P-124 The Efficacy and Safety of Infliximab in Pediatric Crohn’s Disease in China
Wang Xiongqiong 1, Xu Chundi2, Hu Hui3, Xiao Yuan4, Yu Yi5, Zhang Ting3. 1Shanghai Ruijin Hospital, Shanghai, China, 2Shanghai Ruijin Hospital, Shanghai, China, 3Department of Gastroenterology, Children Hospital of Shanghai, Shanghai Jiao Tong University, School of Medicine, Shanghai, China, 4Shanghai Ruijin Hospital, Shanghai, China, 5Shanghai Ruijin Hospital, Shanghai, China
BACKGROUND: Few studies have examined the efficacy and safety of infliximab (IFX) in pediatric Crohn's disease (CD) in China. This study aimed to investigate the response and remission rate of IFX, as well as the associated adverse events.
METHODS: We collected data from CD patients who had received IFX 2 or more times from three hospitals in Shanghai from January 2007 to December 2016. The efficacy of IFX was observed, as well as the adverse events, relapse rate and retreatment efficacy. The overall risk factors related to IFX were also evaluated.
RESULTS: Eighty-six patients participated in the study. With treatment, the patients demonstrated improved growth and nutrition indices and decreased disease activity. The clinical response rate was 91.9% and 88.2% at weeks 10 and 34, respectively. The sustained remission rates were 69.8% and 67.6% at weeks 10 and 34, respectively. The mucous healing rate was 19.3% at week 10 and 25.7% at week 34. Finally, 45 patients (66.2%) demonstrated durable responses, and 23 (33.8%) showed complete LOR. Adverse events related to IFX occurred in 55.8% of the patients, including allergic reactions in 17.4% and infections in 41.9%. Univariate analysis showed that a high pediatric clinical disease activity index score prior to IFX administration was a risk factor for IFX LOR. Continuation of concomitant azathioprine beyond induction was a protective factor for durable response.
CONCLUSION(S): IFX is an effective treatment for CD in Chinese children; however, adverse events can occur. A comprehensive evaluation must be performed before each IFX infusion.
P-125 Anaerobic Stool Preparation Method for Fecal Microbiota Transplantation Is Not Superior to Conventional Aerobic Method in Preserving Anaerobic Bacteria
Shimizu Hirotaka 1, Arai Katsuhiro1, Takeuchi Ichiro1, Takahashi Takuya2, Asahara Takashi2, Tsuji Hirokazu2, Matsumoto Satoshi2, Yamashiro Yuichiro3. 1National Center for Child Health and Development, Setagaya, Japan, 2Yakult Central Institute, Kunitachi-shi, Japan, 3Probiotics Research, Juntendo University Graduate School of Medicine, Bukyo-ku, Japan
BACKGROUND: Fecal Microbiota Transplantation (FMT) has shown to be effective in the treatment of recurrent Clostridium difficile infection, but its efficacy in treating ulcerative colitis has not been promising to date. In several studies, FMT solution is usually prepared using a household blender under aerobic conditions. However, bacterial counts of most anaerobes, which are major components of human microbiota, might be decreased during this procedure. In this study, we prepared FMT suspensions under both anaerobic and aerobic conditions, and compared the live gut microbiota composition by 16S rRNA-targeted reverse transcription-quantitative PCR (RT-qPCR).
METHODS: We collected 20 fecal samples from 20 Japanese healthy adult donors. Feces were collected and transferred under anaerobic conditions using air tight fecal container and Anaeropack® (deoxidizer). In an anaerobic glove box (where air is substituted by nitrogen and oxygen concentration is maintained at ≤1%), we divided each sample into two portions. Aliquots were diluted with normal saline, and blended using a house hold blender for 30 seconds in an anaerobic glove box (“Anaero-group”) or under aerobic conditions (“Aero-group”). Fecal suspensions were transferred into tubes containing 2 mL of RNAlater® (RNA stabilization solution) and stored at 4°C. Using Yakult Intestinal Flora Scan (YIF-SCAN), the number of live gut bacteria per sample were obtained.
RESULTS: The percent change in the number of bacteria after fecal preparation was evaluated for total bacteria, obligate anaerobic bacteria, facultative anaerobic bacteria, and aerobic bacteria. The percent changes in the number of bacteria between the “Anaero-group” and “Aero-group” were compared by Wilcoxon rank sum test. There was no significant difference, between the “Anaero-group” and “Aero-group”, in the percent changes of total bacteria (median 74%, interquartile range 28% vs. median 83%, IQR 41%, respectively), obligate anaerobic bacteria (median 74%, IQR 28% vs. median 85%, IQR 41%, respectively), facultative anaerobic bacteria (median 95%, IQR 26% vs. median 103%, IQR 57%, respectively), and aerobic bacteria (median 100%, IQR 432% vs. median 100%, IQR 513%, respectively).
CONCLUSION(S): In this study, the anaerobic preparation method was not superior to conventional aerobic preparation method in preserving live gut microbiota in FMT suspensions. Limitations of this study include potential sampling bias. Further studies are essential to develop better techniques for preparation of FMT suspension.