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Fróes RDSB, Andrade AR, Faria MAG, de Souza HSP, Parra RS, Zaltman C, Dos Santos CHM, Bafutto M, Quaresma AB, Santana GO, Luporini RL, de Lima Junior SF, Miszputen SJ, de Souza MM, Herrerias GSP, Junior RLK, do Nascimento CR, Féres O, de Barros JR, Sassaki LY, Saad-Hossne R. Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB. Sci Rep 2024; 14:4314. [PMID: 38383742 PMCID: PMC10881489 DOI: 10.1038/s41598-024-54332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn's Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.
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Affiliation(s)
| | | | | | - Heitor Siffert Pereira de Souza
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cyrla Zaltman
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Bafutto
- Department of Gastroenterology, Instituto Goiano de Gastroenterologia, Goiânia, Goiás, Brazil
| | - Abel Botelho Quaresma
- Universidade do Oeste de Santa Catarina - UNOESC - Department of Health Sciences, Joaçaba, Santa Catarina, Brazil
| | | | - Rafael Luís Luporini
- Department of Medicine, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | | | | | | | - Giedre Soares Prates Herrerias
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | | | | | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaqueline Ribeiro de Barros
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil.
| | - Rogerio Saad-Hossne
- Department of Surgery, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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Gonczi L, Lakatos L, Kurti Z, Golovics PA, Pandur T, David G, Erdelyi Z, Szita I, Lakatos PL. Incidence, Prevalence, Disease Course, and Treatment Strategy of Crohn's Disease Patients from the Veszprem Cohort, Western Hungary: A Population-based Inception Cohort Study Between 2007 and 2018. J Crohns Colitis 2023; 17:240-248. [PMID: 36087109 DOI: 10.1093/ecco-jcc/jjac132] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The number of prospective population-based studies on Crohn's disease[CD] is still limited from Eastern Europe. The present study is a continuation of the Veszprem IBD cohort. Our aim was to analyse incidence, prevalence, disease phenotype, treatment strategy, disease course, and surgical outcomes in a prospective population-based inception cohort including CD patients diagnosed between 2007 and 2018. METHODS A total of 421 consecutive inception patients were included [male/female:237/184; mean age at diagnosis: 33.3 ± 16.2years]. Both in-hospital and outpatient records were collected and comprehensively reviewed. Demographic data were derived from the Hungarian Central Statistical Office. RESULTS Mean incidence rate was 9.9 [95% CI: 9.0-10.9]/105 person-years in this 12-year period. Prevalence rate was 236.8 [95% CI: 220.8-252.8] in 2015; 17.6% and 20.0% of the patients had stenosing[B2] and penetrating[B3] disease behavior at diagnosis,respectively. The probability of disease behaviour progression from luminal to B2/B3 phenotype was 14.7% (standard error [SE]: 2.2) at 5 years after diagnosis. Distribution of maximal therapeutic steps during the total follow-up (8.5 years [8.5y], standard deviation [SD]: 3.3) was 5-aminosalicylic acid [5-ASA] in 15.7%, corticosteroids in 14.3%, immunosuppressives in 42.5%, and biologic therapy in 26.2%. The probability of receiving biologictherapy after diagnosis was 20.9% [SE: 2.0] at 5 years. The probability of first resective surgery was 20.7% [SE: 2.0] at 1 year, 26.1% [SE: 2.2] at 5 years, and 30.7% [SE: 2.4] at 10 years. The perianal surgery rate was 31.3% among patients with perianal involvement. CONCLUSIONS The incidence of CD in Hungary was high, similar to high-incidence areas in Western Europe. Treatment strategies are reflecting the biologic era. Disease behaviour progression was lower, as well as long-term [10y] surgery rates decreasing compared with data from previous decades.
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Affiliation(s)
- Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Kurti
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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Pugliese D, Onali S, Privitera G, Armuzzi A, Papi C. Comparative Effectiveness Research: A Roadmap to Sail the Seas of IBD Therapies. J Clin Med 2022; 11. [PMID: 36431194 DOI: 10.3390/jcm11226717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
The drug pipeline for the treatment of inflammatory bowel disease (IBD) has dramatically expanded over the last two decades, and it is expected to further grow in the upcoming years with the introduction of new agents with different mechanisms of action. However, such an increase of therapeutic options needs to be paralleled with an appropriate development of research to help physicians in the decision-making process when choosing which drug to prescribe. On the population level, comparative effectiveness research (CER) is intended to explore and identify relevant differences-in terms of both efficacy and safety outcomes-amongst different therapeutic regimens and/or strategies, in order to find the correct placement for each treatment in the therapeutic algorithm. CER revolves around three cornerstones: network meta-analyses, head-to-head trials and real-world studies, each of which has specific pros and cons, and can therefore offer answers to different questions. In this review, we aim to provide an overview on the methodological features specific to each of these research approaches, as well as to illustrate the main findings coming from CER on IBD target therapies (i.e., biologics and small molecules) and to discuss their appropriate interpretation.
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Magrì S, Demurtas M, Onidi MF, Picchio M, Elisei W, Marzo M, Miculan F, Manca R, Dore MP, Quarta Colosso BM, Cicu A, Cugia L, Carta M, Binaghi L, Usai P, Lai M, Chicco F, Fantini MC, Armuzzi A, Mocci G. Clinical and epidemiological features of ulcerative colitis patients in Sardinia, Italy: Results from a multicenter study. World J Clin Cases 2022; 10:10921-10930. [PMID: 36338227 PMCID: PMC9631144 DOI: 10.12998/wjcc.v10.i30.10921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/06/2021] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis (UC) in the different Italian regions, mainly derived from the absence of a national registry. This prevents correct interpretation of the disease burden.
AIM To assess the main clinical and epidemiological features of adult patients diagnosed with UC in Sardinia, Italy.
METHODS We performed a multicenter, observational, cross-sectional study that included adult patients with UC enrolled in seven gastroenterology unit centers in Sardinia. Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.
RESULTS Four hundred and forty-two patients with UC were included. The median age at diagnosis was 39 years (interquartile range 28-48). After a median disease duration of 10 years, 53 patients experienced proximal extension of proctitis or left-sided colitis. Seventy-five patients developed extraintestinal manifestations. Nineteen patients (4.3%) developed cancer: two with colorectal cancer and seventeen with extracolonic cancers. Mesalazine (5-ASA) remains the mainstay of treatment for UC. Overall, 95 patients (21.5%) were treated with one or more biologic agents, whereas 15 patients (3.4%) underwent surgery, mostly colectomy.
CONCLUSION Our results provide important insights into the clinical and epidemiological features of patients with UC, and while waiting for a national Italian registry, present eligible data on the UC population in Sardinia.
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Affiliation(s)
- Salvatore Magrì
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato 09042, Italy
- Endoscopy Unit, Humanitas Istituto Clinico Catanese, Catania 95045, Italy
| | - Mauro Demurtas
- Endoscopy Unit, San Martino Hospital, Oristano 09170, Italy
| | | | - Marcello Picchio
- Division of General Surgery, Ospedale Civile P Colombo, Velletri 00049, Italy
| | - Walter Elisei
- Gastroenterology Unit, San Camillo Forlanini Hospital, Rome 00152, Italy
| | - Manuela Marzo
- Internal Medicine and Gastroenterology Department, Cardinale Panico Hospital, Tricase 73039, Italy
| | - Federica Miculan
- Department of Surgery, San Martino Hospital, Oristano 09170, Italy
| | - Roberto Manca
- Division of Gastroenterology, Santissima Trinità Hospital, Cagliari 09121, Italy
| | - Maria Pina Dore
- Dipartimento di Medicina Clinica e Sperimentale, University of Sassari, Sassari 07100, Italy
| | | | - Antonio Cicu
- Unit of Gastroenterology, ASL Sassari, Sassari 07100, Italy
| | - Luigi Cugia
- Gastroenterology Unit, Santissima Annunziata Hospital, Sassari 07100, Italy
| | - Monica Carta
- Gastroenterology Unit, Santissima Annunziata Hospital, Sassari 07100, Italy
| | - Laura Binaghi
- Gastroenterology Unit, Brotzu Hospital, Cagliari 09121, Italy
| | - Paolo Usai
- Medical Science and Public Health, University of Cagliari, Cagliari 09042, Italy
| | - Mariantonia Lai
- Medical Sciences and Public health, Presidio Policlinico of Monserrato, Cagliari, Monserrato 09042, Cagliari, Italy
| | - Fabio Chicco
- Medical Science and Public Health, University of Cagliari, Cagliari 09042, Italy
| | | | | | - Giammarco Mocci
- Gastroenterology Unit, Brotzu Hospital, Cagliari 09121, Italy
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Kurti Z, Gonczi L, Lakatos L, Golovics P, Pandur T, David G, Erdelyi Z, Szita I, Lakatos PL. Epidemiology, treatment strategy, natural disease course and surgical outcomes of patients with ulcerative colitis in Western Hungary - a population-based study between 2007 and 2018, data from the Veszprem County cohort. J Crohns Colitis 2022; 17:352-360. [PMID: 36125105 DOI: 10.1093/ecco-jcc/jjac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The number of population-based studies in ulcerative colitis (UC) is limited from Eastern Europe. Our aim was to analyze incidence, prevalence, disease phenotype, treatment strategy, disease course and colectomy rates in a prospective population-based inception cohort including UC patients diagnosed between 2007 and 2018. The present study is a continuation of the Veszprem IBD cohort since 1977. METHODS 467 UC patients were included (male/female: 236/231; median age at diagnosis: 36 years(y) [IQR: 25-54]). Both in-hospital and outpatient records were collected and comprehensively reviewed. The mean length of follow-up was 8.34±3.6y. The source of demographic data was derived from the Hungarian Central Statistical Office. RESULTS Mean incidence rate was 11.02/10 5 person-years in this 12-year period. Prevalence was 317.79/10 5 persons in 2015. Disease extent at diagnosis was proctitis(E1) in 22.3%, left-sided colitis(E2) in 43.9%, and extensive colitis(E3) in 33.8%. The probability of disease extent progression was 11.6%(SE:1.8) after 5 years. Distribution of maximal therapeutic steps were 5-ASA in 46.9%, corticosteroids in 16.3%, immunosuppressives in 19.3%, and biologicals in 16.5%. The probability of receiving biological therapy after diagnosis was 9.9%(SE:1.4) at 3 years. Overall colectomy rate was 4.1% in the population. The probability of colectomy was 1.5%(SE:0.6) at 1 year, 3.6%(SE:0.9) at 5 years and 4.4%(SE:1.0) at 10 years. CONCLUSIONS The incidence of UC was high in Hungary, similar to high-incidence areas in Western Europe. Treatment strategies are in line with the biologic era. The probability of progressing into proximal disease, and the medium- and long-term colectomy rates were both lower compared data from Western European centers.
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Affiliation(s)
- Zsuzsanna Kurti
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Petra Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada; Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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Verdon C, Reinglas J, Coulombe J, Gonczi L, Bessissow T, Afif W, Vutcovici M, Wild G, Seidman EG, Bitton A, Brassard P, Lakatos PL. No Change in Surgical and Hospitalization Trends Despite Higher Exposure to Anti-Tumor Necrosis Factor in Inflammatory Bowel Disease in the Québec Provincial Database From 1996 to 2015. Inflamm Bowel Dis 2021; 27:655-661. [PMID: 32676662 DOI: 10.1093/ibd/izaa166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Crohn disease (CD) and ulcerative colitis (UC) have high health care expenditures because of medications, hospitalizations, and surgeries. We evaluated disease outcomes and treatment algorithms of patients with inflammatory bowel disease (IBD) in Québec, comparing periods before and after 2010. METHODS The province of Québec's public health administrative database was used to identify newly diagnosed patients with IBD between 1996 and 2015. The primary and secondary outcomes included time to and probability of first and second IBD-related hospitalizations, first and second major surgery, and medication exposures. Medication prescriptions were collected from the public prescription database. RESULTS We identified 34,644 newly diagnosed patients with IBD (CD = 59.5%). The probability of the first major surgery increased after 2010 in patients with CD (5 years postdiagnosis before and after 2010: 8% [SD = 0.2%] vs 15% [SD = 0.6%]; P < 0.0001) and patients with UC (6% [SD = 0.2%] vs 10% [SD = 0.6%] ;P < 0.0001). The probability of the second major surgery was unchanged in patients with CD. Hospitalization rates remained unchanged. Patients on anti-tumor necrosis factor (anti-TNF) medications had the lowest probability of hospitalizations (overall 5-year probability in patients with IBD stratified by maximal therapeutic step: 5-aminosalicylic acids 37% [SD = 0.6%]; anti-TNFs 31% [SD = 1.8%]; P < 0.0001). Anti-TNFs were more commonly prescribed for patients with CD after 2010 (4% [SD = 0.2%] vs 16% [SD = 0.6%]; P < 0.0001) in the public health insurance plan, especially younger patients. Corticosteroid exposure was unchanged before and after 2010. Immunosuppressant use was low but increased after 2010. The use of 5-ASAs was stable in patients with UC but decreased in patients with CD. CONCLUSIONS The probability of first and second hospitalizations remained unchanged in Québec and the probability of major surgery was low overall but did increase despite the higher and earlier use of anti-TNFs.
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Affiliation(s)
- Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Jason Reinglas
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Janie Coulombe
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Maria Vutcovici
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Ernest G Seidman
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Paul Brassard
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Rodríguez C, Elosua A, Prieto C, Pérez E, Irisarri R, Campillo A, Rubio S, Nantes Ó, Angós R, Zozaya JM. Colectomy rate in ulcerative colitis 15 years after diagnosis: Results from the 2001-2003 Navarra cohort. Gastroenterol Hepatol 2021; 45:1-8. [PMID: 33545242 DOI: 10.1016/j.gastrohep.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Knowing the natural history of ulcerative colitis (UC) is essential to understand the course of the disease, assess the impact of different treatment strategies and identify poor prognostic factors. One of the most significant matters in this regard is the need for surgery. OBJECTIVES To analyse the Colectomy Incidence Rate (CIR) from diagnosis to end of follow-up (31/12/2017) and identify predictive factors for colectomy. MATERIAL AND METHODS A retrospective study enrolling patients with a definitive diagnosis (DD) of UC or Unclassified Colitis (UnC) in the 2001-03 Navarra cohort. RESULTS We enrolled 174 patients with a DD of UC (E2 42.8%; E3 26.6%) and 5 patients with a DD of UnC: 44.1% women, median age 39.2 years (range 7-88) and median follow-up 15.7 years. A total of 8 patients underwent surgery (CIR 3 colectomies/103 patient-years: 3 at initial diagnosis (<1 month), 2 in the first 2 years, 2 at 5 years from diagnosis and 1 at 12 years from diagnosis. All had previously received steroids; 5 had received immunomodulators and 2 had received biologics. In 7 patients (87%), surgery was performed on an emergency basis. The indication was megacolon in 3 (37.5%), severe flare-up in 3 (37.5%) and medical treatment failure in 2 (25%). In 5 cases (62.5%), an ileoanal pouch was made, and in 3 cases, a definitive ileostomy was performed. In the univariate analysis, patients with loss of more than 5 kg at diagnosis and admission at diagnosis had a lower rate of colectomy-free survival. CONCLUSIONS In our series, colectomy rates are lower than usually reported. Most colectomies were performed in the first 5 years following diagnosis and had an emergency indication.
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Affiliation(s)
- Cristina Rodríguez
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España.
| | - Alfonso Elosua
- Universidad Pública de Navarra, Departamento Sociología, Navarra, España
| | - Carlos Prieto
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
| | - Ernesto Pérez
- Hospital García Orcoyen, Servicio Medicina Interna (Digestivo), Navarra, España
| | - Rebeca Irisarri
- Universidad Pública de Navarra, Departamento Sociología, Navarra, España
| | - Ana Campillo
- Hospital Reina Sofía, Sección Digestivo, Navarra, España
| | - Saioa Rubio
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
| | - Óscar Nantes
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
| | - Ramón Angós
- Clínica Universidad de Navarra, Servicio de Digestivo, Navarra, España
| | - José Manuel Zozaya
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
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Brunet E, Vela E, Melcarne L, Clèries M, Pontes C, Llovet LP, García-Iglesias P, Gallach M, Villòria A, Vergara M, Calvet X. Time Trends of Crohn's Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery. J Clin Med 2020; 9:jcm9092896. [PMID: 32911630 PMCID: PMC7563515 DOI: 10.3390/jcm9092896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background and Aims: Data from clinical trials suggest that biological drugs may improve the outcomes in Crohn’s disease (CD) by reducing the need for surgery or hospitalization. The aim of this study is to evaluate the time-trends of the use of biological drugs and other treatments for CD, and its relationship with outcomes in Catalonia. Materials and Methods: All patients with CD included in the Catalan Health Surveillance System (containing data on a population of more than 7.5 million) from 2011 to 2017 were identified. The exposures to different treatments for inflammatory bowel disease were retrieved from electronic invoicing records. Results: Between 2011 and 2017, the use of salicylates, corticosteroids and immunosuppressive treatment fell from 28.8% to 17.1%, 15.8% to 13.7%, and 32.9% to 29.6%, respectively (p < 0.001). Biological treatment use rose from 15.0% to 18.7% (p < 0.001). Ostomy rates per 1000 patients/year fell from 13.2 in 2011 to 9.8 in 2017 (p = 0.003), and surgical resection rates from 24.1 to 18.0 (p < 0.001). The rate of CD-related hospitalizations per 1000 patients/year also fell, from 92.7 to 72.2 (p < 0.001). Conclusions: Biological drug use rose from 15.0% to 18.7% between 2011 and 2017. During this period, we observed an improvement in the outcomes of CD patients.
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Affiliation(s)
- Eduard Brunet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Emili Vela
- Unitat d’Informació i Coneixement, Servei Català de la Salut, Generalitat de Catalunya, 08002 Barcelona, Spain; (E.V.); (M.C.)
| | - Luigi Melcarne
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
| | - Montserrat Clèries
- Unitat d’Informació i Coneixement, Servei Català de la Salut, Generalitat de Catalunya, 08002 Barcelona, Spain; (E.V.); (M.C.)
| | - Caridad Pontes
- Àrea del Medicament, Servei Català de la Salut, 08002 Barcelona, Spain;
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Laura Patricia Llovet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
| | - Pilar García-Iglesias
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Gallach
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
| | - Albert Villòria
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mercedes Vergara
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xavier Calvet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-(937)-231-010; Fax: +34-(937)-160-646
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9
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Kayar Y, Baran B, Ormeci AC, Akyuz F, Demir K, Besisik F, Kaymakoglu S. Risk factors associated with progression to intestinal complications of Crohn disease. Chin Med J (Engl) 2019; 132:2423-9. [PMID: 31651515 DOI: 10.1097/CM9.0000000000000489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Crohn disease is a chronic bowel disease that causes serious complications. Prevalence of Crohn disease is increasing. Studies have shown that the behavior of the disease is not stable and severe complications secondary to behavior change over time have been shown. In this study, we aimed to evaluate the prognostic risk factors associated with phenotypic change in Crohn disease in a Turkish patient cohort. METHODS Patients followed up from March 1986 to August 2011 were evaluated for demographic and clinical characteristics to determine possible risk factors and initial clinical phenotype of the disease based on the Montreal classification. The cumulative probabilities of developing stricturing or penetrating intestinal complications were estimated using the Kaplan-Meier analysis. Univariate and multivariate Cox-proportional hazard models were used to assess associations between baseline clinical characteristics and intestinal complications. RESULTS Three hundred and thirty patients (mean age, 30.6 ± 11.1 years; 148 female) were included in the study. Mean follow-up duration was 7.4 ± 5.3 years (range: 1.0-25.0 years). At baseline 273 patients had inflammatory-type disease, 57 patients experienced stricturing/penetrating intestinal complications before or at the time of diagnosis. The cumulative probability of developing complicated disease was 37.4% at 5 years, 54.3% at 10 years, 78.8% at 25 years. Independent predictors associated with progression to intestinal complications were current smoking, perianal disease, extra-intestinal manifestations, and location of disease. CONCLUSIONS Location of disease is the most powerful indicator for the development of stenosis and penetrating complications in inflammatory-type disease. Patients with ileal involvement should be considered for more aggressive immunosuppressive therapy.
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10
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Kwak MS, Cha JM, Ahn JH, Chae MK, Jeong S, Lee HH. Practical strategy for optimizing the timing of anti-tumor necrosis factor-α therapy in Crohn disease: A nationwide population-based study. Medicine (Baltimore) 2020; 99:e18925. [PMID: 32150045 PMCID: PMC7478703 DOI: 10.1097/md.0000000000018925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is little consensus on the optimal timing of anti-tumor necrosis factor (anti-TNF) therapy to decrease the rates of hospitalization and surgery in Crohn disease (CD). We aimed to assess the real-world outcomes of anti-TNF therapy and estimate the optimal timing of anti-TNF therapy in Korean patients with CD.Claims data were extracted from the Korean Health Insurance Review and Assessment Service database. Incident patients diagnosed with CD between 2009 and 2016, with at least 1 anti-TNF drug prescription, and with follow-up duration > 6 months were stratified according to the number of relapses prior to initiation of anti-TNF therapy: groups A (≤1 relapse), B (2 relapses), C (3 relapses), and D (≥4 relapses). The cumulative survival curves free from emergency hospitalization (EH) and surgery were compared across groups.Among the 2173 patients analyzed, the best and worst prognoses were noted in groups A and D, respectively. The incidences of EH and surgery decreased significantly as the use of anti-TNF agents increased. The 5-year rate of hospitalization was significantly lower in group A than in groups C and D (P = .004 and .020, respectively), but similar between groups A and B. The 5-year rate of surgery was lower in group A than in group C (P = .024), but similar among groups A, B, and D.In Asian patients with CD, anti-TNF therapy reduces the risk of EH and surgery and should be considered before three relapses, regardless of disease duration.
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Affiliation(s)
- Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
- Department of Medicine, Graduate School, Kyung Hee University
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
- Department of Medicine, Graduate School, Kyung Hee University
| | - Ji Hyun Ahn
- Department of Medicine, Graduate School, Kyung Hee University
| | - Min Kyu Chae
- Department of Medicine, Graduate School, Kyung Hee University
| | - Sara Jeong
- Department of Medicine, Graduate School, Kyung Hee University
| | - Hun Hee Lee
- Kyung Hee University Industry-Academic Cooperation Foundation, Seoul, Republic of Korea
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11
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Bhatia R, Yeoh SW, Vaz K, Studd C, Wilson J, Bell S, Otahal P, Venn A. Inflammatory bowel disease incidence, prevalence and 12-month initial disease course in Tasmania, Australia. Intern Med J 2020; 49:622-630. [PMID: 30230160 DOI: 10.1111/imj.14111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/31/2018] [Accepted: 08/29/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND High inflammatory bowel disease (IBD) rates have been reported in Australasia, but no state-wide studies have yet been performed. AIM This study estimates the 1-year incidence and point prevalence of IBD in the state of Tasmania, Australia. It also reports clinical outcomes after 12 months of diagnosis in an incident cohort. METHODS A prospective, population-based study was performed collecting prevalent and incident state-wide cases from 1 June 2013 to 31 May 2014. Case data were identified from specialist doctors, pathology databases and hospital records. Age-standardised rates (ASR) were calculated based on World Health Organization 2000 standard population characteristics. Incident cases were followed up 12 months after diagnosis. RESULTS There were 1719 prevalent cases: ASR for IBD, Crohn disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) prevalence rates were 303.9, 165.5, 131.4 and 6.9 per 100 000 respectively. Prevalent CD cases were younger, with greater immunomodulator/biological use and bowel resections. There were 149 incident cases: ASR for IBD, CD, UC and IBDU incidence were 29.5, 15.4, 12.4 and 1.7 per 100 000 respectively. Incident CD cases were more likely than UC or IBDU to require escalation of medical therapy, hospitalisation and bowel resection, especially among those with penetrating or stricturing disease. They had a longer duration of symptoms prior to diagnosis. CONCLUSION IBD prevalence and incidence rates are high in Tasmania, comparable to data from other Australasian studies and those from Northern Europe and America. Poorer 12-month clinical outcomes occurred in complicated CD, with greater use of healthcare resources.
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Affiliation(s)
- Rajesh Bhatia
- Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Karl Vaz
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Corrie Studd
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | | | - Sally Bell
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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12
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Abstract
Parents of teens with inflammatory bowel disease must prepare their children for independent disease self-management. This study characterizes the stressors and coping strategies adopted among parents of teens with inflammatory bowel disease. Teens aged 16-22 years with inflammatory bowel disease who were consecutively seen by a pediatric gastroenterologist prior to transition to adult-centered care and their parents completed sociodemographic data, and two validated questionnaires for coping (Coping Health Inventory for Parents) and stress (Pediatric Inventory for Parents). Sixty-six patient-parent pairs were enrolled in this study-impairment was highest in role function (e.g., trying to attend to the needs of other family members, being unable to go to work, and feeling uncertain about how to maintain consistent discipline). These concerns seemed to be most pronounced among parents of children 18 years and older (χ (df) = 1, p = .04) with Crohn disease (χ (df) = 1, p = .02). The top five listed concerns differed depending on the caregiver's gender. Parents of teens with inflammatory bowel disease are concerned about parenting role function. Parents of teens 18 years and older with Crohn disease reported the highest stress. Caregiver gender differences were noted.
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13
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Loy L, Roda G, Fiorino G, Allocca M, Furfaro F, Argollo M, Peyrin-Biroulet L, Danese S. Detection and management of early stage inflammatory bowel disease: an update for clinicians. Expert Rev Gastroenterol Hepatol 2019; 13:547-555. [PMID: 31007098 DOI: 10.1080/17474124.2019.1605291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inflammatory bowel diseases, which include Crohn's disease and ulcerative colitis, are lifetime chronic and progressive disorders of poorly known etiology. Over the past few decades, new therapeutic approaches, including early and more aggressive intervention with immunomodulators and biological agents have offered the possibility of a favorable modification in the natural history of inflammatory bowel diseases. Area covered: Here, we review the literature about the effectiveness of early detection and intervention in adult inflammatory bowel diseases patients. Expert commentary: Detecting and managing early stages of inflammatory bowel diseases represents an effective strategy to avoid disease progression in selected patients. Primary care physicians may play a key role in attaining these outcomes by recognizing the signs and symptoms early and making timely referrals. Moreover, early therapeutic intervention with complete disease control may allow dose reduction or even treatment withdrawal in the maintenance phase, reducing side effects, costs, and also improving quality of life.
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Affiliation(s)
- Laura Loy
- a IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Rozzano, Milan , Italy
| | - Giulia Roda
- a IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Rozzano, Milan , Italy
| | - Gionata Fiorino
- a IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Rozzano, Milan , Italy
| | - Mariangela Allocca
- a IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Rozzano, Milan , Italy
| | - Federica Furfaro
- a IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Rozzano, Milan , Italy
| | - Marjorie Argollo
- a IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Rozzano, Milan , Italy
| | - Laurent Peyrin-Biroulet
- b Department of Hepato-Gastroenterology and Inserm U954 , University Hospital of Nancy, Lorraine University , Vandoeuvre-lès-Nancy , France
| | - Silvio Danese
- a IBD Center, Department of Gastroenterology , Humanitas Research Hospital , Rozzano, Milan , Italy.,c Department of Biomedical Sciences , Humanitas Rozzano , Milan , Italy
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14
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Chaparro M, Barreiro-de Acosta M, Benítez JM, Cabriada JL, Casanova MJ, Ceballos D, Esteve M, Fernández H, Ginard D, Gomollón F, Lorente R, Nos P, Riestra S, Rivero M, Robledo P, Rodríguez C, Sicilia B, Torrella E, Garre A, García-Esquinas E, Rodríguez-Artalejo F, Gisbert JP. EpidemIBD: rationale and design of a large-scale epidemiological study of inflammatory bowel disease in Spain. Therap Adv Gastroenterol 2019; 12:1756284819847034. [PMID: 31205485 PMCID: PMC6535735 DOI: 10.1177/1756284819847034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/25/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with a considerable burden to the patient and society. However, current data on IBD incidence and burden are limited because of the paucity of nationwide epidemiological studies, heterogeneous designs, and a low number of participating centers and sample size. The EpidemIBD study is a large-scale investigation to provide an accurate assessment of the incidence of IBD in Spain, as well as treatment patterns and outcomes. METHODS This multicenter, population-based incidence cohort study included patients aged >18 years with IBD (Crohn's disease, ulcerative colitis, or unclassified IBD) diagnosed during 2017 in 108 hospitals in Spain, covering 50% of the Spanish population. Each participating patient will attend 10 clinic visits during 5 years of follow up. Demographic data, IBD characteristics and family history, complications, treatments, surgeries, and hospital admissions will be recorded. RESULTS The EpidemIBD study is the first large-scale nationwide study to investigate the incidence of IBD in Spain. Enrollment is now completed and 3627 patients are currently being followed up. CONCLUSIONS The study has been designed to overcome many of the limitations of previous European studies into IBD incidence by prospectively recruiting a large number of patients from all regions of Spain. In addition to epidemiological information about the burden of IBD, the 5-year follow-up period will also provide information on treatment patterns, and the natural history and financial burden of IBD.
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Affiliation(s)
| | - Manuel Barreiro-de Acosta
- Gastrointestinal Units of Complexo Hospitalario
Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - José Manuel Benítez
- Gastrointestinal Units of Hospital Universitario
Reina Sofía and IMIBIC, Córdoba, Spain
| | - José Luis Cabriada
- Gastrointestinal Units of Hospital de
Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - María José Casanova
- Gastrointestinal Units of Hospital Universitario
de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP),
Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red
de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Daniel Ceballos
- Gastrointestinal Units of Hospital Universitario
de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - María Esteve
- Gastrointestinal Units of Hospital Universitari
Mutua Terrassa and CIBERehd, Terrassa, Barcelona, Spain
| | | | - Daniel Ginard
- Gastrointestinal Units of Hospital Universitari
Son Espases, Palma de Mallorca, Spain
| | - Fernando Gomollón
- Gastrointestinal Units of Hospital Clínico
Universitario “Lozano Blesa”, IIS Aragón and CIBERehd, Zaragoza, Spain
| | - Rufo Lorente
- Gastrointestinal Units of Hospital General
Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pilar Nos
- Gastrointestinal Units of Hospital Universitari
i Politecnic La Fe and CIBERehd, Valencia, Spain
| | - Sabino Riestra
- Gastrointestinal Units of Hospital
Universitario Central de Asturias and Instituto de Investigación Sanitaria
del Principado de Asturias (ISPA), Oviedo, Spain
| | - Montserrat Rivero
- Gastrointestinal Units of Hospital
Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Pilar Robledo
- Gastrointestinal Units of Hospital
Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Cristina Rodríguez
- Gastrointestinal Units of Complejo Hospitalario
de Navarra, Pamplona, Spain
| | - Beatriz Sicilia
- Gastrointestinal Units of Hospital
Universitario de Burgos, Burgos, Spain
| | - Emilio Torrella
- Gastrointestinal Units of Hospital General
Universitario J.M. Morales Meseguer, Murcia, Spain
| | - Ana Garre
- Gastrointestinal Units of Hospital
Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa
(IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación
Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid,
Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public
Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and
CIBERESP, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public
Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and
CIBERESP, Madrid, Spain
| | - Javier P. Gisbert
- Gastrointestinal Units of Hospital
Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa
(IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación
Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid,
Spain
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15
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King JA, Underwood FE, Panaccione N, Quan J, Windsor JW, Kotze PG, Ng SC, Ghosh S, Lakatos PL, Jess T, Panaccione R, Seow CH, Ben-horin S, Burisch J, Colombel J, Loftus EV, Gearry R, Halfvarson J, Kaplan GG. Trends in hospitalisation rates for inflammatory bowel disease in western versus newly industrialised countries: a population-based study of countries in the Organisation for Economic Co-operation and Development. Lancet Gastroenterol Hepatol 2019; 4:287-95. [DOI: 10.1016/s2468-1253(19)30013-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 12/15/2022]
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16
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Taida T, Nakagawa T, Ohta Y, Hamanaka S, Okimoto K, Saito K, Maruoka D, Matsumura T, Arai M, Katsuno T, Kato N. Long-Term Outcome of Endoscopic Balloon Dilatation for Strictures in Patients with Crohn's Disease. Digestion 2018; 98:26-32. [PMID: 29672285 DOI: 10.1159/000486591] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/18/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Endoscopic balloon dilatation (EBD) is an alternative to surgery for strictures in patients with Crohn's disease (CD). The aim of the present study was to clarify the efficacy and safety of EBD for strictures in patients with CD. METHODS Twenty-six patients with CD who underwent EBD for strictures from August 2008 to November 2015 were followed up after dilatation. Short-term success was defined as the disappearance of obstructive symptoms after technically adequate dilatation was achieved. The short-term success rate of EBD, safety profile of EBD, and cumulative surgery-free and redilatation-free rates were analyzed. RESULTS Sixty-five EBDs were performed for CD patients in the follow-up period. The short-term success rate was 100% (26/26), and no complications were encountered during this study. Two (7.7%) patients underwent surgery during the observation period. The cumulative surgery-free rate after the initial EBD was 90.3% at both 2 and 3 years. The cumulative redilatation-free rate after the initial EBD was 52.1% at 2 years and 39.1% at 3 years. CONCLUSION EBD for strictures secondary to CD provides not only short-term success but also long-term efficacy. Although a high redilatation rate is one of the clinical problems of this procedure, EBD is an effective therapy for avoiding intestinal recession in CD -stricture.
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Affiliation(s)
- Takashi Taida
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoo Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinsaku Hamanaka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Maruoka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Arai
- Medical Oncology, Chiba University Hospital, Chiba, Japan
| | - Tatsuro Katsuno
- Kashiwanoha Clinic of East Asian Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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17
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Holko P, Kawalec P, Pilc A. Impact of Biologic Treatment of Crohn's Disease on the Rate of Surgeries and Other Healthcare Resources: An Analysis of a Nationwide Database From Poland. Front Pharmacol 2018; 9:621. [PMID: 29942260 PMCID: PMC6004509 DOI: 10.3389/fphar.2018.00621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background: There is conflicting evidence on the impact of biologic treatment on the rate of complications and surgeries in Crohn’s disease (CD). We aimed to assess real-world consequences of biologic treatment of CD. Methods: All adult patients with CD treated with infliximab and adalimumab in the years 2012–2014 were identified from the database of the National Health Fund in Poland. Mixed models were used to assess the impact of biologics on medical resource utilization by comparing the periods before and after the first use of biologics (pre-index vs. post-index). The additional analyses including quintile of total exposure to biologic treatment were performed. Results: Data on 1393 patients (age, 31.9 years; males, 52.6%) were analyzed over a median of 1064 days (range: 71, 1148). During the post-index period, patients received from one to four treatments with biologic agents (maximum allowed period of 12 months per treatment). We observed a reduction in the rates of surgeries (by 27%, p = 0.001), hospitalizations for CD excluding surgical procedures (by 45%, p < 0.001), as well as consumption of antibiotics (by 31%, p < 0.001) and steroids (by 35%, p < 0.001) in the post-index compared with the pre-index period. The reduction in the rate of surgeries, hospitalizations for CD, and steroid intake increased with the increase of exposure to biologic agents. Conclusion: Biologic treatment changed the management patterns by lowering the rate of surgeries and other healthcare resources related to complications or worsening of CD. The reduction in the resource utilization was dependent on the level of exposure to treatment, suggesting that limitation of the treatment period itself may be inadequate.
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Affiliation(s)
- Przemysław Holko
- Institute of Public Health, Drug Management Department, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Kawalec
- Institute of Public Health, Drug Management Department, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Pilc
- Institute of Public Health, Drug Management Department, Jagiellonian University Medical College, Kraków, Poland.,Institute of Pharmacology, Department of Neurobiology, Polish Academy of Sciences, Kraków, Poland
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18
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Severs M, Spekhorst LM, Mangen MJJ, Dijkstra G, Löwenberg M, Hoentjen F, van der Meulen-de Jong AE, Pierik M, Ponsioen CY, Bouma G, van der Woude JC, van der Valk ME, Romberg-Camps MJL, Clemens CHM, van de Meeberg P, Mahmmod N, Jansen J, Jharap B, Weersma RK, Oldenburg B, Festen EAM, Fidder HH. Sex-Related Differences in Patients With Inflammatory Bowel Disease: Results of 2 Prospective Cohort Studies. Inflamm Bowel Dis 2018; 24:1298-1306. [PMID: 29688413 DOI: 10.1093/ibd/izy004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The understanding of gender differences in inflammatory bowel disease (IBD) patients is an important step towards tailored treatment for the individual patient. The aim of this study was to compare disease phenotype, clinical manifestations, disease activity, and healthcare utilization between men and women with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Two multicenter observational cohort studies with a prospective design were used to explore the differences between men and women regarding demographic and phenotypic characteristics and healthcare utilization. Detailed data on IBD-phenotype was mainly available from the Dutch IBD Biobank, while the COIN cohort provided healthcare utilization data. RESULTS In the Dutch IBD Biobank study, 2118 CD patients and 1269 UC patients were analyzed. Female CD patients were more often current smokers, and male UC patients were more often previous smokers. Early onset CD (<16 years) was more frequently encountered in males than in females (20% versus 12%, P < 0.01). Male CD patients were more often diagnosed with ileal disease (28% versus 20%, P < 0.01) and underwent more often small bowel and ileocecal resection. Extraintestinal manifestations (EIMs) were more often encountered in female IBD patients. In the COIN study, 1139 CD patients and 1213 UC patients were analyzed. Male CD patients used prednisone more often and suffered more often from osteopenia. IBD-specific healthcare costs did not differ between male and female IBD patients. CONCLUSIONS Sex differences in patients with IBD include age of onset, disease location, and EIM prevalence. No large differences in therapeutic management of IBD were observed between men and women with IBD. 10.1093/ibd/izy004_video1izy004_Video_15786481854001.
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Affiliation(s)
- Mirjam Severs
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Utrecht, The Netherlands
| | - Lieke M Spekhorst
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Marie-Josée J Mangen
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht, the Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, University Medical Center St. Radboud, Nijmegen, The Netherlands
| | | | - Marieke Pierik
- Department of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Janneke C van der Woude
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mirthe E van der Valk
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Utrecht, The Netherlands
| | - Marielle J L Romberg-Camps
- Department of Gastroenterology and Hepatology (Co-MIK), Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Cees H M Clemens
- Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, The Netherlands
| | - Paul van de Meeberg
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Nofel Mahmmod
- Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, The Netherlands
| | - Jeroen Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Bindia Jharap
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Utrecht, The Netherlands
| | - Eleonora A M Festen
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Utrecht, The Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Herma H Fidder
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Utrecht, The Netherlands
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Zhu Z, Mei Z, Guo Y, Wang G, Wu T, Cui X, Huang Z, Zhu Y, Wen D, Song J, He H, Xu W, Cui L, Liu C. Reduced Risk of Inflammatory Bowel Disease-associated Colorectal Neoplasia with Use of Thiopurines: a Systematic Review and Meta-analysis. J Crohns Colitis 2018; 12:546-558. [PMID: 29370346 DOI: 10.1093/ecco-jcc/jjy006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The association between thiopurines and colorectal neoplasia risk remains controversial in inflammatory bowel disease [IBD] patients. We performed a systematic review and meta-analysis examining this association. METHODS A comprehensive search of the PubMed, EMBASE and Cochrane Library databases was performed to identify relevant literature. Random-effects models were applied to calculate the pooled odds ratio [OR] and relative risk [RR] with corresponding 95% confidence intervals [CIs] among case-control and cohort studies. RESULTS Eleven cohort and 16 case-control studies involving 95397 patients were included in this study. Overall, the use of thiopurines was associated with a reduced risk of colorectal neoplasia both in case-control [OR = 0.49, 95% CI: 0.34-0.70] and cohort studies [RR = 0.96, 95% CI: 0.94-0.98]. Moreover, a protective effect of thiopurines against advanced neoplasia [high-grade dysplasia and cancer] [OR = 0.51, 95% CI: 0.31-0.84 for case-control studies; RR = 0.96, 95% CI: 0.94-0.98 for cohort studies] and colorectal cancer [CRC] [OR = 0.56, 95% CI: 0.34-0.93 for case-control studies; RR = 0.96, 95% CI: 0.94-0.98 for cohort studies] was also observed. Furthermore, when the analysis was conducted on patients at a high risk for colorectal neoplasia, the chemopreventive effect was confirmed in patients with long disease duration [> 8 years] but not in those with extensive colitis or primary sclerosing cholangitis. CONCLUSIONS This study demonstrated that thiopurine use was associated with a reduced risk of colorectal neoplasia, advanced neoplasia and CRC in IBD patients, especially those with long disease duration [> 8 years].
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Affiliation(s)
- Zhehui Zhu
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Yuegui Guo
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Guanghui Wang
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Tingyu Wu
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Ximao Cui
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Zhenyu Huang
- Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Yilian Zhu
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Dongpeng Wen
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Jinglve Song
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Hailan He
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Weimin Xu
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Long Cui
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
| | - Chenying Liu
- Department of Colon and Rectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,Shanghai Colorectal Cancer Research Center, Shanghai, PR China
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20
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Holko P, Kawalec P, Stawowczyk E. Prevalence and drug treatment practices of inflammatory bowel diseases in Poland in the years 2012-2014: an analysis of nationwide databases. Eur J Gastroenterol Hepatol 2018; 30:456-64. [PMID: 29256907 DOI: 10.1097/MEG.0000000000001047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs) such as ulcerative colitis (UC) and Crohn's disease (CD) are chronic autoimmune disorders that constitute a major societal and economic burden for individual patients, their families and the society. The aim of this study was to assess the current prevalence and treatment patterns of IBD in Poland. PATIENTS AND METHODS We carried out a retrospective analysis of the nationwide databases of the National Health Fund for the years from 2012 to 2014 to obtain data on the prevalence and treatment patterns of IBD. Patients with IBD were identified according to the ICD-10 codes indicated in medical records and the type of medical resource utilized during the study. Pharmacotherapy for IBD by age group, sex and IBD types was presented. RESULTS The prevalence of IBDs was 157/100 000 individuals, including 35 patients with CD per 100 000 individuals. The use of drugs differed by age and diagnosis (P<0.001). Biologics, steroids and immunosuppressants were used more often by patients with CD than those with UC (13.2 vs. 0.3%, 54.5 vs. 37.5%, and 44.8 vs. 15.1%, respectively). Aminosalicylates were used more often by patients with UC than those with CD. Biologics were used most often by the youngest patients (≤18 years) and seldom by patients aged 65 years or older (7.7 and 0.1%, respectively). CONCLUSION Our study showed a moderate prevalence of IBD in Poland. Treatment patterns depended on the patient's age and IBD type. The use of biologics was higher among young patients with CD than among older patients with other IBDs. Although not recommended, aminosalicylates were still commonly used in patients with CD, even during biologic and/or immunosuppressive treatment.
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21
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Kurti Z, Ilias A, Gonczi L, Vegh Z, Fadgyas-Freyler P, Korponay G, Golovics PA, Lovasz BD, Lakatos PL. Therapeutic preferences and outcomes in newly diagnosed patients with Crohn's diseases in the biological era in Hungary: a nationwide study based on the National Health Insurance Fund database. BMC Gastroenterol 2018; 18:23. [PMID: 29378524 PMCID: PMC5789702 DOI: 10.1186/s12876-018-0746-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/18/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Accelerated treatment strategy, including tight disease control and early aggressive therapy with immunosuppressives (IS) and biological agents have become increasingly common in inflammatory bowel disease (IBD). The aim of the present study was to estimate the early treatment strategy and outcomes in newly diagnosed patients with Crohn's disease (CD) between 2004 and 2008 and 2009-2015 in the whole IBD population in Hungary based on the administrative database of the National Health Insurance Fund (OEP). METHODS We used the administrative database of the OEP, the only nationwide state-owned health insurance provider in Hungary. Patients were identified through previously reported algorithms using the ICD-10 codes for CD in the out-, inpatient (medical, surgical) non-primary care records and drug prescription databases between 2004 and 2015. Patients were stratified according to the year of diagnosis and maximum treatment steps during the first 3 years after diagnosis. RESULTS A total of 6173 (male/female: 46.12%/53.87%) newly diagnosed CD patients with physician-diagnosed IBD were found in the period of 2004-2015. The use of 5-ASA and steroids remained common in the biological era, while immunosuppressives and biologicals were started earlier and became more frequent among patients diagnosed after 2009. The probability of biological therapy was 2.9%/6.4% and 8.4%/13.7% after 1 and 3 years in patients diagnosed in 2004-2008/2009-2015. The probability of hospitalization in the first 3 years after diagnosis was different before and after 2009, according to the maximal treatment step (overall 55.7%vs. 47.4% (p = 0.001), anti-TNF: 73%vs. 66.7% (p = 0.103), IS: 64.6% vs. 56.1% (p = 0.001), steroid: 44.2%vs. 36.8% (p < 0.007), 5-ASA: 32.6% vs. 26.7% p = 0.157)). In contrast, surgery rates were not significantly different in patients diagnosed before and after 2009 according to the maximum treatment step (overall 16.0%vs.15.3%(p = 0.672) anti-TNF 26.7%vs.27.2% (p = 0.993), IS: 24.1%vs22.2% (p = 0.565), steroid 8.1%vs.7.9% (p = 0.896), 5-ASA 10%vs. 11% (p = 0.816)). CONCLUSIONS IS and biological exposure became more frequent, while hospitalization decreased and surgery remained low but constant during the observation period. Use of steroids and 5-ASA remained high after 2009. The association between the maximal treatment step and hospitalization/surgery rates suggests that maximal treatment step can be regarded as proxy severity marker in patients with IBD.
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Affiliation(s)
- Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Akos Ilias
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Petra Fadgyas-Freyler
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, H-1139, Hungary
| | - Gyula Korponay
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, H-1139, Hungary
| | - Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary.,Faculty of Health Sciences, Department of Clinical Studies, Semmelweis University, Budapest, H-1088, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary. .,Division of Gastroenterology, McGill University Health Centre, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada. .,Division of Gastroenterology/Hepatology Unit and Endoscopy, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary.
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Danese S, Fiorino G, Peyrin-Biroulet L. Early intervention in Crohn's disease: towards disease modification trials. Gut 2017; 66:2179-2187. [PMID: 28874419 DOI: 10.1136/gutjnl-2017-314519] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
Abstract
Crohn's disease (CD) is a chronic progressive destructive inflammatory bowel disease. As in rheumatoid arthritis, there is increasing evidence that early treatment initiation with disease-modifying agents, such as biological drugs, may lead to complete disease control, prevention of disease progression thus protecting against irreversible damage and restoration of normal quality of life. Data from randomised clinical trials with immunosuppressants and biologics suggest that treating patients with a disease duration of <2 years and an absence of complications may significantly reduce the risk for complications and increase time in remission in patients with CD. Moreover, rapid disease control may effectively prevent disease progression and allow dose reduction or even withdrawal of treatment, reducing the risk of long-term adverse events and healthcare costs. However, prospective disease modification trials are needed to confirm these initial results. Here we review the literature regarding early intervention in adult patients with CD and propose criteria for future disease modification trials.
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Affiliation(s)
- Silvio Danese
- Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gionata Fiorino
- Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
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23
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Burisch J, Vegh Z, Katsanos KH, Christodoulou DK, Lazar D, Goldis A, O'Morain C, Fernandez A, Pereira S, Myers S, Sebastian S, Pedersen N, Olse J, Rubek Nielsen K, Schwartz D, Odes S, Almer S, Halfvarson J, Turk N, Cukovic-Cavka S, Nikulina I, Belousova E, Duricova D, Bortlik M, Shonová O, Salupere R, Barros L, Magro F, Jonaitis L, Kupcinskas L, Turcan S, Kaimakliotis I, Ladefoged K, Kudsk K, Andersen V, Vind I, Thorsgaard N, Oksanen P, Collin P, Dal Piaz G, Santini A, Niewiadomski O, Bell S, Moum B, Arebi N, Kjeldsen J, Carlsen K, Langholz E, Lakatos PL, Munkholm P, Gerdes LU, Dahlerup JF. Occurrence of Anaemia in the First Year of Inflammatory Bowel Disease in a European Population-based Inception Cohort-An ECCO-EpiCom Study. J Crohns Colitis 2017; 11:1213-1222. [PMID: 28575481 DOI: 10.1093/ecco-jcc/jjx077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Anaemia is an important complication of inflammatory bowel disease [IBD]. The aim of this study was to determine the prevalence of anaemia and the practice of anaemia screening during the first year following diagnosis, in a European prospective population-based inception cohort. METHODS Newly diagnosed IBD patients were included and followed prospectively for 1 year in 29 European and one Australian centre. Clinical data including demographics, medical therapy, surgery and blood samples were collected. Anaemia was defined according to the World Health Organization criteria. RESULTS A total of 1871 patients (Crohn's disease [CD]: 686, 88%; ulcerative colitis [UC]: 1,021, 87%; IBD unclassified [IBDU] 164. 81%) were included in the study. The prevalence of anaemia was higher in CD than in UC patients and, overall, 49% of CD and 39% of UC patients experienced at least one instance of anaemia during the first 12 months after diagnosis. UC patients with more extensive disease and those from Eastern European countries, and CD patients with penetrating disease or colonic disease location, had higher risks of anaemia. CD and UC patients in need of none or only mild anti-inflammatory treatment had a lower risk of anaemia. In a significant proportion of patients, anaemia was not assessed until several months after diagnosis, and in almost half of all cases of anaemia a thorough work-up was not performed. CONCLUSIONS Overall, 42% of patients had at least one instance of anaemia during the first year following diagnosis. Most patients were assessed for anaemia regularly; however, a full anaemia work-up was frequently neglected in this community setting.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Konstantinnos H Katsanos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Dimitrios K Christodoulou
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Daniela Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Colm O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | | | - Santos Pereira
- Department of Gastroenterology. Instituto de Investigación Sanitaria Galicia Sur, Estrutura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
| | - Sally Myers
- IBD Unit, Hull & East Yorkshire NHS Trust, Hull, UK
| | | | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jóngerð Olse
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári Rubek Nielsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Niksa Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb,Zagreb, Croatia
| | - Silvja Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb,Zagreb, Croatia
| | - Inna Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Dana Duricova
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic.,Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Olga Shonová
- Gastroenterology Department, Hospital Ceské Budejovice, Ceské Budejovice, Czech Republic
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital,Tartu, Estonia
| | - Louisa Barros
- Department of Medicine, Hospital de Vale de Sousa, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal.,Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal.,Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - Laimas Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | - Karin Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - Karen Kudsk
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Vibeke Andersen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Laboratory Center, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Niels Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Giulia Dal Piaz
- Dipartimento Medicina Specialistica Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy
| | | | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sally Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Naila Arebi
- St Mark's Hospital, Imperial College London, London, UK
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Katrine Carlsen
- Department of Pediatrics, Hvidovre University Hospital,Hvidovre, Denmark
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev Univerisity Hospital, Herlev, Denmark
| | | | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | | | - Jens Frederik Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Gordon H, Langholz E. The EpiCom Survey-Registries Across Europe, Epidemiological Research and Beyond. J Crohns Colitis 2017; 11:1019-1021. [PMID: 28158624 DOI: 10.1093/ecco-jcc/jjx013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/01/2017] [Indexed: 01/15/2023]
Abstract
The 2015 EpiCom survey evaluated population, patient, and research registries across Europe. Information was collected from 38 countries. The registries included those falling within the remit of national statistics, hospital databases, twin and multiplex registries, inflammatory bowel disease [IBD] registries and biobanks, and cancer and surgical registries. The scale and nature of registries were investigated, and where possible a contact detail for each registry was obtained.The survey demonstrated 33 birth and death registers across Europe. It also highlighted ethical and legal challenges in linking information from health and social registries: 30 delegates reported that their home country has a hospital database; 21 have adverse events registers, although the majority only mandate reporting of events that occur during drug trials; 17 countries have twin registries; And IBD registries have been established in 19 countries, with 15 countries having a biobank with IBD samples. The cancer registries were the most complete and consistent.Despite heterogeneity between countries, the registries represent an invaluable source of information for future IBD research. Supplementary material [available at ECCO-JCC online] depicts active registries in each of the participating countries.
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Affiliation(s)
- Hannah Gordon
- Department of Gastroenterology, Royal London Hospital, London
| | - Ebbe Langholz
- Gastroenterology Section Dept. C, Gentofte and Herlev Hospital, Copenhagen
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25
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Jeuring SF, van den Heuvel TR, Liu LY, Zeegers MP, Hameeteman WH, Romberg-Camps MJ, Oostenbrug LE, Masclee AA, Jonkers DM, Pierik MJ. Improvements in the Long-Term Outcome of Crohn's Disease Over the Past Two Decades and the Relation to Changes in Medical Management: Results from the Population-Based IBDSL Cohort. Am J Gastroenterol 2017; 112:325-36. [PMID: 27922024 DOI: 10.1038/ajg.2016.524] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/04/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Medical treatment options and strategies for Crohn's disease (CD) have changed over the past decades. To assess its impact, we studied the evolution of the long-term disease outcome in the Dutch Inflammatory Bowel Disease South Limburg (IBDSL) cohort. METHODS In total, 1,162 CD patients were included. Three eras were distinguished: 1991-1998 (n=316), 1999-2005 (n=387), and 2006-2011 (n=459), and patients were followed until 2014. Medication exposure and the rates of hospitalization, surgery, and phenotype progression were estimated using Kaplan-Meier survival analyses and compared between eras by multivariable Cox regression models. Second, propensity score matching was used to assess the relation between medication use and the long-term outcome. RESULTS Over time, the immunomodulator exposure rate increased from 30.6% in the era 1991-1998 to 70.8% in the era 2006-2011 at 5 years. Similar, biological exposure increased from 3.1% (era 1991-1998) to 41.2% (era 2006-2011). In parallel, the hospitalization rate attenuated from 65.9% to 44.2% and the surgery rate from 42.9% to 17.4% at 5 years, respectively (both P<0.01). Progression to a complicated phenotype has not changed over time (21.2% in the era 1991-1998 vs. 21.3% in the era 2006-2011, P=0.93). Immunomodulator users had a similar risk of hospitalization, surgery, or phenotype progression as propensity score-matched nonusers (P>0.05 for all analyses). Similar results were found for biological users (P>0.05 for all analyses). CONCLUSIONS Between 1991 and 2014, the hospitalization and surgery rates decreased, whereas progression to complicated disease is still common in CD. These improvements were not significantly related to the use of immunomodulators and biologicals.
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Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) show considerable variation over time and across geographical regions. The first studies on the epidemiology of IBD were mainly from traditionally high-incidence areas, such as North America, and northern and western Europe. In the last two decades, more and more studies have been published from Eastern European and Asian countries with increasing incidence rates from some regions. According to recent studies, the high incidence and prevalence of IBD in some Western countries is plateauing and in some Eastern countries increasing incidences have been reported. In the era of new multicenter epidemiological studies with common methodology the direct comparison of incidences and prevalences has became possible. In the present review we summarized the currently available literatures on west-east differences in the incidences and prevalences of IBD.
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Affiliation(s)
- Zsuzsanna Vegh
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary
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Rönnblom A, Holmström T, Karlbom U, Tanghöj H, Thörn M, Sjöberg D. Clinical course of Crohn's disease during the first 5 years. Results from a population-based cohort in Sweden (ICURE) diagnosed 2005-2009 . Scand J Gastroenterol 2017; 52:81-86. [PMID: 27632773 DOI: 10.1080/00365521.2016.1230777] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study was to describe the medical treatment, change in phenotype, need for surgery and IBD-associated mortality during the first 5 years after diagnosis. MATERIAL AND METHODS Patients diagnosed with Crohn's disease including all age groups in the Uppsala healthcare region in the middle of Sweden 2005-2009 were included in the study. Medical notes were scrutinised and patients contacted. Out of 269 patients, 260 (96.3%) could be followed for 5 full years or until death. RESULTS The following drugs were used: 5-ASA 66.7%, systemic steroids 76.4%, antimetabolites 56.7% and anti-TNF 20.3%. Described with the Montreal classification, the proportion with inflammatory behaviour decreased from 78.1% to 74.0% from diagnosis to end of the observation, patients with stricturing behaviour increased from 13.0% to 15.4% and patients with penetrating behaviour increased from 8.9% to 10.6%. After the first year, 12.4% had been treated with intestinal resection or colectomy, a figure that increased to 14.8 after 5 years. Two patients suffered an IBD-related death. CONCLUSIONS Compared to similar patient cohorts, the present study demonstrates that although the course of Crohn's disease seems difficult to change during the first year after diagnosis, the following years up to 5 years shows a more benign course than has usually been described earlier.
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Affiliation(s)
- Anders Rönnblom
- a Department of Medical Sciences , Uppsala University , Uppsala , Sweden
| | - Tommy Holmström
- b Department of Internal Medicine , Mariehamn , Åland , Finland
| | - Urban Karlbom
- c Department of Surgery , Uppsala University , Uppsala , Sweden
| | - Hans Tanghöj
- d Department of Internal Medicine , Mälar Hospital , Eskilstuna , Sweden
| | - Mari Thörn
- a Department of Medical Sciences , Uppsala University , Uppsala , Sweden
| | - Daniel Sjöberg
- e Department of Internal Medicine , Falu Hospital , Falun , Sweden
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Kirchgesner J, Lemaitre M, Rudnichi A, Racine A, Zureik M, Carbonnel F, Dray-Spira R. Therapeutic management of inflammatory bowel disease in real-life practice in the current era of anti-TNF agents: analysis of the French administrative health databases 2009-2014. Aliment Pharmacol Ther 2017; 45:37-49. [PMID: 27781286 DOI: 10.1111/apt.13835] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/21/2016] [Accepted: 09/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Management of inflammatory bowel disease (IBD) has evolved in the last decade. AIM To assess IBD therapeutic management, including treatment withdrawal and early treatment use in the current era of anti-TNF agents (anti-TNFs). METHODS All patients affiliated to the French national health insurance diagnosed with IBD were included from 2009 to 2013 and followed up until 31 December 2014. Medication uses, treatment sequences after introduction of thiopurine or anti-TNF monotherapies or both (combination therapy), surgical procedures and hospitalisations were assessed. RESULTS A total of 210 001 patients were diagnosed with IBD [Crohn's disease (CD), 100 112; ulcerative colitis (UC), 109 889]. Five years after diagnosis, cumulative probabilities of anti-TNF monotherapy and combination therapy exposures were 33.8% and 18.3% in CD patients and 12.9% and 7.4% in UC patients, respectively. Among incident patients who received thiopurines or anti-TNFs, the first treatment was thiopurine in 69.1% of CD and 78.2% of UC patients. Among patients treated with anti-TNFs, 45.2% and 54.5% of CD patients and 38.2% and 39.9% of UC patients started monotherapy and combination therapy within 3 months after diagnosis, respectively; 31.3% of CD and 27.1% of UC incident patients withdrew from thiopurine or anti-TNFs for more than 3 months after their first course of treatment. Five years after diagnosis, the cumulative risks of first intestinal resection in CD patients and colectomy in UC patients were 11.9% and 5.7%, respectively. CONCLUSIONS Step-up approach remains the predominant strategy, while exposure to anti-TNFs is high. Surgery rates are low. Treatment withdrawal in IBD is more common than expected.
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Affiliation(s)
- J Kirchgesner
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France.,UMR-S 1136, INSERM & UPMC Univ Paris 06, Paris, France
| | - M Lemaitre
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - A Rudnichi
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - A Racine
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris and Gastroenterology Unit, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - M Zureik
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - F Carbonnel
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris and Gastroenterology Unit, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - R Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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Affiliation(s)
| | - Sara Renna
- Di.Bi.M.I.S., Division of Internal Medicine, ‘Villa Sofia-Cervello’ Hospital, Palermo, Italy
| | - Ambrogio Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, ‘Villa Sofia-Cervello’ Hospital, Palermo, Italy
| | - Mario Cottone
- Di.Bi.M.I.S., Division of Internal Medicine, ‘Villa Sofia-Cervello’ Hospital, Palermo, Italy
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Holko P, Kawalec P, Mossakowska M, Pilc A. Health-Related Quality of Life Impairment and Indirect Cost of Crohn's Disease: A Self-Report Study in Poland. PLoS One. 2016;11:e0168586. [PMID: 27992531 PMCID: PMC5161376 DOI: 10.1371/journal.pone.0168586] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/02/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Evidence on indirect cost of Crohn's disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity). METHODS A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients' characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient's version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients' productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients' productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders. RESULTS The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (p<0.001) and lower indirect costs by 71% (p = 0.003) for absenteeism, 41% (p = 0.030) for presenteeism, 76% (p<0.001) for productivity loss at unpaid work, and 75% (p<0.001) for informal care. CONCLUSIONS Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland.
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Rönnblom A, Holmström T, Tanghöj H, Karlbom U, Thörn M, Sjöberg D. Low colectomy rate five years after diagnosis of ulcerative colitis. Results from a prospective population-based cohort in Sweden (ICURE) diagnosed during 2005-2009. Scand J Gastroenterol 2016; 51:1339-44. [PMID: 27356846 DOI: 10.1080/00365521.2016.1200141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The medical treatment of ulcerative colitis (UC) has seen a change towards a more active attitude during recent years, including both the use of more traditional drugs as well as new biological substances. In this epidemiological study we have evaluated the results of modern treatment of UC in a population-based cohort of patients including all age groups, with regard to relapse rate, colectomy and IBD-associated mortality. MATERIAL AND METHODS Patients diagnosed with UC in the Uppsala health care region in the middle of Sweden during 2005-2009 were included in the study. Out of 524 patients, 491 (93%) could be followed for five full years or until death. RESULTS Nineteen patients (3.9%) had died and two of these deaths could be attributed to UC (one postoperative death and one colonic carcinoma). The following drugs were used by the patients during the study period: 5-ASA (91%), systemic steroids (66%), immunomodulators (IMM), mainly thiopurines (26%) and anti-TNF (11%). During the observation period, 74% experienced at least one relapse and 5.3% were subjected to colectomy. Among patients <17 years at diagnosis, colectomy was performed in two (4.8%). CONCLUSIONS Five years after diagnosis of ulcerative colitis, 5.3% had been subjected to colectomy and two patients (0.38%) had died because of the disease.
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Affiliation(s)
- Anders Rönnblom
- a Department of Medical Sciences , Uppsala University , Uppsala , Sweden
| | - Tommy Holmström
- b Department of Internal Medicine , Mariehamn , Finland , Åland
| | - Hans Tanghöj
- c Department of Internal Medicine , Mälar Hospital , Eskilstuna , Sweden
| | - Urban Karlbom
- d Department of Surgery , Uppsala University , Uppsala , Sweden
| | - Mari Thörn
- a Department of Medical Sciences , Uppsala University , Uppsala , Sweden
| | - Daniel Sjöberg
- e Department of Internal Medicine , Falu Hospital , Falun , Sweden
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Annese V, Duricova D, Gower-Rousseau C, Jess T, Langholz E. Impact of New Treatments on Hospitalisation, Surgery, Infection, and Mortality in IBD: a Focus Paper by the Epidemiology Committee of ECCO. J Crohns Colitis 2016; 10:216-25. [PMID: 26520163 DOI: 10.1093/ecco-jcc/jjv190] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/08/2015] [Indexed: 02/08/2023]
Abstract
The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biological therapy. To what extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue, an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in inflammatory bowel disease [IBD] patients. Preference was given to population-based studies but, when data from these sources were limited, large cohort studies and randomised controlled trials were also considered. In general, data on hospitalisation rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biological agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-tumour necrosis factor alpha [TNFα] agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer [absolute risk: low], whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature do not reveal any increase in mortality with immunosuppressant therapy or biologicals/anti-TNF agents.
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Affiliation(s)
- Vito Annese
- Emergency Department, Gastroenterology Unit, AOU Careggi, Florence, Italy
| | - Dana Duricova
- Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE a.s. and Charles University in Prague, Prague, Czech Republic
| | - Corinne Gower-Rousseau
- Epidemiology Unit, Lille University and Hospital, Université Lille Nord de France, Lille, France
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, National Center for Health Data and Disease Control, Copenhagen, Denmark
| | - Ebbe Langholz
- Department of Medicine, Gentofte Hospital, Hellerup, Denmark
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