P609. Long-term prognosis of Crohn's disease and its temporal change between 1981–2012: a hospital-based cohort study from Korea
To date, no large-scale studies have evaluated the prognosis of Crohn's disease (CD) over a period of three decades in non-Caucasian populations. The aims of this study were to update the current information on the long-term prognosis of CD using a large series of patients and to evaluate changes in treatment paradigms over time and their impact on the prognosis of CD in Korea.
We retrospectively analyzed 2,043 Korean CD patients who visited the Asan Medical Center. The study subjects were divided into three groups according to the year of diagnosis (cohort 1: 1981–2000, cohort 2: 2001–2005, and cohort 3: 2006–2012).
Of the study patients, 1,462 (71.6%) were men and 581 (28.4%) were women, yielding a male-to-female ratio of 2.5:1. The median age at diagnosis of CD was 23 years (range, 9–75 years). The median duration of follow-up was 80 months (range, 1–381 months). Azathioprine/6-mercaptopurine and anti-TNF agents have been used increasingly more frequently and earlier over the last 30 years, with a 5-year cumulative probability of prescription of 28.9% and 1.4%, respectively, in cohort 1 and 88.1% and 23.7%, respectively, in cohort 3 (p < 0.001). A total of 726 patients (35.5%) underwent intestinal resection, with a cumulative probability of intestinal resection 10, 20, and 30 years after diagnosis of 43.5%, 70.0%, and 76.1%, respectively. The cumulative probability of surgery was significantly lower in cohort 3 than in cohort 1 (p = 0.012). Early use of azathioprine/6-mercaptopurine was significantly associated with delayed need for intestinal resection by multivariate Cox analysis (hazard ratio: 0.63, 95% confidence interval: 0.46–0.85).
Korean CD patients may have a similar clinical course to Westerners, as indicated by the intestinal resection rate. The surgery rate has decreased over time, and early use of azathioprine/6-mercaptopurine was related to its decrease.
This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120176).