title: Crohn's disease prognosis and early immunomodulator therapy: Results from the CONNECT study.
abstract: BACKGROUND
  It is unknown whether the treatment initiating time of immunomodulators such as thiopurines affects the course of Crohn's disease (CD). We evaluated the efficacy of early immunomodulator therapy (EIT) on the prognosis of patients with CD.
  
  
  METHODS
  We retrospectively analyzed 1157 patients with CD who were enrolled in the CrOhn's disease cliNical NEtwork and CohorT study and received immunomodulator therapy. The patients were divided into an EIT group and a conventional therapy group based on whether immunomodulators were initiated within six months after being diagnosed with CD. We compared the rates of intestinal surgery, bowel complications, and hospitalization because of CD between the groups.
  
  
  RESULTS
  Patient age at diagnosis and sex were not significantly different between the two groups. The mean duration of follow-up was 105.8 ± 51.5 months. A Kaplan-Meier analysis identified that the EIT group was superior to the conventional therapy group in terms of delaying surgery (P = 0.017). In multivariate analysis, EIT was an independent predicting factor associated with delaying the onset of complications (P = 0.050). Patients were divided into two groups based on the year of CD diagnosis: from 1982 to 1999 (A) and from 2000 to 2008 (B). In group A, the time from diagnosis to the start of immunomodulatory therapy was longer (P < 0.001), and the time to first intestinal surgery was shorter than group B (P = 0.002).
  
  
  CONCLUSIONS
  The early use of immunomodulators was associated with a good prognosis as defined by a need for surgery and the occurrence of complications in CD in our multicenter study.
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine.
authors.forename: Bun
authors.initials: B
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine.
authors.forename: Yi Rang
authors.initials: YR
authors.lastname: Park
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center.
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center.
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan.
authors.forename: Geom Seog
authors.initials: GS
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, Yeungnam University College of Medicine, Daegu.
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Inje University College of Medicine.
authors.forename: You Sun
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine.
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul.
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008297:Male; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007155:Immunologic Factors
keywords: Crohn's disease; complications; immunomodulators; prognosis