Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease.
BACKGROUND
The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown.


OBJECTIVE
To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis.


METHODS
Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications.


RESULTS
The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006).


CONCLUSIONS
Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
E
E
Safroneeva
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.|Division of Gastroenterology and Hepatology, Stadtspital Triemli, Zurich, Switzerland.
S R
SR
Vavricka
Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.
N
N
Fournier
Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.
V
V
Pittet
Inserm U954, Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
L
L
Peyrin-Biroulet
Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.
A
A
Straumann
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
G
G
Rogler
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland.
A M
AM
Schoepfer
D000068879:Adalimumab / Q000008:administration & dosage / Q000009:adverse effects; D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000068582:Certolizumab Pegol / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects; D007422:Intestines / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
D000276:Adjuvants, Immunologic; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol