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P528. Effect of early induction with immunomodulators on long-term clinical remission in patients with Crohn's disease

T. Yoshino1, H. Nakase1, M. Matsuura1, T. Chiba1, 1Kyoto University, Gastroenterology and Hepatology, Kyoto, Japan

Background

The efficacy of TNF-α agents suggests a new concept that early induction with intensive therapies could reduce the rate of hospitalization and surgery, and improve the quality of life in patients with Crohn's disease (CD). However, effect of early use of immunomodulators on long-term clinical outcome in patients with CD remains unclear. The aim of this study is to evaluate the effect of early use of thiopurines on long-term clinical remission for patients with CD.

Methods

From January 2004 to December 2011, 148 patients with CD (mean age 30 years (14–71 years); male: 114, female: 34) were enrolled. 51 of 148 patients (34.5%) who had been treated with thiopurines alone for maintenance after achieving clinical remission were analyzed. The dose of thiopurines were adjusted with the number of white blood cells (3000–5000/µl) and the concentration of 6-thioguanine (235–400 pmol/8×108 RBCs). Clinical remission was defined as Crohn's Disease Activity Index (CDAI) of less than 150 points. We classified patients into two groups according to the initiating time of thiopurines after diagnosis of CD as follows: early induction group (starting thiopurines <1.5 years); late induction group (starting thiopurines >1.5 years). We evaluated the effect of early induction of thiopurines on long-term clinical remission between two groups.

Results

(1) Cumulative remission-maintenance rate of 51 CD-patients with achieving clinical remission was 65.7% at 85.0 months. (2) A comparison of differences in characteristics revealed that cumulative remission-maintenance rate in patients without history of surgery was higher than that in patients with it (74.3% at 85.0 months vs. 47.1% at 77.6 months; p = 0.05). (3) 29 and 22 of 51 patients with achieving clinical remission were categorized into early induction group and late induction group, respectively. Cumulative remission-maintenance rate of early induction group was significantly higher than that of late induction group (72.1% at 85.0 months vs. 56.1% at 77.6 months; p < 0.05).

Conclusion

Early induction of thiopurines would contribute to long-term clinical remission in patients with CD.