P429 Influence of Disease Course on Therapeutic Effect of IFX in Crohn's disease
Q. Yang*, X. Gao, M. Zhi, J. Tang, N. Ding, P. Hu
The Sixth Affiliated Hospital of Sun Yat-sen University(Guangdong Gastrointestinal Hospital), Department of Gastroenterology, Guangzhou, China
Mucosal healing (MH) is an important therapeutic target of Crohn's disease (CD). Numerous clinical trials proved biologic therapies such as Infliximab (IFX) could not only induce and maintain clinical remission but also achieve mucosal healing. Studies from Adalimumab and Certolizumab suggested early disease had much better response than long disease course. The relationship between disease course and therapeutic effect of IFX is not clear. We performed this study to investigate whether disease course is a key factor influencing the efficacy of IFX.
CD patients (naive to both IFX and thiopurines) followed up in our center who treated with IFX not less than 6 shots of IFX were recruited since July 2012 to June 2014. Demographics and clinical variables were recorded. Mucosal healing rate and clinical remission rate of the first year as well as serum biomarker (High sensitivity C-reactive protein) at baseline, 2 weeks, 4weeks, 8 weeks and 52 weeks were evaluated. According to disease course, patients were divided into 3 groups as disease course< 2 years, disease course between 2-5 years and >5 years for further evaluation. Mucosal healing was assessed under endoscopy with SES-CD. A score< 2 suggested mucosal healing, otherwise unhealed. CDAI<150 was adopted as clinical remission.
61 patients (42 males and 19 females, mean age 23.66 ± 9.64 yrs) were involved. 35 patients (57.4%) reached mucosal healing after one-year follow-up. The value of high sensitivity C-reactive protein deceased obviously at 2 weeks, 4 weeks, 8 weeks and 52 weeks on IFX treatment (P<0.001). 42 patients had a disease course less than 2 years and 29 of them (69%) reached MH after 1year follow-up; 14 patients had a disease course 2-5 years and 5 of them (36%) reached MH; 5 patients with disease course more than 5 years and only 1 of them reached MH after 1 year follow-up. Patients with a disease course< 2 years had a higher MH rate than the other two groups[ disease course 2˜5 years vs. < 2 years, P=0.028, OR 4.015, 95%CI (1.12-14.35); disease course >5 years vs. <2years, P=0.051 ]. Furthermore, compared with patients only treated with IFX for 6 shots, MH rate increased dramatically in patients who undertaken IFX more than 6 [26/37 vs. 9/24, P=0.011, OR 0.254, 95%CI (0.086-0.75)].
Patients with disease course <2 years had much higher rate of mucosal healing in the first year on IFX treatment. Moreover, compared to patients who had 6 shots of IFX, the mucosal healing rate was higher in patients received more than 6 shots. Our study suggests that an early use of IFX in CD patients and relatively longer therapeutic course may have more benefits to patients.