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Aliment Pharmacol Ther. 2015 Oct;42(8):977-89. doi: 10.1111/apt.13363. Epub 2015 Aug 14.

Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease.

Author information

1
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
2
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
3
Division of Gastroenterology and Hepatology, Stadtspital Triemli, Zurich, Switzerland.
4
Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.
5
Inserm U954, Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
6
Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.
7
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.

Abstract

BACKGROUND:

The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown.

AIM:

To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis.

METHODS:

Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications.

RESULTS:

The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006).

CONCLUSIONS:

Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication.

PMID:
26271358
DOI:
10.1111/apt.13363
[Indexed for MEDLINE]
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