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P605 CRP reduction rate following initiation of anti-tumour necrosis factor-α induction therapy predicts secondary loss of response in patients with Crohn's disease

J. H. Song*1, S. N. Hong1, T. J. Kim1, E. R. Kim1, D. K. Chang1, Y-H. Kim1

1Samsung Medical Center, Department of Medicine, Seoul, South Korea

Background

The objective of this study was to identify clinical predictors of primary non-response (PNR) and secondary loss of response (LOR), in Crohn’s disease (CD) patients treated with anti-tumour necrosis factor-α (anti-TNF) agents.

Methods

This retrospective, longitudinal, and observational cohort study was performed, which included 283 CD patients who received anti-TNF from November 2006 to July 2017 at Samsung Medical Center, Seoul, Korea.

Results

A total of 212 CD patients were eligible and divided into three groups: PNR, LOR, and responder groups.

Flow chart showing the selection of patients. MAS, major abdominal surgery.

PNR occurred in 13 patients (6.1%). CRP level at initiation of anti-TNF (baseline CRP) was a possible predictor of PNR compared with non-PNR group (baseline CRP >1 mg/dl, OR = 4.34, 95% CI = 1.06–17.83).

OR (95% CI)p
Baseline age (years)≤ 401.34 (0.30–5.93)0.699
GenderMale2.20 (0.54–9.02)0.272
Indication of anti-TNFFistulising CD0.998
Baslein Hb (g/dl)≤ 102.83 (0.72–11.04)0.135
Baseline albmin (mg/dl) ≤ 3.50.77 (0.19–3.13)0.710
Baseline CRP (mg/dl) > 14.34 (1.06–17.83)0.042
Baseline BMI (kg/m2)< 18.53.01 (0.82–11.62)0.095

Clinical predictors of PNR in CD patients with anti-TNF.

During maintenance therapy, incidence of LOR was 12.9% at 1 year, 23.2% at 2 years, 37.3% at 3 years, and 52.1% at 5 years.

Cumulative response rate during anti-TNF maintenance therapy.

Baseline CRP and CRP reduction rate [(CRP at 12–14 weeks – baseline CRP)/baseline CRP] were possible predictors of 1 year LOR compared with responder group (baseline CRP >1 mg/dl, OR = 5.84, 95% CI = 1.95–17.53; CRP reduction rate >−70%, OR = 5.09, 95% CI = 1.61–16.05).

OR (95% CI)p
Baseline age (years)≤401.24 (0.39–3.98)0.715
GenderMale0.94 (0.32–2.78)0.905
Disease duration (years)>20.75 (0.22–2.54)0.646
Montreal behaviourB2+B3 (complicating)2.02 (0.54–7.56)0.298
Baseline Hb≤102.38 (0.73–7.76)0.151
Baseline albumin (mg/dl) ≤3.50.74 (0.23–2.38)0.617
Baseline CRP (mg/dl) >15.84 (1.95–17.53)0.002
CRP reduction rate>−70%5.09 (1.61–16.05)0.005
Baseline BMI (kg/m2)<18.51.54 (0.58–4.14)0.390

Clinical predictors of 1-year LOR in CD patients with anti-TNF.

In Cox hazard proportional model, baseline CRP and CRP reduction rate were possible predictors of long-term LOR during maintenance therapy (baseline CRP >1 mg/dl, HR = 2.56 95% CI = 1.55–4.22; CRP reduction rate >−70%, HR = 2.54, 95% CI = 1.54–4.20).

HR ( 95% CI)p
Baseline age (years)≤ 401.32 (0.74–2.33)0.351
GenderMale1.14 (0.68–1.89)0.625
Disease duration (years)> 21.02 (0.57–1.84)0.944
Montreal behaviourB2+B3 (complicating)1.41 (0.78–2.53)0.253
Baseline Hb (g/dl)≤ 101.25 (0.68–2.27)0.475
Baseline albumin (mg/dl)≤ 3.51.40 (0.81–2.39)0.227
Baseline CRP> 12.56 (1.55–4.22)<0.001
CRP reduction rate> −70%2.54 (1.54–4.20)<0.001
Baseline BMI (kg/m2)< 18.51.36 (0.84–2.19)0.206

Clinical predictors of long-term LOR in CD patients with anti-TNF.

Cumulative response rate during anti-TNF maintenance therapy depending on predictors of long-term LOR.

Conclusion

Baseline CRP and CRP reduction rate might be clinical predictors for PNR or LOR to anti-TNF in CD patients and could guide proper therapeutic intervention in CD patients with anti-TNF treatment.