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P346 Early treatment with infliximab for Crohn's disease patients

G. Pineton de Chambrun*1, L. Libier2, M. Nachury2, M. Collins3, D. Koriche4, C. Gower-Rousseau5, P. Zerbib4, A. Cortot6, J.-F. Colombel7, P. Desreumaux2

1Montpellier 1 University, Gastroenterology and Hepatology, Montpellier, France, 2CHU de Lille, Department of Gastroenterology, Lille, France, 3APHP Paris Sud University , Gastroenterology, Le Kremlin Bicêtre, France, 4Lille University Hospital, Colorectal Surgery Department , Lille, France, 5Lille University Hospital, North of France University, Epidemiology, Lille, France, 6Lille University Hospital, North of France University, Gastroenterology, Lille, France, 7Mount Sinai Hospital, Gastroenterology, New-York, United States

Background

The main therapeutic goal in Crohn's disease (CD) is to suppress mucosal inflammation in order to limit intestinal damages and avoid surgery. The utility of an early treatment with infliximab (IFX) to reach this therapeutic goal is still discussed. The aim of our study was to evaluate the effect of an early treatment with IFX on disease outcomes in CD patients naive from anti-TNFα antibodies.

Methods

We performed a retrospective and comparative study of CD patients naive from anti-TNFα antibodies receiving early or late treatment with IFX from 2007 to 2010 in our center. Early IFX treatment was defined as a first infusion < 18 months after CD diagnosis while an infusion done >18 months after diagnosis was considered as a late treatment. Clinical activity was evaluated 3 to 6 months after IFX introduction and mucosal healing at the first colonoscopy performed after IFX introduction. Hospitalizations for CD, intestinal resections, modifications and withdrawal of IFX were recorded during the follow-up after IFX introduction. The rate of global surgery was defined as the number of patients with intestinal resection from CD diagnosis to last follow-up visit . The rate of cumulative surgery was defined as the number of surgeries for each patient from CD diagnosis to last follow-up visit.

Results

Among the 153 patients treated by IFX between 2007 and 2010, 36 (24%) received an early treatment and 83 (54%) a late one. The mean follow up from diagnosis was longer in patients with late IFX compared to early IFX (172 ± 98 months vs. 49 ± 21 months, p<0.01) while the mean follow up after IFX introduction was not different in the two groups (42 ± 21 months vs. 44 ± 23 months, p=0.643). Patients with early IFX had fewer surgeries and were less exposed to thiopurines before IFX introduction compared to patients with late IFX (6% vs. 46%, p<0.0001 and 47% vs. 78%, p=0.001). After IFX introduction, rates of hospitalizations (17% vs. 18%, p=0.89), intestinal resections (8% vs. 8%, p=0.98) and IFX withdrawals (47% vs. 49%, p=0.83) were similar in early and late IFX groups. However patients with early IFX had a lower rate of global surgery compare to those with late IFX (14% vs. 52%, p=0.007) and cumulative surgery was also higher in patients with late IFX with more patients that underwent two or more surgeries (20% vs. 0%, p=0.004).

Conclusion

Early treatment with IFX in CD patients seems to decrease surgery in the first years of evolution but once started, IFX seems to have the same efficacy in patients with early or late treatment. These Results need to be confirmed by prospective studies including a follow-up of patients treated with early IFX.