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Lower Risk of B1-to-pB3-Stage Migration in Crohn’s Disease Upon Immunosuppressive and Anti-TNF Treatment in the Swiss IBD Cohort Study

  • Patrick S. CernochEmail author
  • Nicolas Fournier
  • Jonas Zeitz
  • Michael Scharl
  • Bernhard Morell
  • Thomas Greuter
  • Philipp Schreiner
  • Benjamin Misselwitz
  • Ekaterina Safroneeva
  • Alain M. Schoepfer
  • Stephan R. Vavricka
  • Gerhard Rogler
  • Luc Biedermann
  • Swiss IBD Cohort Study Group
Original Article
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Abstract

Background

While the long-term evolution of disease behavior in Crohn’s disease has been well described in the pre-anti-TNF era, our knowledge thereon remains scarce after the introduction of anti-TNF.

Aims

Our investigation examined the long-term evolution of disease concerning Montreal classification’s B-stages over time in patients enrolled into the Swiss IBD Cohort Study between 2006 and 2017.

Methods

We analyzed prospectively collected SIBDCS data using a Markov model and multivariate testing for effects of treatment and other confounders on B-stage migration over time. The primary outcome was a transition in disease behavior from B1 to either B2 or pB3, or from B2 to pB3, respectively.

Results

The 10- and 15-year probability of remaining in B1 was 0.61 and 0.48, as opposed to a probability to migrate to B2 or B3 of 0.25 or 0.14, and 0.32 or 0.2, after 10 and 15 years, respectively. In multivariate testing, the hazard ratio for migrating from B1 to pB3 (HR 0.27) and from B2 to pB3 (HR 0.12) was lower in patients > 40 years compared to patients < 17 years. We found that immunosuppression (HR 0.38) and treatment with anti-TNF for > 1 year (HR 0.30) were associated with a decreased likelihood of transitioning from stage B1 to pB3.

Conclusions

While in the anti-TNF era most patients with Crohn’s disease will eventually develop stricturing and/or penetrating complications, our data indicate that immunosuppressive and anti-TNF treatment for more than 1 year reduce the risk of transitioning from stage B1 to pB3 in the long-term run.

Keywords

Crohn’s disease Tumor necrosis factor-alpha Immunosuppressive agents Montreal classification Disease-modifying 
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Notes

Acknowledgments

The authors would like to thank the patients enrolled in the SIBDCS for their commitment to promoting research.

Members of the SIBDCS study group: Claudia Anderegg; Peter Bauerfeind; Christoph Beglinger; Stefan Begré; Dominique Belli; José M. Bengoa; Luc Biedermann; Beat Bigler; Janek Binek; Mirjam Blattmann; Stephan Boehm; Jan Borovicka; Christian P. Braegger; Nora Brunner; Patrick Bühr; Bernard Burnand; Emanuel Burri; Sophie Buyse; Matthias Cremer; Dominique H. Criblez; Philippe de Saussure; Lukas Degen; Joakim Delarive; Christopher Doerig; Barbara Dora; Gian Dorta; Mara Egger; Tobias Ehmann; Ali El-Wafa; Matthias Engelmann; Jessica Ezri; Christian Felley; Markus Fliegner; Nicolas Fournier; Montserrat Fraga; Pascal Frei; Remus Frei; Michael Fried; Florian Froehlich; Christian Funk; Raoul Ivano Furlano; Suzanne Gallot-Lavallée; Martin Geyer; Marc Girardin; Delphine Golay; Tanja Grandinetti; Beat Gysi; Horst Haack; Johannes Haarer; Beat Helbling; Peter Hengstler; Denise Herzog; Cyrill Hess; Klaas Heyland; Thomas Hinterleitner; Philippe Hiroz; Claudia Hirschi; Petr Hruz; Rika Iwata; Res Jost; Pascal Juillerat; Vera Kessler Brondolo; Christina Knellwolf; Christoph Knoblauch; Henrik Köhler; Rebekka Koller; Claudia Krieger-Grübel; Gerd Kullak-Ublick; Patrizia Künzler; Markus Landolt; Rupprecht Lange; Frank Serge Lehmann; Andrew Macpherson; Philippe Maerten; Michel H. Maillard; Christine Manser; Michael Manz; Urs Marbet; George Marx; Christoph Matter; Valérie McLin; Rémy Meier; Martina Mendanova; Christa Meyenberger; Pierre Michetti; Benjamin Misselwitz; Darius Moradpour; Bernhard Morell; Patrick Mosler; Christian Mottet; Christoph Müller; Pascal Müller; Beat Müllhaupt; Claudia Münger-Beyeler; Leilla Musso; Andreas Nagy; Michaela Neagu; Cristina Nichita; Jan Niess; Natacha Noël; Andreas Nydegger; Nicole Obialo; Carl Oneta; Cassandra Oropesa; Ueli Peter; Daniel Peternac; Laetitia Marie Petit; Franziska Piccoli-Gfeller; Julia Beatrice Pilz; Valérie Pittet; Nadia Raschle; Ronald Rentsch; Sophie Restellini; Jean-Pierre Richterich; Sylvia Rihs; Marc Alain Ritz; Jocelyn Roduit; Daniela Rogler; Gerhard Rogler; Jean-Benoît Rossel; Markus Sagmeister; Gaby Saner; Bernhard Sauter; Mikael Sawatzki; Michela Schäppi; Michael Scharl; Martin Schelling; Susanne Schibli; Hugo Schlauri; Sybille Schmid Uebelhart; Jean-François Schnegg; Alain Schoepfer; Frank Seibold; Mariam Seirafi; Gian-Marco Semadeni; David Semela; Arne Senning; Marc Sidler; Christiane Sokollik; Johannes Spalinger; Holger Spangenberger; Philippe Stadler; Michael Steuerwald; Alex Straumann; Bigna Straumann-Funk; Michael Sulz; Joël Thorens; Sarah Tiedemann; Radu Tutuian; Stephan Vavricka; Francesco Viani; Jürg Vögtlin; Roland Von Känel; Alain Vonlaufen; Dominique Vouillamoz; Rachel Vulliamy; Jürg Wermuth; Helene Werner; Paul Wiesel; Reiner Wiest; Tina Wylie; Jonas Zeitz; Dorothee Zimmermann.

Funding

This work was supported by grants from the Swiss National Science Foundation (SNF) to Gerhard Rogler [the Swiss IBD Cohort (Grant No. 3347CO-108792)].

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Patrick S. Cernoch
    • 1
    Email author
  • Nicolas Fournier
    • 2
  • Jonas Zeitz
    • 1
    • 6
  • Michael Scharl
    • 1
  • Bernhard Morell
    • 1
  • Thomas Greuter
    • 1
  • Philipp Schreiner
    • 1
  • Benjamin Misselwitz
    • 1
  • Ekaterina Safroneeva
    • 3
  • Alain M. Schoepfer
    • 4
  • Stephan R. Vavricka
    • 1
    • 5
  • Gerhard Rogler
    • 1
  • Luc Biedermann
    • 1
  • Swiss IBD Cohort Study Group
  1. 1.Division of Gastroenterology and Hepatology, Department of Gastroenterology, University Hospital Zurich (USZ)University of ZurichZurichSwitzerland
  2. 2.Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
  3. 3.Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
  4. 4.Division of Gastroenterology and Hepatology, Center Hospitalier Universitaire Vaudois (CHUV)University of LausanneLausanneSwitzerland
  5. 5.Center of Gastroenterology and HepatologyZurichSwitzerland
  6. 6.Center of GastroenterologyClinic HirslandenZurichSwitzerland

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