IDDF2018-ABS-0246 Mucosal healing reduced the occurrence and recurrence of clinical disability in crohn’s disease

Abstract

Background Mucosal healing (MH) is the ‘target’ of ‘treat to target’ strategy in Crohn’s disease (CD), which seeks to prevent disability. However, data is limited on whether achieving MH could reduce disability in CD. We aimed to evaluate the probability of disabling CD and explore the effect of MH achievement on clinical disability in CD. Methods This was a retrospective cohort study of 319 consecutive CD patients in a tertiary hospital in China. MH was defined as the absence of ulcerations. The primary outcome was a clinical disability, which was defined as one of the followings: more than one surgery [index surgery excluded]; new events such as penetrating, perianal disease or stricture; at least three hospitalizations; switching therapy; adverse steroid events. The Kaplan-Meier method, log-rank test and Cox proportional hazards model were used to estimate the cumulative incidence of clinical disability and perform univariate analysis and multivariate analysis, respectively. Results 143 (44.8%) out of the 319 CD patients (median follow-up time 37.2 months, interquartile range: 22.7–57.6 months) progressed to clinical disability, and 51 (16.0%) suffered disability recurrence. Additionally, the cumulative rates of disabling CD were 18.8%, 40.1%, 55.5%, 85.6% at 1, 3, 5, 10 years after diagnosis respectively [figure 1]. All disabling events, except adverse steroid event (p=0.143), were significantly fewer (p=0.018) in MH patients than those without MH. Multivariable analysis revealed the independent protective factor for the occurrence of disability was MH before disability (HR:0.197; 95% CI: 0.120–0.325), while penetrating (B3) disease behaviour (HR:2.045; 95% CI: 1.283–3.259) and ileocolonic (L3) disease location (HR:1.827; 95% CI: 1.251–2.667) at diagnosis were independent risk factors. Furthermore, in disabling CD patients, achieving MH before the first disabling event could prevent recurrence of disability independently (HR:0.251; 95% CI: 0.077–0.823). IDDF2018-ABS-0246 Figure 1. The cumulative rate of remaining free from disabling CD. Conclusions Clinical disability of CD was common and increasing during the follow-up in China. B3 and L3 at diagnosis were predictive risk factors of clinical disability, whereas MH significantly reduced the occurrence and recurrence of disability in CD.