Bun Kim1, Jae Hee Cheon1, Hyun Jin Moon1, Yi Rang Park1, Byong Duk Ye2, Suk-Kyun Yang2, Geom Seog Seo3, Byung Ik Jang4, You Sun Kim5, Joo Sung Kim6, Dong Soo Han7, Young-Ho Kim8, Won Ho Kim1. 1. Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine. 2. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center. 3. Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan. 4. Department of Internal Medicine, Yeungnam University College of Medicine, Daegu. 5. Department of Internal Medicine, Inje University College of Medicine. 6. Department of Internal Medicine, Seoul National University College of Medicine. 7. Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea. 8. Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul.
Abstract
BACKGROUND: It is unknown whether the treatment initiating time of immunomodulators such as thiopurines affects the course of Crohn's disease (CD). We evaluated the efficacy of early immunomodulator therapy (EIT) on the prognosis of patients with CD. METHODS: We retrospectively analyzed 1157 patients with CD who were enrolled in the CrOhn's disease cliNical NEtwork and CohorT study and received immunomodulator therapy. The patients were divided into an EIT group and a conventional therapy group based on whether immunomodulators were initiated within six months after being diagnosed with CD. We compared the rates of intestinal surgery, bowel complications, and hospitalization because of CD between the groups. RESULTS: Patient age at diagnosis and sex were not significantly different between the two groups. The mean duration of follow-up was 105.8 ± 51.5 months. A Kaplan-Meier analysis identified that the EIT group was superior to the conventional therapy group in terms of delaying surgery (P = 0.017). In multivariate analysis, EIT was an independent predicting factor associated with delaying the onset of complications (P = 0.050). Patients were divided into two groups based on the year of CD diagnosis: from 1982 to 1999 (A) and from 2000 to 2008 (B). In group A, the time from diagnosis to the start of immunomodulatory therapy was longer (P < 0.001), and the time to first intestinal surgery was shorter than group B (P = 0.002). CONCLUSIONS: The early use of immunomodulators was associated with a good prognosis as defined by a need for surgery and the occurrence of complications in CD in our multicenter study.
BACKGROUND: It is unknown whether the treatment initiating time of immunomodulators such as thiopurines affects the course of Crohn's disease (CD). We evaluated the efficacy of early immunomodulator therapy (EIT) on the prognosis of patients with CD. METHODS: We retrospectively analyzed 1157 patients with CD who were enrolled in the CrOhn's disease cliNical NEtwork and CohorT study and received immunomodulator therapy. The patients were divided into an EIT group and a conventional therapy group based on whether immunomodulators were initiated within six months after being diagnosed with CD. We compared the rates of intestinal surgery, bowel complications, and hospitalization because of CD between the groups. RESULTS:Patient age at diagnosis and sex were not significantly different between the two groups. The mean duration of follow-up was 105.8 ± 51.5 months. A Kaplan-Meier analysis identified that the EIT group was superior to the conventional therapy group in terms of delaying surgery (P = 0.017). In multivariate analysis, EIT was an independent predicting factor associated with delaying the onset of complications (P = 0.050). Patients were divided into two groups based on the year of CD diagnosis: from 1982 to 1999 (A) and from 2000 to 2008 (B). In group A, the time from diagnosis to the start of immunomodulatory therapy was longer (P < 0.001), and the time to first intestinal surgery was shorter than group B (P = 0.002). CONCLUSIONS: The early use of immunomodulators was associated with a good prognosis as defined by a need for surgery and the occurrence of complications in CD in our multicenter study.
Authors: Jae Jun Park; Suk-Kyun Yang; Byong Duk Ye; Jong Wook Kim; Dong Il Park; Hyuk Yoon; Jong Pil Im; Kang Moon Lee; Sang Nam Yoon; Heeyoung Lee Journal: Intest Res Date: 2017-01-31
Authors: Jaeyoung Chun; Jong Pil Im; Ji Won Kim; Kook Lae Lee; Chang Hwan Choi; Hyunsoo Kim; Jae Hee Cheon; Byong Duk Ye; Young-Ho Kim; You Sun Kim; Yoon Tae Jeen; Dong Soo Han; Won Ho Kim; Joo Sung Kim Journal: Gut Liver Date: 2018-09-15 Impact factor: 4.519