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Adalimumab Dose Escalation Is Effective for Managing Loss of Response in Ulcerative Colitis Carlos Taxonera, Eva Iglesias Flores, Fernando Munoz, Marta Calvo, Manuel Barreiro-de Acosta, David Busquets, Xavier Calvet, Antonio Rodriguez, R. Pajares, Javier P. Gisbert, Pilar Lopez-Serrano, Jose Lazaro Perez-Calle, Angel Ponferrada Diaz, Cristobal De la Coba, Fernando Bermejo, Maria Chaparro, Cristina Alba, David Olivares, Ignacio Fernandez-Blanco

(p = 0.013) during follow-up of the cohort. No statistical significance was obtained regarding the need for biological therapy or surgery. Statistically significant association between smoking and need for hospitalization was also found in CD (p = 0.004). There is also a significant association between younger age at diagnosis and biological therapy need (p = 0.022) and between B3 pattern and need for immunomodulatory therapy (p = 0.009). The B1 pattern was associated with less hospitalization (p = 0.049) and less need for surgery (p = 0.018). For UC no statistically significant association between the independent variables of the patients, disease phenotype and therapeutic needs was found. Conclusions: In our hospital area of southern Spain incidence rates are similar to other areas of southern Europe. However Greater incidence of Crohn’s disease with respect to UC is described. Crohn’s disease requires more aggressive therapy than CU (immunomodulators and surgery). An early age at diagnosis is associated with greater need for biologic therapy.

DOP071 Inflammatory bowel diseases: a new cardiovascular risk factor? L. Caillo1 *, G. Danan1, V. Georgescu2, L. Papineau1, F. Gonzalez1, J.-F. Bourgaux3, F. Guillon4, G.-P. Pageaux1, R. Altwegg1 *. 1University Hospital of St Eloi, Departement of Hepatology and Gastroenterology, Montpellier, France, 2University Hospital, Department of Medical Information, Montpellier, France, 3University Hospital, Department of Hepatology and Gastroenterology, Nimes, France, 4University Hospital of St Eloi, Department of Digestive Surgery, Montpellier, France

M.J. Casanova1, M. Chaparro1 *, E. Domenech2, M. Barreiro-de Acosta3, F. Bermejo4, E. Iglesias5, F. Gomollon6, L. Rodrigo7, X. Calvet8, M. Esteve9, E. Garcia-Planella10, S. Garcia11, C. Taxonera12, M. Calvo13, M. Lopez14, D. Ginard15, M. Gomez16, E. Garrido17, J. Perez-Calle18, B. Beltran19, M. Piqueras20, C. Saro21, B. Botella22, C. Duenas23, A. Ponferrada24, M. Manosa2, M. Iglesias3, A. Algaba4, V. Garcia-Sanchez5, J. Mate1, J.P. Gisbert1. 1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain, 2Hospital Germans Trias i Pujol, Badalona, Spain, 3Hospital Clinico Santiago, Santiago de Compostela, Spain, 4Hospital de Fuenlabrada, Madrid, Spain, 5Hospital Reina Sofia, Cordoba, Spain, 6Hospital Clinico Lozano Blesa, Zaragoza, Spain, 7Hospital Central de Asturias, Asturias, Spain, 8Hospital Parc Tauli, Barcelona, Spain, 9Hospital Mutua de Terrassa, Terrassa, Spain, 10Hospital Santa Creu i Sant Pau, Barcelona, Spain, 11Hospital Miguel Servet, Zaragoza, Spain, 12Hospital Clinico San Carlos, Madrid, Spain, 13Hospital Puerta de Hierro, Madrid, Spain, 14Hospital de Galdakao, Galdakao, Spain, 15Hospital Son Espases, Mallorca, Spain, 16Hospital Virgen de Las Nieves, Granada, Spain, 17Hospital Ramon y Cajal, Madrid, Spain, 18Hospital Fundacion Alcorcon, Madrid, Spain, 19Hospital La Fe, Valencia, Spain, 20Consorcio Sanitario Terrassa, Terrassa, Spain, 21Hospital de Cabuenes, Gijon, Spain, 22Hospital Infanta Cristina, Madrid, Spain, 23Hospital San Pedro Alcantara, Caceres, Spain, 24Hospital Infanta Leonor, Madrid, Spain

Introduction: A significant proportion of Crohn's Disease (CD) patients have already been treated with two biologic therapies. Follow-up from current published retrospective or prospective open label studies on patients who have already received 2 biologics does not extend beyond 1 year (1-4) Methods: Our aim was to collect ‘real-life', long-term data on the tolerability and efficacy of the second biologic agent in (re)-capturing response, and to assess whether the reason for stopping the first agent impacted on the successful use of the second agent. We carried out secure data collection from 3 teaching IBD centres on CD patients currently on, or already failed a second biologic. We collected data on disease duration, distribution and behaviour, and report on the aetiology in the failure of the first biologic and the subsequent outcome of the second biologic agent. Response to biologics was assessed by Harvey Bradshaw Index or Physicians Global Assessment. Results: We collected data on 66 patients (F 46%, mean age at diagnosis: 25). The disease distribution was characterised as L1: 11%, L2:32% L3:56% L4:1% and the behaviour as B1: 41% B2: 35% B3: 24% . 17% of our cohort had perianal involvement. 36 patients have had a total of 41 resectional operations. 1st biologic: 64/66 patients had infliximab (IFX) first-line, followed by adalimumab (ADA), and 2/66 patients had ADA followed by IFX. Reasons for swapping were 1o failure in 23%, secondary-loss of response in 38%, intolerance to the first agent in 29%, and fear of hypersensitivity reaction due to previous episodic exposure to IFX in 10% (irrespective of efficacy or tolerance) 2nd biologic: 70% of patients remained on the second biologic after a median follow-up of 22 months. Reasons for discontinuing therapy were 1o failure in 35%, secondary loss of response in 25%, intolerance (or patient concerns regarding potential side-effects) in 25%, and achieving remission in 5%; no reason provided for the remainder 5%. Neither the demographics, disease characteristics nor the reason for failing the first biologic had a statistically significant bearing in predicting the initial response to and subsequent outcome of the second biologic. Conclusion: 1. We report an overall 70% retention on the second biologic at 22 months following all-cause failure of the first agent in CD patients from England and Ireland. 2. Patients responded equally well to the second biologic, irrespective of the reason for the failure of the first biologic. References: 1.Swaminath A et al, APT 2009 2. Seiderer J et al, APT 2007, Peyrin-Biroulet L et al, APT 2007, 4. Papadakis KA et al, AJG 2005.