PMID- 26520164 OWN - NLM STAT- MEDLINE DCOM- 20160927 LR - 20220311 IS - 1876-4479 (Electronic) IS - 1873-9946 (Linking) VI - 10 IP - 1 DP - 2016 Jan TI - Timing of Thiopurine or Anti-TNF Initiation Is Associated with the Risk of Major Abdominal Surgery in Crohn's Disease: A Retrospective Cohort Study. PG - 55-60 LID - 10.1093/ecco-jcc/jjv187 [doi] AB - INTRODUCTION: Early stages of Crohn's disease [CD] are predominantly inflammatory and early treatment could be useful to change the natural history of CD. We aimed to evaluate the impact of early treatment in our cohort of CD patients. METHODS: We retrospectively reviewed clinical records of all CD patients at our centre who have received immunomodulators. Time from diagnosis to first CD-related major abdominal surgery or end of follow-up was considered. Dates of diagnosis, of starting immunomodulators (thiopurines / anti-tumour necrosis factor [TNF]), and of the first CD-related surgery when appropriate were collected. RESULTS: Of 422 patients who received thiopurines, 189 operated patients started thiopurines after a median of 117 months (interquartile range [IQR] 44-196) since diagnosis; non-operated patients, after a median of 30 months [IQR 6-128], p < 0,005. Odds ratio [OR] for surgery was 1.006 (95% confidence interval [CI]1.004-1008) for each month of delay in starting thiopurines. Among 272 patients who received anti-TNFs, 137 operated patients started anti-TNFs after a median of 166 months [IQR 90-233] since diagnosis; non-operated patients after a median of 59 months [IQR 14-162]; p < 0,005. OR for surgery was 1.008 [95% CI 1.005-1.010] for each month of delay in starting anti-TNFs. Among 467 patients who received thiopurines and/or anti-TNF, 210 operated patients started any immunomodulator after a median of 120 months [IQR 48-197] since diagnosis and non-operated patients after a median of 30 months [IQR 6-126], p < 0,005. OR for surgery was 1.008 [95% CI 1.005-1.010] for each month of delay in starting immunomodulators. CONCLUSIONS: In our experience, time between diagnosis and thiopurine or anti-TNF initiation was associated with the risk of major abdominal surgery in Crohn's disease. CI - Copyright (c) 2015 European Crohn's and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com. FAU - Gonzalez-Lama, Yago AU - Gonzalez-Lama Y AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Suarez, Cristina AU - Suarez C AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Gonzalez-Partida, Irene AU - Gonzalez-Partida I AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Calvo, Marta AU - Calvo M AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Matallana, Virginia AU - Matallana V AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - de la Revilla, Juan AU - de la Revilla J AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Magaz, Marta AU - Magaz M AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Bernardo, Cristina AU - Bernardo C AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Agudo, Belen AU - Agudo B AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Ibarrola, Pilar AU - Ibarrola P AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Relea, Lucia AU - Relea L AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Arevalo, Juan AU - Arevalo J AD - Medicine Department, University of Alcala de Henares, Madrid, Spain. FAU - Vera, Maria Isabel AU - Vera MI AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain. FAU - Abreu, Luis AU - Abreu L AD - Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain labreu.hpth@salud.madrid.org. LA - eng PT - Comparative Study PT - Journal Article DEP - 20151031 PL - England TA - J Crohns Colitis JT - Journal of Crohn's & colitis JID - 101318676 RN - 0 (Immunosuppressive Agents) RN - 0 (Tumor Necrosis Factor-alpha) RN - E7WED276I5 (Mercaptopurine) RN - MRK240IY2L (Azathioprine) SB - IM CIN - J Crohns Colitis. 2017 Aug 1;11(8):1023. PMID: 28333190 MH - Adult MH - Analysis of Variance MH - Azathioprine/administration & dosage/*adverse effects MH - Cohort Studies MH - Colectomy/methods MH - Crohn Disease/diagnosis/*drug therapy/*surgery MH - Databases, Factual MH - Dose-Response Relationship, Drug MH - Drug Administration Schedule MH - Female MH - Follow-Up Studies MH - Humans MH - Immunosuppressive Agents/administration & dosage MH - Laparotomy/methods MH - Logistic Models MH - Male MH - Mercaptopurine/*administration & dosage/*adverse effects MH - Middle Aged MH - Multivariate Analysis MH - Retrospective Studies MH - Risk Assessment MH - Severity of Illness Index MH - Statistics, Nonparametric MH - Time Factors MH - Treatment Outcome MH - Tumor Necrosis Factor-alpha/administration & dosage/*antagonists & inhibitors MH - Young Adult OTO - NOTNLM OT - Crohn's disease OT - anti-TNFs OT - thiopurines EDAT- 2015/11/02 06:00 MHDA- 2016/09/28 06:00 CRDT- 2015/11/02 06:00 PHST- 2015/07/02 00:00 [received] PHST- 2015/10/08 00:00 [accepted] PHST- 2015/11/02 06:00 [entrez] PHST- 2015/11/02 06:00 [pubmed] PHST- 2016/09/28 06:00 [medline] AID - jjv187 [pii] AID - 10.1093/ecco-jcc/jjv187 [doi] PST - ppublish SO - J Crohns Colitis. 2016 Jan;10(1):55-60. doi: 10.1093/ecco-jcc/jjv187. Epub 2015 Oct 31.