Abstract
Objective Bioagents in combination with immunosuppressors have synergistic effect in the treatment of Crohn′s disease, including clinical remission and mucosal healing. Short-term combination therapy (30 weeks) in the treatment of different CD subtypes was rarely reported. This study aimed to analyze the effect on clinical remission and mucosal healing in ileal CD (L1) and colonic CD (L2). Methods L1 and L2 CD patients diagnosed in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between Jan 2014 and Jun 2016 were enrolled. They were given Infliximab (5 mg/kg) in combination with azathioprine (1 mg/kg) for 30 weeks. Evaluation and endoscopy were performed in week 38. Clinical remission was judged by CDAI<150 and endoscopic severity was performed by SES-CD (simple endoscopic score for CD). Mucosal healing was judged by disappearance of ulcers under endoscopy. The difference between the two groups was compared. Results Fourty-three patients were enrolled in the study with 19 L1 and 24 L2 cases, the male female ratio was 31∶12 and the onset age is range 15-53 years. The CDAI score were both≥150 in the two groups before diagnosis and no statistical difference was found in CDAI in the two groups. The clinical remission and mucosal healing rate after 30 weeks was 86%(37/43) and 48.8%(21/43) (P>0.05). Clinical remission rates were 89.5%(17/19) and 83.3%(20/24)in L1 and L2 subtypes respectively.The mucosal healing rate was significantly higher in L1 than in L2 CD patients (68.4% vs. 33.3%, P=0.031). Conclusion Short-term combination therapy induced high remission rate in CD patients and half of the patients achieved mucosal healing. There is difference in mucosal healing rate between subtypes of CD patients, which is low in L2 CD compared with L1 CD, indicating longer combinational treatment for CD patients with involvement of colon. Key words: Combination therapy; Ileum CD; Colonic CD; Clinical remission; Mucosal healing
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