Immunosuppressants are now used much earlier in the course of Crohn’s disease; however their effect on the natural history of the disease, especially on the need for surgery, is not known.
Dr Cosnes and colleagues from Paris, France undertook a study in order to assess the evolution of the need for surgery in Crohn’s disease during the last 25 years.
The researchers retrospectively reviewed a total of 2573 patient medical charts.
The research team assessed the use of immunosuppressants (azathioprine or methotrexate), the need for intestinal resection, and the occurrence of intestinal complications.
The researchers used Kaplan-Meier analysis in order to evaluate 5 consecutive cohorts of patients defined by the date of diagnosis of Crohn’s disease (1978–82; 1983–87; 1988–92; 1993–97; 1998–2002).
|Cumulative risk of developing a stricturing or a penetrating intestinal complication remained unchanged|
In 565 patients seen in the authors’ unit within the first 3 months after diagnosis, characteristics of Crohn’s disease at diagnosis was found to be no different from 1 cohort to another.
The research team calculated that the 5 year cumulative probability to receive immunosuppressants increased from 0 in the 1978–82 cohort to 0.13, 0.25, 0.25, and 0.56 in the 1983–87, 1988–92, 1993–97, and 1998–2002 cohorts, respectively.
Concomitantly, the researchers found that the cumulative risk of intestinal resection remained unchanged.
The cumulative risk of developing a stricturing or a penetrating intestinal complication also remained unchanged.
The authors noted that similar results were obtained in the 2008 patients seen during the same period who were referred to us more than three months after diagnosis.
Dr Cosnes concluded, "Although immunosuppressants have been used more frequently over the last 25 years, there was no significant decrease of the need for surgery, or of intestinal complications of Crohn’s disease."