P571 Long-term operation rate and related prognostic factors in patients with Crohn's Disease treated by infliximab maintenance treatment
H. Tanaka*, M. Miyakawa, R. Sakemi, M. Nasuno, S. Motoya, A. Imamura
Sapporo Kosei General Hospital, IBD Center, Sapporo, Japan
Maintenance treatment by anti-tumour necrosis factor (anti-TNF) antibody has enabled achieving long-term remission in patients with Crohn's disease (CD). However, the factors that allow patients to avoid operative intervention remain unclear. The aim of this study was to investigate the long-term operation rate and related prognostic factors in patients with CD treated by infliximab maintenance treatment.
Retrospective data was collected from luminal CD patients treated with 5 mg/kg of infliximab for >14 weeks between May 2002 and August 2012 at the IBD Center, Sapporo Kosei General Hospital. The cumulative operation rates following the first infliximab administration was estimated using the Kaplan-Meier method. Further, prognostic factors related to the cumulative operation rates were evaluated using a log rank test and a multivariate Cox regression analysis.
A total of 276 patients were included in this study. Of these, 72 were females with a mean age of 31.2 years and mean disease duration of 7.5 years. The mean C-reactive protein (CRP) level at the first infliximab administration was 2.18 mg/dl. One hundred fifty-two patients had ileocolitis, 68 had ileitis and 56 had colitis. Additiomally, 111 patients had stricturing disease, 36 had intra-abdominal fistulas and 114 had perianal disease; 82 patients were smokers. Concomitant treatment with immunomodulators (azathioprine or 6-mercaptopurine), 5-aminosalicylic acid, elemental diet therapy and prednisolone was administered in 197, 245, 194 and 28 patients, respectively. Before initiating infliximab therapy, 89 patients had had at least 1 surgery, and no patients had prior use of other anti-TNF agents. The 3-, 5- and 7-year cumulative operation rates were 10%, 16% and 23%, respectively. In univariate analysis, the stricturing disease (P = 0.036) and the higher CRP level at the first infliximab administration (>1.00 mg/dl; P = 0.034) were significant prognostic factors for the higher cumulative operation rates. Conversely, concomitant treatment with immunomodulators significantly decreased the cumulative operation rate (P = 0.032). In a multivariate Cox regression analysis, the CRP level at the first infliximab administration (>1.00 mg/dl) and concomitant treatment with immunomodulators were identified as independent predictors for the cumulative operation rates.
Approximately 80% patients receiving infliximab maintenance treatment will not require an operation for up to 7 years. It was demonstrated that combination therapy of infliximab and immunomodulators decreased operative risk. Conversely, stricturing disease and higher CRP level at the first infliximab administration may be prognostic factors for a poor long-term operation rate.