P369 Do teenager and adult onset Crohn′s disease patients have different outcomes? A Portuguese cohort study

Abstract

Background Crohn’s disease (CD) is a chronic illness that, according to the age of onset, has disease heterogeneity. Comparing with CD adult-onset (AO), the teenager-onset (TO) may lead to a deeper health impact: late pubertal development and psychosocial problems. There is paucity of data comparing TO with AO in the biologics era. The aim of this single center study was to compare disease characteristics, the use rate and predictive risk factors at diagnosis for CD biologic therapy (anti-TNF) and the rate of CD related surgery Methods Observational study designed as an analysis of a historical cohort: 298 CD patients followed up to 21 years (2000-2021), 49 TO (<20 years-old) and 249 AO (≥20 years-old). Median follow-up was 9 years in TO and 10 years in AO cohort (p=0.792). The data collected included sex, and at diagnosis, age, smoking habits, CD location, CD behaviour, presence of perianal disease and extra intestinal manifestations. The independent effect of significant variables (p<0.05) was assessed using multivariate logistics regression analysis. The cumulative use rate of biologic therapy and CD related surgery were estimated using Kaplan-Meier plots. Results The TO cohort comprised 49 (16.4%) and the AO 249 (83.6%) CD patients. Upper digestive tract involvement and inflammatory behaviour at diagnosis were significantly higher in the TO cohort (p<0.001). Biologic therapy rate was significantly higher in TO than in AO (63.3% vs 43.8%, OR=2.21(95%CI:1.17-4.15), although the time span from diagnosis to the fist biologic use is independent of group (Log-Rank(Mantel-Cox);p=0.812). On multivariate analysis, predictive risk factors at diagnosis for biologic therapy in AO cohort were non-inflammatory phenotype, OR=2.75(95%CI:1.58-4.81), steroid therapy, OR=3.64(95%CI:2.05-6.47) and perianal disease, OR=14.49(95%CI:5.50-38.17); no significant predictive risk factors were identified in the TO cohort. Regarding CD related surgery, there was no significant different rates between the two age groups (18.4% in teens vs 26.1% in adults, OR=0.66(95%CI:0.31-1.45); p=0.300) and the time span from diagnosis to surgery was also independent of group (Log Rank(Mantel-Cox);p=0.204). Conclusion Compared with AO, TO CD has different characteristics and, «per se», is a higher risk for biologics drugs treatment. However, TO CD is not associated with higher risk of surgery.