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S172 61 months. Independent predictors of relapse-free survival were combined use of IMM during IFX induction [Odds ratio 1.47 (95% CI 1.04 2.08), p = 0.031] and short-term complete clinical response [3.30 (2.33 4.67), p < 0.001]. IFX dose optimization was performed in 100 patients (76%) and was successful in half of them. During a median follow-up of 65 months, 56 of the 277 patients (20%) needed colectomy (Figure). Independent predictors of colectomy-free survival were short-term clinical response [11.23 (5.71 21.74), p < 0.001], a baseline CRP 5 mg/L [2.50 (1.22 5.26), p = 0.012] and a baseline albumin 35 g/L [2.33 (1.12 3.23), p = 0.024]. Nine out of 37 patients (24%) with IV steroid-refractory UC required colectomy. During IFX therapy, 99 of 127 patients under CS at baseline (78%) could definitively stop CS. Furthermore, 17 infectious adverse events necessitating hospitalization occurred. Throughout followup, 20 patients developed a malignancy and 10 patients died. Short- and long-term post-operative complications were observed in 53% and 58%, respectively. Poster presentations perianal fistulae, postop. smoking, postop. medications were noted. Rutgeerts score was used to define postop. endoscopic recurrence. Results: The patients’ mean age±SD at their final colonoscopy was 42.81±11.99 yr, at operation: 36.32±11.23 yr, 45% being female. The mean follow-up time between resection and the final colonoscopy was 45 (range, 2 300) months. 13/83 (16%) patients had their 2nd resection. 45/83 patients (54%) had an ileocecal resection without any postop. residual disease in the remnant intestine. 51/83 (61%) patients were in endoscopic remission whereas 32 (39%) were not. There was no difference regarding age at disease onset, at operation, at colonoscopy, and the time from resection to the latest colonoscopy, sex or disease duration, behavior, location, smoking status, and family history between patients with and without endoscopic recurrence. 9/32 (28%) with endoscopic recurrence compared to 4/51 (8%) without relapse had a history of a 2nd resection (p = 0.013), disclosing a 3.58 (1.2 10.68) fold risk for relapse. The presence of any postop. residual disease was another risk factor [p = 0.015; OR: 1.77 (1.12 2.8)] but the regular use of azathioprine (AZA), defined as its use at least in 85% of postop. time period, was found to be a protective factor [p = 0.022; OR: 1.35 (1.06 1.72)]. In a logistic regression analysis all the three variables proved to be independent predictors of relapse (p = 0.013, p = 0.015, p = 0.022 for a history of a 2nd resection, for the presence of any postop. residual disease, and for the absence of regular AZA use, respectively). Conclusions: Having multiple resections for CD was identified as one of the risk factors for endoscopic recurrence, and the strict regular use of AZA seemed to add a little positive effect in preventing endoscopic relapse. The presence of any residual disease after resection came out as an independent risk factor for relapse, an issue never mentioned in previous reports. P406 Predictive factors of refractory to tacrolimus therapy in patients with active ulcerative colitis Figure: Colectomy-free survival. Conclusions: With a median follow-up of 65 months, 20% of 277 patients treated with IFX for refractory UC needed colectomy. Short-term clinical response, normal baseline CRP and normal baseline albumin were independently associated with colectomy-free survival. P405 Predictors of endoscopic recurrence in a long term follow up cohort of Crohn’s disease patients How effective is azathioprine? A single tertiary referral center experience Y. Erzin1 *, G. Sisman1 , I. Hatemi1 , B. Baca2 , I. Hamzaoglu3 , A. Dirican4 , A.F. Celik1 . 1 Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey, 2 Istanbul University Cerrahpasa Medical Faculty, Surgery, Istanbul, Turkey, 3 Istanbul Univesrity Cerrahpasa Medical Faculty, Surgery, Istanbul, Turkey, 4 Istanbul University Istanbul Medical faculty, Biostatistics, Turkey Background: Aim was to determine the predictors of endoscopic recurrence in a cohort of CD patients with prior intestinal resections. Methods: CD patients’ charts were reviewed in a retrospective manner. 104 of 537 (19%) CD patients had a history of prior intestinal resection. 21/104 (20%) were either lost to follow-up or had no postoperative (postop.) colonoscopy, so 83 patients were eligible for the final analysis. Age at disease onset, at resection, at the last postop. colonoscopy; presence of family history, sex, disease location, and behavior, presence of Y. Yokoyama1 *, K. Watanabe2 , N. Hida1 , K. Nogami1 , K. Kamikozuru1 , K. Tozawa1 , K. Nagase1 , K. Fukunaga1 , T. Matsumoto1 . 1 Hyogo College of Medicine, Department of Internal Medicine, Division of Lower Gastroenterology, Nishinomiya, Japan, 2 Graduate School of Medicine, Osaka City University, Department of Gastroenterology, Osaka, Japan Background: Although tacrolimus (TA) is recognized as an effective therapy for induction remission in intractable patients with ulcerative colitis (UC), there are some refractory cases in spite of appropriate TA dose adjustment. Therefore, the evaluation of predictors for refractory including surgery is important issue for suitable treatment strategy. The aim of the present study is to investigate the predictors for refractory to TA therapy in patients with active UC. Methods: Forty-seven patients who had been treated with TA for active intractable UC were investigated retrospectively. Clinical UC activity was assessed with the Lichtiger’s clinical activity index (CAI) and Mayo score. The refractory case was defined as underwent surgery or changing to alternative treatment during TA therapy with high trough level (10 15 ng/ml, at least 7 days). We compared to evaluate the predictors between the response group and refractory group with multivariate analysis for patients’ demographic variables. Results: The median of age was 35.5 years, duration of disease was 4.5 years, CAI was 10.3 and Mayo score was 8.0 for enrolled patients. Nine cases (19.1%) were refractory to TA therapy. Among them, 7 cases underwent surgery and 2 cases were changed to infliximab. The median interval from the achieving high TA trough level to the evaluation as TArefractory was 18.7 days (7 34days). At baseline, both of CAI and Mayo score were significantly higher in the refractory group than the response group (p = 0.016 and p = 0.023, respectively). Clinical: Therapy and observation And the dose of prednisolone (PSL) at baseline was also significantly higher in the refractory group than the response group (p = 0.005). Multiple logistic regression analysis showed that high daily PSL dose (p = 0.032, 95% CI 1.014 1.363) at baseline and high CAI score at 7 days after achieving high trough level (p = 0.047, 95% CI 1.007 3.065) were significant predictive factors for the refractory to TA therapy. Conclusions: Higher activity and higher daily PSL dose at baseline, poor response at 7 days after achieving high trough level were predictive factors for refractory to TA therapy. These refractory patients should be changed to alternative treatment including surgery without missing the appropriate timing. P407 Predictive factors for the efficacy of leukocytapheresis in ulcerative colitis K. Mitsuyama1 *, K. Nagayama1 , H. Takedatsu1 , T. Kobayashi1 , H. Yamasaki1 , K. Kuwaki1 , S. Yoshioka1 , O. Tsuruta1 , M. Sata1 . 1 Kurume University School of Medicine, Division of Gastroenterology, Department of Medicine, Kurume, Japan Background: Leukocytapheresis (LCAP) has been reported to be a safe and effective treatment for active ulcerative colitis (UC). However, the factor predicting the efficacy of LCAP had not been yet established. The aim of this study was to perform the univariate analysis of the predictive factor for the efficacy of LCAP in patients with UC. Methods: Between October 2001 and March 2011, LCAP therapy was conducted in Kurume University Hospital for 41 patients with moderate to severe UC which involves the left-sided to entire colon. These patients received the LCAP treatment from total 5 to 10 sessions once weekly. Disease activity was evaluated clinically by the Lichtiger’s clinical activity index (CAI) and endoscopically by the Rachmilewitz index. Univariate analysis in retrospective based on the patient’s case record was performed to identify the predictive factors which affected the therapeutic effect [1], the rapid response (responds within 3-sessions of LCAP) [2], and the long term remission [3]. Results: [1] The LCAP treatment showed 75.0% of clinical remission (Lichtiger’s CAI of 4 or less than) and 11.1% of clinical response (the reduction of 5 points or half from baseline). A significant difference (p = 0.0369) was observed in body mass index with univariate analysis performed between clinical responders and non-responders. [2] 47.2% of the LCAP-treated patients had rapid effects (the clinical remission and response after 3 LCAP sessions). The sex differed significantly between rapid responders and non-rapid responders (p = 0.0411). [3] Patients with male (p = 0.0222), first attack (p = 0.0005), elevated CRP levels (pre-treatment level, p = 0.0041), high leukocyte counts (post-treatment level, p = 0.0181), low endoscopic scores (post-treatment level, p = 0.0282) and low erythrocyte sedimentation rate (posttreatment level, p = 0.0029) achieved a long-term remission. Conclusions: This study demonstrates the clinical efficacy of LCAP in active UC patients and also indicates that the induction of remission by repeated sessions of LCAP therapy is important to maintain the long-term remission. P408 Prediction of clinical responders to treatment with DIMS0150 a Toll-Like Receptor 9 agonist in therapy refractory ulcerative colitis patients O. von Stein1 *, E. Musch2 , R. Löfberg3 , N. Kuznetsov1 , P. von Stein1 . 1 InDex Pharmaceuticals, Stockholm, Sweden, 2 Marienhospital, Clinic of Colo-Proctology, Bottrop, Germany, 3 IBD unit Sophiahemmet and the Dept of Medicine, Karolinska Institutet, Stockholm, Sweden Background: Previous clinical studies suggest that local rectal administration of the Toll-Like Receptor 9 (TLR9) agonist S173 in therapy refractory UC patients induced clinical response and remission. Clinical improvements were paralleled by a restoration of steroid sensitivity in vitro as determined by the use of specific biomarkers. The aim of the presented study was to determine whether patients mostly likely to benefit from DIMS0150 treatment could be identified through the use of these specific biomarkers. Methods: We investigated, in the context of a randomized, placebo controlled clinical study, whether screening of a preselection of steroid response genes could identify steroid refractory UC subjects most likely to respond to DIMS0150 treatment. Expression analysis of 34 steroid response genes were performed in vitro in peripheral blood mononuclear cells (PBMCs) derived from in 9 steroid refractory UC patients and compared to healthy volunteers. Clinical utility of the biomarkers was subsequently tested in a placebo controlled, randomized, double blinded study in active therapy resistant UC patients on concomitant steroid therapies. Results: We identified two biomarkers CD163 and TSP1 whose response to steroids was significantly enhanced when DIMS0150 was applied in vitro. Thirty-four subjects were randomized to receive a single rectal administration of placebo or 30 mg of DIMS0150. Blood derived PBMCs were obtained prior to dosing and assayed for evidence of a steroid sensitizing effect following steroid incubation in the presence of DIMS0150. Upon study completion and un-blinding, the biomarker assay correctly predicted a clinical response in over 90% of those patients positive for both biomarkers. The clinical response rate in this positively identified group was impressive being over 80% for active at weeks 1 and 4 with a delta of over 50% to placebo. By contrast, patients with a negative outcome for the biomarkers had a response rate no different to placebo being 14% and 27% at weeks 1 and 4 respectively. Conclusions: Using specific steroid response biomarkers, therapy refractory UC patients more likely to benefit from DIMS1050 treatment could be identified and illustrates the usefulness of a personalized treatment approach. P409 Physician knowledge of reproductive issues in inflammatory bowel disease is highly variable V. Huang1 *, K. Kroeker2 , K. Goodman2 , L. Dieleman2 , R. Fedorak2 . 1 University of Alberta, Edmonton, Canada, 2 University of Alberta, Canada Background: Reproductive care during inflammatory bowel disease (IBD) can be challenging in its multifactorial nature. Physicians must consider the impact of IBD and its treatment on fertility, pregnancy, and neonatal outcome. While women with inactive IBD have outcomes similar to the general population, patients with active IBD are faced with decreased fertility and varied fetal outcomes. There is a higher rate of voluntary childlessness in women with IBD compared to the general population, with this decision often being made because of the IBD diagnosis. Our previous study assessing patient knowledge of reproductive issues in IBD demonstrated that patient knowledge regarding reproductive issues in IBD was poor, despite 50% reported discussing these issues with their physicians. The aim of this study was to assess, in physicians treating women with IBD, their IBD-related reproductive knowledge and their practice in discussing this knowledge with IBD patients. Methods: Physicians attending a national IBD conference, and a provincial gastroenterology for general practitioners conference both in 2012, were invited to complete a survey package consisting of: 1) Crohn’s and Colitis Pregnancy Knowledge (CCPKnow) score and 2) questionnaire regarding individual practice patterns. The validated CCPKnow score differentiates between poor (0 7), adequate (8 10), good (11 13) and very good (14 18) reproductive knowledge.