P393. Occurrence of stricturing and penetrating complications is diminished in Crohn's disease patients treated by immunomodulatory and/or anti-TNF therapy within the first two years of disease duration when corrected for diagnostic delay
E. Safroneeva1, S. Vavricka2, N. Fournier3, G. Rogler2, A. Straumann4, A. Schoepfer5, 1University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 2University Hospital Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 3University of Lausanne, Institute of Social and Preventive Medicine, Lausanne, Switzerland, 4University Hospital Basel, Gastroenterology and Hepatology, Switzerland, 5University Hospital Lausanne / CHUV, Gastroenterology and Hepatology, Lausanne, Switzerland
Treatment with immunomodulatory (IM) and/or anti-TNF therapy within the first two years of Crohn's disease diagnosis is associated with better clinical response and remission rates when compared to treatment later in the disease course. However, a true disease duration, which includes the diagnostic delay period (time from the onset of first symptoms to diagnosis) and a period following the establishment of diagnosis, has never been examined. We aimed to assess if treatment with IM and/or anti-TNF therapy within the first two years of CD symptom onset (diagnostic delay is taken into account, “early therapy”) is associated with the diminished risk in developing complications when compared to initiating these therapies >2 years after CD onset (“late therapy”).
Data from the Swiss IBD Cohort were analyzed. IM were comprised of azathioprin, 6-mercaptopurine, or methotrexate, anti-TNF drugs included infliximab, adalimumab, or certolizumab pegol. The following outcomes were assessed using logistic regression modelling: stenosis, internal fistulas, perianal fistulas, intestinal surgery, and perianal surgery.
A group of 181 CD patients on “early therapy” (49.5% females, median age at diagnosis 24 [20–38] years) was compared to a group of 269 CD patients on “late therapy” (46.1% females, median age at diagnosis 27 [21–37].years). Regression modeling evaluating age at diagnosis, gender, disease duration, and therapy initiation time revealed that “early therapy” was negatively associated with stricture formation (OR 0.431, 95% CI 0.251–0.739, p = 0.002) and development of perianal fistulas (OR 0.490, 95% CI 0.256–0.935, p = 0.031). The overall disease duration was positively correlated with stricture formation (OR 1.037, 95% CI 10.14–1.060, p = 0.001) and risk of undergoing intestinal surgery (OR 1.091, 95% CI 1.061–1.121, p < 0.001). No significant associations between examined explicative variables and the occurrence of internal fistulas were found.
Treatment with IM and/or anti-TNF therapy during the first two years of CD onset is associated with a reduced risk for development of bowel stenosis and perianal fistulas. The disease duration, adjusted for diagnostic delay, is positively correlated with the increased risk of developing bowel stenoses and undergoing intestinal surgery. Future studies evaluating the relationship between treatment efficacy and disease duration should consider assessing a true disease duration that takes into account the length of diagnostic delay.