TY - JOUR
T1 - Natural Disease Course of Ulcerative Colitis during the First Five Years of Follow-up in a European Population-based Inception Cohort - An Epi-IBD Study
AU - Burisch, Johan
AU - Katsanos, Konstantinos H.
AU - Christodoulou, Dimitrios K.
AU - Barros, Luisa
AU - Magro, Fernando
AU - Pedersen, Natalia
AU - Kjeldsen, Jens
AU - Vegh, Zsuzsanna
AU - Lakatos, Peter L.
AU - Eriksson, Carl
AU - Halfvarson, Jonas
AU - Fumery, Mathurin
AU - Gower-Rousseau, Corinne
AU - Brinar, Marko
AU - Čuković-Čavka, Silvija
AU - Nikulina, Inna
AU - Belousova, Elena
AU - Myers, Sally
AU - Sebastian, Shaji
AU - Kiudelis, Gediminas
AU - Kupcinskas, Limas
AU - Schwartz, Doron
AU - Odes, Selwyn
AU - Kaimakliotis, Ioannis P.
AU - Valpiani, Daniela
AU - D'Incà, Renata
AU - Salupere, Riina
AU - Chetcuti Zammit, Stefania
AU - Ellul, Pierre
AU - Duricova, Dana
AU - Bortlik, Martin
AU - Goldis, Adrian
AU - Kievit, Hendrika Adriana Linda
AU - Toca, Alina
AU - Turcan, Svetlana
AU - Midjord, Jóngere
AU - Nielsen, Kári Rubek
AU - Andersen, Karina Winther
AU - Andersen, Vibeke
AU - Misra, Ravi
AU - Arebi, Naila
AU - Oksanen, Pia
AU - Collin, Pekka
AU - De Castro, Luisa
AU - Hernandez, Vicent
AU - Langholz, Ebbe
AU - Munkholm, Pia
N1 - Publisher Copyright:
© Copyright 2018 European Crohn's and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Background and Aims Few population-based cohort studies have assessed the disease course of ulcerative colitis [UC] in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the 5-year outcome and disease course of patients with UC in the Epi-IBD cohort. Methods In a prospective, population-based inception cohort of unselected patients with UC, patients were followed up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers, and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results A total of 717 patients were included in the study. During follow-up, 43 [6%] patients underwent a colectomy and 163 [23%] patients were hospitalised. Of patients with limited colitis [distal to the left flexure], 90 [21%] progressed to extensive colitis. In addition, 92 [27%] patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8]. Conclusions Although patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes, including colectomy rates, were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalisation.
AB - Background and Aims Few population-based cohort studies have assessed the disease course of ulcerative colitis [UC] in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the 5-year outcome and disease course of patients with UC in the Epi-IBD cohort. Methods In a prospective, population-based inception cohort of unselected patients with UC, patients were followed up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers, and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results A total of 717 patients were included in the study. During follow-up, 43 [6%] patients underwent a colectomy and 163 [23%] patients were hospitalised. Of patients with limited colitis [distal to the left flexure], 90 [21%] progressed to extensive colitis. In addition, 92 [27%] patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8]. Conclusions Although patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes, including colectomy rates, were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalisation.
KW - Ulcerative colitis
KW - biologics
KW - hospitalisation
KW - prognosis
KW - surgery
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85061058790&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjy154
DO - 10.1093/ecco-jcc/jjy154
M3 - Article
C2 - 30289522
AN - SCOPUS:85061058790
SN - 1873-9946
VL - 13
SP - 198
EP - 208
JO - Journal of Crohn's and Colitis
JF - Journal of Crohn's and Colitis
IS - 2
ER -