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P380. Predictors of clinical response to immunomodulators in moderate to severe Crohn's disease

J.S. Koo, B. Keum, B.J. Lee, Y.J. Jeen, J.H. Choi, Korea University College of Medicine, Department of Internal Medicine, Seoul, Korea, Republic of

Background

Immunomodulators such as azathioprine (AZA) and 6-mercaptopurine (6-MP) have been used for induction and maintenance treatment of Crohn's disease (CD) and have effect to decrease the steroid dose in active CD. In non-responsive patients to AZA or 6-MP, biologic agents or surgical treatment could be considered. This study was to evaluate the predictive factors of response to AZA/6-MP in patients with moderate to severe CD.

Methods

Among total 1,338 patients registered on Crohn's cohort in Korea, 1,221 were enrolled in this study. The patients' medical records including baseline characteristics, location and type of CD, complications, treatment agents, and surgical treatments were reviewed retrospectively. Univariate and multivariate analyses were conducted to evaluate the predictive factors of clinical response to immunomoduators.

Results

Among 1,221 patients with CD, AZA/6-MP treatment was used in 842 (69.0%). In AZA/6-MP treatment group, 602 (71.5%) are male. Between two groups according to AZA/6-MP treatment, the treatment group was younger than the other group (mean age, 25.8 vs 32.4, p < 0.01). AZA/6-MP treatment was used more frequently in patients with ileocolonic CD (60.9% vs 45.4%, p < 0.01) and with perianal disease (30.2% vs 20.6%, p < 0.01). Disease behaviors were not different between two groups. In 842 patients with AZA/6-MP treatment, 356 (42.3%) were treated with biologic agents and/or surgical treatment. Additional treatments were used more frequently in female (32.3% vs 25.7%, p < 0.037). Between two groups according to the result of AZA/6-MP treatment, the disease locations were significantly different (p = 0.015), although the disease behaviors were not different. Multivariate analysis revealed that female gender (OR 1.371 95% CI 1.008–1.866) and disease location (p = 0.021) were significantly associated with AZA/6-MP treatment failure.

Conclusion

AZA/6-MP treatment is effective on induction and maintenance treatment in CD. However, early biologic treatment should be considered in female and colonic CD, since their AZA/6-MP treatment is less effective.