P739 Early use of anti-TNF in Crohn's disease is associated with higher rate of biological and endoscopic remission. (16th January 2018) - Costa Santos, M P
Abstract: Background: The early use of effective therapy may change outcomes in patients with Crohn's disease (CD). We aimed to compare early use (defined as therapy started within the first year after diagnosis) of anti-TNF ± immunomodulator (IM) vs. the early use of IM in patients with an incident diagnosis of CD. Methods: Retrospective study of patients diagnosed with CD at our institution between 01/2012 to 12/2016. Patients were categorised into two groups: group 1) those with early use of anti-TNF ± IM (maximum interval of 6 months between the start of both drugs) vs. group 2) those with early use of IM. The primary outcome was CD-related surgery and/or hospitalisation. Kaplan–Meier analysis was used to estimate the cumulative surgery and/or hospitalisation rates. Objective markers of inflammation [CRP value (g/dl) and mucosal healing (MH) (absence of ulcers in colonoscopy)] were evaluated at 12 and 24 months after starting treatment. Results: Seventy patients with incident diagnosis of CD were diagnosed at our institution and 50 met the inclusion criteria, 52% were women, with a mean age of 30.3 ± 13.1 years at diagnosis. Median time of follow-up was 38 (IQR 21–50) months. Twenty (40%) patients received early anti-TNF ± IM and 30 (60%) early IM. No significant differences in disease location or behaviour were found at diagnosis between both groups but perianal disease was more frequent in the early anti-TNF group (70% vs. 17%, p < 0.0001). During follow-up two patients in the early IM group progressed in phenotype or developed perianal disease. In this group, 30% eventually escalated therapy to anti-TNF, after a median time of 12 months. No differences in time to CD-related surgery and/or hospitalisation between groups were found (log-rank, p = 0.478). At 12 months of treatment, the frequency of MH was higher in early anti-TNF group (88% vs. 35%, p = 0.030). Mean CRP at 24 months of therapy was lower in the early anti-TNF group (0.2 ± 0.2 g/dl vs. 1.1 ± 1.4 g/dl, p = 0.008). Conclusions: In our institution perianal disease was a decisive factor to start early anti-TNF. Around one-third of patients starting IM eventually stepped-up to anti-TNF. Although no significant differences were found in the rates of surgery or hospitalisation between use of anti-TNF ± IM or IM alone within the first year after diagnosis, the first strategy was associated with more sustained control of inflammation, as reflected by lower CRP and higher frequency of MH. Whether this will translate into better long-term outcomes remains to be demonstrated.