Introduction Identification of Crohn’s disease (CD) patients who require early biological and immunosuppressive therapy is essential to target therapy appropriately (1). Clinical predictors of disabling behaviour may point towards early aggressive medical therapy but some of these may not be apparent at diagnosis. Mesenteric fat index (MFI) has been previously shown to predict a complicated disease course in CD (2). In this study, we examined the utility of MFI and other clinical factors in predicting the need for biological and immunosuppressive therapy in CD.
Method In this retrospective single centre study, we identified therapy naïve CD patients who underwent cross sectional imaging at diagnosis at the Royal Liverpool University Hospital between 2005 and 2015. MFI was calculated using previously described methods. Clinical details and need for biological, immunosuppressive and combination therapy was abstracted from the case notes. A logistic regression model was used to examine the utility of clinical factors including MFI in predicting the need for immunosuppressive, biological and combination therapy.
Results A total of 81 patients were included in the study. In a multivariate model, steroids at diagnosis was associated with the need for subsequent immunosuppressive (Odds ratio, OR, 8.0, 95% CI 1.3–51, p=0.027), anti-TNF (OR 4.3, 95% CI, 1.2–16.5, p=0.029) and combination therapy (OR 3.8, 95% CI, 1.1–13.9, p=0.041). Deep ulcers on colonoscopy was associated with the need for subsequent anti-TNF therapy (OR 14.9, 95% CI, 1.1–209.2, p=0.045) but not immunosuppressive or combination therapy. MFI was not significantly associated with the need for subsequent immunosupression, biological or combination therapy.
Conclusion Steroids at diagnosis but not MFI predicted the need for subsequent immunosupressive, anti-TNF and combination therapy. Presence of deep ulceration at index colonoscopy was associated with the need for subsequent anti-TNF therapy. Clinicians should consider patients with these characteristics for early aggressive medical therapy.
. D’Haens G, Baert F, van Assche G, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet Lond Engl. 2008Feb 23;371(9613):660–7. doi: 10.1016/S0140-6736(08)60304-9
. Erhayiem B, Dhingsa R, Hawkey CJ, Subramanian V. Ratio of Visceral to Subcutaneous Fat Area Is a Biomarker of Complicated Crohn’s Disease. Clin Gastroenterol Hepatol. 2011Aug;9(8):684–7.e1. doi: 10.1016/j.cgh.2011.05.005
Disclosure of Interest None Declared
- Crohn’s disease
- mesenteric fat index