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P202. Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease

L. Peyrin-Biroulet, A. Oussalah, N. Williet, C. Pillot, L. Bresler, M.A. Bigard

University Hospital of Nancy, Vandoeuvre-lès-Nancy, France

Aim: We assessed whether azathioprine and anti-tumour necrosis factor (TNF) therapy decrease the long-term need for surgery in patients with Crohn's disease.

Materials and Methods: This was an observational study of a referral centre cohort. The electronic charts of 296 incident cases of Crohn's disease, diagnosed between 2000 and 2008, were reviewed through January 2010. The cumulative incidence of the first Crohn's disease-related major abdominal surgery was estimated using the Kaplan–Meier method, and independent predictors of surgery were identified using Cox proportional-hazards regression with propensity scores adjustment. Receiver operating characteristic (ROC) analysis was used to identify optimal cut-offs for maintenance treatments duration.

Results: The median follow-up time per patient was 57 months. Seventy-six patients (26%) underwent at least one major abdominal surgery. The cumulative probabilities of the first Crohn's disease-related major abdominal surgery were 6.5%, 25.9%, and 44.3% at 1, 5, and 9 years, respectively. In the ROC analysis, the duration of anti-TNF treatment and azathioprine had significant cut-off values (≤475 days ≈ 16 months and ≤ 45 days ≈ 1.5 months, respectively) with positive likelihood ratios (PLR) of 1.52 (P < 0.0001) and 1.51 (P = 0.003) for the first Crohn's disease-related major abdominal surgery. Using multivariate Cox proportional-hazards regression analysis (after propensity score adjustment), independent positive predictors of major abdominal surgery were stricturing (hazard ratio (HR) = 12.01; 95% CI, 5.97 to 24.17) or penetrating (HR = 10.77; 95% CI, 4.87 to 23.80) disease behaviour at diagnosis, duration of anti-TNF treatment of less than 16 months (HR = 3.86; 95% CI, 1.77 to 8.45), and duration of azathioprine treatment of less than 1.5 months (HR = 2.00; 95% CI, 1.20 to 3.34).

Conclusion: Noncomplicated inflammatory disease behaviour and long-term anti-TNF therapy are associated with a lower risk for surgery whereas azathioprine only modestly lowers this risk.