Improved Outcomes of Paediatric and Adult Crohn's Disease and Association With Emerging Use of Biologics–A Nationwide Study From the Epi-IIRN. (4th November 2021)

• Record Type: Journal Article
• Authors: Atia, Ohad; Orlanski-Meyer, Esther; Lujan, Rona; Ledderman, Natan; Greenfeld, Shira; Kariv, Revital; Daher, Saleh; Yanai, Henit; Loewenberg Weisband, Yiska; Gabay, Hagit; Matz, Eran; Nevo, Daniel; Israeli, Eran; Schwartz, Doron; Chowers, Yehuda; Dotan, Iris; Turner, Dan
• Is Part Of: Journal of Crohn's and colitis. Volume 16:Number 5(2022)
• Page Start: 778
• Page End: 785
• Publication Date: 2021-11-04
• Subjects: Crohn's disease -- biologics -- outcomes; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjab204
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: The effectiveness of biologics for improving long-term outcomes in patients with Crohn's disease [CD] is still controversial. In this nationwide study, we aimed to evaluate trends of long-term outcomes in all CD patients in Israel during the biologics era. Methods: Trends of outcomes were analysed using data from the four Israeli health maintenance organisations, covering 98% of the population; joinpoint regression models were used to explore changes of these trends over 2005 to 2019. Results: A total of 16 936 patients were diagnosed with CD in Israel since 2005 (2932 [17%] paediatric onset, 14 004 [83%] adult onset) with 114 947 person-years of follow-up. The cumulative rate of any CD related surgery was 5%, 9%, 11%, and 14% at 1, 3, 5, and 10 years from diagnosis. The increase in use of biologics was sharp (from 8.9% to 36%; average annual percent change [AAPC], 14.3%), and the time to biologics was shorter in recent years (median time of 4.8 [1.9–8.1] years in those diagnosed in 2005–2008 compared with 0.5 [0.2–1.1] years in those diagnosed in 2015–2018; p < 0.001). A significant decrease was noted in the hazard of hospitalisations (1.3 [0.1–4.6] years compared with 0.2 [0.02–0.9] years; p < 0.001), steroid dependency (1.5 [0.2–5.4] years compared with 0.1 [0.02–0.4] years; p < 0.001), and intestinal surgeries [4.7 [1.6–8.2] years compared with 0.6 [0.2–1.4] years; p < 0.001), but not of perianal surgery (4.2 [1.1–7.7] years compared with 0.6 [0.2–1.4] years; p = 0.2). Outcomes were consistently worse in paediatric onset compared with adults. Conclusions: The rates of hospitalisations, steroid dependency, and intestinal resections decreased in association with increased use of biologics both in children and in adults, but not the rate of perianal surgeries.