Search in the Abstract Database

Abstracts Search 2019

P184 Is perianal involvement a crutch for biologic therapy on Crohn’s disease?

R. Magalhaes*1,2,3, F. Dias de Castro1,2,3, M. J. Moreira1,2,3, J. Cotter1,2,3

1Hospital da Senhora da Oliveira, Gastreterology, Guimarães, Portugal, 2Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal, 3ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal

Background

Crohn’s disease (CD) is complicated with perianal disease in 21–23% of patients. Presence of perianal disease has been associated with a disabling course of CD and dreadful impact on quality of life. We aim to identify whether perianal disease has negative implication on CD remission rates, after 1-year infliximab therapy course.

Methods

Cohort, retrospective, single-centre study, including consecutive CD patients on Infliximab perfusion. Patients were followed 1 year, since the beginning of biological therapy. Co-variables were chosen bearing in mind clinical relevance and literature evidence. We splitted our outcome variable into clinical remission; analytical remission; endoscopic remission and deep remission (including all three mentioned before). The correlation towards the outcome variable was assessed with univariate and multi-variate analysis, and a survival assessment, using SPSS—a p-value of <0.05 was considered statistically significant.

Results

We assessed 74 patients with CD, of whom 41 (55.4%) were female, with a mean age of 36 years old, all Caucasian. From our cohort, 36.5% of the patients presented perianal disease at diagnosis. After 1 year of treatment course, we documented 31,5% of deep remissions, 47.2% endoscopic remissions, 55.4% analytical remissions and 70.3% of clinical remissions. Sixty-six (89.2%) presented an initial response to the treatment, from whom, 20 presented disease relapses (clinical or/and analytical or/and endoscopic). Patients with perianal disease, on the first year of Infliximab therapy, have a higher probability of disease relapse, displaying statistically significant difference on Kaplan-Meyer curves (Breslow p-value 0.043). Several variables had statistical significance towards the outcome on the univariate analysis (age at diagnosis; disease behaviour at diagnosis; smoking; hospital admission; days of hospital stay; corticoid cycle; biological naïve patients; blood infliximab levels; calprotectin, protein c reactive, erythrocyte sedimentation rate levels before and after the year follow-up). Adjusting for confoundment, patients without perianal disease have an odd 7.6 times higher of achieving endoscopic remission (p = 0.038) and 26 times higher of achieving clinical remission (p = 0.027).

Conclusion

In CD patients on infliximab therapy, perianal disease involvement is associated with lower endoscopic, analytical and clinical remission rates, after 1-year follow-up. They are also more prone to disease relapses, on the first year of therapeutic.