Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors ofdisease behavior change in patients with Crohn's disease

P. Lakatos, Zsofia Czegledi, T. Szamosi, Janos Banai, Gyula David, Ferenc Zsigmond, T. Pandúr, Z. Erdélyi, Orsolya Gemela, J. Papp, L. Lakatos

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Abstract

Aim: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Methods: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. Results: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P <0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/ biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Conclusion: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

Original languageEnglish
Pages (from-to)3504-3510
Number of pages7
JournalWorld Journal of Gastroenterology
Volume15
Issue number28
DOIs
Publication statusPublished - Jul 28 2009

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Biological Therapy
Azathioprine
Crohn Disease
Smoking
Steroids
Regression Analysis
Phenotype
Kaplan-Meier Estimate
Survival Analysis

Keywords

  • Azathioprine
  • Colectomy
  • Crohn's disease
  • Infliximab
  • Monoclonal antibodies
  • Reoperation
  • Risk
  • Smoking

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{36a6a8dced8a405995e72f10b1bcc572,
title = "Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors ofdisease behavior change in patients with Crohn's disease",
abstract = "Aim: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Methods: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. Results: A change in disease behavior was observed in 30.8{\%} of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P <0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/ biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Conclusion: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.",
keywords = "Azathioprine, Colectomy, Crohn's disease, Infliximab, Monoclonal antibodies, Reoperation, Risk, Smoking",
author = "P. Lakatos and Zsofia Czegledi and T. Szamosi and Janos Banai and Gyula David and Ferenc Zsigmond and T. Pand{\'u}r and Z. Erd{\'e}lyi and Orsolya Gemela and J. Papp and L. Lakatos",
year = "2009",
month = "7",
day = "28",
doi = "10.3748/wjg.15.3504",
language = "English",
volume = "15",
pages = "3504--3510",
journal = "World Journal of Gastroenterology",
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TY - JOUR

T1 - Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors ofdisease behavior change in patients with Crohn's disease

AU - Lakatos, P.

AU - Czegledi, Zsofia

AU - Szamosi, T.

AU - Banai, Janos

AU - David, Gyula

AU - Zsigmond, Ferenc

AU - Pandúr, T.

AU - Erdélyi, Z.

AU - Gemela, Orsolya

AU - Papp, J.

AU - Lakatos, L.

PY - 2009/7/28

Y1 - 2009/7/28

N2 - Aim: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Methods: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. Results: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P <0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/ biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Conclusion: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

AB - Aim: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Methods: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. Results: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P <0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/ biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Conclusion: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

KW - Azathioprine

KW - Colectomy

KW - Crohn's disease

KW - Infliximab

KW - Monoclonal antibodies

KW - Reoperation

KW - Risk

KW - Smoking

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