Disease Outcome of Ulcerative Colitis in an Era of Changing Treatment Strategies: Results from the Dutch Population-Based IBDSL Cohort

Jeuring, Steven; Bours, Paul; Zeegers, Maurice P.; Ambergen, Ton W.; Heuvel, Tim R A van den; Romberg‐Camps, Mariëlle; Bodegraven, Ad A. van; Oostenbrug, Liekele E.; Breukink, Stéphanie O.; Stassen, Laurents P. S.; Hameeteman, Wim; Masclee, Ad; Jonkers, Daisy; Pierik, Marieke

doi:10.1093/ecco-jcc/jjv129

Cited by 64 publications

(66 citation statements)

References 42 publications

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“…The 5-year probability of surgery fell from 7.5 to 4.1% in the population diagnosed during the periods 1991-1997 and 2001-2006 respectively. No change in surgical indication over the time was observed [9] . In contrast, a cohort study of all hospitalizations for UC in Calgary Health Zone during a period 1997-2009 found a decrease in elective colectomies only, while the rate of emergent surgeries remained stable [10] .…”

Section: Ulcerative Colitismentioning

confidence: 91%

“…In a national Danish cohort study , the cumulative probability of colectomy at 9 years decreased from 14.5% in a cohort diagnosed 1979-1994 to 9.1% in patients diagnosed after the year 1994 [4] . Likewise, a Dutch population-based study of UC patients diagnosed during 1991-2010 demonstrated a decline in colectomy rate within that time period [9] . The 5-year probability of surgery fell from 7.5 to 4.1% in the population diagnosed during the periods 1991-1997 and 2001-2006 respectively.…”

Section: Ulcerative Colitismentioning

confidence: 98%

“…In a Dutch population-based study, which demonstrated a decline in colectomy rate, an increase in immunosuppressive and biologic therapy was observed between the 3 cohorts (1991-1997, 1998-2005 and 2006-2010) accompanied with a reduced time to the treatment initiation [9] . The 5-year cumulative probability of immunosuppressive and biologics use across the cohorts was 8.1, 22.8, 21.7% and 0, 4.3 and 10.6%, respectively.…”

Section: Impact Of Immunomodulatorsmentioning

confidence: 99%

“…The 5-year cumulative probability of immunosuppressive and biologics use across the cohorts was 8.1, 22.8, 21.7% and 0, 4.3 and 10.6%, respectively. However, the impact of immunosuppressive therapy per se on colectomy was not analysed [9] . Increasing use of thiopurine therapy was also reported in a General Practice Database study of UC patients from the United Kingdom covering a time period from 1989 to 2009 (5-year probability of thiopurines: 10.9% in era 1989-1995 vs. 27.9% in era 2003-2009) [12] .…”

Section: Impact Of Immunomodulatorsmentioning

confidence: 99%

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What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

Ďuricová

2017

Dig Dis

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Background: Population-based studies represent the whole spectrum of patient population and should represent the mainstay when evaluating patients' prognosis. A high number of CD patients need surgical intervention during the disease course. The disease course of inflammatory bowel diseases, including ulcerative colitis (UC) and Crohn's disease (CD), is quite varied and still quite unpredictable. Key Messages: According to earlier studies, up to 60% of patients undergo at least one operation after 10 years of CD duration. Newer cohorts report lower cumulative probability of surgery of approximately 40% after 10 years. The colectomy rate in UC is approximately 10% after 10 years from diagnosis with a geographic difference. Similarly to CD, the colectomy rate seems to decrease over time. There is some evidence that the increasing use of immunosuppressive and/or biological therapy might have been responsible for this favourable trend. However, other factors may have an impact on decreasing surgical trend over time. The relative risk (RR) of colorectal cancer (CRC) in UC is approximately doubled compared to background population. However, the absolute risk in general is relatively low between 1.1 and 5.3% after 20 years of disease duration. Furthermore, a decreasing trend in the incidence of CRC has been reported in recent studies. Importantly, several factors such as disease extent, activity, age at UC onset, and so on may increase/modify an individual risk. Similar to UC, CD patients have approximately 2 times higher RR of cancer compared to background population. The risk is higher for colon than for rectum cancer and present only in CD patients with colonic involvement. Conclusions: The surgery rate in CD has decreased over the time period. The evidence on colectomy rate in UC is less conclusive. The RR of CRC in UC and CD is approximately doubled compared to that of the background population, but it seems to be decreasing in more recent cohorts.

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Section: Ulcerative Colitismentioning

confidence: 91%

Section: Ulcerative Colitismentioning

confidence: 98%

Section: Impact Of Immunomodulatorsmentioning

confidence: 99%

Section: Impact Of Immunomodulatorsmentioning

confidence: 99%

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What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

Ďuricová

2017

Dig Dis

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“…There is significant morbidity and mortality associated with active UC. Recent cohort studies estimate that 4.1-14.8% of patients with UC undergo colectomy during their disease course [Solberg et al 2009;Targownik et al 2012;Jeuring et al 2015]. For years, management primarily included the use of 5-aminosalicylates, corticosteroids, azathioprine, and surgery.…”

Section: Introductionmentioning

confidence: 99%

Current approaches for optimizing the benefit of biologic therapy in ulcerative colitis

Sofia

Rubin

2016

Therap Adv Gastroenterol

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As biologic-based medication options for ulcerative colitis expand, our understanding of their optimal use in clinical practice is advancing as well. The appropriate use of combination therapy with immunomodulators can reduce the immunogenicity of biologic agents and raise serum drug levels of the biologic. A treat-to-target strategy with objective assessments of disease activity clearly defines the goals of biologic drug treatment. Mucosal healing is an evolving treatment goal and is associated with long-term remission and reduced incidence of colectomy. Furthermore, regular reassessments and therapeutic drug monitoring can allow clinicians to make evidence-based changes in therapy. Biologic drug deescalation or re-initiation are less well developed topics, but are emerging areas of study. We review the evidence underlying these advances and a modern approach to the use of biologic therapy in ulcerative colitis.

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Long‐term prognosis and clinical practice for new‐onset ulcerative colitis in the era of biologics: A Japanese retrospective study

Moroi,

Kakuta,

Obara

et al. 2023

JGH Open

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Background and aimThere is a scarcity of data on long‐term outcomes in patients with new‐onset ulcerative colitis (UC) in the era of biologics. We aimed to clarify the long‐term prognosis of UC and the clinical practice of prescriptions for UC.MethodsWe collected 6689 new‐onset UC cases using a medical claim database provided by DeSC Healthcare, Inc. We investigated the surgery‐free, systemic steroid‐free, and molecular targeting drug‐free rates and compared their differences based on UC‐onset age. We used multivariate analysis to identify clinical factors affecting long‐term prognosis and investigated the transition of prescriptions for UC.ResultsThe surgery‐free, systemic steroid‐free, and molecular targeting drug‐free rates at 5 years post‐UC diagnosis were 98.5%, 61.0%, and 88.7%, respectively. Pediatric patients had higher surgery‐free rates compared with elderly patients and non‐pediatric/non‐elderly patients (P = 0.022), whereas the systemic steroid‐free and molecular targeting drug‐free rates were significantly lower (P< 0.0001, P < 0.0001, respectively). The retention rate of the first molecular targeting drug did not differ between drugs. The prescription rates of systemic steroid, immunomodulator, and molecular targeting drug increased from the second quarter in 2014 to the fourth quarter in 2021 (29.8%–39.1%, 6.8%–17.7%, and 7.6%–16.4%, respectively).ConclusionsWe clarified the long‐term prognosis and clinical practice of new‐onset UC cases. The long‐term outcome after UC onset might improve because of increasing use of new therapeutic agents. Further investigations are warranted.

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Disease Outcome of Ulcerative Colitis in an Era of Changing Treatment Strategies: Results from the Dutch Population-Based IBDSL Cohort

Abstract: Over the past two decades, a reduction in early colectomy rate was observed, with no further reduction in the most recent era. Late colectomy rate and hospitalisation rate remained unchanged over time.

Cited by 64 publications

References 42 publications

What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

What Can We Learn from Epidemiological Studies in Inflammatory Bowel Disease?

Current approaches for optimizing the benefit of biologic therapy in ulcerative colitis

Long‐term prognosis and clinical practice for new‐onset ulcerative colitis in the era of biologics: A Japanese retrospective study

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