Background Representative studies concerning the long-term prognosis and disease course in Crohn’s disease (CD) primarily describe steroid exposure, need for surgery or hospitalisations, and disease progression as characteristics of an unfavourable outcome. Real-life data on long-term disease activity are lacking. We aimed to define clusters with different disease activity patterns in the population-based IBDSL cohort. Methods All CD patients from the IBDSL cohort with at least 10 years follow-up (>18 years, diagnosed between 1991 and 2004) were included. Data on demographics, disease phenotype, medication use, hospitalisations, and surgery were available. In addition, all endoscopy and imaging reports were scrutinised. Since diagnosis, active disease was defined for each yearly quarter by (i) active disease on endoscopy or imaging, (ii) hospitalisation, (iii) surgery, or (iv) treatment adjustment for increased symptoms. Subsequently, formula-based clusters were generated based on four previously published questionnaire-based disease activity patterns,1 completed with two additional clusters (Figure 1). Prediction models were created using discriminant analysis with PLS regression based on characteristics at baseline and 6 months after diagnosis. Results In total, 432 patients were included. During 10 years follow-up after diagnosis, patients experienced 4.2 (SD 3.8) quarters of active disease on average. The distribution of patients over different clusters is shown in Figure 1. Notably, 128 patients (29.6%) were classified as quiescent and, of these, 89.8% never received immunomodulators or biologics. Ileocolonic disease location (OR 0.45; 95% CI 0.21–0.91) and smoking at diagnosis (OR 0.44; 95% CI 0.26–0.70) were negatively associated with a quiescent disease course, while surgery at diagnosis (OR 3.02; 95% CI 1.39–6.64) was positively associated. Our best prediction model for a quiescent course had an area under the ROC curve of 0.72 (p < 0.001) at baseline and 0.75 (p < 0.001) at 6 months after diagnosis.
|Journal||Journal of Crohn's and Colitis|
|Issue number||supplement 1|
|Publication status||Published - 16 Jan 2018|
|Event||13th Congress of ECCO – European Crohn’s and Colitis Organisation (2018) - Vienna, Austria|
Duration: 14 Feb 2018 → 17 Feb 2018