P318 Does anti-tumour necrosis factor therapy decrease the risk of initial intestinal resection after the diagnosis of Crohn’s disease? A retrospective single-centre study
Y. Nagata*1, M. Esaki1, A. Hirano1, J. Umeno1, Y. Maehata1, T. Torisu1, T. Moriyama1, T. Matsumoto2, T. Kitazono1
1Graduate School of Medical Sciences, Kyushu University, Department of Medicine and Clinical Science, Fukuoka, Japan, 2School of Medicine, Iwate Medical University, Division of Gastroenterology, Department of Internal Medicine, Morioka, Japan
In patients with Crohn’s disease (CD), intestinal complications requiring intestinal surgery occur during their clinical course. Although preventive effect of anti-tumour necrosis factor alpha (anti-TNF) therapy against postoperative recurrence in CD has been well discussed, its preventive effect against initial intestinal resection (IIR) remains uncertain. We aimed to investigate whether anti-TNF therapy decreases the risk of IIR after the diagnosis of CD.
We retrospectively investigated clinical course of 247 patients who were diagnosed as CD at our institution during 1973–2014. Amongst them, 14 patients who required IIR within a 1 year, and 30 patients who were primarily nonresponsive or intolerant to anti-TNF therapy were excluded from the analysis. The remaining 203 subjects were then classified into TNF and non-TNF groups, according to the use of anti-TNF therapy during their clinical course. Clinical characteristics and medical treatments other than anti-TNF therapy were compared between the 2 groups. With the multivariate analysis using Cox proportional hazard model, the risk of IIR was compared between TNF group and non-TNF group. We further assessed the effect of anti-TNF therapy against IIR amongst 100 patients with inflammatory CD.
There were 89 patients in the TNF group and 114 patients in the non-TNF group. Colitis type (19% vs 9%; p = 0.034) and inflammatory CD (71% vs 33%; p < 0.0001) were more frequent in the TNF group than in the non-TNF group, whereas previous history of intestinal resection before the diagnosis (15% vs 30%; p = 0.012) was less frequent in the TNF group. As for medical treatments, immunosuppressant was more frequently applied in the TNF group than in the non-TNF group (43% vs 25%; p = 0.011), whereas nutritional therapy of elemental diet or low residue diet was more frequently used in the latter than in the former (76% vs 60%; p = 0.014). During a mean of 91 months follow-up period, 74 patients required IIR. Multivariate analysis demonstrated that anti-TNF therapy was a significant factor associated with the decrease in the risk of IIR (hazard ratio) [HR]; 0.361, 95% confidence interval [CI]; 0.176–0.688). In 100 patients with inflammatory CD, anti-TNF therapy was a significant factor associated with the decrease in the risk (HR; 0.313, 95%CI; 0.084–0.985).
Anti-TNF therapy may contribute to the reduction in the risk of intestinal resection after the initial diagnosis of CD.