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KMID : 1188320220160060907
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Gut and Liver
2022 Volume.16 No. 6 p.907 ~ p.920
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Clinical Features and Long-term Prognosis of Crohn's Disease in Korea: Results from the Prospective CONNECT Study
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Hong Seung-Wook
Ye Byong-Duk
Cheon Jae-Hee
Lee Ji-Hyun
Koo Ja-Seol
Jang Byung-Ik
Lee Kang-Moon
Kim You-Sun
Kim Tae-Oh
Im Jong-Pil
Song Geun-Am
Jung Sung-Ae
Kim Hyun-Soo
Park Dong-Il
Kim Hyun-Soo
Huh Kyu-Chan
Kim Young-Ho
Cha Jae-Myung
Seo Geom-Seog
Choi Chang-Hwan
Song Hyun-Joo
Baik Gwang-Ho
Kim Ji-Won
Shin Sung-Jae
Park Young-Sook
Lee Chang-Kyun
Lee Jun
Jung Sung-Hee
Jung Yun-Ho
Park Sung-Chul
Joo Young-Eun
Jeen Yoon-Tae
Han Dong-Soo
Yang Suk-Kyun
Kim Hyo-Jong
Kim Won-Ho
Kim Joo-Sung
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Abstract
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Background/aims: The prospective Crohn's Disease Clinical Network and Cohort Study is a nationwide multicenter cohort study of patients with Crohn's disease (CD) in Korea, aiming to prospectively investigate the clinical features and long-term prognosis associated with CD.
Methods: Patients diagnosed with CD between January 2009 and September 2019 were prospectively enrolled. They were divided into two cohorts according to the year of diagnosis: cohort 1 (diagnosed between 2009 and 2011) versus cohort 2 (between 2012 and 2019).
Results: A total of 1,175 patients were included, and the median follow-up duration was 68 months (interquartile range, 39.0 to 91.0 months). The treatment-free durations for thiopurines (p<0.001) and anti-tumor necrosis factor agents (p=0.018) of cohort 2 were shorter than those of cohort 1. Among 887 patients with B1 behavior at diagnosis, 149 patients (16.8%) progressed to either B2 or B3 behavior during follow-up. Early use of thiopurine was associated with a reduced risk of behavioral progression (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.50 to 0.90), and family history of inflammatory bowel disease was associated with an increased risk of behavioral progression (aHR, 2.29; 95% CI, 1.16 to 4.50). One hundred forty-one patients (12.0%) underwent intestinal resection, and the intestinal resection-free survival time was significantly longer in cohort 2 than in cohort 1 (p=0.003). The early use of thiopurines (aHR, 0.35; 95% CI, 0.23 to 0.51) was independently associated with a reduced risk of intestinal resection.
Conclusions: The prognosis of CD in Korea appears to have improved over time, as evidenced by the decreasing intestinal resection rate. Early use of thiopurines was associated with an improved prognosis represented by a reduced risk of intestinal resection.
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KEYWORD
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Cohort studies, Crohn disease, Korea, Multicenter study, Prognosis.
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