P220 CROHN'S DISEASE (CD): The predictive value of Montreal clinical patterns, and biological treatment in a Latin American IBD reference center.
SambuelliMD, A.(1);Gil, A.(1);Tirado, P.(1);Huernos, S.(1);Negreira, S.(1);Goncalves , S.(1);Rothwain, M.J.(1);Candel, I.(1);
(1)Bonorino Udaondo Hospital, IBD section - Clinical Department, Buenos Aires, Argentina;
Background
CD is a potencially disabling condition, with high rate of complications and surgical requirement. Biological treatments have revolutionized the CD treatment management, but their efficacy and predictive factors could be influenced for epidemiological and environmental conditions which should be locally analyzed wordly.
AIMS: to describe by a retrospective study in a Latin American IBD reference center, clinical features of the CD casuistic, predictive Montreal patterns for surgical risk and efficay of biologs and immunosuppressant drugs.
Methods
Data of CD patients (pts) assisted from 1990-June 2020 (CD duration ≥1 yr), categorized by Montreal classification, and by biological and IMM treatment in the prevention as first mayor surgery. Clinical patterns were evaluated as predictive factors at the basal time (up to 90 days from debut) in: Age at diagnosis (A)A1:≦16yrs, A2:17-40, A3:>40, Behavior (B): nonstricturing nonpenetrating (B1), stricturing (B2), penetrating (B3), perianal disease modifier (p), Location (L): L1: ileal, L2: colonic, L3: ileocolonic, L4: upper G.I. Incidence rates of surgery and preventive treatment efficacy were estimated by a Cox regression model.
Results
598 CD pts (M 313, F 285) with mentioned available data, CD median duration 13.9 yr (IQR 7.1-21.2) were analyzed. Montreal patterns A1: n 93 (15.6%), A2: n 335 (56.0%), A3: n 170 (28.4%), B1: n 523 (87.5%), B2: n 52 (8.7%), B3: n 23 (3.8%) L1: 52 (8.7%), L2: n 368 (61.5%), L3: n 176 (29.4%), L4: iUGI: n 2 (0.33%) and L4 combined with L1, L2, L3: n 47 (7.9%) Perianal disease (p) n 286 (47.8%). Biologics (before first surgery) in 202 pts, primary non response in 45 pts. Major surgery was performed in 304/598 pts (50.8%) Kaplan Meier estimates: Major surgery incidence rate was 5.1 per 100 person/yrs. Median survival without surgery: 14.2 yrs. Signifficant variables of Cox model for surgery risk were: B1 HR 1 (reference), B2 HR 3.03 (95%CI 2.14-4.29, p=0.000), B3 HR 3.27 (95%CI 2.03-5.29, p=0.000), L2 HR 1 (reference), L1 HR 2.025 (95%CI 1.37-2.99, p=0.000), L3 HR 2.51 (95%CI 1.95-3.23, p=0.000), A1 HR 1 (reference), A2 HR 1.48 (95%CI 1.05-2.10, p=0.027), A3 HR 1.89 (95%CI 1.27-2.83, p=0.002), Biologics (mainly Anti-TNFs) only induction 1.49 (95%CI 1.005-2.195, p=0.047). Induction plus maintenance HR 0.388 (95% CI 0.27-0.55), p=0.000. Non signifficant variables involved in the risk for surgery were: gender, perianal complication, and IMM treatment.
Conclusion
In our CD population we found: 1) Montreal patterns associated with surgical risk (fistulizing and stricturing behaviors), ileal and ileocolonic locations, A2, but also A3 (debut beyond 40 yrs). 2) Biologics showed a reduction in surgical risk (induction plus maintenance versus only induction).