Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study

Abstract

Background/Aims: The optimal timing for initiation of anti-tumor necrosis factor (TNF) therapy in Crohn's disease (CD) is still debated. Little is known about the clinical outcomes of early versus late administration of anti-TNF agents, especially in Asian CD patients. We aimed to evaluate the impact of early anti-TNF therapy on clinical outcomes in Korean CD patients. Methods: Using the Korean National Health Insurance Claims database, we collected data on patients diagnosed with CD who received anti-TNF therapy for more than 6 months between 2010 and 2016. Early initiation of anti-TNF therapy was defined as those starting infliximab or adalimumab therapy within 1 year of diagnosis. The following outcomes were assessed using a Cox proportional hazard model: abdominal surgery, CD-related emergency room (ER) visit, CD-related hospitalization, and new corticosteroid use. Results: Among 1,207 patients, 609 were early initiators of anti-TNF. Late anti-TNF initiation (> 1 year after diagnosis) was associated with increased risk of surgery (adjusted hazard ratio [aHR], 1.64; 95% confidence interval [CI], 1.05 to 2.55) and tended to be associated with increased risk of ER visit (aHR, 1.38; 95% CI, 0.99 to 1.94). However, there were no significant differences in the risk of hospitalization and corticosteroid use between early and late initiators. Conclusions: Early anti-TNF therapy among Korean CD patients within 1 year of diagnosis was associated with better clinical outcomes than late therapy, such as lower surgery and ER visit rates. Our results suggest that aggressive medical intervention in the early stages of CD may potentially change the course of this disease.

Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis

“…Furthermore, it has been suggested that the decrease in surgical rates occurs mostly due to emergency procedures, with no significant changes in elective procedures [ 54 ]. The results from this study are in agreement with international trends, showing progressive reductions in surgeries and hospitalizations, including surgical hospitalizations, and decreased surgery-related lethality among the patients with IBD throughout the country [ 23 , 55 , 56 ]. The widespread use of immunosuppressants, followed by the introduction of biologic therapies in the public health system in the last decade, might have had an important impact on the overall outcomes of patients with IBD in the country, as pointed out previously [ 57 ].…”

Bowel Preparation and Subsequent Colonoscopy Is Associated with the Risk of Atrial Fibrillation: A Population-Based Case-Crossover Study

“…Universal medical coverage was achieved in Korea in 1989, and all Koreans are mandatorily enrolled in the NHIS database. Thus, the NHIS database contains data on all claims, including prescribed drugs and procedures, for the entire population of South Korea [ 10 , 11 , 12 , 13 ]. Medical claims data submitted between 1 January 2013 and 31 December 2019, were obtained for the current study.…”

Updates on conventional therapies for inflammatory bowel diseases: 5-aminosalicylates, corticosteroids, immunomodulators, and anti-TNF-α

“…IFX (Remicade, Janssen, Seoul, Korea; Remsima, Celltrion, Incheon, Korea; and Remaloce, SAMSUNG BIOEPIS, Incheon, Korea) is a chimeric monoclonal antibody biologic drug that is infused intravenously at 5 mg/kg over 2 hours (shortened to 1 hour if well tolerated) at 0, 2, and 6 weeks and every 8 weeks thereafter in IBD patients ( Table 3 ) [ 81 , 82 ]. A subcutaneous formulation of the IFX biosimilars, CT-P13 (Remsima) or SB2 (Remaloce), is now available for IBD patients.…”