TY - JOUR
T1 - Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort
T2 - an Epi-IBD study
AU - Burisch, Johan
AU - Kiudelis, Gediminas
AU - Kupcinskas, Limas
AU - Kievit, Hendrika Adriana Linda
AU - Andersen, Karina Winther
AU - Andersen, Vibeke
AU - Salupere, Riina
AU - Pedersen, Natalia
AU - Kjeldsen, Jens
AU - D'Inca, Renata
AU - Valpiani, Daniela
AU - Schwartz, Doron
AU - Odes, Selwyn
AU - Olsen, Jongero
AU - Nielsen, Kari Rubek
AU - Vegh, Zsuzsanna
AU - Lakatos, Peter Laszlo
AU - Toca, Alina
AU - Turcan, Svetlana
AU - Katsanos, Konstantinos H.
AU - Christodoulou, Dimitrios K.
AU - Fumery, Mathurin
AU - Gower-Rousseau, Corinne
AU - Zammit, Stefania Chetcuti
AU - Ellul, Pierre
AU - Eriksson, Carl
AU - Halfvarson, Jonas
AU - Magro, Fernando Jose
AU - Duricova, Dana
AU - Bortlik, Martin
AU - Fernandez, Alberto
AU - Hernandez, Vicent
AU - Myers, Sally
AU - Sebastian, Shaji
AU - Oksanen, Pia
AU - Collin, Pekka
AU - Goldis, Adrian
AU - Misra, Ravi
AU - Arebi, Naila
AU - Kaimakliotis, Ioannis P.
AU - Nikuina, Inna
AU - Belousova, Elena
AU - Brinar, Marko
AU - Cukovic-Cavka, Silvija
AU - Langholz, Ebbe
AU - Munkholm, Pia
AU - Kjeldsen, Jens
AU - Dahlerup, Jens Frederik
AU - Thorsgaard, Niels
AU - Epi-IBD Grp
PY - 2019/3
Y1 - 2019/3
N2 - Objective The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD). Design Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5). Conclusion Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.
AB - Objective The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD). Design Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5). Conclusion Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.
KW - AZATHIOPRINE
KW - CLINICAL-COURSE
KW - CONVENTIONAL MANAGEMENT
KW - EARLY COMBINED IMMUNOSUPPRESSION
KW - HISTORY
KW - HOSPITALIZATIONS
KW - INFLAMMATORY-BOWEL-DISEASE
KW - MEDICAL-MANAGEMENT
KW - METAANALYSIS
KW - SURGERY RATES
UR - http://www.scopus.com/inward/record.url?scp=85048295105&partnerID=8YFLogxK
U2 - 10.1136/gutjnl-2017-315568
DO - 10.1136/gutjnl-2017-315568
M3 - Journal article
SN - 0017-5749
VL - 68
SP - 423
EP - 433
JO - Gut
JF - Gut
IS - 3
ER -