Temporal Trends in Surgical Resection Rates and Biologic Prescribing in Crohn’s Disease: A Population-based Cohort Study

Abstract Background The use of biologic therapy for Crohn’s disease [CD] continues to evolve, however, the effect of this on the requirement for surgery remains unclear. We assessed changes in biologic prescription and surgery over time in a population-based cohort. Methods We performed a retrospective cohort study of all 1753 patients diagnosed with CD in Lothian, Scotland, between January 1, 2000 and December 31, 2017, reviewing the electronic health record of each patient to identify all CD-related surgery and biologic prescription. Cumulative probability and hazard ratios for surgery and biologic prescription from diagnosis were calculated and compared using the log-rank test and Cox regression analysis stratified by year of diagnosis into cohorts. Results The 5-year cumulative risk of surgery was 20.4% in cohort 1 [2000–2004],18.3% in cohort 2 [2005–2008], 14.7% in cohort 3 [2009–2013], and 13.0% in cohort 4 [2014–2017] p <0.001. The 5-year cumulative risk of biologic prescription was 5.7% in cohort 1, 12.2% in cohort 2, 22.0% in cohort 3, and 44.9% in cohort 4 p <0.001. Conclusions The increased and earlier use of biologic therapy in CD patients corresponded with a decreasing requirement for surgery over time within our cohort. This could mean that adopting a top-down or accelerated step-up treatment strategy may be effective at reducing the requirement for surgery in newly diagnosed CD.

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P768 Long-term prognosis of Crohn’s disease and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.896 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S609-S610

Author(s):

B D Ye ◽

H Park ◽

S H Kim ◽

S N Hong ◽

H Yoon ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Confidence Interval ◽

Intestinal Resection ◽

Population Based ◽

Natural Course ◽

Cumulative Probability ◽

Cox Regression Analysis ◽

Korean Patients

Abstract Background No previous population-based study has evaluated the natural course of Crohn’s disease (CD) over three decades in non-Caucasians. We previously reported a 30-year trend in the epidemiology of inflammatory bowel disease (IBD) in the Songpa-Kangdong (SK) District of Seoul, Korea between 1986 and 2015 (1). In this study, we aimed to analyse the long-term natural course of Korean patients with CD in the SK-IBD population-based cohort. Methods All patients newly diagnosed with CD between 1986 and 2015 were enrolled in this study. To assess the temporal trends in treatment paradigms and in the prognosis of CD, patients were divided into two cohorts according to the year of CD diagnosis: cohort 1, 1986–2003 and cohort 2, 2004–2015 (the anti-tumour necrosis factor [anti-TNF] era). Disease characteristics at diagnosis, outcomes and their predictors were evaluated. Results A total of 418 patients were enrolled. There were 318 males (76.1%) and median age at CD diagnosis was 22 years (interquartile range [IQR], 18–29). Disease location at CD diagnosis was ileal in 104 patients (24.9%), colonic in 39 (9.3%), and ileocolonic in 275 (65.8%). Disease behaviour at CD diagnosis was inflammatory in 339 patients (81.1%), stricturing in 34 (8.1%), and penetrating in 45 (10.8%). Perianal fistula/abscess was present in 43.3% (n = 181) before or at CD diagnosis. During the median follow-up of 108.1 months, the overall use of systemic corticosteroids, thiopurines, and anti-TNF agents was 57.4%, 80.9%, and 34.2%, respectively. Compared with the cohort 1, the cumulative probability of commencing corticosteroids decreased (p = 0.001), whereas that of commencing thiopurines and anti-TNF agents increased (both p < 0.001) in the cohort 2. A total of 113 patients (27.0%) underwent intestinal resection, demonstrating cumulative risks of intestinal resection at 1, 5, 10, 20, and 25 years after diagnosis of 12.5%, 16.5%, 25.6%, 49.7%, and 55.5%, respectively. Multivariate Cox regression analysis revealed that stricturing behaviour at diagnosis (hazard ratio [HR] 2.393, 95% confidence interval [CI] 1.234–4.641), penetrating behaviour at diagnosis (HR 4.514, 95% CI 1.752–11.629), and the cohort 2 (HR 0.530, 95% CI 0.297–0.945) were independent predictors of intestinal resection. The standardised mortality ratio was 1.867 (95% confidence interval, 0.502–4.780). Conclusion Korean patients showed a similar clinical course and intestinal resection rate compared with Western patients. The risk of intestinal resection has decreased in the anti-TNF era. Reference

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79 Disease Behavior in Crohn's Disease Patients Diagnosed in the Biological Era - A Dutch Population-Based IBD-SL Cohort Study

Gastroenterology ◽

10.1016/s0016-5085(15)30079-2 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-22-S-23 ◽

Cited By ~ 4

Author(s):

Steven Jeuring ◽

Tim Van den Heuvel ◽

Maurice Zeegers ◽

Wim Hameeteman ◽

Mariëlle Romberg-Camps ◽

...

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Population Based ◽

Dutch Population ◽

Disease Behavior

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A37 ASTHMA IS NOT ASSOCIATED WITH THE NEED FOR SURGERY IN CROHN’S DISEASE WHEN CONTROLLING FOR SMOKING STATUS: A POPULATION-BASED COHORT STUDY

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwy009.037 ◽

2018 ◽

Vol 1 (suppl_2) ◽

pp. 63-63

Author(s):

E Kuenzig ◽

M Sadatsafavi ◽

A Avina-Zubieta ◽

R Burne ◽

M Abrahamowicz ◽

...

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Smoking Status ◽

Population Based

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THU0661 RISK OF PSORIASIS, CROHN’S DISEASE, ULCERATIVE COLITIS AND ANKYLOSING SPONDYLITIS IN PATIENTS WITH UVEITIS: A NATIONWIDE, POPULATION-BASED COHORT STUDY

10.1136/annrheumdis-2019-eular.361 ◽

2019 ◽

Author(s):

Hsin-Hua Chen ◽

Tsu-Yi Hsieh ◽

Ching-Heng Lin ◽

Yi-Ming Chen ◽

Kuo-Lung Lai ◽

...

Keyword(s):

Ulcerative Colitis ◽

Cohort Study ◽

Crohn’S Disease ◽

Ankylosing Spondylitis ◽

Crohn's Disease ◽

Population Based

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P821 Incidence of paediatric stricturing duodenal Crohn’s disease in South-East Scotland: A 12-year population-based cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx180.948 ◽

2018 ◽

Vol 12 (supplement_1) ◽

pp. S531-S531

Author(s):

C Burgess ◽

P Gillett ◽

D Mitchell ◽

P Hammond ◽

P Henderson ◽

...

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Population Based

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110 – Stopping 5-Aminosalicylates in Crohn's Disease Patients Starting Biologic Therapy Does Not Increase the Risk of Adverse Clinical Outcomes: Analysis of Two Nationwide Population-Based Cohorts

Gastroenterology ◽

10.1016/s0016-5085(19)36844-1 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-28-S-29

Author(s):

Ryan C. Ungaro ◽

Berkeley Limketkai ◽

Camilla Bjorn Jensen ◽

Clara Yzet ◽

Kristine Allin ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Outcomes ◽

Biologic Therapy ◽

Population Based ◽

Outcomes Analysis

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Mortality in adult-onset and elderly-onset IBD: a nationwide register-based cohort study 1964–2014

Gut ◽

10.1136/gutjnl-2018-317572 ◽

2019 ◽

Vol 69 (3) ◽

pp. 453-461 ◽

Cited By ~ 14

Author(s):

Ola Olén ◽

Johan Askling ◽

Michael C Sachs ◽

Martin Neovius ◽

Karin E Smedby ◽

...

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Adult Onset ◽

Risk Of Death ◽

Increased Risk ◽

Elderly Onset ◽

Incident Cases ◽

Over Time

ObjectivesTo examine all-cause and cause-specific mortality in adult-onset and elderly-onset IBD and to describe time trends in mortality over the past 50 years.DesignSwedish nationwide register-based cohort study 1964–2014, comparing mortality in 82 718 incident IBD cases (inpatient and non-primary outpatient care) with 10 times as many matched general population reference individuals (n=801 180) using multivariable Cox regression to estimate HRs. Among patients with IBD, the number of participants with elderly-onset (≥60 years) IBD was 17 873.ResultsDuring 984 330 person-years of follow-up, 15 698/82 718 (19%) of all patients with IBD died (15.9/1000 person-years) compared with 121 095/801 180 (15.1%) of reference individuals, corresponding to an HR of 1.5 for IBD (95% CI=1.5 to 1.5 (HR=1.5; 95% CI=1.5 to 1.5 in elderly-onset IBD)) or one extra death each year per 263 patients. Mortality was increased specifically for UC (HR=1.4; 95% CI=1.4 to 1.5), Crohn’s disease (HR=1.6; 95% CI=1.6 to 1.7) and IBD-unclasssified (HR=1.6; 95% CI=1.5 to 1.8). IBD was linked to increased rates of multiple causes of death, including cardiovascular disease (HR=1.3; 1.3 to 1.3), malignancy (HR=1.4; 1.4 to 1.5) and digestive disease (HR=5.2; 95% CI=4.9 to 5.5). Relative mortality during the first 5 years of follow-up decreased significantly over time. Incident cases of 2002–2014 had 2.3 years shorter mean estimated life span than matched comparators.ConclusionsAdult-onset and elderly-onset patients with UC, Crohn’s disease and IBD-unclassified were all at increased risk of death. The increased mortality remained also after the introduction of biological therapies but has decreased over time.

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