriasis have higher rates of MS; therefore, some authors suggest an MS screening within this population. In addition, TNF inhibitor treatment often modifies the metabolic profiles of these patients. This study describes the epidemiological, clinical, and laboratory characteristics of patients with psoriasis undergoing anti-TNF treatment and evaluates whether anti-TNF treatments influence changes in their metabolic parameters. Methods: A prospective 6-month cohort study followed patients who underwent three consecutive consultations at 0, 3, and 6 months. The sample composed of 83 patients with psoriasis using anti-TNF. Results: The mean age and disease duration of the patients were 48 ± 11 and 16 ± 9 years, respectively. Most patients were men (61.5%). The prevalence of MS was 36%, and high rates of abdominal obesity (59%) and overweight (82%) were observed. Anti-TNF treatment significantly altered total cholesterol levels (195.5 ± 36.17 vs. 183.5 ± 41.23, P = 0.04) and low-density lipoprotein (LDL) cholesterol levels (128.5 ± 31.26 vs. 113 ± 36.31, P = 0.04). This study has some limitations, such as small sample size, brief follow-up period (6 months), patient recruitment from a tertiary-level referral center, and no control group. Conclusions: Patients with psoriasis have high rates of MS, overweight, and obesity, but anti-TNF treatment seems to improve the metabolic profile of these patients by decreasing their total and LDL cholesterol levels.

Effects of 1-year anti-TNF-\u03b1 therapy on vascular function in rheumatoid arthritis and ankylosing spondylitis

Accelerated atherosclerosis, increased cardiovascular morbidity and mortality have been associated with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Vascular function, clinical and laboratory markers and the effects of anti-TNF therapy were assessed in arthritides. Fifty-three 53 patients including 36 RA patients treated with either etanercept (ETN) or certolizumab pegol and 17 AS patients treated with ETN were included in a 12-month follow-up study. Ultrasonography was performed to determine flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and arterial pulse-wave velocity (PWV) in all patients. All assessments were performed at baseline and 6 and 12 months after treatment initiation. A significant improvement of brachial artery FMD was observed after 6 months (p = 0.004). A tendency of FMD improvement was also observed after 12 months (p = 0.065). ccIMT did not change throughout the year. PWV significantly improved after 12 months (p = 0.034). Higher baseline ccIMT (p = 0.009) and PWV (p = 0.038) were associated with clinical non-response (cNR) versus response (cR) to biologics. Multiple analysis confirmed the association of baseline ccIMT with age (p = 0.003) and cNR (p = 0.009), as well as that of baseline PWV with age at diagnosis (p = 0.022) and current chest pain (p = 0.004). Treatment itself determined the 12-month changes in FMD (p = 0.020) and PWV (p = 0.007). In a mixed cohort of RA and AS patients, TNF inhibition improved or stabilized vascular pathophysiology. Inflammation may be associated with FMD, while, among others, cNR may influence vascular function.

Effectiveness and safety of anti-TNF therapy for inflammatory bowel disease in liver transplant recipients for primary sclerosing cholangitis: A nationwide case series

BackgroundThere is a lack of consensus regarding the treatment of inflammatory bowel disease (IBD) after liver transplantation (LT) forprimary sclerosing cholangitis (PSC). AimTo investigate the safety and effectiveness of anti-TNF therapy in patients with IBD after a LT for PSC. MethodsWe reviewed the medical files of all of the IBD patients who underwent a LT for PSC and who were treated with anti-TNF therapy at 23 French liver transplantation centers between 1989 and 2012. ResultsEighteen patients (12 with ulcerative colitis and 6 who had Crohn’s disease) were recruited at 9 LT centers. All of these patients received infliximab or adalimumab following their LT, and the median duration of their anti-TNF treatment was 10.4 months. The most frequent concomitant immunosuppressive treatment comprised a combination of tacrolimus and corticosteroids. Following anti-TNF therapy induction, a clinical response was seen in 16/18 patients (89%) and clinical remission in 10 (56%). At the end of the anti-TNF treatment or at the last follow-up examination (the median follow-up was 20.9 months), a clinical response was achieved in 12 patients (67%) and clinical remission in 7 (39%). A significant endoscopic improvement was observed in 9 out of 14 patients and a complete mucosal healing in 3 out of 14 patients (21%). Six patients experienced a severe infection. These were due to cholangitis, cytomegalovirus (CMV) infection, Clostridium difficile, cryptosporidiosis, or Enterococcus faecalis. Three patients developed colorectal cancer after LT, and two patients died during the follow-up period. ConclusionsAnti-TNF therapy proved to be effective for treating IBD after LT for PSC. However, as 17% of the patients developed colorectal cancer during the follow-up, colonoscopic annual surveillance is recommended after LT, as specified in the current guidelines.

P469 Self-reported cutaneous side effects of anti-TNF therapy in inflammatory bowel disease patients

P469 Self-reported cutaneous side effects of anti-TNF therapy in inflammatory bowel disease patients

P463 Long-term effects of anti-TNF therapy on bone metabolism

P463 Long-term effects of anti-TNF therapy on bone metabolism

The effect of anti-TNF therapy on thyroid function in patients with inflammatory bowel disease.

The aim of this study was to investigate for first time the thyroid function in patients with inflammatory bowel disease (IBD) and the potential effect of anti-TNF (tumor necrosis factor) therapy. We evaluated 41 patients with IBD (25M/16F, 36.5 ± 11.3 y, 27 with Crohn's disease and 14 with ulcerative colitis), without any known thyroid disorder. Eighteen patients (9M/9F, 33.6 ± 8.8 y) were on anti-TNF therapy, while 23 patients (16M/7F, 38.7 ± 12.5 y) were treated with Azathioprine and Mesalazine (Aza/Mes) for more than 1 year. Twelve patients from the second group were then treated with anti-TNF and studied 6 months later. We assessed thyroid function by measuring thyroid stimulating hormone (TSH), free thyroxine (FT4), triiodothyronine (T3), thyroid peroxidase autoantibodies (TPOAb) and thyroglobulin autoantibodies (TgAb) levels. One patient presented with overt and one with subclinical hyperthyroidism. Thyroid auto-antibodies were positive in 12.2%. Patients from the anti-TNF group had lower levels of FT4 (1.09 ± 0.15 vs. 1.38 ± 0.9 ng/dL, p = 0.042), while TSH and T3 were comparable. The percentage of patients with positive thyroid auto-antibodies was lower in the anti-TNF group (5.6% vs. 17.4%). In the subgroup of patients who changed to anti-TNF, we found statistically significant reduction in FT4 after 6 months (1.26 ± 0.24 vs. 1.08 ± 0.15 ng/dL, p = 0.044), without changes in TSH and T3 levels. There was no change regarding thyroid auto-antibodies. In conclusion, patients with IBD showed a quite high percentage of thyroid autoimmunity. After treatment with anti-TNF, FT4 levels were found to be reduced, while no changes in TSH, T3 levels and thyroid auto-antibodies were noted.

Periodontitis Response to Anti-TNF Therapy in Ankylosing Spondylitis.

Recently, it has been demonstrated that patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) have a higher risk of periodontitis; however, the effect of anti-TNF therapy in periodontal status of patients with AS and particularly in dental attachment is not known. To evaluate longitudinally the local periodontal effect of TNF-antagonist in AS and compare to patients with RA. Fifteen patients with AS and 15 RA control patients were prospectively evaluated at baseline and after 6 months (6 M) of anti-TNF therapy. Periodontal assessment included: probing pocket depth (PPD), clinical attachment level (CAL), gingival bleeding index, and plaque index. Rheumatologic clinical and laboratory evaluations were the following: Bath AS Disease Activity Index, Bath AS Metrology Index, Bath AS Functional Index, C-reactive protein and erythrocyte sedimentation rate for AS and Disease Activity Score 28 joints, and C-reactive protein and erythrocyte sedimentation rate for patients with RA. At baseline, periodontal parameters were alike in AS and RA (P > 0.05). After 6 M of anti-TNF therapy, clinical and laboratory parameters of rheumatic diseases decreased significantly in the patients with AS and RA (P < 0.05). A significant improvement in periodontal attachment measurements were observed in the patients with AS (PPD, 2.18 vs 1.94 mm; P = 0.02; CAL, 2.29 vs.2.02 mm; P = 0.03), but not in RA (PPD, 1.92 vs 2.06 mm; P = 0.06; CAL, 2.14 vs 2.28 mm; P = 0.27). Oral hygiene and gingival inflammation remained unchanged from baseline to 6-M evaluation in AS and RA (P > 0.05). Patients with AS under anti-TNF improved periodontal attachment. The mechanism for this effect needs further studies.

The effect of anti-TNF therapy on thyroid function in patients with inflammatory bowel disease

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Effects of anti-TNF therapy on ophtalmological complications in children with rheumatic diseases

Biologics started a new era in treatment of different aspects of rheumatic disases. Authors present the effects of anti-TNF therapy on ophtalmological complications in their patients with juvenile idiopathic artritis (JIA), juvenile dermatomiositis (JDM) and sarcoidosis.

FRI0053 Comparison of the Risk of Developing Comorbities and Adverse Events by Type of Diagnosis: Results from the Lorhen Registry

BackgroundThe relationship between systemic rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) and various comorbidities has long been debated, and it has also been...

Tu1939 Association of Hif1α Pathway Genes With Relevant Clinical Subphenotypes in Inflammatory Bowel Disease (IBD)

analyzed by gene array, immunofluorescence, flow cytometry and thymidine incorporation. Results Anti-TNF induced regulatory macrophages displayed increased numbers of autophagosomes as well as an increased expression of autophagy related transcripts including atg5, atg7, atg9 and atg16l2, suggesting induction of autophagy by IFX treatment. Of all donors, 7 were homozygously carrying the CD associated risk allele, 14 were heterozygous and 7 were homozygous for the WT allele. The number of CD14+ regulatory macrophages correlated significantly with the number of WT alleles present in each individual culture, with the largest number of macrophages found in cultures containing 3 or 4 WT alleles (2 WT donors or 1 WT and 1 heterozygous). Similarly, expression of CD206, which is associated with the immunosuppressive function of macrophages, positively correlated with the number of WT alleles present. To confirm the functional consequences of these findings, IFX mediated suppression of T cell proliferation was determined. Again, the level of suppression correlated significantly with the number of WT alleles present in the respective donor combinations. Conclusion Induction of regulatory macrophages by IFX is associated with induction of autophagy. In vitro, the number and function of IFX induced macrophages correlated with the number of WT alleles for the autophagy related gene ATG16L1. This suggests that an intact autophagy pathway is important for effectiveness of anti-TNF therapy.

P322 The effects of anti TNF therapy on growth in Scottish children with IBD

pMayo of 0 1 points and endoscopic Mayo subscore of 0 points at week 52. The time elapsed between the diagnosis and the first biological therapy was assessed in every patient, who was then categorized to groups according to the elapsed time (0 2 years, 2 5 years, 5 10 years etc). Data were collected from five Hungarian IBD centres. Results: The mean elapsed time between the diagnosis and the start of biological therapy was 7 years. 50.4% of patients started infliximab therapy within 5 years after diagnosis. After induction with infliximab 65.6% of the enrolled patients achieved remission and 34.4% achieved response. After oneyear treatment period, the remission and response rates remained 67.7% and 21.8%. 10.6% of patients showed loss of efficacy at one year infliximab therapy. 74.6% of subjects achieved clinical remission at week 14 and remained in remission at week 52. Complete mucosal healing was detected in 31.2% and deep remission in 13.9% of the patients at week 52. Response rates to infliximab therapy at one year were significantly lower compared to rates at week 14 (p = 0.029). The rate of response, remission and loss of efficacy did not depend on the elapsed time between the diagnosis and the start of biological therapy. Conclusions: Our results did not reveal an association between the remission rates and the elapsed time between the diagnosis and the first biological therapy in UC.

P354 Satisfaction and concerns about anti-TNF alpha therapy in Crohn's disease – the patient's perspective in a Portuguese population

Background: Anti-TNF alpha therapy is a common option in Crohn’s disease treatment. However, there is still no consensus about its interruption in patients with remission. Few studies have evaluated patient’s perspective about anti-TNF alpha therapy, namely the importance of a finite therapy. Aims: To evaluate patient’s opinion about the importance of a finite anti-TNF alpha therapy; to assess patients’ satisfaction about the administration scheme of its current anti-TNF alpha therapy and to compare it to the alternative regimen. Methods: Crohn’s disease patients treated with anti-TNF alpha therapy (infliximab and adalimumab) during 2013 were studied. A questionnaire was performed by a single physician (CF). Data evaluated: (1) the effect of anti-TNF alpha therapy in daily routine; (2) the administration scheme and its comparison with the alternative and (3) the relevance of a finite therapy. Results: 43 patients were selected and of these 38 agreed to answer the questionnaire (55.3% female; mean age: 38.3 [±10.7] years); (1) infliximab group: 21 patients (mean age: 40.4 [±10.4] years; 57.1% male); Median follow-up since the beginning of anti-TNF alpha therapy: 21.0 [26.1] months; 57.1% of the patients were employed, and from these 58.3% needed to miss work days to comply with the treatment; patients rated the beneficial effect of anti-TNF therapy as 8.4 [in a scale of 0 10]) and the comfort of the administration scheme as 8.1 [0 10]. 52.7% patients declared that they would prefer administration scheme of the alternative therapy. (2) adalimumab group: 17 patients (mean age 35.6 [±10.9] years; 70.6% female); Median follow-up since the beginning of anti-TNF alpha therapy: 13.0 [±16.3] months; 47.1% patients were employed but adalimumab didn’t have any impact in their daily activities; patients rated the beneficial effect of anti-TNF alpha therapy as 8.6 [0 10]) and the comfort of the administration scheme as 7.6 [0 10]; however only 35.3% would prefer to change to the alternative scheme; (3) the hypothesis of a finite therapy was highly valued in our sample (total: 8.3; infliximab group 8.3; adalimumab group 8.4 [0 10]) and almost half of the patients (47.3%) admitted to fear some therapy adverse effects. Conclusions: In our sample: (1) patients are globally satisfied with their current anti-TNF alpha therapy scheme of administration; (2) the majority of patients under infliximab admitted will to change their administration scheme; (3) patients considered the possibility of a finite anti-TNF alpha therapy a very important issue; (4) almost half of the patients admitted to fear some adverse effects of anti-TNF alpha therapy.

P355 Safety and efficacy of restorative proctocolectomy in the elderly. A European, prospective, multicenter, S-ECCO study

Background: Anti-TNF alpha therapy is a common option in Crohn’s disease treatment. However, there is still no consensus about its interruption in patients with remission. Few studies have evaluated patient’s perspective about anti-TNF alpha therapy, namely the importance of a finite therapy. Aims: To evaluate patient’s opinion about the importance of a finite anti-TNF alpha therapy; to assess patients’ satisfaction about the administration scheme of its current anti-TNF alpha therapy and to compare it to the alternative regimen. Methods: Crohn’s disease patients treated with anti-TNF alpha therapy (infliximab and adalimumab) during 2013 were studied. A questionnaire was performed by a single physician (CF). Data evaluated: (1) the effect of anti-TNF alpha therapy in daily routine; (2) the administration scheme and its comparison with the alternative and (3) the relevance of a finite therapy. Results: 43 patients were selected and of these 38 agreed to answer the questionnaire (55.3% female; mean age: 38.3 [±10.7] years); (1) infliximab group: 21 patients (mean age: 40.4 [±10.4] years; 57.1% male); Median follow-up since the beginning of anti-TNF alpha therapy: 21.0 [26.1] months; 57.1% of the patients were employed, and from these 58.3% needed to miss work days to comply with the treatment; patients rated the beneficial effect of anti-TNF therapy as 8.4 [in a scale of 0 10]) and the comfort of the administration scheme as 8.1 [0 10]. 52.7% patients declared that they would prefer administration scheme of the alternative therapy. (2) adalimumab group: 17 patients (mean age 35.6 [±10.9] years; 70.6% female); Median follow-up since the beginning of anti-TNF alpha therapy: 13.0 [±16.3] months; 47.1% patients were employed but adalimumab didn’t have any impact in their daily activities; patients rated the beneficial effect of anti-TNF alpha therapy as 8.6 [0 10]) and the comfort of the administration scheme as 7.6 [0 10]; however only 35.3% would prefer to change to the alternative scheme; (3) the hypothesis of a finite therapy was highly valued in our sample (total: 8.3; infliximab group 8.3; adalimumab group 8.4 [0 10]) and almost half of the patients (47.3%) admitted to fear some therapy adverse effects. Conclusions: In our sample: (1) patients are globally satisfied with their current anti-TNF alpha therapy scheme of administration; (2) the majority of patients under infliximab admitted will to change their administration scheme; (3) patients considered the possibility of a finite anti-TNF alpha therapy a very important issue; (4) almost half of the patients admitted to fear some adverse effects of anti-TNF alpha therapy.