Abstract
Background
Few data are available at the population level on the impact of the changes in therapeutic strategies over the last decades on inflammatory bowel diseases (IBD) long-term outcomes. We have evaluated the impact of immunosuppressants (IS) and anti-TNF introduction on intestinal resection rate, hospitalisation, and Crohn’s disease (CD) behaviour progression in a large population-based paediatric-onset IBD cohort.
Methods
Paediatric-onset IBD (<17 years) were issued from a prospective population-based study in France between 1988 and 2011 and were retrospectively followed until 2013. Risks for intestinal resection, hospitalisation and complicated CD behaviour (stricturing or penetrating) were compared between three diagnostic periods: 1988–1993 (P1), 1994–2000 (P2) and 2001–2011 (P3) using Kaplan–Meier survival analyses.
Results
One thousand and sixty-one patients diagnosed with CD (n = 800) or ulcerative colitis (UC, n = 261) were followed up during a median of 8.9 years (IQR: 5.0–14.7). Median age at diagnosis was 14.3 years (IQR: 11.8–16.0) and half of patients were female (n = 530, 50%). Over time, in CD, the IS and anti-TNF exposure rate increased from, respectively, 32% (P1) to 75% (P3) and from 0% (P1) to 51% (P3) at 5 years. In UC, IS and anti-TNF exposure increased from, respectively, 9% (P1) to 65% (P3) and from 0% (P1) to 40% (P3) at 5 years. In parallel, risk for intestinal resection at 5 years significantly declined in CD (P1: 35%, P2: 30%, P3: 20%, p < 0.05). No significant change in 5-year colectomy risk in UC was observed (P1: 14%, P2: 19%, P3: 9%, p = 0.08). Exposure to corticosteroid at 5 years of diagnosis did not change over time (P1: 10%, P2: 10%, P3: 8%, p = 0.54). Risk for IBD-flare-related hospitalisation at 5 years was similar over time in CD (P1: 43%, P2: 45%, P3: 43%, p = 0.60) and UC (P1: 31%, P2: 46%, P3: 52%, p = 0.10). Progression to a complicated behaviour in CD at 5 years did not change over time (P1: 31%, P2: 33%, P3: 25%, p = 0.20).
Conclusion
In parallel with the increased use of IS and anti-TNF agents, risk for intestinal resection within 5 years after diagnosis decreased in paediatric CD, whereas risks for flare-related hospitalisation and behaviour progression remained unchanged over a 24-year period.
New Therapeutic Strategies for Inflammatory Bowel Diseases
