Ileal Predominance in Crohn's Disease Is Associated With Increased Intestinal Surgery and Biological Therapy Use, With Lower Treatment Persistence.

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Giordano A
  • Pérez-Martínez I
  • Gisbert JP
  • Ricart E
  • Martín-Arranz MD
  • Mesonero F
  • Parga MLC
  • Rivero M
  • Iglesias E
  • Fernández-Prada S
  • Calafat M
  • Villarino MTA
  • de Jorge Turrión MÁ
  • Hernández-Camba A
  • Lidón RV
  • Carpio D
  • Brunet E
  • Moranta FR
  • García LA
  • Cuquerella JT
  • Bermejo F
  • Madero L
  • Esteve M
  • González-Muñoza C
  • Martínez-Montiel P
  • Huguet JM
  • Pérez Calle JL
  • Rodríguez-Lago I
  • Ausín MS
  • Poyatos RHL
  • García-Bosch O
  • Marín GS
  • Taxonera C
  • Ponferrada-Diaz Á
  • Acosta MB
  • Bujanda L
  • Serra RB
  • Ramos L
  • Vera I
  • Abizanda ES
  • Piqueras M
  • Gómez CS
  • García-Sepulcre MF
  • Arregui MV
  • Murillo NR
  • Llaó J
  • Lucendo AJ
  • Marín-Jiménez I
  • Camps-Aler B
  • Villafranca CM
  • Ceballos D
  • Ver Y
  • Fernández-Salazar LI
  • Alcaín G
  • Valldosera G
  • Andrés PR
  • Martínez-Flores C
  • Coronel AF
  • Ginard D
  • García L
  • Gómez IB
  • Argüelles-Arias F
  • Miyashiro EI
  • De la Piscina PR
  • Villalba LH
  • Notari PA
  • de Jesús Martínez-Pérez T
  • Fernández H
  • Gilabert P
  • Rosas CM
  • Gil JL
  • Navas López VM
  • Muñoz F
  • Palomares MTD
  • Lucio AS
  • Merino O
  • de Prado IN
  • Leal C
  • de Carpi JM
  • Sánchez LB
  • Arce NM
  • Frago S
  • Mateu BB
  • Domènech E
  • Garcia Planella E
  • ENEIDA project of GETECCU

Grupos

Abstract

INTRODUCTION: Crohn's disease (CD) varies by location, potentially affecting therapy efficacy and surgery risk, although research on this topic is conflicting. This study aims to investigate the independent association between CD location and therapeutic patterns. METHODS: We analyzed patients with CD diagnosed from January 2005 to May 2023 registered in the nationwide ENEIDA registry. A univariate Cox regression analysis assessed the association of disease location with biologic use and persistence (with treatment discontinuation as a failure event), as well as the use of intestinal resections. A multivariate model was constructed to evaluate the independent association of disease location with therapeutic patterns, controlling for potential confounders such as sex, age at inclusion and diagnosis, disease duration and behavior, previous surgery or biological therapy, extraintestinal manifestations, and perianal disease. RESULTS: The study included 17,292 patients with a median follow-up period of 6 years (interquartile range 2-10 years). Ileocolonic location was associated with a higher biologic use than colonic location (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.22-1.38) and ileal disease (HR 1.21, 95% CI 1.16-1.27), independently predicting biologic use (P < 0.001). Ileal location was associated with a lower biologic persistence than ileocolonic location (HR 1.14, 95% CI 1.07-1.21) and colonic disease (HR 1.10, 95% CI 1.01-1.20), independently predicting biologic persistence (P = 0.019). Ileal disease was associated with a higher likelihood of intestinal resections than colonic (HR 2.82, 95% CI 2.45-3.25) and ileocolonic location (HR 1.13, 95% CI 1.05-1.22), independently predicting the use of surgery (P < 0.001). DISCUSSION: CD location with ileal predominance is associated with a distinct therapeutic pattern, including higher biologic use, lower treatment persistence, and increased rates of intestinal resections.

Copyright © 2024 by The American College of Gastroenterology.

Datos de la publicación

ISSN/ISSNe:
0002-9270, 1572-0241

AMERICAN JOURNAL OF GASTROENTEROLOGY  LIPPINCOTT WILLIAMS & WILKINS

Tipo:
Article
Páginas:
194-203
PubMed:
39745305
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
2,683 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 8

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Keywords

  • Adult; Colon; Crohn Disease; Digestive System Surgical Procedures; Female; Humans; Ileal Diseases; Ileum; Male; Middle Aged; Proportional Hazards Models; Registries; Young Adult; Article; behavior; biological therapy; Crohn disease; demographics; disease duration; female; follow up; gastrointestinal tract; hepatobiliary system; human; ileum; ileum disease; intestine resection; intestine surgery; major clinical study; perineum; surgical risk; ulcerative colitis; abdominal surgery; adult; colon; drug therapy; ileum; male; middle aged; pathology; procedures; proportional hazards model; register; surgery; young adult

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