Early Initiation of Anti-Tnf is Associated with Favourable Long-Term Outcome in Crohn's Disease: 10-Year-Follow-Up Data from the Swiss IBD Cohort Study.

Frei, Roy; Fournier, Nicolas; Zeitz, Jonas; Scharl, Michael; Morell, Bernhard; Greuter, Thomas; Schreiner, Philipp; Misselwitz, Benjamin; Safroneeva, Ekaterina; Schoepfer, Alain M; Vavricka, Stephan R; Rogler, Gerhard; Biedermann, Luc (2019). Early Initiation of Anti-Tnf is Associated with Favourable Long-Term Outcome in Crohn's Disease: 10-Year-Follow-Up Data from the Swiss IBD Cohort Study. Journal of Crohn's & colitis, 13(10), pp. 1292-1301. Oxford University Press 10.1093/ecco-jcc/jjz057

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BACKGROUND AND AIMS

The optimal timing of treatment escalation in Crohn's disease (CD) remains a challenge and very little is known about its long-term development following early versus late administration of anti-TNF antibodies. The long-term outcome of Swiss CD patients was comparatively assessed in an up to 10-year follow-up, using patients participating in the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS).

METHODS

Prospectively-collected SIBDCS patient data, including disease history, baseline characteristics at enrolment and course of disease were analysed in patients with early versus late (<24 versus >=24 months after diagnosis) and no anti-TNF treatment.

RESULTS

A reduced risk of developing bowel stenosis was found in patients who received early anti-TNF treatment. This association was seen in patients overall and also in the subgroups of CD patients without pre-existing complications (Log-rank test: p<0.001).Furthermore, osteoporosis and anaemia were observed significantly less frequently in patients who received early anti-TNF treatment, compared to either patients who received treatment late (p<0.001 and p=0.046, respectively) or were never (p<0.001 for both) treated with anti-TNF antibodies. Patients with early anti-TNF administration sought medical consultations significantly less often, including gastroenterologists in private practice (p=0.017), ambulatory (outpatient) hospital visits (p=0.038) and a composite of any medical visits (p=0.001). The percentage of patients unable to work was lowest for early anti-TNF treated patients, in comparison to patients who were treated late or never (3.6% versus 8.8% versus 3.7%, p=0.016).

CONCLUSIONS

Early anti-TNF administration was found to be associated with several indicators of a more favourable long-term outcome, in CD patients within the SIBDCS.

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