Abstract
Although early treatment of Crohn’s disease (CD) patients with anti-tumor necrosis factor (TNF) agents or immunomodulators (IMs) may improve long-term outcomes, especially those with poor prognostic factors, their effectiveness in Asians remains unclear. In this study, Korean patients with CD naïve to both intestinal surgery and intestinal complications, and with at least two risk factors for progression (diagnosis at age <40 years, systemic corticosteroid treatment <3 months after diagnosis, and perianal fistula at diagnosis) were retrospectively analyzed. Patients were classified into those who started anti-TNFs, or IMs but not anti-TNFs, within 2 years of diagnosis, and those who started anti-TNFs and/or IMs later. Their probabilities of intestinal surgery and intestinal complications were compared. A total of 670 patients were enrolled, 79 in the early anti-TNF, 286 in the early IM, and 305 in the late treatment group. Kaplan-Meier analysis with the log-rank test showed that from starting anti-TNFs/IMs, times to intestinal surgery (P < 0.001), stricturing complications (P = 0.002), and penetrating complications (P < 0.001) were significantly longer in the early anti-TNF/IM groups than in the late treatment group. Multivariate Cox regression analysis showed that, from starting anti-TNFs/IMs, late anti-TNF/IM treatment was independently associated with higher risks 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 complications (aHR 1.736, 95% CI 1.209–2.493, P = 0.003), and penetrating complications (aHR 3.315, 95% CI 2.094–5.249, P < 0.001) than early treatment. In conclusion, treatment of Asian CD patients having poor prognostic factors with anti-TNFs/IMs within 2 years of diagnosis is associated with better clinical outcomes than later treatment.
Highlights
Crohn’s disease (CD) is a chronic systemic inflammatory disease that mainly affects the gastrointestinal tract, it has multiple extra-intestinal manifestations [1]
Of the 2,915 patients definitively diagnosed with CD during the study period, 813 were excluded, five because they were younger than 18 years at study enrollment, 678 because they were followed up for
The remaining 930 patients were categorized into three groups, the early anti-tumor necrosis factor (TNF) (n = 104), early IM (n = 483), and late treatment (n = 343) groups
Summary
Crohn’s disease (CD) is a chronic systemic inflammatory disease that mainly affects the gastrointestinal tract, it has multiple extra-intestinal manifestations [1]. CD is relatively common in Western countries, with a prevalence of up to 0.5% in the general population [2]. It is not as common in Asian countries, its incidence and prevalence in East Asian countries have increased markedly over the past decades and are expected to increase more in the future [3, 4]. The introduction of anti-tumor necrosis factor (TNF) agents has greatly changed the treatment paradigm of patients with inflammatory bowel disease (IBD), including CD. These agents are effective in inducing and maintaining clinical remission of active IBD [5,6,7,8,9]. The effectiveness of anti-TNF agents may be greater if they are used early in the course of disease, and in combination with immunomodulators (IMs) [12,13,14]
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