P605 Effect of medication type on patients’ health-related quality of life in Crohn’s disease
D. Schwartz*1, D. Greenberg2, E. Chernin2, O. Sarid2, V. Slonim-Nevo2, M. Friger2, H. Vardi2, S. Odes2
1Soroka UMC, Gastroenterology, Beer Sheva, Israel, 2Ben Gurion University, Beer Sheva, Israel
Crohn’s disease (CD) is a chronic relapsing disease affecting men and woman at their prime, influencing both physical and social aspects of life. While the multiple medications given to these patients are directed at improving their medical status, it is not certain whether this is matched by a better quality of life status. Therefore, we assessed the association between medical treatments and patients’ health-related quality of life (HRQoL).
Israeli CD adult patients were asked to fill a questionnaire containing data regarding HRQoL (SF-36 & SIBDQ) and clinical data including medical treatments and current disease severity by the Harvey–Bradshaw index (HBI). The effect of medication type on HRQoL was assessed.
In total, 597 CD patients completed the questionnaire. Patients treated with 5-ASA were older (48 vs 38), and patients treated with combination therapy had more severe disease than monotherapy (7.3 vs 4.9). When analysing HRQoL for patients exposed to each medication group, the ranking of HRQoL was best for untreated patients for all parameters. Second was 5-ASA followed by immunomodulator and biological treatment. Steroid treatment was the worst in all parameters of HRQoL. To isolate the effect of specific medication we analysed the group of patients receiving one medication only vs combination therapy vs no therapy. The ranking was maintained between treatment groups with even higher scores for patients treated with 5-ASA than no treatment at all. In a multivariable regression analysis (Table 1), SF-36 physical health summary score was worsened by higher HBI, steroid, biologic and combination treatment and older age, and was improved with longer disease duration and male gender. The SF-36 mental health summary score was worsened by steroid treatment and high HBI and smoking, and improved with longer disease duration and older age. The SIBDQ score was worsened by HBI, steroid and combination treatment and smoking and improved with longer disease duration and male gender. We did not find a correlation between other medication groups and HRQoL. Table 1. Multivariable analysis of HRQoL adjusted to medical treatments and demographics; only statistically
SIBDQ SF-36 physical health SF-36 mental health 5-ASA or
Immunomodulators NS NS NS Biologics NS -.136 NS Steroids -.087 -.131 -.092 Combination treatment -.151 -.218 NS HBI -.609 -.584 -.353 Age NS -.178 .190 Gender .100 0.99 NS Smoking -.111 NS -.135 Disease duration .091 .084 .137
Table 1. Multivariable analysis of HRQoL adjusted to medical treatments and demographics; only statistically
Crohn’s disease patients’ HRQoL is impacted by the type of medical treatment in addition to disease severity and activity. Steroid treatment in particular has an adverse effect on HRQoL and exposure should be minimised.