Earlier Anti-Tumor Necrosis Factor Therapy of Crohn’s Disease Correlates with Slower Progression of Bowel Damage
Crohn’s disease (CD) follows a relapsing and remitting course incurring cumulative bowel damage over time. The question of whether or not the timing of the initiating biologic therapy affects long-term disease progression remains unanswered. Herein, we calculated rates of change in the Lémann index—which quantifies accumulated bowel damage—as a function of the time between the disease onset and initiation of biologic therapy. We aimed to explore the impact of the earlier introduction of biologics on the rate of progression of long-term cumulative bowel damage.
Medical records of CD patients treated during 2009–2014 at The Mount Sinai Hospital were queried. Inclusion criteria were two comprehensive assessments allowing calculation of the index at t1 and t2: two time-points ≥ 1 year apart. Patients with biologics introduced before or within 3 months at inclusion (t1) were defined as Bio-pre-t1 and those who did not as Bio-post-t1. The rate of disease progression was calculated as the change in the index per year during t1–t2.
A total of 88 patients were studied: 58 Bio-pre-t1 and 30 Bio-post-t1. Among the 58 Bio-pre-t1 cases, damage progressed in 29 (50%), regressed in 20 (34.5%), and stabilized in 9 (15.5%). Median time to initiation of biologics among patients whose index improved was nominally shorter compared to that in patients whose index progressed (8 vs. 15 years). Earlier introduction of biologics tended to correlate with the slower rate of progression (ρ = 0.241; p = 0.069).
Earlier introduction of biologics tended to correlate with the slower progression of bowel damage in CD, reflected by the reduced rate of Lémann index progression.
KeywordsCrohn disease Biological therapy Infliximab Adalimumab Inflammatory bowel disease
We wish to acknowledge the energetic support of a cooperating group at Centre Hospitalier Régional Universitaire de Lille, France, including Benjamin Pariente MD, Nicolas Deaveus MD, and Mustapha Azahaf MD. We are grateful also for valuable input from Jean-Frédéric Colombel MD, Ph.D, and Jean-Yves Mary, Ph.D. Their assistance does not imply endorsement of all the analyses and conclusions of this study, which are of course those of the authors alone.
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Conflict of interest
No industrial support was received for the work presented in this article. Dr. Dubinsky serves as a consultant for Janssen, Abbvie, and UCB. Dr. Taouli reports research grant support from Guerbet and Bayer. None of the other authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
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