P089. Disease course, phenotype, and medication use in elderly-onset Crohn's disease patients - A population-based IBD-SL 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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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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Erratum: The Influence of Antidepressants on the Disease Course Among Patients With Crohn’s Disease and Ulcerative Colitis—A Danish Nationwide Register–Based Cohort Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz050 ◽

2019 ◽

Vol 25 (11) ◽

pp. e152-e152

Author(s):

Marie Skov Kristensen ◽

Thora Majlund Kjærulff ◽

Annette Kjær Ersbøll ◽

Anders Green ◽

Jesper Hallas ◽

...

Keyword(s):

Ulcerative Colitis ◽

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Course

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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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