Accelerated treatment strategy in inflammatory bowel diseases; is it associated with a change in the disease course?

BACKGROUND AND AIMS: Evidence from new clinical trials in inflammatory bowel diseases (IBD) suggests that tight disease control and early aggressive therapy is associated with superior outcomes in patients with poor prognostic factors. The aim of the present study was to investigate the evolution of the treatment strategy and probability of resective surgery/colectomy in three IBD-centers according to the era of diagnosis. Methods: Data of 352 consecutive anti-TNF treated IBD patients (CD/UC: 296/56, males: 48.3%/42.9%, 1st anti TNF infliximab/adalimumab: 300/52, median age at diagnosis: 22/25.5 years, follow-up from diagnosis: 8.5/5.5 years, complicated disease behavior and ileocolonic location in CD: 48% and 57.1%, extensive location in UC: 39.3% at diagnosis) were analysed. Both in- and outpatient records were collected and comprehensively reviewed. Results: The time to anti-TNF, immunosuppressives and steroids was significantly and progressively shortened in both CD (pLogRank< 0.001 for all) and UC (pLogRank< 0.003 for all) according to the era of diagnosis (A: < 2004, B: 2004 – 2008, C: 2009 – 2013). Mean time to anti TNFs and immunosuppressives was 123.8/76.6, 40.8/16.8 and 20.5/8.8 months in CD in Groups A, B and C (pANOVA< 0.001, pScheffeA.vs.B/C< 0.001). Despite similar disease phenotype, the era of diagnosis was not associated with the time to resective surgery or colectomy (pLogRankCD = 0.08, pLogRankUC = NS) in the total cohort. However, need for resective surgery decreased over time in CD patients treated with infliximab as 1st anti-TNF (pLogRank = 0.034) and in patients with perianal disease (pLogRank = 0.04). Conclusions: An accelerated treatment strategy was observed in this referral IBD cohort. Further data are required to determine whether accelerated treatment strategy is associated with superior long-term outcomes in IBD.