Ileal Predominance in Crohn’s Disease Is Associated with Increased Intestinal Surgery and Biological Therapy Use, with Lower Treatment Persistence

Background and aims: Crohn's disease (CD) varies by location, potentially affecting therapy efficacy and surgery risk, though research on this topic is conflicting. This study aims to investigate the independent association between CD location and therapeutic patterns. Methods: We analyzed pati...

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Published in:	The American journal of gastroenterology
Main Authors:	Giordano, Antonio, Pérez-Martínez, Isabel, Gisbert, Javier P, Ricart, Elena, Martín-Arranz, María Dolores, Mesonero, Francisco, De Castro Parga, María Luisa, Rivero, Montserrat, Iglesias, Eva, Fernández-Prada, Samuel, Calafat, Margalida, Arroyo Villarino, María Teresa, Ángel de Jorge Turrión, Miguel, Hernandez-Camba, Alejandro, Lidón, Raquel Vicente, Carpio, Daniel, Brunet, Eduard, Moranta, Francisco Rodríguez, García, Lara Arias, Cuquerella, Joan Tosca, Bermejo, Fernando, Madero, Lucía, Esteve, Maria, González-Muñoza, Carlos, Martínez-Montiel, Pilar, Huguet, Jose M, Pérez Calle, Jose Lázaro, Rodríguez-Lago, Iago, Ausín, Mónica Sierra, Lorente Poyatos, Rufo H, García-Bosch, Orlando, Marín, Gerard Surís, Taxonera, Carlos, Ponferrada-Diaz, Ángel, Acosta, Manuel Barreiro-de, Bujanda, Luis, Serra, Rosa Blat, Ramos, Laura, Vera, Isabel, Abizanda, Eva Sesé, Piqueras, Marta, Gómez, Cristina Sánchez, García-Sepulcre, Mariana Fe, Arregui, Miren Vicuña, Murillo, Nuria Rull, LLaó, Jordina, Lucendo, Alfredo J, Marín-Jiménez, Ignacio, Camps-Aler, Blau, Villafranca, Carmen Muñoz, Ceballos, Daniel, Ver, Yolanda, Fernández-Salazar, Luis Ignacio, Alcaín, Guillermo, Valldosera, Gemma, Andrés, Pilar Robledo, Martínez-Flores, Carlos, Coronel, Ana Fuentes, Ginard, Daniel, García, Laura, Gómez, Isabel Blázquez, Argüelles-Arias, Federico, Miyashiro, Eduardo Iyo, De la Piscina, Patricia Ramírez, Villalba, Luís Hernández, Notari, Pedro Almela, de Jesús Martínez-Pérez, Teresa, Fernández, Hipólito, Gilabert, Pau, Rosas, Concepción Muñóz, Nos, Pilar, Gil, Jesús Legido, Navas López, Víctor Manuel, Muñoz, Fernando, Diz-Lois Palomares, María Teresa, Lucio, Ana Santos, Merino, Olga, Nicolás de Prado, Isabel, Leal, Carles, Martín de Carpi, Javier, Sánchez, Lidia Buendía, Arce, Nuria Maroto, Frago, Santiago, Mateu, Belén Botella, Domènech, Eugeni, Planella, Esther Garcia
Format:	Journal Article
Language:	English
Published:	14-11-2024
Online Access:	Get full text
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Summary:	Background and aims: Crohn's disease (CD) varies by location, potentially affecting therapy efficacy and surgery risk, though research on this topic is conflicting. This study aims to investigate the independent association between CD location and therapeutic patterns. Methods: We analyzed patients with CD diagnosed from January 2005 to May 2023 registered in the nationwide ENEIDA registry. A univariate Cox regression analysis assessed the association of disease location with biologic use and persistence (with treatment discontinuation as a failure event), as well as the use of intestinal resections. A multivariate model was constructed to evaluate the independent association of disease location with therapeutic patterns, controlling for potential confounders such as sex, age at inclusion and diagnosis, disease duration and behavior, prior surgery or biological therapy, extraintestinal manifestations, and perianal disease. Results: The study included 17,292 patients with a median follow-up period of six years (IQR 2-10 years). Ileocolonic location was associated with a higher biologic use than colonic location (HR 1.30, 95% CI 1.22-1.38) and ileal disease (HR 1.21, 95% CI 1.16-1.27), independently predicting biologic use (p<0.001). Ileal location was associated with a lower biologic persistence than ileocolonic location (HR 1.14, 95% CI 1.07-1.21) and colonic disease (HR 1.10, 95% CI 1.01-1.20), independently predicting biologic persistence (p=0.019). Ileal disease was associated with a higher likelihood of intestinal resections than colonic (HR 2.82, 95% CI 2.45-3.25) and ileocolonic location (HR 1.13, 95% CI 1.05-1.22), independently predicting the use of surgery (p<0.001). Conclusions: CD location with ileal predominance is associated with a distinct therapeutic pattern, including higher biologic use, lower treatment persistence, and increased rates of intestinal resections.
ISSN:	0002-9270 1572-0241
DOI:	10.14309/ajg.0000000000003207