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P646 Has there been a change in the treatment of Crohn’s disease over the years? Comparison of 2 prospective cohorts in a tertiary referral centre

O. Icht*1, H. Yanai1, Y. Ron1, G. Rosner1, A. Yaron2, A. Waizbard3, S. Fishman1, I. Dotan1

1IBD Centre, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Centre, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Pediatric Gastroenterology Unit, Dana’s Children Hospital, Tel Aviv Sourasky Medical Centre, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 3Department of Gastroenterology, Laniado medical Centre, Netanya, Israel

Background

Early introduction of biologics and immunomodulatory agents in the course of Crohn’s disease (CD) is becoming more prevalent. Improvement in disease outcomes using this strategy was suggested. Comparing 2 cohorts of newly diagnosed CD patients (differing based upon diagnosis year), we aimed to evaluate the proportion of early biologics/immunomodulatory treatment compared with step up therapy and the CD course and outcomes.

Methods

CD patients diagnosed in a tertiary IBD referral centre during 2005–2012 were stratified into 2 groups based upon the year of diagnosis. Baseline characteristics, medical and surgical treatments, and disease complications were prospectively collected. Analysis of therapy and CD course during a 2-year follow-up was performed retrospectively.

Results

Two cohorts, each including 60 newly diagnosed CD patients were compared. In the early cohort patients were diagnosed in 2005–2007 and in the late cohort in 2010–2012. Baseline characteristics were similar, except for higher C-reactive protein in the late cohort (median 7.2 mg/dl [1.6–20] vs 3 mg/dl, [1.1–8.9] in the early cohort, p = 0.021). Significantly higher proportions of biologics/immunomodulatory therapies were administered to patients in the late cohort (immunomodulatory, HR 1.91, 95% CI 1.23–2.98; biologics, HR 2.92, 95% CI 1.17–7.39).In contrast, steroid therapy was less prevalent in the late cohort (HR 0.41, 95% CI 0.16–1.03).Average time since CD diagnosis to commencing immunomodulatory therapy was 4 (2–6) months in the early vs 3 (2–7) months in the late cohort (p = 0.56), whereas for biologics, the average time was 7 (4–10) months in the early vs 4 (3–7) months in the late cohort (p = 0.40). Significantly more infections were observed in the late cohort (11 vs 2 in the early cohort, p = 0.008), specifically in patients treated with dual or triple immunomodulation (84.6% of infections occurred under dual/triple immunomodulation, OR 7.34 CI 1.48–33.22). The most prevalent were upper respiratory tract infections (53.8%). However, medical and surgical CD outcomes, including exacerbations/hospitalisations and surgeries, were comparable in the 2 cohorts.

Conclusion

A change in treatment strategy, reflected in earlier administration and higher proportions of biologic/immunomodulatory therapy for CD patients diagnosed in recent years, compared with a decade ago, was observed. This was associated with a steroid-sparing effect. Significantly more minor infections were observed in the recently diagnosed cohort, specifically if dual/triple therapy was administered. Thus, the main short-term (2-year) effect of earlier combination therapy is steroid sparing.