P201 Evaluation of the role of anti-TNF in stabilizing the progression of intestinal lesions in Crohn's disease using the Lemann Index
Hassine, A.(1);Akkari, I.(1);Mrabet, S.(1);Ben Jazia, E.(1);
(1)Hôpital universitaire Farhat Hached, service de gastro-entérologie, Sousse, Tunisia
Background
The Lemann Index (LI) was developed to assess cumulative digestive tract damage in patients with Crohn's disease (CD), independently of clinical and biological activity. Recently, therapeutic goals in CD have focused on achieving mucosal healing and deep remission rather than simple symptom control, thus requiring prevention of progression of intestinal damage. The aim of this study was to assess the influence of different treatments on the progression of structural damage, using the LI.
Methods
we retrospectively included all patients with CD, followed in our center during the period between January 2016 and January 2020. The LI was calculated from the first (LI1) and the last (LI2) clinical consultations. The evolution of (LI1-LI2) or Delta LI (DLI) was recorded.
Results
112 patients with CD were collected, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15-63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115-493]. Regarding maintenance treatment, 51.8% of patients (n = 58) were on Azathioprine, 23.2% (n = 26) were on aminosalicylates, and 25% (n = 28) were on anti-TNF, including 42 , 9% under combination therapy. The median follow-up was 36.82 ± 16.83 months, with no difference between the groups. During follow-up, the mean LI increased significantly from 3.34 [0.58-8.82] to 7.82 [0.62-32.6] in the azathioprine group (p = 0.0001), from 2.0 [0.58-6.52] to 3.91 [0.6-14.03] in the Aminosalicylates group (p = 0.001) and from 3.79 [1.05-8.42] to 10.01 [2.58-33.08] in the Anti-TNF group (p = 0.0001). The mean DLI was -4.48 for the Azathioprine group, -1.9 for the Salicylates group and -6.14 for the Anti-TNF group, with no statistically significant difference (p = 0.16).
Conclusion
In patients with CD, the LI tends to increase over time. In our series, the use of Anti-TNF α does not appear to be able to reduce the progression of intestinal lesions, compared to other therapies.