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P482 Early anti-TNF/immunomodulator therapy is associated with better clinical outcomes in Asian patients with Crohn's disease with poor prognostic factors

Oh E.H.*1, Oh K.1, Seo H.2, Chang K.2, Kim G.-U.2, Song E.M.2, Seo M.2, Lee H.-S.3, Kwon E.J.2,4, Hwang S.W.2,4, Park S.H.2,4, Yang D.-H.2, Kim K.-J.2,4, Byeon J.-S.2, Myung S.-J.2, Yang S.-K.2,4, Ye B.D.2,4

1University of Ulsan College of Medicine, Asan Medical Center, Department of Internal Medicine, Seoul, South Korea 2University of Ulsan College of Medicine, Asan Medical Center, Department of Gastroenterology, Seoul, South Korea 3University of Ulsan College of Medicine, Asan Medical Center, Health Screening and Promotion Center, Seoul, South Korea 4Asan Medical Center, University of Ulsan College of Medicine, Inflammatory Bowel Disease Center, Seoul, South Korea

Background

Although the use of anti-TNFs or immunomodulators (IMs) in the early course of disease is believed to be effective in improving long-term outcomes of patients with Crohn's disease (CD), especially those with poor prognostic factors, this concept was not clearly proved in Asian patients.

Methods

We retrospectively analyzed clinical data of Korean patients with CD who were treated at the Asan Medical Center between January 1997 and August 2016. Patients with two or more among the following risk factors for progression; diagnosis at age of under 40, need for systemic corticosteroids within three months after diagnosis, and perianal fistula at diagnosis were included. Patients who already experienced intestinal surgery and/or intestinal complications before or at diagnosis of CD were excluded. A total of 670 patients were enrolled and the probabilities of intestinal surgery and intestinal complications were compared between the following three groups; the early anti-TNF group (n=79, starting anti-TNFs within 2 years after diagnosis), the early IM group (n=286, starting IMs, but not anti-TNFs within 2 years after diagnosis), and the late therapy group (n=305, starting anti-TNFs and/or IMs 2 years after diagnosis).

Results

The chi-squared test showed that lower proportion of patients in the early anti-TNF/IM groups suffered from intestinal surgery (p<0.001), stricturing complication (p=0.001), and penetrating complication (p<0.001) than the late therapy group. However, there were no significant differences between the early anti-TNF group and the early IM group in terms of intestinal surgery and intestinal complications. The Kaplan-Meier analysis with the log-rank test showed the superiority of the early anti-TNF/IM groups in terms of delaying intestinal surgery (p<0.001), stricturing complication (p=0.002), and penetrating complication (p<0.001) compared with the late therapy group, but not identifying the superiority of the early anti-TNF group compared with the early IM group. In the multivariate Cox regression analysis, the late anti-TNF/IM therapy was independently associated with a higher risk of intestinal surgery (adjusted hazard ratio [aHR] 2.321, 95% confidence interval [CI] 1.503–3.584, p<0.001), behavioral progression (aHR 2.001, 95% CI 1.449–2.763, p<0.001), stricturing complication (aHR 1.736, 95% CI 1.209–2.493, p=0.003) and penetrating complication (aHR 3.315, 95% CI 2.094–5.249, p<0.001).

Conclusion

In Asian CD patients with poor prognostic factors and who are naïve to both intestinal surgery and intestinal complications, use of anti-TNFs or IMs within 2 years after diagnosis of CD is associated with better outcomes than the late use of the drugs in terms of intestinal surgery and intestinal complication.