Changes in medical treatment and surgery rates in inflammatory bowel disease: a nationwide cohort study 1979-2011
| Autor: | Jan Wohlfahrt, Ebbe Langholz, Saima Basit, Mikael Andersson, Tine Jess, Christine Rungoe, Nete Munk Nielsen |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Denmark Population Disease Gastroenterology Inflammatory bowel disease Cohort Studies Young Adult Crohn Disease Risk Factors Internal medicine Azathioprine medicine Humans education Mesalamine Glucocorticoids Survival analysis Digestive System Surgical Procedures Aged Aged 80 and over Crohn's disease education.field_of_study business.industry Middle Aged medicine.disease Ulcerative colitis Survival Analysis Drug Utilization Surgery Cohort Colitis Ulcerative Female business Cohort study |
| Zdroj: | Gut. 63(10) |
| ISSN: | 1468-3288 |
| Popis: | 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.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.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 use3 months, only 3+ months use of oral corticosteroids reduced the risk of surgery in patients with disease duration of1 year.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. |
| Databáze: | OpenAIRE |
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