Biological treatment approach to inflammatory bowel disease is similar in academic and nonacademic centres - prime time for decentralisation of inflammatory bowel disease care?

Autor:	Tepeš K; Department of Gastroenterology, General Hospital Celje, Celje., Hanžel J; Department of Gastroenterology, University Medical Centre Ljubljana.; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana., Štubljar D; In-Medico, Department of Research and Development, Metlika, Slovenia., Strmšek K; Department of Gastroenterology, University Medical Centre Ljubljana., Erjavec L; Department of Gastroenterology, University Medical Centre Ljubljana., Supovec E; Faculty of Medicine, University of Ljubljana., Jagodic Z; Faculty of Medicine, University of Ljubljana., Končan M; Faculty of Medicine, University of Ljubljana., Grosek J; Department of Abdominal Surgery, University Medical Centre Ljubljana.; Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana., Košir JA; Department of Abdominal Surgery, University Medical Centre Ljubljana., Tomažič A; Department of Abdominal Surgery, University Medical Centre Ljubljana.; Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana., Kogovšek U; Department of Abdominal Surgery, University Medical Centre Ljubljana., Norčič G; Department of Abdominal Surgery, University Medical Centre Ljubljana.; Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana., Šibli R; Department of Gastroenterology, General Hospital Celje, Celje., Žnidaršič M; Department of Gastroenterology, General Hospital Celje, Celje., Pačnik Vižintin T; Department of Gastroenterology, General Hospital Celje, Celje., Sodin B; Department of Gastroenterology, General Hospital Celje, Celje., Breznik J; Department of Gastroenterology, General Hospital Jesenice, Jesenice., Hribar VA; Department of Gastroenterology, General Hospital Jesenice, Jesenice., Ocepek A; Department of Gastroenterology, University Medical Centre Maribor, Maribor., Pernat Drobež C; Department of Gastroenterology, University Medical Centre Maribor, Maribor., Bukovnik N; Department of Gastroenterology, University Medical Centre Maribor, Maribor., Zafošnik A; Department of Gastroenterology, University Medical Centre Maribor, Maribor., Marušič T; Department of Gastroenterology, General Hospital Izola, Izola., Jurečič Brglez N; Diagnostic Centre Bled, Bled, Slovenia., Denkovski M; Diagnostic Centre Bled, Bled, Slovenia., Smrekar N; Department of Gastroenterology, University Medical Centre Ljubljana., Novak G; Department of Gastroenterology, University Medical Centre Ljubljana.; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana., Koželj M; Department of Gastroenterology, University Medical Centre Ljubljana., Kurent T; Department of Gastroenterology, University Medical Centre Ljubljana., Simonič J; Department of Gastroenterology, University Medical Centre Ljubljana., Pintar Š; Department of Gastroenterology, University Medical Centre Ljubljana., Štabuc B; Department of Gastroenterology, University Medical Centre Ljubljana.; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana., Drobne D; Department of Gastroenterology, University Medical Centre Ljubljana.; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana.
Jazyk:	angličtina
Zdroj:	European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2024 Jun 01; Vol. 36 (6), pp. 728-734. Date of Electronic Publication: 2024 Apr 02.
DOI:	10.1097/MEG.0000000000002771
Abstrakt:	Background: With the increasing number of inflammatory bowel disease (IBD) patients, it is difficult to manage them within specialised IBD teams in academic medical centres: many are therefore treated in nonacademic IBD centres. It is unclear whether the time to introducing biologics is the same in both settings. Aim: We aimed to compare treatment approach with biologics in academic vs. nonacademic centres. Methods: We analysed Slovenian national IBD registry data (UR-CARE Registry, supported by the European Crohn's and Colitis Organisation), which included 2 academic (2319 patients) and 4 nonacademic IBD (429 patients) centres. Results: The disease phenotype was similar in both settings. In total, 1687 patients received 2782 treatment episodes with biologics. We observed no differences in treatment episodes with TNF-alpha inhibitors (60% vs. 61%), vedolizumab (24% vs. 23%), or ustekinumab (17% vs. 16%) in academic compared to nonacademic centres ( P  = 0.949). However, TNF inhibitors were less often the first biologic in academic centres (TNF inhibitors: 67.5% vs. 74.0%, vedolizumab: 20.3% vs. 17.9%, ustekinumab: 12.1% vs. 8.1%; P = 0.0096). Consequently, more patients received ustekinumab (29.8% vs. 18.3%) and vedolizumab (17.4% vs. 13.5%) and fewer TNF inhibitors (52.7% vs. 68.2%) for Crohn's disease in academic compared to nonacademic centres, with no such differences for ulcerative colitis. The time to initiation of the first biologic from diagnosis was short and similar in both settings (11.3 vs. 10.4 months, P  = 0.2). Conclusion: In this nationwide registry analysis, we observed that biological treatment choice was similar in academic and nonacademic settings. These findings support the decentralisation of IBD care. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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