SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Philippe AYGALENQ
Coup de coeur :
 
 
Alimentary Pharmacology & Therapeutics (APT)
  2015/10  
 
  2015 Oct;42(8):977-89  
  doi: 10.1111/apt.13363  
 
  Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease  
 
  Safroneeva E, Vavricka SR, Fournier N, Pittet V, Peyrin-Biroulet L, Straumann A, Rogler G, Schoepfer AM; Swiss IBD Cohort Study Group  
  http://onlinelibrary.wiley.com/doi/10.1111/apt.13363/abstract  
 
 

Background
The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown.

Aim
To assess whether ‘early treatment’ with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to ‘late treatment’, which was defined as treatment initiation after >2 years from the time of CD diagnosis.

Methods
Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications.

Results
The ‘early treatment’ group of 292 CD patients was compared to the ‘late treatment’ group of 248 CD patients. We found that ‘early treatment’ with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P  = 0.018 for TNF antagonists]. Furthermore, ‘early treatment’ with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006).

Conclusions
Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication.

 
Question posée
 
Intérêt d'un traitement précoce par IS ou et ATNF dans la maladie de Crohn.
 
Question posée
 
Positive dans la plupart des items, confirme la tendance actuelle de l'intérêt du traitement dans les 2 ans qui suivent le diagnostic.
 
Commentaires

Avec les limites d'une étude de registre, même suisse, cette étude confirme l'intérêt d un traitement précoce dans les 2 ans qui suivent le diagnostic. Reste néanmoins criticable sur la qualité du recueil qui explique quelques résultqts curieux (plus de fistules anales dans le groupe traitement précoce).

 
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