P679 Risk factors for disease relapse after stepping down from combination to anti-TNF monotherapy in children with IBD

Abstract Background Stepping down from combination therapy of anti-TNF and immunomodulator drug to monotherapy is common practice in IBD. The aim of our study was to define risk factors for disease exacerbation after withdrawal from combination therapy in children with IBD. Methods We retrospectively compared disease course between children with IBD who stepped down to anti-TNF monotherapy (group 1) and children who continued combination therapy until the end of the study follow-up (group 2). In order to define risk factors for disease exacerbation after stepping down, we compared clinical data between children who exacerbated and children that kept disease remission. Results Sixty-four patients were included: 32 in group 1 and 32 in group 2, with median (IQR) age of 16 (13.4–17.5) years and mean (range) follow-up of 19.1 (6.5–24) months. The median (IQR) duration of combination therapy was 6 (6–10) months for children who stepped down. In a multivariate analysis, the risk for disease exacerbation and hospital admissions was significantly higher in group 1 compared with group 2 (OR 4.35, p = 0.01 and OR 3.13, p = 0.045, respectively). Penetrating phenotype, upper GI involvement, moderate–severe disease activity at diagnosis, treatment with Infliximab, sub-therapeutic anti-TNF levels and high stool calprotectin during combination therapy were associated with disease exacerbation and hospital admissions after stepping down to monotherapy. Conclusions Children with IBD are at higher risk of disease relapse after stepping down from combination to monotherapy. Several risk factors for disease relapse after cessation of combination therapy were identified.