炎症性腸疾患と障害のジャーナル

Therapeutic Decisions Often Cannot be Maintained for One Year in Crohn's Disease Patients

Abstract

Lamprecht G, Reichel C, Heitmann L, Li Y, Brinkmann B, Holle A, Schäffler H, Huth A, Hauenstein K and Klar G

Objective: In Crohn's disease (CD) major therapeutic decisions are triggered by failure of medical therapy or by a flare and are based on various diagnostic modalities, the prior clinical course and the patient’s perception. We analyzed, whether under real world conditions a therapeutic decision can be maintained over 12 months or needs to be adjusted in this time.
Methods: In 50 patients diffusion-weighted magnetic resonance imaging (DW MRI) studies were used as an indicator for the need to make a therapeutic decision. Decisions were based on the prior clinical course, endoscopy, ultrasound, DW MRI and the patient’s perception of the situation and were categorized as surgery (A), no change (B) or intensification of medical therapy (C). The clinical course was analyzed using CDAI and CRP at 3, 6 and 12 months follow up.
Results: 33 of 50 patients had a failure of medical therapy and 17 of 50 had a flare in absence of medical therapy. The median disease duration was 8 years. Group A: In 13 patients surgery for fibro-stenosis or a penetrating complication induced remission lasting for 12 months. Group B: In 17 cases medical therapy initially was kept unchanged. As a group they had a wide range of CDAI values. During 1 year 3 of 17 went on to intensified medication, and 5 of 17 were operated, eventually leading to clinical response or remission. Group C: 20 patients changed to intensified medication, 3 of these 20 were later operated. In group C CDAI improvement lasted longer in those with a disease duration ≤ 5 years.
Conclusion: In CD therapeutic decisions often cannot be maintained but need to be adjusted even during 1 year. The likelihood to err is highest if the initial decision is to leave the existing medical therapy unchanged.