Prevalence and Outcomes of No Treatment Versus 5-ASA in Ulcerative Colitis: A Nationwide Analysis From the epi-IIRN.

Autor:	Atia O; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel., Magen Rimon R; Pediatric Gastroenterology and Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Medical Center, Rappaport Faculty of Medicine, Technion - Israel University of Technology, Haifa, Israel., Ledderman N; Meuhedet Health Services, Tel-Aviv, Israel., Greenfeld S; Maccabi Health Services, Tel-Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Israel., Kariv R; Maccabi Health Services, Tel-Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Israel., Loewenberg Weisband Y; Clalit Health Services, Clalit Research Institute, Tel-Aviv, Israel., Shaoul R; Pediatric Gastroenterology and Nutrition Institute, Ruth Rappaport Children's Hospital, Rambam Medical Center, Rappaport Faculty of Medicine, Technion - Israel University of Technology, Haifa, Israel., Matz E; Leumit Health Services, Tel-Aviv, Israel., Odes S; Department of Gastroenterology and Hepatology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel., Goren I; Sackler Faculty of Medicine, Tel Aviv University, Israel.; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel., Yanai H; Sackler Faculty of Medicine, Tel Aviv University, Israel.; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel., Dotan I; Sackler Faculty of Medicine, Tel Aviv University, Israel.; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel., Turner D; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
Jazyk:	angličtina
Zdroj:	Inflammatory bowel diseases [Inflamm Bowel Dis] 2024 Feb 01; Vol. 30 (2), pp. 213-221.
DOI:	10.1093/ibd/izad057
Abstrakt:	Background: Data regarding patients with ulcerative colitis (UC) not receiving maintenance treatment are scarce. In this nationwide study, we aimed to explore the frequency and long-term outcomes of untreated patients with UC vs treated patients. Methods: We retrieved data from Israel's Health Maintenance Organizations, covering 98% of the population. No maintenance treatment (NMT) was defined as lack of treatment during the period from 3 to 6 months from diagnosis, allowing at most 3 months for induction treatment. Results: A total of 15 111 patients have been diagnosed with UC since 2005, of whom 4410 (29%) have had NMT, with 36 794 person-years of follow-up. NMT was more likely in adults (31%) and in elderly-onset UC (29%) than in pediatric-onset UC (20%; P < .001) and decreased from 38% in 2005 to 18% in 2019 (P < .001). The probability of remaining without treatment was 78%, 49%, and 37% after 1, 3, and 5 years from diagnosis, respectively. In propensity score-matched analysis of 1080 pairs of treated (93% with 5-aminosalicylic acid) and untreated patients, outcomes were comparable for time to biologics (P = .6), surgery (P = .8), steroid dependency (P = .09), and hospitalizations (P = .2). Multivariable modeling indicated that failing NMT was less likely in adults or elderly-onset patients who received at most rectal therapy or antibiotics as induction therapy. Conclusions: Nowadays, 18% of patients with UC do not receive maintenance therapy, of whom half remain without treatment after 3 years. Matched pairs of patients on NMT and 5-aminosalicylic acid, representing the mildest patients of the latter, had similar outcomes. Prospective studies are needed to further explore the role of NMT in UC. (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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