A Real-World Prospective Cohort Study of Patients With Newly Diagnosed Crohn's Disease Treated by a Multidisciplinary Team: 1-Year Outcomes

Henit Yanai; Tali Sharar Fischler; Idan Goren; Hagar Eran-Banai; Jacob E Ollech; Yifat Snir; Yelena Broitman; Revital Barkan; Tamar Pfeffer-Gik; Lihi Godny; Yelena Kutokov; Adi Friedeberg; Maor H Pauker; Keren Masha Rabinowitz; Irit Avni-Biron; Iris Dotan

doi:10.1093/crocol/otad064

A Real-World Prospective Cohort Study of Patients With Newly Diagnosed Crohn's Disease Treated by a Multidisciplinary Team: 1-Year Outcomes

Crohns Colitis 360. 2023 Oct 18;5(4):otad064. doi: 10.1093/crocol/otad064. eCollection 2023 Oct.

Authors

Henit Yanai^{1

2}, Tali Sharar Fischler^{1

2}, Idan Goren^{1

2

3}, Hagar Eran-Banai^{1

2}, Jacob E Ollech^{1

2}, Yifat Snir^{1

2}, Yelena Broitman^{1

2}, Revital Barkan^{1

2}, Tamar Pfeffer-Gik^{1

2}, Lihi Godny^{1

2}, Yelena Kutokov^{1

2}, Adi Friedeberg^{1

2}, Maor H Pauker^{1

2}, Keren Masha Rabinowitz^{1

2

4}, Irit Avni-Biron^{1

2}, Iris Dotan^{1

2}

Affiliations

¹ IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
² Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Felsenstein Medical Research Center, Faculty of Medicine, Tel Aviv, Israel.

Abstract

Background: Real-world data on outcomes of patients with newly diagnosed Crohn's disease (ndCD) is limited. We aimed to assess the achievement of corticosteroid-free clinical remission (CS-free CR) and other therapeutic targets 1 year after diagnosis in a cohort of patients with ndCD treated by a multidisciplinary team (MDT).

Methods: A prospective observational cohort study was conducted on consecutive treatment-naïve adults with ndCD. Patients received management at the treating physician's discretion, along with a tailored nutritional plan provided by an inflammatory bowel disease (IBD)-oriented dietitian. Patients were guided and educated by an IBD nurse, with flexible communication access to the IBD team. Therapeutic targets were assessed at 1 year. Multivariable logistic regression was used to evaluate predictors of CS-free CR.

Results: Seventy-six patients (50% female) with a median age of 27 (22-39) years were eligible. Over 75% of patients were assessed by IBD-oriented dietitians and the IBD nurse. Within a median of 4.3 (2.5-6.7) months from diagnosis 60.5% initiated biologics (96% anti- tumor necrosis factor). Dietary intervention was applied to 77.6% of the cohort, either monotherapy (33.9%) or add-on (66.1%). At 1 year, 64.5% of patients achieved sustained CS-free CR, 56.6% biochemical remission, 55.8% endoscopic response, 44.2% endoscopic remission, 30.8% deep remission, and in 39.5% there was an improvement in health-related quality of life (HRQoL). Predictors for CS-free CR were uncomplicated phenotype (B1/P0), lower body mass index, and lower patient-reported outcome 2 scores at diagnosis.

Conclusions: In a real-world setting at a tertiary medical center, a cohort of ndCD patients treated by an MDT resulted in favorable 1-year outcomes. Over 60% achieved CS-free CR, along with significant improvements in biomarkers and HRQoL.

Keywords: Crohn’s disease; multidisciplinary team; real world; therapeutic targets.