부산대학교 도서관

Background The impact of combination therapy on disease-related morbidity in patients with established Crohn's disease ( CD) or ulcerative colitis ( UC) remains to be well-defined. Aim To examine the effect of combination therapy on disease outcomes in CD and UC. Methods Using a multicenter prospective cohort, we classified CD and UC patients as being on monotherapy with anti- TNF or on combination with an immunomodulator. The primary outcome was a composite of new IBD-related surgery, hospitalisations, penetrating complications, need for corticosteroids or new biological at 1 year. Multivariable regression models adjusted for potential confounders. Results We included 707 patients with CD (45% combination therapy) and 164 with UC (38% combination therapy). Combination therapy was not associated with reduction in the composite outcome in either CD ( OR: 0.87, 95% CI: 0.63-1.22) or UC ( OR: 1.45, 95% CI: 0.63-3.38). However, while no difference was noted in those with nonstricturing, nonpenetrating CD, a significant reduction in the likelihood of the outcome was seen in those with stricturing or penetrating CD (30% vs 39%, OR: 0.58, 95% CI: 0.37-0.90). A stronger effect was also observed in those with disease duration <5 years ( OR: 0.35, 95% CI: 0.14-0.87) compared to those with a longer duration ( OR: 0.75, 95% CI: 0.45-1.27). A similar reduction in occurrence of composite outcome was noted with infliximab and with other anti- TNF biologics. Conclusion The benefit of combination immunomodulator-biological therapy is stronger in those with complicated Crohn's disease, particularly early on in their disease course. [ABSTRACT FROM AUTHOR]