P0926Does Intestinal Ultrasound Combined with Visceral Adipose Tissue more Accurately Predict Primary Non-response to Infliximab in Patients with Crohn’s Disease? A Prospective, Observational Study

Background Infliximab (IFX) is widely used for the treatment of Crohn’s disease (CD), yet up to 40% patients experience primary non-response (PNR). Visceral adipose tissue and intestinal ultrasound (IUS) could be used as noninvasive tools to predict treatment efficacy with limited value, respectively. Therefore, we aimed to investigate their complementary to predict PNR in CD patients. Methods Consecutive patients with active CD initiating regular IFX therapy were prospectively included. Patients underwent IUS at baseline (T0), week 2 to 4 (T1) and week 14 (T2), and CT at T0 to collected visceral fat area (VFA). Multivariable analyses and logistic regression analysis were used to identify predictors based on the efficacy at T2, regardless of prior biologic exposure. Results Of 100 patients, 31 (31%) experienced PNR. Multivariable analysis identified baseline bowel wall thickness [BWTT0; odds ratio(OR), 2.08; 95% confidence interval (CI), 1.04-4.18; P<0.05], VFA (VFAT0; OR, 1.03; 95% CI, 1.01-1.05; P<0.01), the decrease of BWT(△BWT; OR, 2.72; 95% CI, 1.35-5.47; P <0.01) and the International Bowel Ultrasound Segmental Activity Score (△IBUS-SAS; OR, 1.08; 95% CI, 1.01-1.16; P<0.05) at T1 were independent predictors of PNR. The △BWT combined with VFAT0 can accurately predict PNR with an ROC of 0.84 (95%CI, 0.76-0.93), superior to BWTT0 combined with VFAT0 (ROC, 0.83; 95%CI, 0.75-0.90) and △IBUS-SAS combined with VFAT0 (ROC, 0.830; (95%CI, 0.75-0.92). Conclusion Early change in BWT on IUS combined with baseline VFA is highly predictive of PNR to IFX in CD patients, allowing stratification of patients beneficial from treatment initiation and guiding individualized clinical practice. Conflict of interest: Ye, Mingmei: No conflict of interest Zhao, Panpan: No conflict of interest Gao, Feng: No conflict of interest Mei, Ying: No conflict of interest Xiong, Rujing: No conflict of interest Huang, Yuanyuan: No conflict of interest Mao, Xiayu: No conflict of interest Meng, Tianjing: No conflict of interest Tian, Li: No conflict of interest