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Long-term clinical outcomes of korean patient with Crohn's disease following early use of infliximab.

Kim NH, Jung YS, Moon CM, Lee SY, Kim ER, Kim YH, Lee CK, Lee SH, Kim JH, Huh KC, Yoon SM, Song HJ, Boo SJ, Jang HJ, Kim YS, Lee KM, Shin JE, Park DI - Intest Res (2014)

Bottom Line: Although the cumulative probabilities of immunosuppressant (P<0.001) and IFX use (P<0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P=0.905) or reoperation (P=0.418) between two groups.The early use of IFX did not reduce CD-related surgery requirements in Korean patients with CD.These study results suggest that the early use of IFX may have little impact on the clinical outcome of CD in Korean patients in the setting of a conventional step-up algorithm.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Several recent studies have reported that the early use of infliximab (IFX) improves the prognosis of Crohn's disease (CD). However, no data are available from Asian populations, as the forementioned studies have all been conducted in Western countries. The aim of the current study was to evaluate the impact of early use of IFX on the prognosis of Korean patients with CD.

Methods: Patients with a diagnosis of CD established between July 1987 and January 2012 were investigated in 12 university hospitals in Korea. Because insurance coverage for IFX treatment began in August 2005, patients were assigned to either of 2 groups based on diagnosis date. The first group included patients diagnosed from July 1987 to December 2005, and the second from January 2006 to January 2012. We compared the cumulative probabilities of operation and reoperation between the two groups using the Kaplan-Meier method and a log-rank test.

Results: Of the 721 patients investigated, 443 (61.4%) comprized the second group. Although the cumulative probabilities of immunosuppressant (P<0.001) and IFX use (P<0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P=0.905) or reoperation (P=0.418) between two groups.

Conclusions: The early use of IFX did not reduce CD-related surgery requirements in Korean patients with CD. These study results suggest that the early use of IFX may have little impact on the clinical outcome of CD in Korean patients in the setting of a conventional step-up algorithm.

No MeSH data available.


Related in: MedlinePlus

Cumulative probability of azathioprine (AZA) use during follow-up.
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Figure 2: Cumulative probability of azathioprine (AZA) use during follow-up.

Mentions: Log rank tests and Kaplan-Meier analyses were conducted in order to compare the cumulative probabilities of IFX use between groups. The cumulative probabilities of IFX use were 1.1% vs. 16.8%, 4.4% vs. 26.0%, and 11.3% vs. 33.6% between the first and second groups at 1, 3, and 5 years after diagnosis. The cumulative probabilities were significantly higher in the second group (P<0.001) (Fig. 1). The cumulative probabilities of AZA use were 16.6% vs. 54.2%, 33.4% vs. 66.0%, and 42.2% vs. 73.0% between the 2 groups at 1, 3, and 5 years after diagnosis. The cumulative probabilities of immunosuppressive drugs were significantly higher in the second group (P<0.001) (Fig. 2). Conversely, the cumulative probabilities of operation were 12.6% vs. 10.2%, 13.7% vs. 13.4%, and 16.0% vs. 15.8% between the 2 groups at 1, 3, and 5 years after diagnosis. No statistically significant difference was found in the cumulative probabilities of operation between the 2 groups (P=0.905) (Fig. 3). Moreover, the cumulative probabilities of reoperation were 7.6% vs. 11.2%, 13.0% vs. 16.8%, and 38.7% vs. 25.0% between the 2 groups at 1, 3, and 5 years after the first surgery, and no statistically significant difference was found in the cumulative probabilities of reoperation between the 2 groups (P=0.418) (Fig. 4). No statistically significant difference was detected in the cumulative probabilities of operation and reoperation in a Cox-proportional hazard regression analysis conducted after adjusting for potentially confounding variables such as gender, smoking status, disease duration, the location and behavior of CD, and medication use.


Long-term clinical outcomes of korean patient with Crohn's disease following early use of infliximab.

Kim NH, Jung YS, Moon CM, Lee SY, Kim ER, Kim YH, Lee CK, Lee SH, Kim JH, Huh KC, Yoon SM, Song HJ, Boo SJ, Jang HJ, Kim YS, Lee KM, Shin JE, Park DI - Intest Res (2014)

Cumulative probability of azathioprine (AZA) use during follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214954&req=5

Figure 2: Cumulative probability of azathioprine (AZA) use during follow-up.
Mentions: Log rank tests and Kaplan-Meier analyses were conducted in order to compare the cumulative probabilities of IFX use between groups. The cumulative probabilities of IFX use were 1.1% vs. 16.8%, 4.4% vs. 26.0%, and 11.3% vs. 33.6% between the first and second groups at 1, 3, and 5 years after diagnosis. The cumulative probabilities were significantly higher in the second group (P<0.001) (Fig. 1). The cumulative probabilities of AZA use were 16.6% vs. 54.2%, 33.4% vs. 66.0%, and 42.2% vs. 73.0% between the 2 groups at 1, 3, and 5 years after diagnosis. The cumulative probabilities of immunosuppressive drugs were significantly higher in the second group (P<0.001) (Fig. 2). Conversely, the cumulative probabilities of operation were 12.6% vs. 10.2%, 13.7% vs. 13.4%, and 16.0% vs. 15.8% between the 2 groups at 1, 3, and 5 years after diagnosis. No statistically significant difference was found in the cumulative probabilities of operation between the 2 groups (P=0.905) (Fig. 3). Moreover, the cumulative probabilities of reoperation were 7.6% vs. 11.2%, 13.0% vs. 16.8%, and 38.7% vs. 25.0% between the 2 groups at 1, 3, and 5 years after the first surgery, and no statistically significant difference was found in the cumulative probabilities of reoperation between the 2 groups (P=0.418) (Fig. 4). No statistically significant difference was detected in the cumulative probabilities of operation and reoperation in a Cox-proportional hazard regression analysis conducted after adjusting for potentially confounding variables such as gender, smoking status, disease duration, the location and behavior of CD, and medication use.

Bottom Line: Although the cumulative probabilities of immunosuppressant (P<0.001) and IFX use (P<0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P=0.905) or reoperation (P=0.418) between two groups.The early use of IFX did not reduce CD-related surgery requirements in Korean patients with CD.These study results suggest that the early use of IFX may have little impact on the clinical outcome of CD in Korean patients in the setting of a conventional step-up algorithm.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Several recent studies have reported that the early use of infliximab (IFX) improves the prognosis of Crohn's disease (CD). However, no data are available from Asian populations, as the forementioned studies have all been conducted in Western countries. The aim of the current study was to evaluate the impact of early use of IFX on the prognosis of Korean patients with CD.

Methods: Patients with a diagnosis of CD established between July 1987 and January 2012 were investigated in 12 university hospitals in Korea. Because insurance coverage for IFX treatment began in August 2005, patients were assigned to either of 2 groups based on diagnosis date. The first group included patients diagnosed from July 1987 to December 2005, and the second from January 2006 to January 2012. We compared the cumulative probabilities of operation and reoperation between the two groups using the Kaplan-Meier method and a log-rank test.

Results: Of the 721 patients investigated, 443 (61.4%) comprized the second group. Although the cumulative probabilities of immunosuppressant (P<0.001) and IFX use (P<0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P=0.905) or reoperation (P=0.418) between two groups.

Conclusions: The early use of IFX did not reduce CD-related surgery requirements in Korean patients with CD. These study results suggest that the early use of IFX may have little impact on the clinical outcome of CD in Korean patients in the setting of a conventional step-up algorithm.

No MeSH data available.


Related in: MedlinePlus