title: Predictors for subsequent need for immunosuppressive therapy in early Crohn's disease.
abstract: OBJECTIVE
  The clinical course of Crohn's disease (CD) is highly variable with a subgroup of patients developing a progressive disease course necessitating immunosuppressive therapy (IT). However, reliable, stable and non-invasive individual clinical parameters in order to identify patients at risk for undergoing subsequent IT have not been sufficiently established. We therefore aimed to identify such clinical parameters.
  
  
  METHODS
  A retrospective, multicenter analysis of CD patients from 6 German tertiary IBD centers was performed. Patients were classified into two groups depending on requiring IT or not. Personal data, clinical and laboratory parameters during the first 3 months after CD diagnosis and effects of initial medical therapy were compared between these two groups.
  
  
  RESULTS
  In 218 (61.8%) of the 353 patients the CD course necessitated IT. Those patients were significantly younger at symptom onset and diagnosis, and required significantly more often a systemic corticosteroid therapy. Furthermore, significant differences in serological markers of inflammation were observed. Age, gender and the effect of initial steroid therapy were used to develop a prognostic model predicting the individual probability of necessitating IT.
  
  
  CONCLUSIONS
  The simple clinical items age at diagnosis, gender, and need for systemic steroid therapy can predict a progressive disease course in early CD. Our model based on these parameters allows an individualized estimation of each patient's risk to develop a progressive disease course. Thereby, our model can help in deciding if patients will need immunosuppressive drugs early in the disease course or if a careful watch and wait strategy is justified.
authors.affiliation: University Clinic Jena, Clinic of Internal Medicine II, Jena, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Wenger
authors.forename: Susanna
authors.initials: S
authors.lastname: Nikolaus
authors.forename: Stefanie
authors.initials: S
authors.lastname: Howaldt
authors.forename: Bernd
authors.initials: B
authors.lastname: Bokemeyer
authors.forename: Andreas
authors.initials: A
authors.lastname: Sturm
authors.forename: Jan C
authors.initials: JC
authors.lastname: Preiss
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
authors.forename: Carsten
authors.initials: C
authors.lastname: Schmidt
mesh_terms: D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents