P-099: Single center experience with infliximab in Japanese children with ulcerative colitis

s of the 3rd International Symposium on Pediatric Inflammatory Bowel Disease S431 and need of surgery. Despite the introduction of highly effective biological drugs, treatment with glucocorticoids or azathioprine continues to be first-choice approach even for early-onset IBD; however azathioprine response is reduced in early-onset IBD. Aim: To evaluate retrospectively azathioprine doses and metabolites concentration and their associations with patients’ age in children with IBD treated at Trieste Children’s Research Hospital Burlo Garofolo. Methods: Azathioprine doses, metabolites and clinical effects were assessed after at least 3 months of therapy in 10 earlyonset (age 12 and <18 years) pediatric IBD patients. Azathioprine dose was titrated on therapeutic efficacy (response and adverse effects). Clinical efficacy was defined as disease activity score below 10. Results: Frequency of clinical efficacy was not different among early-onset and control group (respectively 40% and 57%, p-value = 0.50). However, early-onset patients required higher doses of azathioprine (median 2.8 vs 2.0mg/kg/day, p-value = 0.00062), which resulted in comparable azathioprine active thioguanine-nucleotides (TGN) metabolites concentrations (median 292 vs 345U, p-value = 0.96) and higher methylmercaptopurine-nucleotides (MMPN) metabolites in earlyonset patients (median 1978 vs 1427U, p-value = 0.020). Interestingly, early-onset patients presented also higher MMPN/TGN ratio (median 7.6 vs 4.2, p-value = 0.026). Conclusion: Early-onset IBD patients require higher azathioprine doses to achieve therapeutic response and present augmented inactivating azathioprine metabolism, putatively through increased activity of the enzyme thiopurine-S-methyl transferase. P-099 Single center experience with infliximab in Japanese children with ulcerative colitis H. Shimizu1 *, T. Yanagi2, K. Minowa3, N. Obayashi3, K. Hosoi1, K. Arai1. 1National Center for Child Health and Development, Tokyo, Japan, 2Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan, 3Department of Pediatrics and Adolescent Medicine, Juntendo University, Tokyo, Japan Introduction: It has been reported that infliximab (IFX) is effective and safe in pediatric ulcerative colitis (UC) in Western countries. However, there is limited data in Asian children. Methods: We retrospectively reviewed Japanese children with UC, who had received IFX at a children’s hospital. Besides demographic data, clinical response to IFX and adverse events were reviewed. Results: Ten children with UC had received IFX for their steroid dependency or refractoriness. Nine of them were female. Median age at the first IFX was 13.5 years (10 17 years). Median duration from diagnosis to the first IFX was 120 weeks (7 215 weeks). Median follow-up period was 86 weeks (26 308 weeks), and 9 of 10 remained on IFX as of April 2014. At week 0, 6 had moderate/severe disease (PUCAI 35). At weeks 30 and 54, 5 of 9 (56%) and 5 of 7 (71%) were in remission (PUCAI <10), respectively. Three (30%) required dose escalation for impaired response to IFX. Corticosteroids were discontinued in 5 of 8 (63%) and 6 of 7 (86%) by week 30 and 54, respectively. One underwent colectomy due to the refractory disease at week 17. One required intravenous antibiotics for acute focal bacterial nephritis. None developed malignancy or died during the observation period. Conclusion: IFX was effective and safe in Japanese children with UC. Amulticenter study with increased number of subjects and longer follow-up period for Asian children with UC should be conducted. P-100 Immune thrombocytopenia and pediatric ulcerative colitis management: a role for anti-TNF alpha treatment? S. Valerio de Azevedo1 *, H. Loreto1, A.I. Lopes2. 1Unit of Gastroenterology-Santa Maria University Hospital CHLN, Lisbon, Portugal, 2Unit of Gastroenterology-Santa Maria University Hospital CHLN, Lisbon Academic, Lisbon, Portugal Introduction: Immune thrombocytopenia (IT) is a rare extradigestive manifestation of Inflammatory Bowel Disease (IBD), especially in ulcerative colitis (UC), with <10 pediatric cases reported. The best treatment strategy is yet to defined. We report a pediatric case of UC and associated IT, emphasizing the treatment dilemmas and potential usefulness of Infliximab therapy. Case report: Nine-year-old boy, unremarkable family and personal history; UC diagnosis at 3 years; initial remission: prednisolone; maintenance treatment: messalamine and 12 months later, azathioprine. Since 4 years old (under azathioprine), several relapses occurred, with steroid dependence. During this period persistent low platelet count (<60,000) was documented. Diagnosis of UC-associated IT was established after etiological investigation and exclusion of azathioprine-related thrombocytopenia. Subsequent outcome: several flares, associated to a decrease of platelets counts, also evident whenever steroid were tapered. Considering poor contr ...