Change in clinical features of Korean Crohn's Disease patients following the introduction of an anti-TNF-alpha agent: Results from the CONNECT study

Abstract

Background: Background: Anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents have been known to alter the natural course of Crohn's disease (CD). Therefore, we aimed to compare the changes in clinical features and disease course according to the time of introduction of an anti-TNF-alpha agent in Korea. Methods: Methods: We performed a retrospective analysis of 1,382 Korean CD patients diagnosed between 1982 and 2008 who were enrolled in the retrospective cohort of the CrOhn's disease cliNical NEtwork and CohorT (CONNECT) study. The anti-TNF-alpha agent was applied to national medical insurance in 2005, and has been more widely used in Korea since 2007. Accordingly, the patients were divided into three groups [Group A (1981-2004): 656 patients; Group B (2005-2006): 282 patients; and Group C (2007-2008): 362 patients]. Results: The average age (p = 0.251), disease location (p = 0.941), and disease behavior (p = 0.813) at the time of diagnosis with CD were not different among the three groups. The anti-TNFalpha agent was administered to a total of 31.0% of patients (n = 403), which was not different among groups (p = 0.124). However, the 3- and 5-year cumulative probabilities for administering an anti-TNF-alpha agent were significantly higher in group C (p < 0.001). The 3- and 5-year cumulative probabilities of the occurrence of perianal fistula and CD-related surgery were higher in group A than in group C (perianal fistula, p = 0.032; surgery, p = 0.003). Conclusions: Conclusions: After the introduction of the anti-TNFalpha agent to the treatment of Korean CD patients, the natural history of CD changed. We found that early administration of an anti-TNF-alpha agent may help delay the occurrence of perianal fistula and the need for surgery in Korean CD patients.