title: Predictive value of early restoration of quality of life in Crohn's disease patients receiving antitumor necrosis factor agents.
abstract: OBJECTIVE
  Crohn's disease (CD) impairs patients' health-related quality of life (HRQoL), therefore a goal of treatment is to improve their health. Recently, a more ambitious therapeutic target has been proposed, to reestablish patients' HRQoL to normal standards. There is no information on long-term prognostic value of restoring the health of patients with CD. Our aim was to determine if early restoration of HRQoL with antitumor necrosis factor (anti-TNF) agents is associated with long-term clinical remission.
  
  
  METHODS
  Retrospective longitudinal study in patients with active CD treated with anti-TNF agents. Patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ)-36 at baseline and weeks 2, 6, 14, 28, and 52. Early restoration of health was defined as an IBDQ-36 score > 209 at week 14, and long-term clinical remission as a Cohn's disease activity index (CDAI) score < 150 maintained through week 52.
  
  
  RESULTS
  Ninety-four patients were included. Sixty-three patients maintained long-term remission, with 47 (75%) of them achieving early restoration of HRQoL. Of the 31 patients who did not maintain long-term remission, only 4 (13%) restored their HRQoL early (P < 0.01). There was a strong negative correlation between the IBDQ-36 at week 14 and CDAI values at week 52 (rs = - 0.64, P < 0.01). Ninety-two percent of patients with early restoration of HRQoL maintained long-term remission versus 37% who did not restore their HRQoL (P < 0.01). To predict long-term remission, the cutoff point of 209 of the early IBDQ-36 had an area under the receiver operating characteristic (AUROC) curve of 0.87.
  
  
  CONCLUSIONS
  Achieving early restoration of HRQoL with anti-TNF agents is associated with sustained long-term remission. This could be a therapeutic goal of treatment in clinical trials and daily practice.
authors.affiliation: Unitat Atenció Crohn-Colitis (UACC), Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Herrera-deGuise
authors.forename: Francesc
authors.initials: F
authors.lastname: Casellas
authors.forename: Virginia
authors.initials: V
authors.lastname: Robles
authors.forename: Ester
authors.initials: E
authors.lastname: Navarro
authors.forename: Natalia
authors.initials: N
authors.lastname: Borruel
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005544:Forecasting; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012372:ROC Curve; D012074:Remission Induction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn's disease; anti-TNF agents; quality of life; restoration of health