P120 First year remission rates among patients with newly diagnosed Crohn’s disease: data from a real-world prospective inception cohort
Yanai, H.(1);Sharar Fischler, T.(1);Goren, I.(1);Ollech, J.(1);Snir, Y.(1);Broitman, Y.(1);Barkan, R.(1);Peffer-Gik, T.(1);Raykhel , B.(1);Kutukov, L.(1);Friedeberg, A.(1);Pauker, M.(1);Eran-Banai, H.(1);Avni-Biron, I.(1);Dotan, I.(1);
(1)Division of Gastroenterology- Rabin Medical Center- Petah-Tikva- Israel- affiliated to the Sackler Faculty of Medicine- Tel Aviv University- Tel Aviv- Israel, Gastroenterology- Petah-Tikva- Israel, Tel Aviv, Israel;
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%.