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Efficacy of early immunomodulator therapy on the outcomes of Crohn's disease.

Kwak MS, Kim DH, Park SJ, Kim TI, Hong SP, Kim WH, Cheon JH - BMC Gastroenterol (2014)

Bottom Line: Early adoption of immunomodulator therapy has been proposed in order to address this; however, it is still uncertain whether early immunomodulator therapy could affect the natural course of the disease in real practice.Patients with a baseline elevated CRP level were more likely to relapse (P<0.005).Baseline high CRP level was a significant indicator of relapse.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea. geniushee@yuhs.ac.

ABSTRACT

Background: The natural course of Crohn's disease (CD), with continuing relapses and remissions, leads to irreversible intestinal damage. Early adoption of immunomodulator therapy has been proposed in order to address this; however, it is still uncertain whether early immunomodulator therapy could affect the natural course of the disease in real practice. We evaluated the efficacy of such therapy on the prognosis of newly diagnosed patients with CD.

Methods: This retrospective study included 168 patients who were newly diagnosed with CD and who started treatment at Severance Hospital, Seoul, Korea between January 2006 and March 2013. The short- and long-term outcomes were compared between patients treated with early immunomodulator therapy and those treated with conventional therapy.

Results: A Kaplan-Meier analysis identified that administration of immunomodulators within 6 months after diagnosis of CD was superior to conventional therapy in terms of clinical remission and corticosteroid-free remission rates (P=0.043 and P=0.035). However, P=0.827). Patients with a baseline elevated CRP level were more likely to relapse (P<0.005). Drug-related adverse events were more frequent in the early immunomodulator therapy group than in the conventional therapy group P=0.029).

Conclusions: Early immunomodulator therapy was more effective than conventional therapy in inducing remission, but not in preventing relapse. Baseline high CRP level was a significant indicator of relapse.

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Related in: MedlinePlus

The cumulative probabilities of patients who achieved clinical remission (A), and steroid-free remission (B) between early immunomodulator therapy and conventional therapy groups.
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Figure 1: The cumulative probabilities of patients who achieved clinical remission (A), and steroid-free remission (B) between early immunomodulator therapy and conventional therapy groups.

Mentions: The median length of follow-up for patients was 27 months (Range, 35 or IQR, 21). The clinical remission rates at 6 months were 85.0% in the early immunomodulator group and 76.4% in the conventional therapy group, respectively (Figure 1A). There was a statistically significant difference in the overall remission rate between the two groups (Log Rank test P =0.043). In addition, corticosteroid-free clinical remission rates at 6 and 12 months were noted in 44.8% and 62.1% of patients in the early immunomodulator group, respectively, and in 22.7% and 38.6% in the conventional group. This also reached statistical significance (Log Rank test P =0.035) (Figure 1B).


Efficacy of early immunomodulator therapy on the outcomes of Crohn's disease.

Kwak MS, Kim DH, Park SJ, Kim TI, Hong SP, Kim WH, Cheon JH - BMC Gastroenterol (2014)

The cumulative probabilities of patients who achieved clinical remission (A), and steroid-free remission (B) between early immunomodulator therapy and conventional therapy groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4017088&req=5

Figure 1: The cumulative probabilities of patients who achieved clinical remission (A), and steroid-free remission (B) between early immunomodulator therapy and conventional therapy groups.
Mentions: The median length of follow-up for patients was 27 months (Range, 35 or IQR, 21). The clinical remission rates at 6 months were 85.0% in the early immunomodulator group and 76.4% in the conventional therapy group, respectively (Figure 1A). There was a statistically significant difference in the overall remission rate between the two groups (Log Rank test P =0.043). In addition, corticosteroid-free clinical remission rates at 6 and 12 months were noted in 44.8% and 62.1% of patients in the early immunomodulator group, respectively, and in 22.7% and 38.6% in the conventional group. This also reached statistical significance (Log Rank test P =0.035) (Figure 1B).

Bottom Line: Early adoption of immunomodulator therapy has been proposed in order to address this; however, it is still uncertain whether early immunomodulator therapy could affect the natural course of the disease in real practice.Patients with a baseline elevated CRP level were more likely to relapse (P<0.005).Baseline high CRP level was a significant indicator of relapse.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea. geniushee@yuhs.ac.

ABSTRACT

Background: The natural course of Crohn's disease (CD), with continuing relapses and remissions, leads to irreversible intestinal damage. Early adoption of immunomodulator therapy has been proposed in order to address this; however, it is still uncertain whether early immunomodulator therapy could affect the natural course of the disease in real practice. We evaluated the efficacy of such therapy on the prognosis of newly diagnosed patients with CD.

Methods: This retrospective study included 168 patients who were newly diagnosed with CD and who started treatment at Severance Hospital, Seoul, Korea between January 2006 and March 2013. The short- and long-term outcomes were compared between patients treated with early immunomodulator therapy and those treated with conventional therapy.

Results: A Kaplan-Meier analysis identified that administration of immunomodulators within 6 months after diagnosis of CD was superior to conventional therapy in terms of clinical remission and corticosteroid-free remission rates (P=0.043 and P=0.035). However, P=0.827). Patients with a baseline elevated CRP level were more likely to relapse (P<0.005). Drug-related adverse events were more frequent in the early immunomodulator therapy group than in the conventional therapy group P=0.029).

Conclusions: Early immunomodulator therapy was more effective than conventional therapy in inducing remission, but not in preventing relapse. Baseline high CRP level was a significant indicator of relapse.

Show MeSH
Related in: MedlinePlus