The effect of maintenance therapy on Crohn’s disease clinical outcomes

Aim of investigation. To study the effect of maintenance therapy on clinical outcomes of Crohn’s disease (CD) in patients with inflammatory and complicated forms. Material and methods. Five-year prospective study of 210 patients with CD receiving maintenance therapy was carried out. Treatment response was estimated in real-life conditions according to the guidelines of European Crohn's and Colitis Organisation (ECCO). Treatment response and failure at different types of pharmaceutical treatment were estimated. Results. At mesalazine maintenance therapy in patients with inflammatory forms of CD there was no statistically significant demand in treatment enhancement for medium-term perspective (р=0,0088, OR=0,46, 95% CI=0,26-0,80). «The steroid-sparing effect» of immunosuppressors was observed generally in all patients with inflammatory form of disease, which provided reduction of steroid dependency rate by 17%. Repeated prescription of systemic steroids led to development ofsteroid-dependency in complicated forms more frequently (p=0,0083, OR=10,1, 95% CI=1,9-52,5). The long-term outcomes related to biological maintenance therapy demonstrate more frequent mucosal healing at inflammatory (p=0,0423, OR=3,3, 95%CI=1,2-9,4), though not for complicated forms of disease. Conclusions. Mesalazine maintenance therapy is possible only at patients with the inflammatory form of CD without systemic activity under close follow-up by physician. In order to avoid disease progression it is necessary to avoid repeated application of systemic steroids at uncomplicated forms of disease. In complicated cases the combination of systemic steroids and immunosuppressants is ineffective. Biological therapy should be considered as disease-modifying treatment in patients with inflammatory forms of CD. The decision on pharmaceutical treatment of patients with complications should be made by gastroenterologists in consort with surgeons-coloproctologists.