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

PY - 2019

Y1 - 2019

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 - biologics

KW - hospitalisation

KW - prognosis

KW - surgery

KW - treatment

KW - Ulcerative colitis

U2 - 10.1093/ecco-jcc/jjy154

DO - 10.1093/ecco-jcc/jjy154

M3 - Journal article

C2 - 30289522

AN - SCOPUS:85061058790

VL - 13

SP - 198

EP - 208

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

SN - 1873-9946

IS - 2

ER -