{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T08:52:13Z","timestamp":1765356733573,"version":"3.37.3"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,6,27]],"date-time":"2020-06-27T00:00:00Z","timestamp":1593216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We assessed whether differential efficacy of early combined immunosuppression (ECI) in comparison with conventional management (CM) is present in patients with Crohn disease (CD) according to disease location.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this posthoc analysis of the Randomized Evaluation of an Algorithm for Crohn\u2019s Treatment trial, the effect of ECI vs CM modified by disease location (isolated-colonic vs ileal-dominant) in terms of time to first complication (hospitalization, surgery, or disease-related complications\u2014presence of a new abscess, fistula, or stricture; serious worsening of disease activity; extraintestinal manifestations) was analyzed using a marginal Cox proportional hazard model to account for cluster randomization. Factors adjusted included practice size, country, and other covariates selected in a backward logistic regression analysis with the first composition as outcome and P &amp;lt; 0.10.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 1969 patients with CD, 435 had isolated colonic CD (ECI n = 257, CM n = 178) and 1534 had ileal CD (ECI n = 817, CM n = 717). Over 24 months there was a significant differential impact for ECI vs CM for reducing the risk of a CD-related complication between patients with colonic CD and ileal CD (colonic CD hazard ratio [HR] = 0.51; 95% CI, 0.30-0.85 vs ileal CD HR = 0.79; 95% CI, 0.57-1.10; P = 0.033). No difference was identified between ECI vs CM for reducing the risk of surgery (colonic HR = 0.52 vs ileal HR = 0.74; P = 0.468) or hospitalization (colonic HR = 0.77 vs ileal HR = 0.83; P = 0.806).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this posthoc analysis of the Randomized Evaluation of an Algorithm for Crohn\u2019s Treatment trial, symptom-based ECI was associated with greater efficacy for reducing the risk of CD-related complications in patients with colonic disease location relative to ileal disease location.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ibd\/izaa168","type":"journal-article","created":{"date-parts":[[2020,6,27]],"date-time":"2020-06-27T13:24:04Z","timestamp":1593264244000},"page":"639-646","source":"Crossref","is-referenced-by-count":5,"title":["Early Combined Immunosuppression May Be More Effective for Reducing Complications in Isolated Colonic- vs Ileal-Dominant Crohn Disease"],"prefix":"10.1093","volume":"27","author":[{"given":"Parambir S","family":"Dulai","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, University of California San Diego , La Jolla, California"},{"name":"Robarts Clinical Trials Inc , London, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vipul","family":"Jairath","sequence":"additional","affiliation":[{"name":"Robarts Clinical Trials Inc , London, Ontario , Canada"},{"name":"Department of Medicine, Division of Gastroenterology, University Hospital , Ontario , Canada"},{"name":"Department of Epidemiology and Biostatistics, Western University , London, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangyong","family":"Zou","sequence":"additional","affiliation":[{"name":"Robarts Clinical Trials Inc , London, Ontario , Canada"},{"name":"Department of Epidemiology and Biostatistics, Western University , London, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larry W","family":"Stitt","sequence":"additional","affiliation":[{"name":"Robarts Clinical Trials Inc , London, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reena","family":"Khanna","sequence":"additional","affiliation":[{"name":"Robarts Clinical Trials Inc , London, Ontario , Canada"},{"name":"Department of Medicine, Division of Gastroenterology, University Hospital , Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J","family":"Sandborn","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, University of California San Diego , La Jolla, California"},{"name":"Robarts Clinical Trials Inc , London, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian G","family":"Feagan","sequence":"additional","affiliation":[{"name":"Robarts Clinical Trials Inc , London, Ontario , Canada"},{"name":"Department of Medicine, Division of Gastroenterology, University Hospital , Ontario , Canada"},{"name":"Department of Epidemiology and Biostatistics, Western University , London, Ontario , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siddharth","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, University of California San Diego , La Jolla, California"},{"name":"Division of Biomedical Informatics, University of California San Diego , La Jolla, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,6,27]]},"reference":[{"key":"2022092519081649200_CIT0001","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1136\/gutjnl-2014-307126","article-title":"Systematic review: Monotherapy with antitumour necrosis factor \u03b1 agents versus combination therapy with an immunosuppressive for 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