Remission in patients with Crohn's disease is associated with improvement in employment and quality of life and a decrease in hospitalizations and surgeries
Remission in patients with Crohn's disease is associated with improvement in employment and quality of life and a decrease in hospitalizations and surgeries
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DOI：
10.1046/j.1572-0241.2003.04010.x
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发表时间：
2004-01-01
影响因子：
9.8
通讯作者：
Hanauer, S
中科院分区：
文献类型：
--
作者：
Lichtenstein, GR;Yan, SK;Hanauer, S
目标：住院、手术、工作损失和生活质量受损增加了克罗恩病患者的护理成本和负担。我们在一项临床试验中研究了缓解对患者就业、生活质量、住院和手术的影响，以验证克罗恩病活动指数 (CDAI) 所定义的临床缓解作为控制克罗恩病的关键治疗目标。方法：ACCENT I 在 573 名中度至重度活动性活动患者中评估了长期服用英夫利昔单抗与单剂量英夫利昔单抗的疗效和安全性。克罗恩病。在第 54 周，比较 CDAI 缓解患者和未 CDAI 缓解患者（基线时未就业的患者）的就业状况。 SF-36 问卷的身体成分总结（PCS）和心理成分总结（MCS）分数也在两组之间进行了比较。研究期间，CDAI 缓解时间分别为 0-25%、25-50%、50-75% 和 75-100% 的四组患者对克罗恩病相关的住院和手术次数进行了比较。 结果：基线时，患者的生活质量严重受损，失业率很高（38.4%）。在基线时失业的患者组中，第 54 周达到 CDAI 缓解 (CDAI < 150) 的患者中有 31% 就业，而第 54 周未达到 CDAI 缓解的患者中有 16% (p < 0.05)。第 54 周 CDAI 缓解的患者的 PCS 和 MCS 评分显着高于第 54 周 CDAI 缓解的患者 (p < 0.0001)，表明其心理和身体功能更好，并且与美国一般人群相似。随着患者 CDAI 缓解时间百分比的增加，住院率和手术率下降（分别为 p < 0.01 和 p < 0.05）。 结论：CDAI 缓解与住院和手术减少、就业增加和生活质量正常化相关。持续 CDAI 缓解应该是控制克罗恩病的关键治疗目标。
OBJECTIVES: Hospitalization, surgery, work loss, and impaired quality of life contribute to the cost and burden of care for patients with Crohn's disease. We examined the impact of remission on patients' employment, quality of life, and hospitalization and surgery in a clinical trial to validate clinical remission, as defined by the Crohn's disease activity index (CDAI), as the key treatment goal in managing Crohn's disease.METHODS: ACCENT I evaluated the efficacy and safety of long-term dosing of infliximab compared to a single dose of infliximab in 573 patients with moderately-to-severely active Crohn's disease. At wk 54, employment status was compared between patients in CDAI remission and those not in CDAI remission, for those not employed at baseline. Physical component summary (PCS) and mental component summary (MCS) scores of the SF-36 questionnaire were also compared between these two groups. The numbers of Crohn's-related hospitalizations and surgeries were compared among four groups of patients who spent 0-25%, 25-50%, 50-75%, and 75-100% of time, respectively, in CDAI remission during the study.RESULTS: At baseline, patients had a severely impaired quality of life and a high unemployment rate (38.4%). Among the group of patients who were unemployed at baseline, 31% of those patients who achieved CDAI remission (CDAI < 150) at wk 54 were employed, compared to 16% who were not in CDAI remission at wk 54 (p < 0.05). PCS and MCS scores of patients in CDAI remission at wk 54 were significantly higher (p < 0.0001), indicating better mental and physical functioning, than those of patients not in CDAI remission at wk 54, and were similar to those of the general U.S. population. Hospitalization and surgery rates decreased as the percentage of time patients were in CDAI remission increased (p < 0.01 and p < 0.05, respectively).CONCLUSIONS: CDAI remission is associated with reduced hospitalizations and surgeries, increased employment, and normalized quality of life. Sustained CDAI remission should be the key therapeutic goal in managing Crohn's disease.