scholarly journals P201 Evaluation of the role of anti-TNF in stabilizing the progression of intestinal lesions in Crohn’s disease using the Lemann Index

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S265-S265
Author(s):  
A Hassine ◽  
I Akkari ◽  
S Mrabet ◽  
E Ben Jazia
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Structural Damage ◽  
Symptom Control ◽  
Intestinal Damage ◽  
Intestinal Lesions ◽  
Significant Difference ◽  
The Mean ◽  
Azathioprine Group

Abstract Background The Lemann Index (LI) was developed to assess cumulative digestive tract damage in patients with Crohn’s disease (CD), independently of clinical and biological activity. Recently, therapeutic goals in CD have focused on achieving mucosal healing and deep remission rather than simple symptom control, thus requiring prevention of progression of intestinal damage. The aim of this study was to assess the influence of different treatments on the progression of structural damage, using the LI. Methods we retrospectively included all patients with CD, followed in our center during the period between January 2016 and January 2020. The LI was calculated from the first (LI1) and the last (LI2) clinical consultations. The evolution of (LI1-LI2) or Delta LI (DLI) was recorded. Results 112 patients with CD were collected, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. Regarding maintenance treatment, 51.8% of patients (n = 58) were on Azathioprine, 23.2% (n = 26) were on aminosalicylates, and 25% (n = 28) were on anti-TNF, including 42, 9% under combination therapy. The median follow-up was 36.82 ± 16.83 months, with no difference between the groups. During follow-up, the mean LI increased significantly from 3.34 [0.58–8.82] to 7.82 [0.62–32.6] in the azathioprine group (p = 0.0001), from 2.0 [0.58–6.52] to 3.91 [0.6–14.03] in the Aminosalicylates group (p = 0.001) and from 3.79 [1.05–8.42] to 10.01 [2.58–33.08] in the Anti-TNF group (p = 0.0001). The mean DLI was -4.48 for the Azathioprine group, -1.9 for the Salicylates group and -6.14 for the Anti-TNF group, with no statistically significant difference (p = 0.16). Conclusion In patients with CD, the LI tends to increase over time. In our series, the use of Anti-TNF α does not appear to be able to reduce the progression of intestinal lesions, compared to other therapies.

scholarly journals P160 Can the Lemann index at diagnosis predict the risk of early surgery in Crohn’s disease?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S239-S239
Author(s):  
A Hassine ◽  
I Akkari ◽  
S Mrabet ◽  
E Ben Jazia
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Treatment Decision ◽  
Early Surgery ◽  
First Year ◽  
Rapid Disease Progression ◽  
Significant Difference ◽  
The Mean ◽  
Optimal Patient Management

Abstract Background Identifying patients with Crohn’s disease (CD) with rapid disease progression or at high risk for early surgery is a crucial pillar in the treatment decision to ensure optimal patient management. The objective of this study was to assess the correlation between the Lemann index at the time of diagnosis and abdominal surgery in the first year after diagnosis of Crohn’s disease and to find the risk factors for early surgery. Methods This is a retrospective study of all patients with CD followed in our center over a period of 4 years (January 2016- January 2020), and who were evaluated by endoscopy and MRI at baseline. The Lemann Index is a score that measures cumulative damage to digestive tissue from entero-MRI and endoscopy data. It was calculated by noting the previous surgery, the location and extension of the disease and any intestinal complications. The sociodemographic and clinical characteristics of the patients were studied. Hypothesis tests were applied to identify associations. Results 112 patients with CD were included in this study, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. Anoperineal manifestations were noted in 24 patients. An upper digestive tract was present in 19.6% of patients. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. During the first year after diagnosis of CD, 19.6% of patients (n = 22) required surgical treatment. The indications for surgery were: the presence of an intra-abdominal collection (27.3%), severe acute corticosteroid-resistant colitis (18.2%); ileocaecal stenosis resistant to medical treatment (27.3%) or acute bowel obstruction (27.3%). The LI at diagnosis was much higher in the early surgery group: 5.22 +/- 2.65 vs. 2.63 +/- 1.88; with a statistically significant difference (p = 0.01). A severe initial flare as well as a penetrating phenotype were predictors of early abdominal surgery (p = 0.022, p = 0.024, respectively). Conclusion According to our study, a high Lemann score at diagnosis correlates well with the risk of early surgery in Crohn’s disease. Further, larger-scale studies would be needed to establish the reliability of this test in predicting this risk.

scholarly journals P568 Effectiveness of ustekinumab after vedolizumab failure in patients with anti-TNF-refractory Crohn’s disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S528-S528
Author(s):  
N Dussias ◽  
F Rizzello ◽  
C Calabrese ◽  
A Sanna Passino ◽  
L Melotti ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Partial Response ◽  
Clinical Remission ◽  
Primary Outcome ◽  
Symptom Control ◽  
Primary Outcome Measure ◽  
Referral Centre ◽  
Single Centre Study

Abstract Background Both vedolizumab (VDZ) and ustekinumab (UST) are indicated in the treatment of Crohn’s disease (CD) when anti-TNF treatment fails. While there are some studies regarding the efficacy of these two drugs in this setting, data are lacking regarding the effectiveness of UST in the treatment of VDZ-refractory disease. We aim to address this particularly challenging clinical picture in a real-world single-centre study. Methods CD patients from a single tertiary IBD referral centre receiving treatment with UST after failure to VDZ with a minimum follow-up period of 6 months were included. All patients had previously failed anti-TNF treatment. The primary outcome measure was achievement of steroid-free clinical remission, defined as HBI < 5 at 6 months. We also assessed rates of partial response, defined as a reduction in HBI by ≥ 3 points and/or cessation of steroid treatment in patients who required corticosteroids at baseline for symptom control. Results A total of 32 patients (20 male, mean age ± SD 40.7 ± 14.2, range 21–75) receiving UST treatment after VDZ failure were analysed. Complete steroid-free clinical remission at 6 months from starting UST therapy was achieved in 19 patients (59.4%). Nine patients (28.1%) had partial response, while in the remaining 4 patients (12.5%) no response was achieved. No adverse events were recorded during the follow-up period. Conclusion Preliminary results suggest that UST is effective and safe in the treatment of VDZ-refractory CD.

scholarly journals P118 External validation of model predicting early-onset surgery in Crohn’s Disease patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S209-S210
Author(s):  
J Yao ◽  
B Hu ◽  
H Wang ◽  
M Zhi
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Early Onset ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
External Validation ◽  
Therapeutic Strategies ◽  
Goodness Of Fit Test ◽  
The Mean

Abstract Background Screening Crohn’s disease (CD) patients with high risk of early-onset surgery is crucial in launching therapeutic strategies. We have already identified disease behavior, smoking, body mass index, C-reactive protein level at diagnosis, previous perianal or intestinal surgery, maximum bowel wall thickness, use of biologics, and exclusive enteral nutrition as independent significant factors associated with 1-year surgery surgeries risk and further established a prognostic model (Fig.1,World J Gastroenterol. 2020;26(5):524–534). We aimed to validate this model using external cohort. Methods This retrospective study was conducted from Jan, 1, 2017, to Dec, 31, 2019 in three tertiary referral centers including Sixth Affiliated Hospital of Sun Yat-Sen University, Second Affiliated Hospital of Zhejiang University, and Second Affiliated Hospital of Military Medical University. Data of patients with a confirmed diagnosis of CD were collected through hospital electronic system. The published model was validated with calibration using the Hosmer-Lemeshow goodness-of-fit test, and discrimination was assessed using areas under the curve (AUC). Results A total of 756 patients were enrolled in our study with 101 (13.4%) excluded for the sake of incomplete data and loss of follow-up. Of the enrolled patients, 74.8% were male (n = 490) at the mean age of 28.4 ± 11.0 years, with the mean follow-up period of 21.8 ± 8.1 months. An ideal predictive ability of this model was confirmed by receiver operating characteristic curves and AUC as high as 94.5%. Besides, acceptable sensitivity of 69.5% and excellent specificity of 97.0% supported further clinical promotion and application of this model. Conclusion This model owns ideal ability to predict 1-year surgery risk in CD patients, which definitely help clinical decision-making and acid therapeutic strategies launching.

scholarly journals P587 Adalimumab in pediatric Crohn’s disease: A long-term multi-centre real-world experience

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S491-S492
Author(s):  
S Lawrence ◽  
H Huynh ◽  
W El-Matary ◽  
J DeBruyn ◽  
M Carroll ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Clinical Remission ◽  
Long Term Outcomes ◽  
Faecal Calprotectin ◽  
Significant Difference ◽  
Necrosis Factor

Abstract Background There is a paucity of data regarding long-term outcomes for adalimumab (ADA) in pediatric Crohn’s disease (CD). We describe the long-term effectiveness of ADA, in achieving clinical and biochemical remission in a Canadian multi-centre pediatric CD cohort. Moreover, we report the effects of prior anti-TNF exposure and use of a concomitant immunomodulator (IM) on durability of clinical and biochemical response. The primary outcome was 24-month corticosteroid (CS) free remission. Secondary objectives included biochemical and faecal calprotectin response over the study period. Methods Retrospective review of electronic records of all children aged 3–18 years with CD requiring ADA at 4 centres across Canada (Vancouver, Edmonton, Winnipeg and Calgary) between January 2005 and December 2017. Results One hundred and nine children (68% male; median age 13.07 [IQR 10.6–15.1]) with CD (L1 21.7%, L2 28.3%, L3 50%) were included with a median follow-up of 15.9 months [IQR 7.6–24]. Seventy-four patients (67.9%) were anti-tumour necrosis factor (TNF) naïve. Concomitant IM therapy was used in 51 (46.8%). CS free clinical remission at 24 months was observed in 45/66 (68%). Over time, the median PCDAI, CRP, ESR and faecal calprotectin significantly improved (Table 1). During follow-up, 36 (33%) patients discontinued ADA; 6 (5.5%) had primary non-response, 28 (25.7%) had secondary LOR and 2 (1.8%) had intolerance. At 24 months, clinical remission was achieved more frequently in patients who were Anti-TNF naïve (81% vs. 43.5% p 0.002). There was no significant difference in biochemical or faecal calprotectin outcomes between those who were bio-naive or experienced. There was no significant difference in the time to loss of response between those on monotherapy and combination therapy with an IM and ADA (HR 0.64 [95% CI 0.33–1.26] p0.2). Conclusion This study demonstrates that ADA is effective and durable in pediatric CD. Over 24 months, clinical, biochemical and faecal calprotectin improvement was seen. In our cohort, clinical response to ADA was greater in anti-TNF naïve compared with anti-TNF experienced patients; however,, biochemical and faecal calprotectin outcomes did not differ. ADA response appears durable with no significant difference in patients on monotherapy or combination therapy.

scholarly journals Utility of Computed Tomographic Enteroclysis/Enterography for the Assessment of Mucosal Healing in Crohn's Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Shinichi Hashimoto ◽  
Kensaku Shimizu ◽  
Hiroaki Shibata ◽  
Satoko Kanayama ◽  
Ryo Tanabe ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Remission ◽  
Mucosal Healing ◽  
Active Group ◽  
Computed Tomographic ◽  
Intestinal Lesions ◽  
Significant Difference ◽  
Small Intestinal ◽  
Inactive Group

Aim. When determining therapeutic strategy, it is important to diagnose small intestinal lesions in Crohn's disease (CD) precisely and to evaluate mucosal healing as well as clinical remission in CD. The purpose of this study was to compare findings from computed tomographic enteroclysis/enterography (CTE) with those from the mucosal surface and to determine whether the state of mucosal healing can be determined by CTE.Materials and Methods. Of the patients who underwent CTE for CD, 39 patients were examined whose mucosal findings could be confirmed by colonoscopy, capsule endoscopy, balloon endoscopy, or with the resected surgical specimens.Results. According to the CTE findings, patients were determined to be in the active CD group (n=31) or inactive CD group (n=8). The proportion of previous surgery, clinical remission, stenosis, and CDAI score all showed significant difference between groups. Mucosal findings showed an association with ulcer in 93.6% of active group patients but in only 12.5% of inactive group patients (P<0.0001), whereas mucosal healing was found in 62.5% of inactive group patients but in only 3.2% of active group patients (P<0.0001).Conclusion. CTE appeared to be a useful diagnostic method for assessment of mucosal healing in Crohn's disease.

P105 PREDICTIVE FACTORS FOR DEVELOPING SMALL BOWEL OBSTRUCTIONS AFTER ILEAL RESECTION IN PATIENTS WITH CROHN’S DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S21-S22
Author(s):  
Aditi Mulgund ◽  
Nedhi Patel ◽  
Michael Schwartz ◽  
Poonam Beniwal-Patel ◽  
Patel Amir ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Ileocecal Resection ◽  
Ileal Resection ◽  
Post Surgery ◽  
Initial Surgery ◽  
The Mean ◽  
Resected Bowel

Abstract Background and Aims Patients with Crohn’s disease (CD) may require small bowel resections. Unfortunately, some of these patients may develop post-operative small bowel obstructions (SBO). Many clinicians perceive ileal resections dramatically increase the risk of developing SBO in the future, but the incidence and risk factors to developing SBO are poorly described. The primary aim of this study is to document the incidence and factors associated with the development of SBO not related to recurrence of disease in CD patients that undergo ileal resection. We also sought to assess long-term outcomes of this complication. Methods We performed a retrospective cohort study including patients aged 18 years or older with CD, who have had ileocecal resection with ileocolonic anastomosis or segmental small bowel resection. Data abstracted included demographics, phenotype and therapies of CD, disease recurrence post-ileal resection and multiple surgical variables. The primary outcome was the development of SBO within 5 years post-surgery not including obstructions secondary to recurrence of CD. Results 92 total patients were included in the analysis. All had a colonoscopy within a year of the surgery. The mean Rutgeerts score was 0 (interquartile range [IQR] 0 to 2) and the mean short endoscopic score was 0 (IQR 0 to 4). The remainder of baseline characteristics are shown in Table 1. At 6 months, 1 year, and 5 years, the rate of SBO was 4/92 (4%), 6/92 (6.5%), and 15/92 (16%), respectively. Throughout follow-up, only 5 patients had an SBO attributed to intra-abdominal adhesions and only 2 patients required surgical lysis of adhesions. Patients that were found to have histologic inflammation in the margins of the resected bowel specimen had a significantly higher chance of developing an SBO within 5 years of the initial surgery (OR: 4.5 [95%CI: 1.3–15.3], p=0.02 - Table 2). Conversely, patients with either active endoscopic and/or radiologic inflammation on post surgical surveillance colonoscopy did not have a higher risk of developing an SBO within 5 years of the initial surgery (p=0.37). Finally the length of bowel resected at the index surgery was not associated with the development of an SBO (AUC: 0.62, p=0.18). Conclusions The incidence of SBO after ileal resection in CD is low and resolves with medical management on most cases. Inflammation in the margins of the resected bowel and previous bowel resections were associated with new SBO within 5 years. These results must take into account the study population were monitored and cannot be extrapolated to those patients that lost follow-up.

Impact of Aphthous Colitis at Diagnosis on Crohn’s Disease Outcomes

2019 ◽  
Vol 14 (3) ◽  
pp. 342-350
Author(s):  
Charlotte Delattre ◽  
Ayanna Lewis ◽  
Julien Kirchgesner ◽  
Isabelle Nion-Larmurier ◽  
Anne Bourrier ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatments ◽  
Ileal Resection ◽  
Colonic Involvement ◽  
Intestinal Lesions ◽  
Aphthous Ulcers ◽  
Therapeutic Decisions ◽  
History Of

Abstract Background The natural history of intestinal lesions in Crohn’s disease [CD] is not fully understood. Although the extent of lesions at diagnosis usually defines the extent of the disease, some lesions seen at diagnosis, particularly aphthous ulcers [AUs], may resolve before follow-up. The aim of this study was to evaluate the outcomes of CD patients with colonic AUs seen at diagnosis. Methods CD patients with aphthous colitis at diagnosis who had been followed since 2001 were included in a case control study matched with two groups of controls: one without colonic involvement at diagnosis and a second group with colonic lesions more severe than AUs at diagnosis. Results Seventy-five patients were included, with a median follow-up of 7.3 years [interquartile range 2.7–9.8]. Seventy-one per cent of those having a second colonoscopy at least 6 months after diagnosis were stable or healed. Medical treatments were similar between the three groups. The AU group’s rate of ileal surgery was similar to those without colitis. In multivariate analysis, the independent factors associated with ileal resection were ileal involvement (odds ratio [OR]: 8.8; 95% confidence interval [CI] [7.68–33.75]; p = 0.002) and the presence of severe colitis (OR = 0.5; 95% CI [0.32–0.79], p = 0.003). The risk of ileal surgery was not influenced by the presence of aphthous colitis (OR: 0.63; 95% CI [0.37–1.1]; p = 0.1). Conclusion Aphthous colitis at diagnosis seems to resolve in most patients. This suggests that these lesions are of little clinical significance and may not need to be considered prior to ileal resection in CD or when making other important therapeutic decisions.

Influence of Vitamin D3 Supplementation on Infliximab Efficacy in Chinese Patients With Crohn’s Disease: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Sheng-long Xia ◽  
Quan-jia Min ◽  
Xiao-xiao Shao ◽  
Dao-po Lin ◽  
Guo-long Ma ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Remission Rate ◽  
Chinese Patients ◽  
Cytokine Profiles ◽  
Clinical Remission Rate ◽  
Tnf Α ◽  
Vitamin D3 Supplementation ◽  
The Mean

Abstract Background: It remains uncertain whether vitD3 supplementation is beneficial for remission of Crohn’s disease (CD). The influence of vitD3 supplementation on Infliximab (IFX) efficacy was retrospectively analyzed in Chinese CD patients.Methods: Patients with moderate-to-severe CD, who were bio-naïve and prescribed with IFX treatment for at least 54 weeks were recorded. VitD3 supplementation was defined as patients additionally took oral vitD3 (125 IU/d) within 3 days after the first infusion and persisted in the whole follow-up period. Disease activity was assessed using Harvey-Bradshaw Index (HBI). Serum cytokine profiles were quantitatively analyzed in a subset of all patients at baseline and 54-week after intervention.Results: Among 73 enrolled patients, 37 took vitD3 regularly (D3-patients), the others (non-D3-patients) did not. At 54-week, the mean 25-hydroxyvitaminD level increased in D3-patients (P<0.001). The clinical remission rate was higher in D3-patients compared to non-D3-patients (P=0.030). The decrease of HBI from baseline to 54-week was more in D3-patients than non-D3-patients (P=0.023). Furthermore, vitD3 supplementation was independently related to the increase of remission rate at 54-week in D3-patients (P=0.015). The benefit of vitD3 supplementation was significant only in patients with deficient vitD3, but not in non-deficient vitD3. In non-D3-patients, the decreases of IL-6 and TNF-α at 54-week were more obvious than at baseline (both P<0.05). In D3-patients, however, only IL-10 increased at 54-week compared with its baseline value (P=0.037).Conclusions: VitD3 supplementation could not only improve IFX efficacy, especially for patients with vitD3 deficiency, but also affected the cytokine profiles in CD patients. (Clinical Trials. Gov NCT04606017)

P218 Assessment of the degree of intestinal destruction in Crohn’s disease at the time of diagnosis

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S273-S274
Author(s):  
A Hassine ◽  
I Akkari ◽  
S Mrabet ◽  
E Ben Jazia
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Univariate Analysis ◽  
Biological Data ◽  
Bowel Injury ◽  
Age At Diagnosis ◽  
Duration Of Symptoms ◽  
Intestinal Lesions ◽  
History Of ◽  
The Mean

Abstract Background Certainly the presence of advanced intestinal lesions in Crohn’s disease (CD) is associated with a more frequent recourse to surgical resection. However, in general, the degree of intestinal destruction in patients with CD is not assessed at the time of diagnosis, and the natural history of CD may differ phenotypically from patient to patient. The aim of this study was to assess the degree of intestinal destruction in patients with CD at the time of diagnosis, using the Lemann Index (LI), and to identify the associated factors. Methods A retrospective study was conducted involving all patients with CD followed in our center over a period of 4 years (2016- 2020), and who were evaluated by endoscopy and MRI at baseline. The Lemann Index is a score that measures cumulative damage to digestive tissue from entero-MRI and endoscopy data. A LI score &gt; 2.0 was set as a cutoff to define advanced bowel injury. Hypothesis tests were applied to identify associations. Results 112 patients with CD were included in this study, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Regarding the localization of CD, it was ileal, colonic, and ileocolonic in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory in 60.7%, stricturing in 21.42%, and penetrating in 17.85%. The initial flare was judged to be severe in 33.9%, moderate in 55.4% and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. 12 patients had already undergone bowel resection. As for the biological data, the mean value of C-Reactive Protein (CRP) at the time of diagnosis was 74.08 +/- 54.05 mg / l, and that of the sedimentation rate (ESR) was 62, 13 +/- 36.49 (the 1st hour). The mean LI was 3.14 (± 2.28) with 64 patients (57.1%) presenting an LI score indicating advanced bowel injury at diagnosis. In univariate analysis, the factors associated in a statistically significant way, with a more important Lemann Index were: the male sex (p = 0.037), the history of intestinal resection (p = 0.009), a severe initial flare (p = 0.049). Similarly, a strong correlation was observed with the initial CDAI score (p = 0.024, r = 0.05) and the initial value of ESR (p = 0.001, r = 0.01). In addition, the duration of symptoms, age at diagnosis, initial disease location and phenotype, presence or absence of anoperineal manifestations, and CRP value at diagnosis were not correlated to the degree of intestinal destruction according to the LI score, with respectively: p = 0.43, p = 0.12, p = 0.19, p = 0.49, p = 0.34 and p = 0.063. Conclusion In our series, advanced intestinal lesions are present at the time of diagnosis in a significant proportion of patients. Thus, the use of the Lemann score from the diagnosis of Crohn’s disease is necessary.

scholarly journals P405 Comparison of long-term outcomes of infliximab vs. adalimumab in 1488 biologic-naive Korean patients with Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S374-S374
Author(s):  
Y S Jung ◽  
M Han ◽  
S Park ◽  
J H Cheon
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Population Based ◽  
Long Term Outcomes ◽  
Population Based Study ◽  
Korean Patients ◽  
Asian Patients ◽  
Significant Difference

Abstract Background Data on the comparative effectiveness of infliximab (IFX) or adalimumab (ADA) in patients with Crohn’s disease (CD) are rare, particularly for Asian patients. We compared the clinically key outcomes (surgery, hospitalisation, and corticosteroid use) of these two drugs in biologic-naive Korean patients with CD. Methods Using National Health Insurance claims, we collected data on patients who were diagnosed with CD and exposed to IFX or ADA between 2010 and 2016. Results We included 1488 new users of biologics (1000 IFX users and 488 ADA users). Over a median follow-up of 2.1 years after starting biological therapy, there were no significant differences in the risk of surgery (ADA vs. IFX; adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 0.86–1.95), hospitalisation (aHR, 1.05; 95% CI, 0.84–1.32), and corticosteroid use (aHR, 0.84; 95% CI, 0.58–1.22) between IFX and ADA users. These results were unchanged even when only patients who used biologics for over 6 months were analysed (aHR [95% CI]; surgery: 1.41 [0.88–2.26], hospitalisation: 1.06 [0.83–1.35], and corticosteroid use: 0.82 [0.56–1.21]). Additionally, these results were stable in patients treated with biological monotherapy or combination therapy with immunomodulators. Conclusion In this nationwide population-based study, there was no significant difference in the long-term effectiveness of IFX and ADA in the real-world setting of biologic-naive Korean patients with CD. In the absence of trials to directly compare IFX and ADA, our study supports that the choice of one of these two biologics may be allowed to be determined by the preference of patients and/or physicians.

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