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P528. Complications of IBD in the anti-TNF era: reason for optimism?

V. Nuij1, G. Fuhler1, A. Edel1, R. Ouwendijk2, M. Rijk3, R. Beukers4, R. Quispel5, A. van Tilburg6, T. Tang7, H. Smalbraak8, K. Bruin9, F. Lindenburg10, L. Peyrin-Biroulet11, C.J. van der Woude1, 1ErasmusMC University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands, 2Ikazia Hospital, Gastroenterology and Hepatology, Rotterdam, Netherlands, 3Amphia Hospital, Gastroenterology and Hepatology, Breda, Netherlands, 4Albert Schweitzer Hospital, Gastroenterology and Hepatology, Rotterdam, Netherlands, 5Reinier de Graaf Gasthuis, Gastroenterology and Hepatology, Rotterdam, Netherlands, 6Sint Franciscus Gasthuis, Gastroenterology and Hepatology, Rotterdam, Netherlands, 7IJsselland Hospital, Gastroenterology and Hepatology, Capelle aan den IJssel, Netherlands, 8Lievensberg Hospital, Internal Medicine, Bergen op Zoom, Netherlands, 9Tweesteden Hospital, Gastroenterology and Hepatology, Tilburg, Netherlands, 10Franciscus Hospital, Gastroenterology and Hepatology, Roosendaal, Netherlands, 11Nancy University Hospital, Université de Lorraine, Gastroenterology and Hepatology, Vandoeuvre-les-Nancy, France


To assess the effect of early anti-TNF (defined as sixteen months from diagnosis IBD) on the ocurrence of new IBD related complications.


Aside from IBD related surgery, the following IBD related complications were analyzed in relation to the time until anti-TNF therapy start from diagnosis in newly diagnosed IBD patients (pts) (n = 413) from the Delta cohort: fistula formation, abscess formation, extra intestinal manifestation (EIM), defined as erythema nodosa, pyoderma gangrenosum, psoriasis, arthritis, eye inflammation, osteopenia, osteoporosis, embolisms, thrombosis, fissures and apthous stomatitis.


Overall, 27.6% (114 pts) experienced at least one IBD related complication and 13.8% (57 pts) underwent 96 IBD-related surgeries. Eighty-five pts (20.6%) received anti-TNF (66 CD, 16 UC, 3 IBDU) of whom 56.5% (48 pts) within the first 16 months after diagnosis. Median duration of follow up was 38.93 months (0.2–47.9). Fistulizing disease was confirmed in 41 pts (9.9%, 25 pts perianal, 16 pts abdominal) and in 28 pts abscesses were present (6.8%, 13 pts perianal, 15 pts abdominal).

Overall, 17.7% (73 pts) experienced at least one EIM, of which 8 pts had skin manifestations, 28 pts suffered from arthritis, 8 pts had ocular manifestations, 8 pts had aphthous stomatitis, 8 had thrombosis/embolisms, 16 pts suffered from osteopenia or osteoporosis and 14 pts had anal fissures and 4 pts had psoriasis. Additionally, three pts had ankylosing spondylitis.

Pts receiving anti-TNF late (>16 months) did not differ from pts receiving anti-TNF early (<16 months) regarding gender, age, smoking status, familial IBD, familial CRC, and the amount of fistula formation, abscess formation, extra-intestinal manifestations, resection, overall IBD surgery. Similar results were obtained when patient groups were stratified more stringently, i.e. <12 months (40 pts) to anti-TNF vs. >24 months to anti-TNF treatment (24 pts). A Cox-regression analysis showed no beneficial correlations between time to anti-TNF start and extra-intestinal manifestations, resections, overall IBD surgery, abscess formation or fistula formation.


In this study we were unable to find a beneficial effect of starting anti-TNF early compared to starting anti-TNF late on disease complications and surgery. It seems that an inappropriate selection of pts leads to a suboptimal drug efficacy lacking the ability to prevent the development of complications. Future research should aim to elucidate the method for selecting pts.