Open Access Research article

Efficacy of early immunomodulator therapy on the outcomes of Crohn’s disease

Min Seob Kwak1, Duk Hwan Kim1, Soo Jung Park12, Tae Il Kim12, Sung Pil Hong12, Won Ho Kim12 and Jae Hee Cheon123*

Author Affiliations

1 Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea

2 Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

3 Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea

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BMC Gastroenterology 2014, 14:85  doi:10.1186/1471-230X-14-85

Published: 3 May 2014

Abstract

Background

The natural course of Crohn’s disease (CD), with continuing relapses and remissions, leads to irreversible intestinal damage. Early adoption of immunomodulator therapy has been proposed in order to address this; however, it is still uncertain whether early immunomodulator therapy could affect the natural course of the disease in real practice. We evaluated the efficacy of such therapy on the prognosis of newly diagnosed patients with CD.

Methods

This retrospective study included 168 patients who were newly diagnosed with CD and who started treatment at Severance Hospital, Seoul, Korea between January 2006 and March 2013. The short- and long-term outcomes were compared between patients treated with early immunomodulator therapy and those treated with conventional therapy.

Results

A Kaplan-Meier analysis identified that administration of immunomodulators within 6 months after diagnosis of CD was superior to conventional therapy in terms of clinical remission and corticosteroid-free remission rates (P=0.043 and P=0.035). However, P=0.827). Patients with a baseline elevated CRP level were more likely to relapse (P<0.005). Drug-related adverse events were more frequent in the early immunomodulator therapy group than in the conventional therapy group P=0.029).

Conclusions

Early immunomodulator therapy was more effective than conventional therapy in inducing remission, but not in preventing relapse. Baseline high CRP level was a significant indicator of relapse.

Keywords:
Crohn’s disease; Azathioprine; 6-mercaptopurine; Immunomodulator