Impact of anti-TNF-alpha therapy on colectomy rate and indications for colectomy in ulcerative colitis: comparison of two patient cohorts from 2005 to 2007 and from 2014 to 2016

Kolehmainen, Sara; Lepistö, Anna; Färkkilä, Martti

doi:10.1080/00365521.2019.1620326

Cited by 12 publications

(7 citation statements)

References 25 publications

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“…A retrospective study comparing two cohorts of UC patients who underwent colectomy during the years 2005–2007 and 2014–2016 showed an increased use of biological therapy during the time preceding colectomy (2.3% versus 18.8%, p < 0.001) and a significantly decreased rate of surgery (8.6 versus 5.1/1.000 patient-years, p < 0.001) but no changes in the indications for colectomy. 36 This is consistent with a nationwide cohort study from Norway that included 8257 IBD patients (2829 CD and 5428 UC) showing the large regional differences that exist during the first 3 years after diagnosis and in which the region with the lowest anti-TNF use had the highest surgery rates for both UC and CD. 37 However, the timing of anti-TNF initiation seems less important than in CD, as reflected by two retrospective studies in which earlier treatment within 2–3 years of diagnosis prevents neither hospitalization nor colectomy.…”

Section: The Impact Of Therapies On Hospitalization and Surgery Ratessupporting

confidence: 88%

Can we change the natural course of inflammatory bowel disease?

Berre

Danese

Peyrin–Biroulet

2023

Therap Adv Gastroenterol

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Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are lifelong diseases characterized by chronic inflammation of the gastrointestinal tract leading to its progressive and irreversible destruction. Whether early initiation of IBD-specific therapy impacts the long-term course of the disease remains unclear and has to be further explored in prospective disease-modification trials. Historically, surgery and hospitalization rates have been the surrogate markers to measure disease progression in IBD, providing an overview of the effectiveness of medical therapies. However, neither surgery nor hospitalization necessarily reflects a fail in therapeutic medical management, and many confounding factors make them biased outcomes. The Selecting Endpoints for Disease-Modification Trials consensus has defined the disease-modification endpoints required for these trials, including the impact of the disease on patient’s life (health-related quality of life, disability, and fecal incontinence), the mid-term disease complications (bowel damage in CD, IBD-related surgery and hospitalizations, disease extension in UC, extra-intestinal manifestations, permanent stoma, short bowel syndrome), and the development of dysplasia/cancer and mortality in the long term. Most available data in the literature regarding the impact of current therapies on disease progression focused on anti-tumor necrosis factor agents and are based on retrospective or post-hoc studies. Thus, prospective disease-modification trials are pressingly required to explore the effectiveness of early intensified treatment in patients with severe disease or at risk for disease progression.

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Section: The Impact Of Therapies On Hospitalization and Surgery Ratessupporting

confidence: 88%

Can we change the natural course of inflammatory bowel disease?

Berre

Danese

Peyrin–Biroulet

2023

Therap Adv Gastroenterol

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“…A recent evaluation of colectomy patterns in Helsinki demonstrated a similar decrease in colectomy rate during the current biologic era, without a significant difference in the percentage of colectomies performed for colorectal cancer or dysplasia. 34 There have been several recent changes in the approach to specific findings on surveillance colonoscopy among patients with UC, including recommendations from the SCENIC consensus statement, 35 in which surveillance colonoscopy is recommended over colectomy in multiple scenarios. Despite the overall decrease in colectomy rates for UC, the impact of these recommendations and other changes in practice patterns may not be fully captured in administrative claims data.…”

Section: Discussionmentioning

confidence: 99%

Decreasing Colectomy Rate for Ulcerative Colitis in the United States Between 2007 and 2016: A Time Trend Analysis

Barnes

Jiang

Kappelman

et al. 2019

Inflammatory Bowel Diseases

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Background Improved treatment approaches for ulcerative colitis (UC), including novel medications, might reduce the need for colectomy. We performed a retrospective cohort study of adult patients (age 18–64) with UC in the United States to examine time trends for colectomy and biologic use from 2007 to 2016. Methods We estimated quarterly rates for colectomy and biologic use using the IQVIA Legacy PharMetrics Adjudicated Claims Database. We used interrupted time series methods with segmented regression to assess time trends with 95% confidence intervals (CIs) for biologic use and colectomy before and after the emergence of newly available biologic therapies in 2014. Results Among 93,930 patients with UC, 2275 (2.4%) underwent colectomy from 2007 to 2016. Biologic use rates increased significantly from 2007 to 2016, from 131 per 1000 person-years in 2007 (95% CI, 121 to 140) to 589 per 1000 person-years in 2016 (95% CI, 575 to 604; P < 0.001). Colectomy rates decreased significantly between 2007 and 2016, from 7.8 per 1000 person-years (95% CI, 7.4 to 8.2) to 4.2 per 1000 person-years in 2016 (95% CI, 3.2 to 5.1; P < 0.001). An interruption in 2014 was associated with a positive trend deflection for biologic use (+72 treatments per 1000 person-years per year (95% CI, 61 to 83) and a negative trend deflection for colectomy (–0.76 per 1000 person-years per year; 95% CI, –1.47 to –0.05). Conclusions Among commercially insured patients in the United States from 2007 to 2016, biologic use rates increased, colectomy rates decreased, and both trends were impacted by the interruption in 2014. These findings suggest that new biologic therapies may have contributed to decreased colectomy rates.

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“…The authors found the adjusted odds of colectomy of 0.51 ( p < 0.01), adjusted additional mean hospital costs decreased by $2898 ( p < 0.01), hospital charges increased by $26,554 ( p < 0.01), and length of hospitalization decreased by 2.2 days ( p < 0.01) in 2016 compared with 2007, likely due to improved medical care and the ability to use more drugs in patients refractory to conventional therapy [42] . Another study confirmed that the rate of surgery in UC has decreased in the biological agent era, but the indications to colectomy have not changed in the last decade [43] . Avoiding colectomy in UC patients because of disability and complications that may occur after the procedure [44 , 45] is still considered a goal for many gastroenterologists.…”

Section: The Role Of Surgery In Ucmentioning

confidence: 91%