P120 First year remission rates among patients with newly diagnosed Crohn’s disease: data from a real-world prospective inception cohort
Journal of Crohn's and Colitis(2022)
摘要
Abstract Background There are sparse data regarding the effectiveness of novel treatment strategies for newly diagnosed patients with Crohn’s disease (CD). Data from clinical trials demonstrate 30–40% remission rates after 1-year. We aim to assess remission rates among newly diagnosed patients with CD in a referral center. Methods A prospective observational cohort study of patients with newly diagnosed CD between 03/2018- 01/2021. Patients were scheduled for semi-annual visits for assessment, data collection, and education by an IBD-oriented gastroenterologist who determined a treatment plan, IBD nurse, and dietitian. Disease activity was determined by Crohn’s disease activity index (CDAI). Clinical remission (CR) at 1-year-period (9–18 months) was defined as: CDAI < 150, no active perianal disease, and steroid-free> 3 months. Biochemical remission: C-reactive protein (CRP)<1mg/dl, fecal calprotectin (FC)<150 ug/g and normal albumin levels. Endoscopic remission: SES-CD<3. Deep remission: composite of clinical, biochemical, and endoscopic remission. Predictors for clinical remission were assessed by multivariable logistic regression. Results Out of 110 enrollees, 77 completed 1-year period: 50.6% female, median age 27 years (22–38), median BMI 22 kg/m2 (20–25), 16.9% smokers. At diagnosis 72.7% had an inflammatory phenotype (B1), and 26% had complex perianal disease, 55.8% had moderate-severe CD (CDAI>220). During the first year after diagnosis 59.7% were treated with a biologic (58.5% anti-TNF, 1.3% ustekinumab, 3.9%>1 biologic), diagnosis-biologic interval 4.3 months (IQR:2.6–7.3), and 9.1% required surgery. At 1-year-period 63.6% achieved CR (comparable CR rates in patients recruited with mild-moderate vs moderate-severe CD:61.8% vs 65.1%, p= 0.814). Biochemical, endoscopic and deep remission rates: 51.9% (40/77), 44.4% (24/54), and 25.9% (14/54), respectively. Significant decrease in clinical and biochemical activity during follow up: median CDAI 233 (IQR:143–286) to 83 (IQR:29–150); median CRP 1.8 mg/dl (IQR:0.4–4.1) to 0.2 (IQR:0.1–1); median FC 714 ug/g (IQR:128–1538) to 114 (IQR:18–355); all p<0.001. Paired endoscopic data, available for 54 patients, demonstrated decrease in median SES-CD from 8 (IQR:5–11) to 3 (IQR:0–5), p<0.001. Short IBDQ score increased from a median of 43 (IQR:36–55) to 56 (IQR:42–61). B1/P0 phenotype and lower BMI at diagnosis were associated with higher probability to achieve CR (OR 3.37, 95% CI, 1.08–10.46; p=0.036, and 1.2, 95% CI, 1.37-1.05; p=0.06, respectively). Conclusion In a cohort of patients with newly diagnosed CD treated by a multidisciplinary team, there were favorable 1-year outcomes; specifically, CR demonstrated in >60%.
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