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P144 TNF-inhibitor use and efficacy in upper-GI Crohn’s disease: results from a multicentre retrospective study

W. Bos*1, E. H. Lamers1, B. Oldenburg1, A. E. van der Meulen - de Jong2, G. Dijkstra3, 4, M. Pierik5, Q. van der Vliet1, A. M. van der Aalst5, K. van der Aalst1, J. J. ten Thije1, M. van der Have1, H. H. Fidder1

1University Medical Centre Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands, 2Leiden University Medical Centre, Department of Gastroenterology and Hepatology, Leiden, Netherlands, 3University Medical Centre Groningen, Department of Gastroenterology and Hepatology, Groningen, Netherlands, 4University of Groningen, Groningen, Netherlands, 5Maastricht University Medical Centre, Division of Gastroenterology and Hepatology, Maastricht, Netherlands

Background

Upper gastrointestinal involvement (L4) of Crohn’s disease (CD) has been associated with a more severe disease course compared with non-upper gastrointestinal CD. Although current guidelines advice to consider early anti-TNF use in L4 patients, data regarding the efficacy of this approach are lacking. We aimed to compare the use and efficacy of TNF-inhibitors between adult L4 and non-L4 CD patients.

Methods

In this retrospective study, L4 patients and a randomly selected control group of non-L4 patients were selected from 4 tertiary centres. L4 patients were divided into 2 subgroups based on disease localisation proximal (L4a) and distal (L4b) to Treitz. Data on demographics, disease characteristics, first and second anti-TNF-inhibitor use, and clinical outcomes were derived from medical records. Clinical outcomes included incidence rates (IR per 100 patient years) of CD-related hospitalisation, abdominal surgery, discontinuation of TNF-inhibitors, and reasons for discontinuation (remission, non-response, loss of response, or adverse effects).

Results

In total, 412 CD patients were identified, including 142 L4 and 270 non-L4 patients. L4 patients were more likely to be younger at diagnosis (27.0 ± 12.5 vs 31.7 ± 14.6 years, p < 0.001), have coexisting ileal involvement (26.1 vs 16.7%, p < 0.023), stricturing disease (36.6 vs 19.3%, p < 0.001), and extra-intestinal manifestations (35.2 vs 25.9%, p = 0.05) compared with non-L4 patients. L4 patients were more frequently treated with TNF-inhibitors (66.2% vs 28.1%, p < 0.001) and hospitalised (IR 9.2 vs 4.4, p < 0.001) compared with non-L4 patients. No differences were found between L4 and non-L4 patients regarding abdominal surgery (IR 8.0 vs 7.2, p = 0.297), discontinuation of anti-TNF therapy (IR 28.1 vs 25.1, p = 0.485), and reasons for discontinuation (remission: 1.1 vs 2.6%; non-response: 5.3 vs 5.3%; loss of response: 34.0 vs 39.5%; adverse events: 14.9 vs 14.5%). After discontinuation, equal proportions of L4 and non-L4 patients switched to a second TNF-inhibitor (37.2 vs 35.5%, p = 0.823). No differences were found between L4a and L4b patients regarding TNF-inhibitor use and clinical outcomes.

Conclusion

Upper-GI (L4) CD patients are about 3 times more frequently treated with TNF-inhibitors and are more frequently hospitalised compared with non-upper-GI CD patients (non-L4). The efficacy of TNF-inhibitors is comparable between both groups as reflected by discontinuation rates and loss of response. No differences in treatment and clinical outcomes were found between upper-GI CD localised proximal (L4a) and distal (L4b) to Treitz.