Evaluation of a downstaging, bidirectional version of the Montreal classification of Crohn's disease: Analysis of 5-year follow-up data from the prospective BioCrohn study.
Crohn’s disease
Montreal classification
disease behaviour
dynamic classification
prospective study
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
revised:
30
08
2022
received:
28
07
2022
accepted:
29
03
2023
medline:
14
6
2023
pubmed:
14
4
2023
entrez:
13
4
2023
Statut:
ppublish
Résumé
Under the assumption of irreversibility, the Montreal classification provides a unidirectional assessment of the complications and behaviour of Crohn's disease (CD) that does not allow for downstaging. We examined the use of a bidirectional Montreal classification system that can capture disease regression. From the BioCrohn Registry, an inception cohort of patients with CD for ≤12 months duration was defined and followed up for 5-years. Cumulative probabilities for developing complications were estimated using the Kaplan-Meier method. Potential associations of explanatory variables with disease progression were estimated with Cox regression. Among 393 incident CD patients (of whom 255 completed the entire follow-up), the 5-year cumulative probability of developing complications was 41.5% (15.6% and 25.9% for stricturing and penetrating complications respectively). Perianal disease (hazard ratio [95% confidence interval]: 8.45 [4.74-15.07]) and surgical resection of the intestine (2.71 [1.50-4.92]) in the very early phase of the disease were associated with a higher risk of developing a penetrating complication within the 5-year follow-up. The use of a bidirectional Montreal classification system which can account for disease regression demonstrated that 90% of patients exhibited inflammatory disease behaviour at 5 years, in contrast to 58%, if the hierarchical, unidirectional Montreal classification system was used. An additional bidirectional disease behaviour assessment capturing reversed or fully controlled complications may provide a more realistic appraisal of the complexity and unmet needs of patients treated with advanced therapies.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
35-47Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.
Références
Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2-6. discussion 16-9.
Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn's disease complicated by strictures: a systematic review. Gut. 2013;62:1072-84.
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal world congress of gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5A-36A.
Gasche C, Scholmerich J, Brynskov J, DʼHaens G, Hanauer SB, Irvine JE, et al. A simple classification of Crohn's disease: report of the working Party for the World Congresses of gastroenterology, Vienna 1998. Inflamm Bowel Dis. 2000;6:8-15.
Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis. 2002;8:244-50.
Henriksen M, Jahnsen J, Lygren I, Aadland E, Schulz T, Vatn MH, et al. Clinical course in Crohn's disease: results of a five-year population-based follow-up study (the IBSEN study). Scand J Gastroenterol. 2007;42:602-10.
Vester-Andersen MK, Prosberg MV, Jess T, Andersson M, Bengtsson BG, Blixt T, et al. Disease course and surgery rates in inflammatory bowel disease: a population-based, 7-year follow-up study in the era of immunomodulating therapy. Am J Gastroenterol. 2014;109:705-14.
Lo B, Vester-Andersen MK, Vind I, Prosberg M, Dubinsky M, Siegel CA, et al. Changes in disease behavior and location in patients with Crohn's disease after seven years of follow-up: a Danish population-based inception cohort. J Crohns Colitis. 2018;12:265-72.
Smith BR, Arnott ID, Drummond HE, Nimmo ER, Satsangi J. Disease location, anti-Saccharomyces cerevisiae antibody, and NOD2/CARD15 genotype influence the progression of disease behavior in Crohn's disease. Inflamm Bowel Dis. 2004;10:521-8.
Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749-53.
Irwin J, Ferguson E, Simms LA, Hanigan K, Carbonnel F, Radford-Smith G. A rolling phenotype in Crohn's disease. PLoS One. 2017;12:e0174954.
Bokemeyer B. Addressing unmet needs in inflammatory bowel disease. Drug Discov Today. 2015;20:1037-9.
Brandes A, Groth A, Gottschalk F, Wilke T, Ratsch BA, Orzechowski HD, et al. Real-world biologic treatment and associated cost in patients with inflammatory bowel disease. Z Gastroenterol. 2019;57:843-51.
Louis E, Reenaers C, Belaiche J. Does the behavior of Crohn's disease change over time? Inflamm Bowel Dis. 2008;14(Suppl 2):S54-5.
Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr el Yafi FA, Belaiche J. Behavior of Crohn's disease according to the Vienna classification: changing pattern over the course of the disease. Gut. 2001;49:777-82.
Bokemeyer B, Helwig U, Stallmach A, Teich N, Halle R, Bläker M, et al. Anti-TNF in patients with an early course of Crohn's disease - a prospective observational study in Germany. J Crohns Colitis. 2013;7:S2.
Bokemeyer B, Helwig U, Stallmach A, Teich N, Halle R, Bläker M, et al. Large burden of disease in early CD-patients in the Biocrohn registry in Germany. J Crohns Colitis. 2011:6.
Preiss JC, Bokemeyer B, Buhr HJ, Dignass A, Häuser W, Hartmann F, et al. Updated German clinical practice guideline on "diagnosis and treatment of Crohn's disease" 2014. Z Gastroenterol. 2014;52:1431-84.
Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, et al. ECCO-ESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019;13:144-64.
Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med. 1998;17:873-90.
Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65-70.
Bokemeyer B, Ghiani M, Fuchs A, Deiters B, Hardtstock F, Brandes A, et al. Indicators of active disease and steroid dependency in patients with inflammatory bowel diseases not treated with biologics in a German real-world-setting. Int J Colorectal Dis. 2020;35:1587-98.
Armijo-Olivo S, Warren S, Magee D. Intention to treat analysis, compliance, drop-outs and how to deal with missing data in clinical research: a review. Phys Ther Rev. 2009;14:36-49.
Kalaria R, Desai D, Abraham P, Joshi A, Gupta T, Shah S. Temporal change in phenotypic behavior in patients with Crohn's disease: do Indian patients behave differently from western and other Asian patients? J Crohns Colitis. 2015;10:255-61.
Chow DK, Leong RW, Lai LH, Wong GL, Leung WK, Chan FK, et al. Changes in Crohn's disease phenotype over time in the Chinese population: validation of the Montreal classification system. Inflamm Bowel Dis. 2008;14:536-41.
Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV Jr. Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort. Gastroenterology. 2010;139:1147-55.
Tarrant KM, Barclay ML, Frampton CM, Gearry RB. Perianal disease predicts changes in Crohn's disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol. 2008;103:3082-93.
Sjoberg D, Holmstrom T, Larsson M, Nielsen AL, Holmquist L, Ekbom A, et al. Incidence and clinical course of Crohn's disease during the first year - results from the IBD cohort of the Uppsala region (ICURE) of Sweden 2005-2009. J Crohns Colitis. 2014;8:215-22.
Ronnblom A, Holmstrom T, Karlbom U, Tanghöj H, Thörn M, Sjöberg D. Clinical course of Crohn's disease during the first 5 years. Results from a population-based cohort in Sweden (ICURE) diagnosed 2005-2009. Scand J Gastroenterol. 2017;52:81-6.
Jeuring SFG, van den Heuvel TRA, Liu LYL, Zeegers MP, Hameeteman WH, Romberg-Camps MJL, et al. Improvements in the long-term outcome of Crohn's disease over the past two decades and the relation to changes in medical management: results from the population-based IBDSL cohort. Am J Gastroenterol. 2017;112:325-36.
Kennedy NA, Jones GR, Plevris N, Patenden R, Arnott ID, Lees CW. Association between level of fecal calprotectin and progression of Crohn's disease. Clin Gastroenterol Hepatol. 2019;17:2269-2276.e4.
Aldhous MC, Drummond HE, Anderson N, Smith LA, Arnott IDR, Satsangi J. Does cigarette smoking influence the phenotype of Crohn's disease? Analysis using the Montreal classification. Am J Gastroenterol. 2007;102:577-88.
Tang LY, Rawsthorne P, Bernstein CN. Are perineal and luminal fistulas associated in Crohn's disease? A population-based study. Clin Gastroenterol Hepatol. 2006;4:1130-4.
Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn's disease. Gastroenterology. 2006;130:650-6.
Gordon M. 5-Aminosalicylates to maintain remission in Crohn's disease: interpreting conflicting systematic review evidence. World J Gastrointest Pharmacol Ther. 2017;8:99-102.
Fukushima K, Sugita A, Futami K, Takahashi KI, Motoya S, Kimura H, et al. Postoperative therapy with infliximab for Crohn's disease: a 2-year prospective randomized multicenter study in Japan. Surg Today. 2018;48:584-90.
Samaan M, Campbell S, Cunningham G, Tamilarasan AG, Irving PM, McCartney S. Biologic therapies for Crohn's disease: optimising the old and maximising the new. F1000Res. 2019:8. https://doi.org/10.12688/f1000research.18902.1
Panes J, Garcia-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, et al. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016;388:1281-90.
Bislenghi G, Wolthuis A, Van Assche G, Vermeire S, Ferrante M, D'Hoore A. Cx601 (darvadstrocel) for the treatment of perianal fistulizing Crohn's disease. Expert Opin Biol Ther. 2019;19:607-16.