Early intervention with biologic therapy in Crohn´s disease: how early is early?

IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Crohns & Colitis Pub Date : 2023-11-24 DOI:10.1093/ecco-jcc/jjad089
Joana Revés, André Mascarenhas, Maria José Temido, Bárbara Morão, Catarina Neto Nascimento, Ana Rita Franco, Raquel R Mendes, Carolina Palmela, Cristina Chagas, Pedro Narra Figueiredo, Luísa Glória, Francisco Portela, Joana Torres
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引用次数: 1

Abstract

Background: Early biologic therapy within the first 18-24 months after diagnosis is associated with improved clinical outcomes in Crohn's disease [CD]. However, the definition of the best time to initiate biologic therapy remains unclear. We aimed to assess if there is an optimal timing for early biologic therapy initiation.

Methods: This was a multicentre retrospective cohort study including newly diagnosed CD patients who started anti-tumour necrosis factor [TNF] therapy within 24 months from diagnosis. The timing of initiation of biologic therapy was categorised as ≤6, 7-12, 13-18, and 19-24 months. The primary outcome was CD-related complications defined as a composite of progression of Montreal disease behaviour, CD-related hospitalisations, or CD-related intestinal surgeries. Secondary outcomes included clinical, laboratory, endoscopic, and transmural remission.

Results: We included 141 patients where 54%, 26%, 11%, and 9% started biologic therapy at ≤6, 7-12, 13-18, and 19-24 months after diagnosis, respectively. A total of 34 patients [24%] reached the primary outcome: 8% had progression of disease behaviour, 15% were hospitalised, and 9% required surgery. There was no difference in the time to a CD-related complication according to the time of initiation of biologic therapy within the first 24 months. Clinical, endoscopic, and transmural remission was achieved in 85%, 50%, and 29%, respectively, but no differences were found according to the time of initiation of biologic therapy.

Conclusion: Starting anti-TNF therapy within the first 24 months after diagnosis was associated with a low rate of CD-related complications and high rates of clinical and endoscopic remission, although we found no differences with earlier initiation within this window of opportunity.

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克罗恩病早期干预生物治疗:多早算早?
背景:诊断后18-24个月内的早期生物治疗与克罗恩病的临床预后改善相关[CD]。然而,开始生物治疗的最佳时间的定义仍然不清楚。我们的目的是评估是否存在早期生物治疗开始的最佳时机。方法:这是一项多中心回顾性队列研究,包括在诊断后24个月内开始抗肿瘤坏死因子(TNF)治疗的新诊断的CD患者。开始生物治疗的时间分为≤6个月、7-12个月、13-18个月和19-24个月。主要结局是cd相关并发症,定义为蒙特利尔疾病行为进展、cd相关住院或cd相关肠道手术的复合。次要结局包括临床、实验室、内窥镜和经壁缓解。结果:我们纳入了141例患者,其中54%、26%、11%和9%分别在诊断后≤6个月、7-12个月、13-18个月和19-24个月开始生物治疗。共有34例患者(24%)达到主要结局:8%的患者出现疾病行为进展,15%住院,9%需要手术。根据开始生物治疗的时间,在前24个月内出现cd相关并发症的时间没有差异。临床、内镜和经壁缓解分别为85%、50%和29%,但根据开始生物治疗的时间没有发现差异。结论:在诊断后的前24个月内开始抗tnf治疗与cd相关并发症发生率低,临床和内窥镜缓解率高相关,尽管我们发现在这个机会窗口内早期开始抗tnf治疗没有差异。
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来源期刊
Journal of Crohns & Colitis
Journal of Crohns & Colitis 医学-胃肠肝病学
CiteScore
15.50
自引率
7.50%
发文量
1048
审稿时长
1 months
期刊介绍: Journal of Crohns and Colitis is concerned with the dissemination of knowledge on clinical, basic science and innovative methods related to inflammatory bowel diseases. The journal publishes original articles, review papers, editorials, leading articles, viewpoints, case reports, innovative methods and letters to the editor.
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