Disease Activity Patterns of Crohn's Disease in the FirstTen Years After Diagnosis in the Population-based IBD South Limburg Cohort

Background and Aims: Real-life data on long-term disease activity in Crohn's disease [CD] are scarce. Most studies describe disease course by using proxies, such as drug exposure, need for surgery or hospitalisations, and disease progression. We aimed to describe disease course by long-term disease activity and to identify distinctive disease activity patterns in the population-based IBD South Limburg cohort [IBDSL]. Methods: All CD patients in IBDSL with AO years follow-up [n = 432] were included. Disease activity was defined for each yearly quarter by mucosal inflammation on endoscopy or imaging, hospitalisation, surgery, or treatment adjustment for increased symptoms. Six distinct disease activity clusters were defined. Subsequently, the associations between clinical characteristics and the patterns were assessed using multivariable logistic regression models. Results: On average, patients experienced 5.44 (standard deviation [SD] 3.96) quarters of disease activity during the first 10 years after diagnosis. Notably, 28.2% of the patients were classified to a quiescent pattern [<= 2 active quarters in 10 years], and 89.8% of those never received immunomodulators nor biologics. Surgery at diagnosis (odds ratio [OR] 2.99; 95% confidence interval [CI] 1.07-8.34) and higher age [OR 1.03; 95% CI 1.01-1.06] were positively associated with the quiescent pattern, whereas inverse associations were observed for ileocolonic location [OR 0.44; 95% CI 0.19-1.00], smoking [OR 0.43; 95% CI 0.24-0.76] and need for steroids <6 months [OR 0.24; 95% CI 0.11-0.52]. Conclusions: Considering long-term disease activity, 28.2% of CD patients were classified to a quiescent cluster. Given the complex risk-benefit balance of immunosuppressive findings underline the importance of identifying better predictive markers to prevent both overtreatment and under-treatment.

Automated summary

This study examined long-term disease activity in Crohn's disease patients and found that 28.2% were classified as having a quiescent disease course. Factors positively associated with quiescent patterns included surgery at diagnosis and older age, while factors negatively associated included ileocolonic location, smoking, and short-term steroid use. The findings highlight the need for better predictive markers to prevent over or under-treatment in CD patients.