Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease. Issue 8 (14th August 2015)

• Record Type: Journal Article
• Authors: Safroneeva, E.; Vavricka, S. R.; Fournier, N.; Pittet, V.; Peyrin‐Biroulet, L.; Straumann, A.; Rogler, G.; Schoepfer, A. M.
• Other Names: Bauerfeind Peter investigator.; Beglinger Christoph investigator.; Begré Stefan investigator.; Bengoa José investigator.; Binek Janek investigator.; Boller Daniel investigator.; Borovicka Jan investigator.; Braegger Christian investigator.; Burnand Bernard investigator.; Camara Rafael investigator.; Criblez Dominique investigator.; de Saussure Philippe investigator.; Degen Lukas investigator.; Delarive Joakim investigator.; Ehmann Tobias investigator.; Engelmann Matthias investigator.; Wafa Ali El investigator.; Felley Christian investigator.; Frei Alain investigator.; Frei Remus investigator.; Fried Michael investigator.; Friedt Michael investigator.; Froehlich Florian investigator.; Gallot‐Lavallée Suzanne investigator.; Gerlach Tilman investigator.; Geyer Martin investigator.; Girardin Marc investigator.; Goetze Oliver investigator.; Haack Horst investigator.; Hediger Serge investigator.; Hengstler Peter investigator.; Heyland Klaas investigator.; Janiak Patrick investigator.; Juillerat Pascal investigator.; Brondolo Vera Kessler investigator.; Knoblauch Christoph investigator.; Kullak‐Ublick Gerd A. investigator.; Maillard Michel investigator.; Manz Michael investigator.; Marbet Urs investigator.; Meier Rémy investigator.; Meyenberger Christa investigator.; Michetti Pierre investigator.; Mottet Christian investigator.; Müller Christoph investigator.; Müllhaupt Beat investigator.; Nicolet Thierry investigator.; Nydegger Andreas investigator.; Pache Isabelle investigator.; Piccoli Franziska investigator.; Pilz Julia investigator.; Rentsch Ronald investigator.; Rey Jean‐Pierre investigator.; Rihs Silvia investigator.; Rogler Daniela investigator.; Sagmeister Markus investigator.; Sauter Bernhard investigator.; Schaub Niklaus investigator.; Schibli Susanne investigator.; Seibold Frank investigator.; Spalinger Johannes investigator.; Stadler Philippe investigator.; Steuerwald Michael investigator.; Sul Michael investigator.; Tempia‐Caliera Michela investigator.; Thorens Joël investigator.; Vader John‐Paul investigator.; Vögtlin Jürg investigator.; Von Känel Roland investigator.; Wachter Gert investigator.; Wermuth Jürg investigator.; Wiesel Paul investigator.;
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 42:Issue 8(2015)
• Page Start: 977
• Page End: 989
• Publication Date: 2015-08-14
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13363
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: 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.