Changes in medical treatment and surgery rates in inflammatory bowel disease: a nationwide cohort study 1979-2011

TY - JOUR

T1 - Changes in medical treatment and surgery rates in inflammatory bowel disease

T2 - a nationwide cohort study 1979-2011

AU - Rungoe, Christine

AU - Langholz, Ebbe

AU - Andersson, Mikael

AU - Basit, Saima

AU - Nielsen, Nete M

AU - Wohlfahrt, Jan

AU - Jess, Tine

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - INTRODUCTION: Treatment possibilities have changed in inflammatory bowel disease (IBD). We assessed changes in medical treatment and surgery over time and impact of medications on risk of surgery in a population-based cohort.METHODS: 48 967 individuals were diagnosed with IBD (Crohn's disease (CD), 13 185; ulcerative colitis (UC), 35 782) during 1979-2011. Cumulative probability of receiving 5-aminosalicylic acids (5-ASA), topical, oral corticosteroids, thiopurines, and tumour necrosis factor-α (TNF-α) blockers, and of first minor or major surgery according to period of diagnosis, was estimated. Medication use and risk of surgery was examined by Cox regression.RESULTS: 5-year cumulative probability of first major surgery decreased from 44.7% in cohort (1979-1986) to 19.6% in cohort (2003-2011) (p < 0.001) for CD, and from 11.7% in cohort (1979-1986) to 7.5% in cohort (2003-2011) (p < 0.001) for UC. Minor surgery risk decreased significantly in CD. From cohort (1995-2002) to cohort (2003-2011), a significant increase in use of thiopurines and TNF-α blockers was observed, paralleled by a significant decrease in use of 5-ASA and corticosteroids. Comparing use of azathioprine (or oral corticosteroids) to never-use, no convincing surgery-sparing effect was found. Comparing use in 3+ months of a given drug with use <3 months, only 3+ months use of oral corticosteroids reduced the risk of surgery in patients with disease duration of >1 year.CONCLUSIONS: Parallel to an increasing use of thiopurines and TNF-α blockers in IBD over time, a persistent significant decrease in surgery rates was observed along with a significant decrease in use of 5-ASA and corticosteroids. However, no convincing surgery-sparing effect of newer medications was found.

AB - INTRODUCTION: Treatment possibilities have changed in inflammatory bowel disease (IBD). We assessed changes in medical treatment and surgery over time and impact of medications on risk of surgery in a population-based cohort.METHODS: 48 967 individuals were diagnosed with IBD (Crohn's disease (CD), 13 185; ulcerative colitis (UC), 35 782) during 1979-2011. Cumulative probability of receiving 5-aminosalicylic acids (5-ASA), topical, oral corticosteroids, thiopurines, and tumour necrosis factor-α (TNF-α) blockers, and of first minor or major surgery according to period of diagnosis, was estimated. Medication use and risk of surgery was examined by Cox regression.RESULTS: 5-year cumulative probability of first major surgery decreased from 44.7% in cohort (1979-1986) to 19.6% in cohort (2003-2011) (p < 0.001) for CD, and from 11.7% in cohort (1979-1986) to 7.5% in cohort (2003-2011) (p < 0.001) for UC. Minor surgery risk decreased significantly in CD. From cohort (1995-2002) to cohort (2003-2011), a significant increase in use of thiopurines and TNF-α blockers was observed, paralleled by a significant decrease in use of 5-ASA and corticosteroids. Comparing use of azathioprine (or oral corticosteroids) to never-use, no convincing surgery-sparing effect was found. Comparing use in 3+ months of a given drug with use <3 months, only 3+ months use of oral corticosteroids reduced the risk of surgery in patients with disease duration of >1 year.CONCLUSIONS: Parallel to an increasing use of thiopurines and TNF-α blockers in IBD over time, a persistent significant decrease in surgery rates was observed along with a significant decrease in use of 5-ASA and corticosteroids. However, no convincing surgery-sparing effect of newer medications was found.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Azathioprine/therapeutic use

KW - Cohort Studies

KW - Colitis, Ulcerative/drug therapy

KW - Crohn Disease/drug therapy

KW - Denmark

KW - Digestive System Surgical Procedures/trends

KW - Drug Utilization/statistics & numerical data

KW - Female

KW - Glucocorticoids/therapeutic use

KW - Humans

KW - Male

KW - Mesalamine/therapeutic use

KW - Middle Aged

KW - Risk Factors

KW - Survival Analysis

KW - Young Adult

U2 - 10.1136/gutjnl-2013-305607

DO - 10.1136/gutjnl-2013-305607

M3 - Journal article

C2 - 24056767

SN - 0017-5749

VL - 63

SP - 1607

EP - 1616

JO - Gut

JF - Gut

IS - 10

ER -