Temporal Changes in the Treatment Paradigm and Long-term Prognosis of Patients With Crohn's Disease: A Hospital-Based Cohort Study in China. (30th December 2021)

• Record Type: Journal Article
• Authors: Yao, Lingya; Chen, Haotian; Shao, Bule; Liu, Jing; Wang, Chaohui; Zhang, Zhou; Cao, Qian
• Is Part Of: Inflammatory bowel diseases. Volume 28(2022)Supplement 2
• Page Start: S25
• Page End: S34
• Publication Date: 2021-12-30
• Subjects: Crohn's disease -- hospitalization -- surgery -- phenotype progression -- infliximab; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izab327
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: The temporal trends in medical treatment and long-term outcomes of patients with Crohn's disease (CD) have not been well elucidated in China over the past 2 decades. Accordingly, we aimed to evaluate the treatment paradigm and long-term clinical course of Chinese patients with CD in a hospital-based cohort. Methods: All adult patients newly diagnosed with CD ( n = 1338) between 1999 and 2019 in the Sir Run Run Shaw Hospital were included in this cohort. Medication utilization, disease outcomes, and risk factors were investigated. Results: Overall, 48.7%, 35.6%, 67.8%, and 61.6% of patients used 5-aminosalicylates (5-ASA), corticosteroids, thiopurines, and infliximab (IFX), respectively. The cumulative risk of 5-ASA and corticosteroid initiation decreased during follow-up, whereas that of IFX initiation increased. Throughout a median follow-up duration of 26.4 (interquartile range, 12.0–49.2) months, a total of 486 and 300 patients underwent hospitalization and surgery, respectively. Of the 1097 patients with B1/B2 disease behavior at diagnosis, 10.3% experienced phenotype progression. The hospitalization rate decreased after 2015; however, surgery and phenotype progression rates did not significantly change. A Cox regression analysis indicated that IFX use since diagnosis was a contributing factor for lower rates of hospitalization and phenotype progression, whereas thiopurine use was associated with a lower surgery rate. Conclusions: Infliximab use was observed to increase as 5-ASA and corticosteroid use decreased. Additionally, hospitalization rates decreased following temporal changes in IFX management, yet the surgery and phenotype progression rates remained the same.