Risk factors that predict the requirement of aggressive therapy among Chinese patients with Crohn's disease

Abstract

OBJECTIVES: Crohn's disease is now increasingly considered as a disabling disease. Conventionally, the disease is managed by step‐up therapy. In recent years, the top‐down strategy has been proposed and is thought to benefit the patients in whom the condition is likely to rapidly deteriorate toward disabling. However, this strategy has severe adverse effects which have to be weighed against its benefits. The aim of this study is to identify the risk factors that can predict the requirement of top‐down therapy among Chinese patients. METHODS: We included 207 Chinese patients who had histories of Crohn's disease for ≥5 years, or those who had Crohn's disease for <5 years and at least one criterion of disabling disease. The risk factors related to the 5‐year disabling course and the 2‐year disabling course of Crohn's disease were separately analyzed in the same cohort by logistic regression. RESULTS: Among the 207 patients, the rate of disabling disease was 80.19% for 5‐year, and 71.01% for 2‐year. The risk factors of age <40 years at diagnosis, steroids requirement for treating acute exacerbation, and presence of perianal disease at diagnosis were significantly associated with a 5‐year disabling course. In the same cohort, the risk factors related to 2‐year disabling course were likewise steroids requirement for treating acute exacerbation and presence of perianal disease at diagnosis. CONCLUSION: The risk factors associated with disabling Crohn's disease, which entails the requirement of top‐down therapy in Chinese patients, are requirement of steroids for treating acute exacerbation and the presence of perianal disease at diagnosis.

Low-dose azathioprine is effective in maintaining remission among Chinese patients with Crohn’s disease

“…The efficacy of ~1.0 mg/kg AZA in maintaining remission of CD was confirmed. Next, we compared the effect of <1.0 mg/kg AZA with that of 1.0-2.0 mg/kg AZA at 24 months, based on our previous result that the severity of disease remained unaltered in 90% patients with CD during the 2-year period [17]. To our surprise, the remission rate in patients of <1.0 mg/kg group was significantly higher than that in those of 1.0-2.0mg/kg group.…”

“…On the other hand, higher rates of relapse were seen in female patients; their doses of AZA had to be escalated. Older age was another factor for long-term remission and young patients were prone to be disabling CD [17,19-21]. Patients in <1.0 mg/kg group were significantly older than those in 1.0-2.0 mg/kg group at the start of AZA therapy, and the age (35.5 years) was almost the same as that reported by Fraser AG et al, who observed a lower relapse rate in the patients above 36 years of age [19].…”

Inflammatory bowel disease in Asia: A systematic review

“…A study from China 171 has identified similar risk factors for developing disabling disease as in the West, namely age < 40 years at diagnosis, steroid requirement for treating acute exacerbation and perianal disease at diagnosis 109,161 …”

An Envirogenomic Signature Is Associated with Risk of IBD-Related Surgery in a Population-Based Crohn’s Disease Cohort

“…[4][5][6][7][8]18 Smoking has also been associated with the development and progression of CD, 6,8,[12][13][14]18 increasing the risk for IBD-related surgery. Similarly, perianal disease is associated with an increased risk of progressive complicated CD [8][9][10][11] and resectional surgery.…”

“…These characteristics and outcomes may inform the clinician as to the therapeutic strategy to adopt, for example early aggressive therapy for those patients who are most likely to progress to surgery. 2,3 A range of factors have been associated with an increased risk of complicated (stricturing and penetrating) CD behaviour including the specific NOD2 genotypes [4][5][6] having had perianal disease [8][9][10][11] and cigarette smoking. 1,6,8,[12][13][14] Complicated disease is strongly associated with a requirement for surgery 15 ; therefore, knowledge of such genetic, environmental and clinical predictors may guide clinicians in developing a personalised approach for individual patients.…”