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P559. Anti-tumour necrosis factor therapy improves initial resection rates in Crohn's disease

S. Kanmura1, M. Numata1, H. Fujita1, H. Ohi2, M. Kodama3, K. Tokushige4, A. Ido1, 1Kagoshima University Hospital, Gastroenterology, Kagoshima, Japan, 2Imamura Hospital, Gastroenterology, Kagoshima, Japan, 3Miyazaki Medical Center Hospital, Gastroenterology, Miyazaki, Japan, 4Kagoshima Kouseiren Hospital, Gastroenterology, Kagoshima, Japan

Background

Anti-tumour necrosis factor (anti-TNF-α) therapy is useful in refractory Crohn's disease, but it remains unclear whether this therapy reduces the rate of intestinal resection. We evaluated resection rates after the administration of anti-TNF-α for Crohn's disease.

Methods

The study population consisted of 193 patients with Crohn's disease who were treated at our institution for more than 5 years. We retrospectively analysed patient characteristics, cumulative resection rates during the study period, risk factors involved in surgery, and cumulative resection rates with or without anti-TNF-α agents.

Results

(1) In this cohort the male-to-female ratio was 124:69, average age of onset was 23.8 years (range, 17 to 72 years), and disease duration was 16.3±7.7 years. In terms of Crohn's type, 23.3% of patients had ileitis, 9.0% had colitis, and 67.6% had ileocolitis. Patients received anti-TNF-α drugs or immunomodulators in 38.6% or 38.5% of cases, respectively. Anti-TNF-α therapy was prescribed more frequently in the late-onset group (Crohn's developed after 2002) than the early-onset group (developed before 2001).

(2) The cumulative resection rate in the early-onset group was 29.2% and that in the late-onset group was 20.8%. The resection rate in the late-onset group tended to be lower than that in the early-onset group. In particular, the resection rate was significantly lower in patients with the perforating type in the late-onset group (12.5%) compared to the early-onset group (21.3%).

(3) Multivariate analysis revealed that absence of anti-TNF-α therapy was a sole risk factor for surgery.

(4) The cumulative resection rate over 5 years was significantly lower in patients receiving anti-TNF-α therapy than in those not receiving this therapy, based on a background-matched analysis between the 2 groups (30.0% vs. 17.7%). In addition, the early initiation of anti-TNF-α therapy (within 3 years of disease onset) resulted in a decreased resection rate compared with late initiation of anti-TNF-α therapy (3 or more years after disease onset).

Conclusion

Anti-TNF-α therapy was effective at preventing surgery for intestinal complications of Crohn's disease.