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DOP054. Predictors of phenotype progression in Crohn's disease

E. Rodrigues-Pinto, F. Magro, R. Coelho, P. Andrade, J. Santos-Antunes, S. Lopes, G. Macedo, Centro Hospitalar São João, Gastroenterology Department, Porto, Portugal

Background

Crohn's disease (CD) induces cumulative structural damage, being initially characterized by a non-stenosing non-penetrating behaviour (B1), with progression over time to a fibro-stenosing (B2) and/or penetrating phenotype (B3). Our aim was to assess the long-term evolution of disease behaviour of CD and determine whether treatment with azathioprine or anti-tumor necrosis factor-alpha (antiTNF alfa) changes phenotype progression.

Methods

Study based on prospectively collected data from a CD database in an inflammatory bowel disease (IBD) outpatient clinic. B1 corresponds to a non-stenosing non-penetrating disease, B2 to a stenosing behaviour and B3 to a penetrating one.

Results

Seven hundred and thirty-six patients with CD (368 female) were followed-up during 12.3 years (±8.4), with 87.0% of them being B1 phenotype at diagnosis. Of these patients, 28.5% progressed to B2 phenotype, 23.5% to B3 and 49.0% required surgery. Fifty percent of the patients started azathioprine prior to phenotype change and 13.9% started antiTNF alfa prior to phenotype change. Patients on monotherapy with azathioprine prior to phenotype change had disease progression (B1 to B2 or B3) later on the course of the disease than the ones that were not on azathioprine (median: 361 months, 95% CI: [306.3; 415.7] vs 71 months [47.6; 94.4], p < 0.001). Similar results were achieved on patients on combination therapy with azathioprine and antiTNF alfa prior to phenotype change (p < 0.001). The hazard ratio (HR) for disease progression was lower either for monotherapy with azathioprine (HR 0.28, p < 0.001) or combination therapy with antiTNF alfa (HR 0.33, p < 0.001).

Conclusion

Monotherapy with azathioprine and combination therapy of azathioprine and antiTNF alfa prior to behaviour change modifies the phenotype progression of CD.