P394 Prolonged azathioprine treatment reduces the need for surgery in early Crohn's disease
Qiu Y.*1, Mao R.1, Zhang S.-h.2, Feng R.2, Zeng Z.-r.1, Chen M.-h.2
1The first affiliated hospital of Sun-yat Sen University, Gastroenterology, Guangzhou, China 2The first affiliated hospital of Sun-yat Sen University, Guangzhou, China
Whether an early use of azathioprine (AZA) could alter the natural history of Crohn's disease (CD) remains debated. We aimed to evaluate the impact of AZA on disease progression in a cohort of Chinese patients with early CD.
This longitudinal cohort study examined patients with early CD defined as disease duration ≤18 months and no previous use of disease-modifying agents (immunomodulators/ biologics) according to Paris definition. The primary outcome was the proportion of CD-related intestinal surgery. Cox regression analysis was performed to identify potential predictive factors of CD progression.
One-hundred and ninety patients with early CD were enrolled in the study. After a median follow-up of 57 months (interquartile range, 31.3–76.2), 31 patients underwent abdominal surgeries, 48 patients were hospitalized, and 68 patients experienced clinical flares. The cumulative rate of remaining free of CD-related bowel surgery, hospitalization and flare at 5-year on AZA treatment was 0.65, 0.59 and 0.39, respectively. The median CD-related bowel surgery, hospitalization and flare-free survival were 73.5 months (95% confidence interval (CI), 62.53–84.47), 76.9 months (95% CI 66.59–87.18) and 49.3 months (95% CI 34.9–63.7), respectively. Four independent predictors of CD-related operations were identified: prior bowel resection (hazard ratio (HR), 9.23; 95% CI 3.67–23.23), smoker (HR, 4.00; 95% CI 1.38–11.65), AZA treatment duration <36 months (HR, 9.62; 95% CI 2.43–38.47) and hemoglobin <110 g/L at the time of initiation of AZA (HR, 4.36; 95% CI 1.80–10.58).
Prolonged use (≥36 months) of AZA was associated with a more favourable disease course of early CD, evident as a lower risk of CD-related surgeries.