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P355 What is treat-to-target of Crohn's Disease: the comparison of long-term outcome among patients with mucosal healing, deep remission and biological remission ?

Y. Qiu*, R. Mao, B.-l. Chen, Y. He, Z.-r. Zeng, M.-h. Chen

First Affiliated Hospital of Sun Yat-Sen University, Department of Gastroenterology, Guangzhou, China

Background

Treat-to-target aiming to improve long-term outcomes of Crohn's disease (CD) is receiving increasing attention. However, great controversy existed in the treatment goals to be achieved. We aimed to examine whether a more strict treatment target predicts a better outcome in CD.

Methods

We conducted a retrospective, observational cohort study of patients with CD by using a prospectively maintained IBD database (October 1, 2001 through September 30, 2013).

The long-term outcomes of CD patients with complete MH were compared with those of patients with deep remission (DR,defined as the absence of mucosal ulceration and CD Activity Index scores less than 150) and biological remission(BR, defined as DR combined with negative surrogate markers of inflammation). The primary efficacy outcome was the proportions of CD-related intestinal surgery and hospitalization at the successive visits throughout follow-up.

Results

A total of 195 patients who had MH detected at the scheduled endoscopic follow-up evaluation to assess MH constituted the study population. These 195 patients were then divided into three homogeneous arms according to the normalization of simultaneous CDAI and/ or hs-CRP: the DR group (referred to DR patients with elevated hs-CRP, n=53), the BR group (referred to DR patients with normalized hs-CRP, n=106) and the MH only group (referred to patients with a CDAI >150 at the detection of endoscopic remission, n=36).

After a median follow-up period of 46.03 months (IQR, 28.15-67.93 months), 25 patients had CD-related bowel surgery, 44 patients had CD-related hospitalizationshospitalized, and 53 patients experienced CR. Of 151 patients performed at least one follow-up colonoscopy after the initial colonoscopy, 96 patients experienced an ER.

Overall there were significant longer CD-related hospitalizations-free survival (133.5 ± 17.1 vs. 68.6 ± 5.1 vs.86.3 ± 8.6 months, P =0.004), ER-free survival (33.38 ± 3.7 vs. 20.3 ± 3.2 vs.33.7 ± 5.8 months, P =0.015), and CR-free survival (109.38 ± 12.1 vs. 50.52 ± 6.5 vs.50.6 ± 9.3 months, P =0.006) of patients in the BR group than both the DR and MH group. There was a trend, albeit not significant, for an increased proportion of patients remaining free of CD-related bowel surgery in the BR group (85.3 ± 7.3% vs. 67.8 ± 10.8% vs. 37.5 ± 19%, P=0.087). Patients with DR tented to had longer CFREM (P=0.03) but not less Crohn's related operations or hospitalizations or ER when compared with patients with MH only.

Conclusion

CD patients with appeared to have better long-term outcome than those with DR and MH. BR. A more strict treatment target predicts a better outcome in patients with CD.