P479 Factors Associated with Development of Endoscopic Stricture in Patients with Crohn's Disease Treated with Infliximab
T. Feng*1, B.-l. Chen1, R. Mao1, M. Li1, P. Rao1, Z.-r. Zeng1, P. Hu2, M.-h. Chen1
1First Affiliated Hospital of Sun Yat-Sen University, Department of Gastroenterology, Guangzhou, China, 2Sixth Affiliated Hospital of Sun Yat-Sen University, Department of Gastroenterology, Guangzhou, China
Controversy exists that whether rapid luminal healing in Crohn's disease (CD) with inﬂiximab increases the risk of intestinal stricture. Data from TREAT and ACCENT I did not suggest that inﬂiximab therapy increased risk of developing intestinal obstruction. The aim of our study was to identify risk factors associated with endoscopic stricture, a more objective index of intestinal stenosis, in CD patients treated with infliximab.
This was a case-control study. Established CD patients who received infliximab therapy between September,2007 and June,2014 were divided into two homogeneous arms: endoscopic stricture group and control group The primary outcome was development of endoscopic stricture. The duration of follow-up was calculated from the first time of infliximab treatment up to the time of detection of endoscopic stricture, loss of follow-up or the end of study (October 20, 2014).Cox regression analysis was used to evaluate risk factors associated with endoscopic stricture.
Among 88 patients who received infliximab therapy, 17 patients (19.3%, 8.45 events/100 patient-years) developed intestinal stricture after a median follow-up of 19.5 (IQR, 7.7-47.8) months. The cumulative rates of endoscopic stricture were 17%, 26% and 31% at 1, 3 and 5 years, respectively. Independent risk factors associated with development of endoscopic stricture in CD patients treated with infliximab were new immunomodulator use(HR=9.892, 95% CI, 1.852-52.844, P=0.007) and CRP level(HR=1.044, 95% CI, 1.022-1.067, P<0.001). Smoking, age, disease area, disease duration, CDAI, prior bowel surgery, perianal lesion and extraintestinal manifestation, new corticosteroids use，new infliximab use, times of infliximab infusion and cumulative infliximab dose were not associated with endoscopic stricture.
For CD patients treated with infliximab, factors associated with subsequent development of endoscopic stricture were new immunomodulator use and CRP level. New infliximab use, times of infliximab infusion and cumulative infliximab dose were not associated with endoscopic stricture.