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P477 Biological Therapy Is Able To Modify The Disease Progression of Crohn's Disease Preventing Its Long-Term Associated Disability - A Study Performed By Using The Lèmann Score

G. Bodini*1, V. Savarino1, I. Baldissarro1, C. De Maria1, L. Yehia1, E. Savarino1, 2

1IRCCS San Martino Genova, Dipartimento di medicina interna, Genova, Italy, 2University of Padua, Department of Surgery, Oncology and Gastroenterology, padova, Italy

Background

Crohn's disease (CD) is a chronic inflammatory bowel disorder characterized by an alternation of remission and relapse phases. Even during periods of clinical remission a subclinical inflammation persists, reflecting a progressive, destructive disease course in the later phases of the disease. Surgical resection of bowel is the ultimate manifestation of bowel damage. Recently a new score, the Lèmann Score (LS), has been proposed in order to assess the cumulative structural damage to the bowel in different CD patients. Limited data are present assessing the value of this instrument in measuring the effect of various medical therapies on the progression of bowel damage.

The aim of our observational study was to evaluate the effect of various medical therapies on the progression of bowel damage by using the Lèmann Score : Group A, biological therapy, Group B immunomodulation therapy, Group Cmelamine therapy.

Methods

In this retrospective study we included consecutive CD patients who were followed up at our IBD Unit. All patients underwent every tree month clinical assessment with measurement of disease status based on HBI index, and every year or before in case of disease relapse bowel magnetic resonance imaging and a colonoscopy. Patients were divided on the basis of drug administered during the follow-up period: Group A: biological mono-therapy; Group B, azathioprine therapy; Group C: melamine therapy. We calculated the LS at the beginning and end of follow-up period.

Results

We included 88 patients (39 F/49M, mean age 43.5 range 19-79) with a median follow-up of 26 months. At the start of the observational period the median LS in group A, B and C was respectively 7.05 (2.5-292.3), 4.2 (0.6-159.6) and 4.1 (0.6-202.6). At the end of the follow-up the median LS in group A, B and C was respectively 17.05 (1.3-292.3), 7 (0.6-209.6) and 6.7 (1-206.5). Evaluating the difference of LS between the beginning and end of follow-up period, we observed that the delta was higher (p<0.05) in Group A (median delta LS 0.0, range 3.1; -24.3) compared to Group B (median delta LS -1.55, range -1.2;-83.3) and Group C (median delta LS 0.0, range 0.0;-79.2). Moreover no statistical difference was found between Group B and Group C (p=0.3)

Conclusion

Our data suggest that the use of biological therapy rather than Azathioprine and melamine changes the cumulative structural damage to the bowel and, therefore, modifies the disease progression of CD, preventing its long-term associated disability.