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Poster presentations: Clinical: Therapy and Observation 2020

P673 Strategy of selecting anti-TNF agent in patients with Crohn’s disease: A multi-centre retrospective cohort study by the Osaka gut forum

T. Amano, S. Shinzaki, T. Tashiro, Y. Otake, M. Tani, T. Yoshihara, S. Iwatani, Y. Tsujii, T. Inoue, Y. Hayashi, H. Iijima, T. Takehara, Osaka Gut Forum

Osaka University Graduate School of Medicine, Gastroenterology and Hepatology, Suita, Japan

Background

Previous reports showed that disease activity before treatment affected long-term continuation of anti-tumour necrosis factor (anti-TNF) therapy in patients with Crohn’s disease (CD). However, there is no consensus about which anti-TNF agent should be selected dependent on patient’s condition. The aim of this study was to investigate factors affecting the continuation period of anti-TNF therapy and to clarify how to select each anti-TNF agent in patients with CD.

Methods

This was a retrospective multicenter cohort study of consecutive patients who started anti-TNF therapy (infliximab: IFX or adalimumab: ADA) as an induction therapy from January 2010 to March 2019 at 16 hospitals participating in the Osaka Gut Forum. We excluded patients who did not respond to therapy or had toxic events within 8 weeks. Factors affecting the continuation period of each anti-TNF agent such as backgrounds, blood tests, clinical features before treatment and concomitant medications were analyzed by the Cox proportional hazards model. The cumulative continuation rate of each agent was analyzed by the Kaplan–Meier method and evaluated by log-rank test.

Results

A total of 250 patients were enrolled (IFX /ADA; 138 /148 treatments, bio-naïve; 73%, median age; 36 years [Interquartile range (IQR); 24–46], median disease duration; 2.0 years [0.0–11.0], median observation period; 4.5 years [3.9–5.0]). Median Harvey–Bradshaw Index (HBI), C-reactive protein (CRP) and Albumin (Alb) were 5 [3–8], 0.71 mg/dl [0.14–2.04] and 3.5 g/dl [3.0–4.0], respectively. In patients with Alb ≥3.5 g/dl before treatment (median value), patients treated with IFX showed no significantly higher continuation rate than those with ADA. However, in those with Alb <3.5 g/dl, patients treated with IFX (N =82) showed significantly higher continuation rate than those with ADA (N = 50) (p = 0.007). In the observation period, 50%/34% of patients treated with IFX /ADA increased dose and 29% /38% of them concomitantly used azathioprine. In patients with Alb <3.5g/dl, by univariate analysis, stricturing and penetrating disease (B2 and B3/B1) [hazard ratio (HR); 4.18, 95% Confidence interval (CI); 1.83–12.0], disease duration [HR; 3.57, 95% CI; 1.16–9.77], and IFX/ADA [HR; 0.48, 95% CI; 0.28–0.83] were extracted as factors affecting continuation period of anti-TNF therapy. Furthermore, B2 and B3/B1 [HR; 3.80, 95% CI; 1.60–11.2] and IFX /ADA [HR; 0.49, 95% CI; 0.26–0.92] were extracted by multivariate analysis. After 8 weeks after treatment, the increase in Alb level was significantly higher in patients with IFX than those with ADA (p = 0.006), although there was no difference in HBI and CRP.

Conclusion

When serum Alb level is less than 3.5 g/dl before treatment, IFX can be used longer than ADA for CD patients.