P243 Subgroup analysis of the placebo-controlled CHARM trial: Increased remission rates for adalimumab-treated patients with early Crohn's disease

Abstract

Background: Patients with a chronic disease tend to use complementary and alternative medicine (CAM) during its evolution. Frequency and clinical impact of the use of these kinds of medicines in patients with inflammatory bowel disease (IBD) is unknown. The aim of the present study is to evaluate the use of CAM in IBD patients and to know potential risk factors for their use. Methods: A prospective, descriptive and transversal study was designed. Patients over 18 years old with Crohn’s disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC) were included. All patients were classified according to demographic and clinical characteristics (previous surgeries, hospitalizations, extraintestinal manifestations, steroiddependency and need of immunosuppressive or biological drugs). A questionnaire was completed about the use of CAM that included the kind of CAM, their subjective clinical response to the CAM and if the use of CAM had been associated with abstaining from conventional medication. Results were expressed in percentages with OR CI 95% and multivariate logistic regression was performed. Results: 705 patients were included, mean age 43 years (ranging from 18 to 86 years old); 53.4% were women, 369 UC (52.3%), 328 CD (45%) and eight IC (1.2%). Regarding clinical characteristics, 23% had previously had surgery, 50% had been hospitalized during their disease, 40% had developed steroiddependency, 25% presented extraintestinal manifestations, 47% had been treated with immunosuppressive drugs and 30% with biological ones. 126 patients (23%) had used CAM at least once since their IBD diagnosis. The most used CAM was herbal remedies (n = 61), homeopathy (n = 36), acupuncture (n = 31), kefir (n = 31), aloe vera (n = 25) and local witchdoctor therapies (n = 21). More than one type of CAM was used by 43 patients. After a multivariate analysis the factors associated with the use of CAM were extraintestinal manifestations (OR 1.69 CI95% 1.19 2.57) and a long-term evolution of the disease (OR 2.08 CI95% 1.44 2.99). Most patients (74%) had the subjective feeling of their diseases not improving after the use of CAM and 11 patients had adverse events related to CAM. 11% of patients abstain from conventional therapy during the use of CAM. Conclusions: Use of CAM in IBD patients is frequent, especially in those with extraintestinal manifestations and long-term evolution. In most cases, the use of CAM was not associated with clinical benefit for patients, but supposed a risk due to abstention from conventional therapy.