Time Trends of Crohn’s Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery

Brunet, E; Vela, Emili; Melcarne, Luigi; Clèries, Montserrat; Pontes, Caridad; Llovet, Laura Patricia; García-Iglesias, Pilar; Gallach, Marta; Villòria, Albert; Vergara, Mercedes; Calvo, Xavier Calvet

doi:10.3390/jcm9092896

Cited by 9 publications

(11 citation statements)

References 37 publications

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“…The use of IFX treatment also showed a negative correlation with the rate of abdominal surgery in patients with AOP. This veri ed the conclusion that the increased use of biologics is positively correlated with a reduced need for abdominal surgery [26]. Furthermore, we observed that the time from the onset of PD to the diagnosis of PCD and the time from the diagnosis of PCD to the rst use of IFX were longer in the adult-onset cohort.…”

Section: Discussionsupporting

confidence: 82%

Perianal Disease Onset Age is Associated with Need for Abdominal Surgery in Perianal Crohn’s Disease: A Ten-year Observational Study in China

Wang

Wang³

et al. 2021

Preprint

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Background and aims: The significance of different ages of perianal disease (PD) onset in patients with perianal Crohn’s disease (PCD) remains unknown. We aimed to investigate the impact of paediatric-onset PD (POP, <18 years) and adult-onset PD (AOP, ≥18 years) on the Crohn’s disease (CD) course in a Chinese cohort.Methods: The medical records of the diagnosed PCD patients from 2008 to 2018 were reviewed retrospectively. The cumulative incidence of abdominal surgery was calculated using the Kaplan-Meier, and independent predictors of surgery were identified by logistic regression analysis.Results: Complex perianal fistulas (71.7% vs 50.0%, p=0.011) and infliximab (IFX) treatment (33.3% vs 22.0%, p=0.044) were more common among the POP patients (n=84). A younger PD onset age (15.1±2.9 vs 30.2±10.5 years, p<0.001) and shorter PCD diagnostic delay (12 vs 24 months, p =0.033) was seen in the POP cohort. AOP patients (n=209) had a higher rate of current smoking (12.9% vs 4.8%, p=0.040), stricturing behaviour (42.1% vs 27.4%, p=0.024) and abdominal surgery (21.1% vs 4.8%, p=0.001). The cumulative probability of abdominal surgery in AOP patients was higher than that in POP patients (p=0.007). In multivariable analysis, AOP (odds ratio [OR]: 2.915, 95% CI: 1.479-5.744, p=0.002) and stricturing behaviour (OR: 8.374, 95% CI: 1.055-66.488, p=0.044) were predictive factors for CD-related abdominal surgery in all PCD patients, complex perianal fistula was associated with the increased incidence of abdominal surgery in the AOP cohort (OR: 2.257, 95% CI: 1.041-4.891, p=0.039). The IFX administration significantly decreased the rate of abdominal surgery in AOP patients (r=-0.900, p=0.037). Conclusions: This Chinese cohort suggested that AOP indicate a later disease course and a higher risk of abdominal surgery than POP. Early diagnosis and positive IFX treatment could improve the prognosis of CD patients with AOP.

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Section: Discussionsupporting

confidence: 82%

Perianal Disease Onset Age is Associated with Need for Abdominal Surgery in Perianal Crohn’s Disease: A Ten-year Observational Study in China

Wang

Wang³

et al. 2021

Preprint

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“…As shown in our previous study [ 31 , 32 ], relative risk of overall hospitalization increased when compared with 2011, CD-related hospitalization rates slightly decreased (being statically significant in 2016 and 2017) and surgery and ostomies tend to decrease but not significantly. Regarding drugs, biological drugs increased (being statically significant over the period), immunosuppressant’s remained stable and salicylates and systemic corticosteroids significantly decreased (being statically significant between 2013 and 2017) ( Figure 2 , Supplementary Table 5 ).…”

Section: Resultssupporting

confidence: 52%

“…Data on the prevalence, incidence and mortality on CD and demographical variables have been described in detail in previous articles [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Heterogeneity in pharmacological treatment and outcomes in Crohn’s disease patients in Catalonia: a population-based observational study

Brunet

Vela

Melcarne³

et al. 2022

Annals of Medicine

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Background Heterogeneity in the treatment of a disease is a marker of suboptimal quality of care. The aim of this study is to evaluate the heterogeneity in the treatment used and the outcomes for Crohn’s disease (CD) in Catalonia. Methods All patients with CD included in the Catalan Health Surveillance System (data on more than seven million individuals from 2011 to 2017) were identified. The different Catalonian health areas were grouped into 19 district groups (DG). Treatments used rates (systemic corticosteroids, non-biological and biological immunosuppressant) and outcomes rates (hospitalization and surgery) were calculated. Results The use of systemic corticosteroids presented a decreasing trend over the study period, with an average rate of use in the different territories between 11% and 17%. The use of non-biological immunosuppressant treatment has remained stable, with an average rate of use ranging from 22% to 40% per year depending on the DG. The use of biological immunosuppressant treatment increased with an average rate of use in the different territories ranging from 10 to 23%. Hospitalizations for any reason showed an increasing trend between 2011 and 2017 with an average rate of between 23% and 32% per year depending on the area. Hospitalizations for CD presented a decreasing trend, with an average rate of between 5% and 11% per year. Surgical treatment remained stable over time, rates per year were between 0.5% and 2%. Conclusion A remarkable geographical heterogeneity in the use of different treatments and in outcomes of CD was observed between different geographical areas of Catalonia. KEY MESSAGE There is a notable geographical heterogeneity in the administration of biological and immunosuppressive treatments to Crohn’s disease patients in Catalonia. There is also a geographical heterogeneity in their rates of hospitalization and surgical intervention.

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“…Inflammatory bowel disease (IBD), either Crohn’s disease (CD) or ulcerative colitis (UC), is a chronic, progressive, and life‐long condition that affects a large number of people in our country. 1 , 2 Lifetime medical costs associated with IBD care are comparable to those of other severe chronic diseases such as diabetes mellitus or cancer. 3 IBD is typically managed by gastroenterologists in collaboration with other healthcare specialities.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory bowel disease integral care units: Evaluation of a nationwide quality certification programme. The GETECCU experience

et al. 2021

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Background One of the most valued targets in inflammatory bowel disease (IBD) is for physicians to provide and patients to receive a high‐level quality of care. This study aimed to evaluate the implementation of a nationwide quality certification programme for IBD units. Methods Identification of quality indicators (QI) for IBD Unit certification was based on Delphi methodology that selected 53 QI, which were subjected to a normalisation process. Selected QI were then used in the certification process. Coordinated by GETECCU, this process began with a consulting round and an audit drill followed by a formal audit carried out by an independent certifying agency. This audit involved the scrutiny of the selected QI in medical records. If 80%–90% compliance was achieved, the IBD unit audited received the qualification of “advanced”, and if it exceeded 90% the rating was “excellence”. Afterwards, an anonymous survey was conducted among certified units to assess satisfaction with the programme for IBD units. Results As of January 2021, 66 IBD units adhere to the nationwide certification programme. Among the 53 units already audited by January 2021, 31 achieved the certification of excellence, 20 the advanced certification, and two did not obtain the certification. The main survey results indicated high satisfaction with an average score of 8.5 out of 10. Conclusion Certification of inflammatory bowel disease units by GETECCU is the largest nationwide certification programme for IBD units reported. More than 90% of IBD units adhered to the programme achieved the certification.

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Time Trends of Crohn’s Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery

Cited by 9 publications

References 37 publications

Perianal Disease Onset Age is Associated with Need for Abdominal Surgery in Perianal Crohn’s Disease: A Ten-year Observational Study in China

Perianal Disease Onset Age is Associated with Need for Abdominal Surgery in Perianal Crohn’s Disease: A Ten-year Observational Study in China

Heterogeneity in pharmacological treatment and outcomes in Crohn’s disease patients in Catalonia: a population-based observational study

Inflammatory bowel disease integral care units: Evaluation of a nationwide quality certification programme. The GETECCU experience

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