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P320 Factors determining therapeutic strategy at diagnosis and evolution of disease severity in a cohort of Belgian pediatric Crohn's disease patients (BELCRO)
Clinical: Therapy and observation P319 Inflammatory uncomplicated phenotype at the start of biological therapy predicts best surgery-free outcomes G. Moran1 *, G. Kaplan1 , H. Yang1 , C. Seow1 , S. Devlin1 , L. Dieleman1 , R. Fedorak1 , S. Ghosh1 , R. Panaccione1 . 1 Alberta IBD Consortium, Canada Background: The effect of biological therapy on surgical rates in Crohn’s disease (CD) is unclear. Our objective is to describe the post-biologic surgical incidence and identify prognostic factors. Methods: A CD cohort (n = 104) prescribed infliximab or adalimumab between 1/7/2000 and 29/6/2011 was identified. The primary outcome was post-biologic CD-related surgery. The primary exposure of interest was disease behavior at onset of first biologic: inflammatory (B1), fibrostenotic (B2) or penetrating disease (B3). Secondary factors collected were: age at diagnosis; sex; time from diagnosis to onset of first biologic; and pre-biologic surgical history. The surgical rate following the start of the first biologic was calculated assuming a Poisson distribution. Kaplan Meier (KM) survival curves of post-biologic surgery, stratified by disease behavior at onset of biologics, were compared using the log rank test. Cox proportional regression model evaluated the effect of prebiologic disease behavior (B1 referent versus B2 and B3) on the post-biologic surgical risk after adjusting for confounders. Risk estimates were presented as hazard rate ratios (HR) with 95% confidence intervals (CI). Results: 26.0% of CD patients underwent post-biologic surgery (0.09 per person-year; 95% CI 0.06 0.13). B2 (mean time to surgery = 1.6±0.17 years; figure 1) and B3 (mean time to surgery = 1.4±0.08 years) disease behavior showed a significant (p = 0.002) increase in surgical rates when compared to B1 (mean time to surgery = 7.3±0.48 years). B2 (HR = 10.7; 95% CI: 3.3 37.5; p = 0.0001) and B3 (HR = 4.2; 95% CI: 1.2 15.4; p = 0.027) disease behavior at onset of the first biologic showed a significantly increased risk for surgery as compared to B1 after adjusting for age at the onset of biologic (HR = 1.0; 95% CI: 0.97 1.03), pre-biologic surgical status (HR = 0.48; 95% CI: 0.18 1.3), time from diagnosis to onset of biologic (HR = 0.97; 95% CI: 0.91 1.03), and pre-biologic perianal disease (HR = 1.9; 95% CI: 0.75 5.1). Conclusions: Complicated CD behavior at the start of biological therapy is a significant predictor of surgery. Treating CD at the inflammatory stage may improve disease outcomes.
KM curves indicating the cumulative risk of surgery following onset of first biologic.
S137 P320 Factors determining therapeutic strategy at diagnosis and evolution of disease severity in a cohort of Belgian pediatric Crohn’s disease patients (BELCRO) E. De Greef1 *, J. Mahachie2 , I. Hofman3 , F. Smets4 , S. Van Biervliet5 , M. Scaillon6 , B. Hauser1 , P. Alliet7 , W. Arts8 , O. Dewit9 , H. Peeters10 , F. Baert11 , G. D’Haens12 , J.-F. Rahier13 , I. Etienne14 , O. Bauraind15 , A. Van Gossum16 , S. Vermeire17 , F. Fontaine18 , V. Muls19 , E. Louis20 , F. Van de Mierop21 , J.-C. Coche22 , K. Van Steen23 , G. Veereman1 . 1 UZ Brussels, Brussels, Belgium, 2 Montefiore Institute, ULG, Li` ege, Belgium, 3 University Hospital Gasthuisberg, Leuven, Belgium, 4 UCL St Luc, Brussels, Belgium, 5 UZ Gent, Ghent, Belgium, 6 Hˆ opital des Enfants Reine Fabiola, Brussels, Belgium, 7 Jessa Hospital, Hasselt, Belgium, 8 ZOL, Genk, Belgium, 9 Cliniques Universitaires St-Luc, Department of Gastroenterology, Brussels, Belgium, 10 Ghent University Hospital, Department of Gastroenterology, Ghent, Belgium, 11 Heilig Hartziekenhuis, Roeselare, Belgium, 12 Academic Medical Center, Gastroenterology and Endoscopy, Amsterdam, Netherlands, 13 Cliniques Universitaires UCL Mont Godinne, Yvoir, Belgium, 14 CHR De La Citadelle, Li` ege, Belgium, 15 Clinique St Pierre, Ottignies, Belgium, 16 Hˆ opital Erasme, Department of Gastroenterology, Brussels, Belgium, 17 University Hospital Gasthuisberg, Department of Gastroenterology, Leuven, Belgium, 18 Clinique St. Joseph, Department of Gastroenterology, Li` ege, Belgium, 19 CHU St-Pierre, Gastroenterology, Brussels, Belgium, 20 University of Li` ege and CHU Li` ege, Department of Gastroenterology, Li` ege, Belgium, 21 Hospital Sint Augustinusziekenhuis, Department of Gastroenterology, Wilrijk, Belgium, 22 Clinique Saint Pierre, Corroy Le Grand, Belgium, 23 Montefiore Institute, System and Modeling Unit, Li` ege, Belgium Background: To determine associations between variables at diagnosis and disease severity at inclusion in the BELCRO database. Methods: Data from previously diagnosed pediatric Crohn’s disease patients were retrospectively evaluated at inclusion in the BELCRO database (current visit). Disease severity scores (PCDAI and PGA) were compared to initial treatment. Nonparametric association tests and multinomial logistic regression tests were used. Results: Data on 152/156 patients were available with a median follow-up 2.4 yrs (range 0.1 7.9 yrs). Severe disease persisted in patients with L1 and L3 at diagnosis (p = 0.042 and 0.033). Patients with initial steroid treatment had a less active disease (p = 0.004). The need for surgery was only influenced by disease behavior (S) (p = 0.001), not by disease severity, location or treatment. No influence of treatment on BMI evolution was noticed. A positive family history was the only factor influencing treatment choice for 5-ASA and immunomodulators (p = 0.02 and p = 0.004), except for L1 patients receiving less steroids (p = 0.039). During follow-up, there was a significant decrease in the use of steroids and 5-ASA (p = 0.001; p = 0.001) and a significant increase in prescription of immunomodulators (p = 0.031). This parallels a significant decrease in the disease severity of this group of patients over time (p = 0.01). Conclusions: L1 and L3 at diagnosis persist in more severe disease. More patients treated with corticosteroids at diagnosis achieved remission after a mean of 2.4 yrs follow-up. Family history appears to have been be the sole determinant for therapeutic strategy in this group.
KM curves indicating the cumulative risk of surgery following onset of first biologic.
S137 P320 Factors determining therapeutic strategy at diagnosis and evolution of disease severity in a cohort of Belgian pediatric Crohn’s disease patients (BELCRO) E. De Greef1 *, J. Mahachie2 , I. Hofman3 , F. Smets4 , S. Van Biervliet5 , M. Scaillon6 , B. Hauser1 , P. Alliet7 , W. Arts8 , O. Dewit9 , H. Peeters10 , F. Baert11 , G. D’Haens12 , J.-F. Rahier13 , I. Etienne14 , O. Bauraind15 , A. Van Gossum16 , S. Vermeire17 , F. Fontaine18 , V. Muls19 , E. Louis20 , F. Van de Mierop21 , J.-C. Coche22 , K. Van Steen23 , G. Veereman1 . 1 UZ Brussels, Brussels, Belgium, 2 Montefiore Institute, ULG, Li` ege, Belgium, 3 University Hospital Gasthuisberg, Leuven, Belgium, 4 UCL St Luc, Brussels, Belgium, 5 UZ Gent, Ghent, Belgium, 6 Hˆ opital des Enfants Reine Fabiola, Brussels, Belgium, 7 Jessa Hospital, Hasselt, Belgium, 8 ZOL, Genk, Belgium, 9 Cliniques Universitaires St-Luc, Department of Gastroenterology, Brussels, Belgium, 10 Ghent University Hospital, Department of Gastroenterology, Ghent, Belgium, 11 Heilig Hartziekenhuis, Roeselare, Belgium, 12 Academic Medical Center, Gastroenterology and Endoscopy, Amsterdam, Netherlands, 13 Cliniques Universitaires UCL Mont Godinne, Yvoir, Belgium, 14 CHR De La Citadelle, Li` ege, Belgium, 15 Clinique St Pierre, Ottignies, Belgium, 16 Hˆ opital Erasme, Department of Gastroenterology, Brussels, Belgium, 17 University Hospital Gasthuisberg, Department of Gastroenterology, Leuven, Belgium, 18 Clinique St. Joseph, Department of Gastroenterology, Li` ege, Belgium, 19 CHU St-Pierre, Gastroenterology, Brussels, Belgium, 20 University of Li` ege and CHU Li` ege, Department of Gastroenterology, Li` ege, Belgium, 21 Hospital Sint Augustinusziekenhuis, Department of Gastroenterology, Wilrijk, Belgium, 22 Clinique Saint Pierre, Corroy Le Grand, Belgium, 23 Montefiore Institute, System and Modeling Unit, Li` ege, Belgium Background: To determine associations between variables at diagnosis and disease severity at inclusion in the BELCRO database. Methods: Data from previously diagnosed pediatric Crohn’s disease patients were retrospectively evaluated at inclusion in the BELCRO database (current visit). Disease severity scores (PCDAI and PGA) were compared to initial treatment. Nonparametric association tests and multinomial logistic regression tests were used. Results: Data on 152/156 patients were available with a median follow-up 2.4 yrs (range 0.1 7.9 yrs). Severe disease persisted in patients with L1 and L3 at diagnosis (p = 0.042 and 0.033). Patients with initial steroid treatment had a less active disease (p = 0.004). The need for surgery was only influenced by disease behavior (S) (p = 0.001), not by disease severity, location or treatment. No influence of treatment on BMI evolution was noticed. A positive family history was the only factor influencing treatment choice for 5-ASA and immunomodulators (p = 0.02 and p = 0.004), except for L1 patients receiving less steroids (p = 0.039). During follow-up, there was a significant decrease in the use of steroids and 5-ASA (p = 0.001; p = 0.001) and a significant increase in prescription of immunomodulators (p = 0.031). This parallels a significant decrease in the disease severity of this group of patients over time (p = 0.01). Conclusions: L1 and L3 at diagnosis persist in more severe disease. More patients treated with corticosteroids at diagnosis achieved remission after a mean of 2.4 yrs follow-up. Family history appears to have been be the sole determinant for therapeutic strategy in this group.