P482 Early anti-TNF/immunomodulator therapy is associated with better clinical outcomes in Asian patients with Crohn's disease with poor prognostic factors

Abstract

Background: Although the use of anti-TNFs or immunomodulators (IMs) in the early course of disease is believed to be effective in im-proving long-term outcomes of patients with Crohn's disease (CD), especially those with poor prognostic factors, this concept was not clearly proved in Asian patients. Method(s): We retrospectively analyzed clinical data of Korean pa-tients with CD who were treated at the Asan Medical Center between January 1997 and August 2016. Patients with two or more among the following risk factors for progression; diagnosis at age of un-der 40, need for systemic corticosteroids within three months after diagnosis, and perianal fistula at diagnosis were included. Patients who already experienced intestinal surgery and/or intestinal compli-cations before or at diagnosis of CD were excluded. A total of 670 patients were enrolled and the probabilities of intestinal surgery and intestinal complications were compared between the following three groups; the early anti-TNF group (n=79, starting anti-TNFs within 2 years after diagnosis), the early IM group (n=286, starting IMs, but not anti-TNFs within 2 years after diagnosis), and the late therapy group (n=305, starting anti-TNFs and/or IMs 2 years after diagnosis). Result(s): The chi-squared test showed that lower proportion of patients in the early anti-TNF/IM groups suffered from intestinal surgery (p<0.001), stricturing complication (p=0.001), and pene-trating complication (p<0.001) than the late therapy group. How-ever, there were no significant differences between the early anti-TNF group and the early IM group in terms of intestinal surgery and intestinal complications. The Kaplan-Meier analysis with the log-rank test showed the superiority of the early anti-TNF/IM groups in terms of delaying intestinal surgery (p<0.001), stricturing complica-tion (p=0.002), and penetrating complication (p<0.001) compared with the late therapy group, but not identifying the superiority of the early anti-TNF group compared with the early IM group. In the multivariate Cox regression analysis, the late anti-TNF/IM therapy was independently associated with a higher risk of intestinal surgery (adjusted hazard ratio [aHR] 2.321, 95% confidence interval [CI] 1.503-3.584, p<0.001), behavioral progression (aHR 2.001, 95% CI 1.449-2.763, p<0.001), stricturing complication (aHR 1.736, 95% CI 1.209-2.493, p=0.003) and penetrating complication (aHR 3.315, 95% CI 2.094-5.249, p<0.001). Conclusion(s): In Asian CD patients with poor prognostic factors and who are naive to both intestinal surgery and intestinal complications, use of anti-TNFs or IMs within 2 years after diagnosis of CD is as-sociated with better outcomes than the late use of the drugs in terms of intestinal surgery and intestinal complication.