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P163. Predictive value of early restoration of quality of life in Crohn's disease patients receiving antiTNF agents

C. Herrera, V. Robles, N. Borruel, E. Navarro, A. Torrejón, F. Casellas, Unitat Atenció Crohn-Colitis. Hospital Universitari Vall d'Hebron, Digestive System Research Unit, Barcelona, Spain

Background

Crohn's disease (CD) impairs patients' health related quality of life (HRQOL), therefore a goal of treatment is to improve their health. Recently, a more ambitious therapeutic target has been proposed, to reestablish the quality of life of patients to normal standards. Effective treatment with antiTNF agents is related to the restoration of health. However, there is no information on long-term prognostic value of restoring the health of patients with CD. Our aim was to determine if early restoration of HRQOL in patients with CD with antiTNF agents is associated with long-term remission.

Methods

Retrospective longitudinal study in patients with active CD treated with an antiTNF agent, either infliximab or adalimumab. Patients completed the IBDQ-36 questionnaire at baseline (prior to the start of antiTNF) and at weeks 2, 6, 14, 28 and 52. Early restoration of health was defined according to an IBDQ-36 score <209 at week 14, and long-term clinical remission as a CDAI (Cohn's disease activity index) score <150 at week 52.

Results

Ninety-four patients were included in the study. Sixty-three patients (67%) maintained long-term remission, with forty-seven (75%) of them achieving an early restoration of HRQOL. Of the 31 patients (33%) who did not maintain clinical remission, only 4 (13%) restored the HRQOL (p < 0.01, OR: 8.19, 95% CI 5.51–86.5). There was a strong negative correlation between the global value of IBDQ-36 at week 14 with CDAI values at week 52 (rs: −0.64, n = 94, p < 0.01), with lower CDAI scores when HRQOL score was better. Ninety-two percent of patients with early restoration of HRQOL maintained long-term remission vs 37% who did not reach early reestablishment of HRQOL (p < 0.01). To predict long-term remission, the cutoff point of 209 of the IBDQ-36 at week 14 had an area under the ROC curve of 0.81, with a sensitivity and specificity of 0.75 and 0.87 respectively.

Conclusion

Achieving early restoration of HRQOL with antiTNF agents was associated with sustained long-term remission. This could be a therapeutic goal of treatment both in clinical trials and in daily practice.