P184 Is perianal involvement a crutch for biologic therapy on Crohn's disease?. (25th January 2019)

• Record Type: Journal Article
• Authors: Magalhaes, R; Dias de Castro, F; Moreira, M J; Cotter, J
• Is Part Of: Journal of Crohn's and colitis. Volume 13(2019)Supplement 1
• Page Start: S182
• Page End: S182
• Publication Date: 2019-01-25
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjy222.308
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Crohn's disease (CD) is complicated with perianal disease in 21–23% of patients. Presence of perianal disease has been associated with a disabling course of CD and dreadful impact on quality of life. We aim to identify whether perianal disease has negative implication on CD remission rates, after 1-year infliximab therapy course. Methods: Cohort, retrospective, single-centre study, including consecutive CD patients on Infliximab perfusion. Patients were followed 1 year, since the beginning of biological therapy. Co-variables were chosen bearing in mind clinical relevance and literature evidence. We splitted our outcome variable into clinical remission; analytical remission; endoscopic remission and deep remission (including all three mentioned before). The correlation towards the outcome variable was assessed with univariate and multi-variate analysis, and a survival assessment, using SPSS—a p -value of <0.05 was considered statistically significant. Results: We assessed 74 patients with CD, of whom 41 (55.4%) were female, with a mean age of 36 years old, all Caucasian. From our cohort, 36.5% of the patients presented perianal disease at diagnosis. After 1 year of treatment course, we documented 31, 5% of deep remissions, 47.2% endoscopic remissions, 55.4% analytical remissions and 70.3% of clinical remissions. Sixty-six (89.2%) presented an initial response to the treatment, from whom, 20 presented disease relapses (clinical or/and analytical or/and endoscopic). Patients with perianal disease, on the first year of Infliximab therapy, have a higher probability of disease relapse, displaying statistically significant difference on Kaplan-Meyer curves (Breslow p -value 0.043). Several variables had statistical significance towards the outcome on the univariate analysis (age at diagnosis; disease behaviour at diagnosis; smoking; hospital admission; days of hospital stay; corticoid cycle; biological naïve patients; blood infliximab levels; calprotectin, protein c reactive, erythrocyte sedimentation rate levels before and after the year follow-up). Adjusting for confoundment, patients without perianal disease have an odd 7.6 times higher of achieving endoscopic remission ( p = 0.038) and 26 times higher of achieving clinical remission ( p = 0.027). Conclusions: In CD patients on infliximab therapy, perianal disease involvement is associated with lower endoscopic, analytical and clinical remission rates, after 1-year follow-up. They are also more prone to disease relapses, on the first year of therapeutic.