P0333 Predictive factors for thiopurine treatment failure in anti-TNF naïve IBD patients: Insights from a tertiary care Hepato-Gastroenterology center experience

Abstract

Abstract Background Chronic Inflammatory Bowel Diseases (IBDs) pose a significant challenge due to their chronic nature and the characteristic pattern of relapse and remission. The maintenance’s goal therapy is to prolong remission as much as possible. Immunosuppressants, particularly thiopurines, are widely employed for this purpose. However, Nearly half of patients on these drugs lose remission or fail to maintain it, with the causes still unclear. This study explores patient-related factors linked to thiopurine failure. Methods This retrospective study, conducted over five years and two months (January 2018 to March 2023), included IBD patients treated with thiopurines who had not previously received anti-TNF therapy. Patients were followed for 1 to 5 years after starting thiopurines, with treatment failure defined as requiring two or more corticosteroid courses in a year, escalation to anti-TNF therapy, or surgical intervention. Data were collected from medical records and analyzed using SPSS software, employing the chi-square test and multivariate logistic regression to assess relationships Results We analyzed 165 patients, including 119 with Crohn’s disease (CD) and 46 with ulcerative colitis (UC), with a median age of 39.05 years and a female predominance (sex ratio 0.81). All patients consumed tea (100%), smoking was present in 15.15%, alcohol consumption in 6%, and NSAID use in 10%. Among UC patients, 13 failed thiopurine treatment, with 3 requiring colectomy and 10 escalating to anti-TNF therapy, all diagnosed with UC E3. For CD patients, 99 experienced treatment failure, including 15 ileocolectomies, 30 ileocecal resections, and 54 cases requiring anti-TNF therapy. Hypoalbuminemia (<35 mg/L) at diagnosis was a significant risk factor for thiopurine failure (p=0.05). Non-smoking UC patients (p=0.06) and UC E3 patients with frequent flares (p=0.09) showed a strong, though not statistically significant, trend towards failure. In CD, smoking (p=0.05), NSAID use (p=0.08), and active inflammatory colonic disease with over two flares annually (p=0.04) increased failure risk. Common factors for both UC and CD included anemia (p=0.001), tea consumption (p=0.003), phytotherapy (p=0.06), and younger age (17–32 years, p=0.09) Conclusion Our findings demonstrate that hypoalbuminemia, anemia, and young age at diagnosis pose an increased risk of thiopurine treatment failure. Moreover, some patients characteristics such as smoking, frequency of flares, NSAID use, and phytotherapy may also serve as predictive factors for thiopurine treatment failure. These factors should be regarded as markers of non-response to thiopurines as monotherapy in patients with moderate to severe colonic CD or UC E3.