Lower Risk of B1-to-pB3-Stage Migration in Crohn's Disease Upon Immunosuppressive and Anti-TNF Treatment in the Swiss IBD Cohort Study.
Adolescent
Adult
Aged
Aged, 80 and over
Crohn Disease
/ classification
Disease Progression
Female
Humans
Immunosuppressive Agents
/ therapeutic use
Male
Middle Aged
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Switzerland
Time Factors
Treatment Outcome
Tumor Necrosis Factor Inhibitors
/ therapeutic use
Young Adult
Crohn’s disease
Disease-modifying
Immunosuppressive agents
Montreal classification
Tumor necrosis factor-alpha
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
14
04
2019
accepted:
27
11
2019
pubmed:
5
12
2019
medline:
30
12
2020
entrez:
5
12
2019
Statut:
ppublish
Résumé
While the long-term evolution of disease behavior in Crohn's disease has been well described in the pre-anti-TNF era, our knowledge thereon remains scarce after the introduction of anti-TNF. Our investigation examined the long-term evolution of disease concerning Montreal classification's B-stages over time in patients enrolled into the Swiss IBD Cohort Study between 2006 and 2017. We analyzed prospectively collected SIBDCS data using a Markov model and multivariate testing for effects of treatment and other confounders on B-stage migration over time. The primary outcome was a transition in disease behavior from B1 to either B2 or pB3, or from B2 to pB3, respectively. The 10- and 15-year probability of remaining in B1 was 0.61 and 0.48, as opposed to a probability to migrate to B2 or B3 of 0.25 or 0.14, and 0.32 or 0.2, after 10 and 15 years, respectively. In multivariate testing, the hazard ratio for migrating from B1 to pB3 (HR 0.27) and from B2 to pB3 (HR 0.12) was lower in patients > 40 years compared to patients < 17 years. We found that immunosuppression (HR 0.38) and treatment with anti-TNF for > 1 year (HR 0.30) were associated with a decreased likelihood of transitioning from stage B1 to pB3. While in the anti-TNF era most patients with Crohn's disease will eventually develop stricturing and/or penetrating complications, our data indicate that immunosuppressive and anti-TNF treatment for more than 1 year reduce the risk of transitioning from stage B1 to pB3 in the long-term run.
Sections du résumé
BACKGROUND
While the long-term evolution of disease behavior in Crohn's disease has been well described in the pre-anti-TNF era, our knowledge thereon remains scarce after the introduction of anti-TNF.
AIMS
Our investigation examined the long-term evolution of disease concerning Montreal classification's B-stages over time in patients enrolled into the Swiss IBD Cohort Study between 2006 and 2017.
METHODS
We analyzed prospectively collected SIBDCS data using a Markov model and multivariate testing for effects of treatment and other confounders on B-stage migration over time. The primary outcome was a transition in disease behavior from B1 to either B2 or pB3, or from B2 to pB3, respectively.
RESULTS
The 10- and 15-year probability of remaining in B1 was 0.61 and 0.48, as opposed to a probability to migrate to B2 or B3 of 0.25 or 0.14, and 0.32 or 0.2, after 10 and 15 years, respectively. In multivariate testing, the hazard ratio for migrating from B1 to pB3 (HR 0.27) and from B2 to pB3 (HR 0.12) was lower in patients > 40 years compared to patients < 17 years. We found that immunosuppression (HR 0.38) and treatment with anti-TNF for > 1 year (HR 0.30) were associated with a decreased likelihood of transitioning from stage B1 to pB3.
CONCLUSIONS
While in the anti-TNF era most patients with Crohn's disease will eventually develop stricturing and/or penetrating complications, our data indicate that immunosuppressive and anti-TNF treatment for more than 1 year reduce the risk of transitioning from stage B1 to pB3 in the long-term run.
Identifiants
pubmed: 31797187
doi: 10.1007/s10620-019-05978-9
pii: 10.1007/s10620-019-05978-9
doi:
Substances chimiques
Immunosuppressive Agents
0
Tumor Necrosis Factor Inhibitors
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2654-2663Subventions
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
ID : N 3347CO-108792/1
Pays : International
Investigateurs
Claudia Anderegg
(C)
Peter Bauerfeind
(P)
Christoph Beglinger
(C)
Stefan Begré
(S)
Dominique Belli
(D)
José M Bengoa
(JM)
Luc Biedermann
(L)
Beat Bigler
(B)
Janek Binek
(J)
Mirjam Blattmann
(M)
Stephan Boehm
(S)
Jan Borovicka
(J)
Christian P Braegger
(CP)
Nora Brunner
(N)
Patrick Bühr
(P)
Bernard Burnand
(B)
Emanuel Burri
(E)
Sophie Buyse
(S)
Matthias Cremer
(M)
Dominique H Criblez
(DH)
Philippe de Saussure
(P)
Lukas Degen
(L)
Joakim Delarive
(J)
Christopher Doerig
(C)
Barbara Dora
(B)
Gian Dorta
(G)
Mara Egger
(M)
Tobias Ehmann
(T)
Ali El-Wafa
(A)
Matthias Engelmann
(M)
Jessica Ezri
(J)
Christian Felley
(C)
Markus Fliegner
(M)
Nicolas Fournier
(N)
Montserrat Fraga
(M)
Pascal Frei
(P)
Remus Frei
(R)
Michael Fried
(M)
Florian Froehlich
(F)
Christian Funk
(C)
Raoul Ivano Furlano
(RI)
Suzanne Gallot-Lavallée
(S)
Martin Geyer
(M)
Marc Girardin
(M)
Delphine Golay
(D)
Tanja Grandinetti
(T)
Beat Gysi
(B)
Horst Haack
(H)
Johannes Haarer
(J)
Beat Helbling
(B)
Peter Hengstler
(P)
Denise Herzog
(D)
Cyrill Hess
(C)
Klaas Heyland
(K)
Thomas Hinterleitner
(T)
Philippe Hiroz
(P)
Claudia Hirschi
(C)
Petr Hruz
(P)
Rika Iwata
(R)
Res Jost
(R)
Pascal Juillerat
(P)
Vera Kessler Brondolo
(VK)
Christina Knellwolf
(C)
Christoph Knoblauch
(C)
Henrik Köhler
(H)
Rebekka Koller
(R)
Claudia Krieger-Grübel
(C)
Gerd Kullak-Ublick
(G)
Patrizia Künzler
(P)
Markus Landolt
(M)
Rupprecht Lange
(R)
Frank Serge Lehmann
(FS)
Andrew Macpherson
(A)
Philippe Maerten
(P)
Michel H Maillard
(MH)
Christine Manser
(C)
Michael Manz
(M)
Urs Marbet
(U)
George Marx
(G)
Christoph Matter
(C)
Valérie McLin
(V)
Rémy Meier
(R)
Martina Mendanova
(M)
Christa Meyenberger
(C)
Pierre Michetti
(P)
Benjamin Misselwitz
(B)
Darius Moradpour
(D)
Bernhard Morell
(B)
Patrick Mosler
(P)
Christian Mottet
(C)
Christoph Müller
(C)
Pascal Müller
(P)
Beat Müllhaupt
(B)
Claudia Münger-Beyeler
(C)
Leilla Musso
(L)
Andreas Nagy
(A)
Michaela Neagu
(M)
Cristina Nichita
(C)
Jan Niess
(J)
Natacha Noël
(N)
Andreas Nydegger
(A)
Nicole Obialo
(N)
Carl Oneta
(C)
Cassandra Oropesa
(C)
Ueli Peter
(U)
Daniel Peternac
(D)
Laetitia Marie Petit
(LM)
Franziska Piccoli-Gfeller
(F)
Julia Beatrice Pilz
(JB)
Valérie Pittet
(V)
Nadia Raschle
(N)
Ronald Rentsch
(R)
Sophie Restellini
(S)
Jean-Pierre Richterich
(JP)
Sylvia Rihs
(S)
Marc Alain Ritz
(MA)
Jocelyn Roduit
(J)
Daniela Rogler
(D)
Gerhard Rogler
(G)
Jean-Benoît Rossel
(JB)
Markus Sagmeister
(M)
Gaby Saner
(G)
Bernhard Sauter
(B)
Mikael Sawatzki
(M)
Michela Schäppi
(M)
Michael Scharl
(M)
Martin Schelling
(M)
Susanne Schibli
(S)
Hugo Schlauri
(H)
Sybille Schmid Uebelhart
(SS)
Jean-François Schnegg
(JF)
Alain Schoepfer
(A)
Frank Seibold
(F)
Mariam Seirafi
(M)
Gian-Marco Semadeni
(GM)
David Semela
(D)
Arne Senning
(A)
Marc Sidler
(M)
Christiane Sokollik
(C)
Johannes Spalinger
(J)
Holger Spangenberger
(H)
Philippe Stadler
(P)
Michael Steuerwald
(M)
Alex Straumann
(A)
Bigna Straumann-Funk
(B)
Michael Sulz
(M)
Joël Thorens
(J)
Sarah Tiedemann
(S)
Radu Tutuian
(R)
Stephan Vavricka
(S)
Francesco Viani
(F)
Jürg Vögtlin
(J)
Roland Von Känel
(R)
Alain Vonlaufen
(A)
Dominique Vouillamoz
(D)
Rachel Vulliamy
(R)
Jürg Wermuth
(J)
Helene Werner
(H)
Paul Wiesel
(P)
Reiner Wiest
(R)
Tina Wylie
(T)
Jonas Zeitz
(J)
Dorothee Zimmermann
(D)
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