P0784 Independent association between baseline simple endoscopic score for Crohn’s disease and C-reactive protein with Crohn’s disease-related complications: An analysis of the Randomized Evaluation of an Algorithm for Crohn’s Treatment – Study 2 (RE

Background

Endoscopic improvement in the validated Simple Endoscopic Score for Crohn’s disease (SES-CD) is associated with better long-term outcomes in CD; however, a relationship with CD-related complications is not clear. Elevated biomarkers, such as C-reactive protein (CRP) also are associated with adverse long-term outcomes. We assessed the relationship between baseline (BL) SES-CD score, elevated CRP, and CD-related complications and identified the threshold for SES-CD score associated with an increased risk of complications.

Methods

Pooled data from REACT2 (NCT01698307) was analysed. SES-CD at BL was categorized as inactive disease (0–2), mild (3–6), moderate (7–16) and severe disease (>16). Elevated BL CRP was defined as >5mg/L. CD-related complications (ie, hospitalisation, surgery, medications-related, and non-surgical CD events) were assessed from BL through 24 months. Exposure-adjusted incidence (EAI) of CD-related complications was analysed as incidence rates. Adjusted analyses compared time to the first occurrence of CD-related complication, with Cox proportional hazard regression used to adjust for clustering effects and key patient characteristics. The BL SES-CD threshold that was associated with complications was determined using receiver operating curve (ROC) approach.

Results

Of 502 patients (pts) reporting BL SES-CD, 21.9% had inactive disease, 32.7% had mild disease and 45.4% had moderate-to-severe disease. A greater proportion of pts in the moderate-to-severe group (50.0%) had ≥1 CD-related complication vs those with inactive disease (32.0%; P=.0004). More pts with moderate-to-severe disease (20.6%) had CD-related hospitalizations vs those with inactive disease (5.8%; P=.0002). The EAI rate of CD-related complications was higher with moderate-to-severe vs inactive disease (0.4347 vs 0.2239; P=.0003). The adjusted risk of CD-related complications was higher in moderate-to-severe SES-CD vs inactive disease (HR=1.72; P=.0058). The ROC approach suggested SES-CD ≥7 was associated with CD-related complications.

The proportion of pts with ≥1 CD-related complication was higher in those with elevated CRP at BL (48.6%) vs not (34.6%; P<.0001). Similar trends were observed for CD-related hospitalization. The adjusted risk of CD -related complications was higher among pts with elevated CRP vs not (HR=1.48; P=.0016); results were similar for CD-related hospitalizations (HR=1.75; P=.0013).

Conclusion

Elevated SES-CD and CRP are independently associated with a higher risk of complications in pts with CD. These findings point to the importance of controlling mucosal healing and inflammation to reduce risk of complications.