Revés Joana, Mascarenhas André, José Temido Maria, Morão Bárbara, Neto Nascimento Catarina, Rita Franco Ana, Mendes Raquel R, Palmela Carolina, Chagas Cristina, Figueiredo Pedro Narra, Glória Luísa, Portela Francisco, Torres Joana
Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal.
Gastroenterology Division, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
J Crohns Colitis. 2023 Nov 24;17(11):1752-1760. doi: 10.1093/ecco-jcc/jjad089.
Early biologic therapy within the first 18-24 months after diagnosis is associated with improved clinical outcomes in Crohn's disease [CD]. However, the definition of the best time to initiate biologic therapy remains unclear. We aimed to assess if there is an optimal timing for early biologic therapy initiation.
This was a multicentre retrospective cohort study including newly diagnosed CD patients who started anti-tumour necrosis factor [TNF] therapy within 24 months from diagnosis. The timing of initiation of biologic therapy was categorised as ≤6, 7-12, 13-18, and 19-24 months. The primary outcome was CD-related complications defined as a composite of progression of Montreal disease behaviour, CD-related hospitalisations, or CD-related intestinal surgeries. Secondary outcomes included clinical, laboratory, endoscopic, and transmural remission.
We included 141 patients where 54%, 26%, 11%, and 9% started biologic therapy at ≤6, 7-12, 13-18, and 19-24 months after diagnosis, respectively. A total of 34 patients [24%] reached the primary outcome: 8% had progression of disease behaviour, 15% were hospitalised, and 9% required surgery. There was no difference in the time to a CD-related complication according to the time of initiation of biologic therapy within the first 24 months. Clinical, endoscopic, and transmural remission was achieved in 85%, 50%, and 29%, respectively, but no differences were found according to the time of initiation of biologic therapy.
Starting anti-TNF therapy within the first 24 months after diagnosis was associated with a low rate of CD-related complications and high rates of clinical and endoscopic remission, although we found no differences with earlier initiation within this window of opportunity.
在克罗恩病（CD）诊断后的18 - 24个月内尽早进行生物治疗与改善临床结局相关。然而，启动生物治疗的最佳时间定义仍不明确。我们旨在评估早期生物治疗启动是否存在最佳时机。
这是一项多中心回顾性队列研究，纳入了新诊断的CD患者，这些患者在诊断后24个月内开始接受抗肿瘤坏死因子（TNF）治疗。生物治疗启动时间分为≤6个月、7 - 12个月、13 - 18个月和19 - 24个月。主要结局是CD相关并发症，定义为蒙特利尔疾病行为进展、CD相关住院或CD相关肠道手术的综合情况。次要结局包括临床、实验室、内镜和透壁缓解。
我们纳入了141例患者，分别有54%、26%、11%和9%的患者在诊断后≤6个月、7 - 12个月、13 - 18个月和19 - 24个月开始生物治疗。共有34例患者（24%）达到主要结局：8%有疾病行为进展，15%住院，9%需要手术。在前24个月内，根据生物治疗启动时间，发生CD相关并发症的时间没有差异。临床、内镜和透壁缓解分别达到85%、50%和29%，但根据生物治疗启动时间未发现差异。
诊断后24个月内开始抗TNF治疗与低CD相关并发症发生率以及高临床和内镜缓解率相关，尽管我们发现在这个机会窗口内更早启动没有差异。
