Prevalence and risk factors for therapy escalation in ulcerative colitis in the Swiss IBD Cohort Study

Détails

ID Serval
serval:BIB_93A80D34FABA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Prevalence and risk factors for therapy escalation in ulcerative colitis in the Swiss IBD Cohort Study
Périodique
Inflammatory Bowel Diseases
Auteur(s)
Safroneeva E., Vavricka S.R., Fournier N., Straumann A., Rogler G., Schoepfer A.M.
ISSN
1536-4844 (Electronic)
ISSN-L
1078-0998
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
21
Numéro
6
Pages
1348-1358
Langue
anglais
Notes
IUMSP2015/06
Résumé
BACKGROUND: Physicians traditionally treat ulcerative colitis (UC) using a step-up approach. Given the paucity of data, we aimed to assess the cumulative probability of UC-related need for step-up therapy and to identify escalation-associated risk factors.
METHODS: Patients with UC enrolled into the Swiss IBD Cohort Study were analyzed. The following steps from the bottom to the top of the therapeutic pyramid were examined: (1) 5-aminosalicylic acid and/or rectal corticosteroids, (2) systemic corticosteroids, (3) immunomodulators (IM) (azathioprine, 6-mercaptopurine, methotrexate), (4) TNF antagonists, (5) calcineurin inhibitors, and (6) colectomy.
RESULTS: Data on 996 patients with UC with a median disease duration of 9 years were examined. The point estimates of cumulative use of different treatments at years 1, 5, 10, and 20 after UC diagnosis were 91%, 96%, 96%, and 97%, respectively, for 5-ASA and/or rectal corticosteroids, 63%, 69%, 72%, and 79%, respectively, for systemic corticosteroids, 43%, 57%, 59%, and 64%, respectively, for IM, 15%, 28%, and 35% (up to year 10 only), respectively, for TNF antagonists, 5%, 9%, 11%, and 12%, respectively, for calcineurin inhibitors, 1%, 5%, 9%, and 18%, respectively, for colectomy. The presence of extraintestinal manifestations and extended disease location (at least left-sided colitis) were identified as risk factors for step-up in therapy with systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and surgery. Cigarette smoking at diagnosis was protective against surgery.
CONCLUSIONS: The presence of extraintestinal manifestations, left-sided colitis, and extensive colitis/pancolitis at the time of diagnosis were associated with use of systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and colectomy during the disease course.
Pubmed
Web of science
Création de la notice
09/04/2015 15:18
Dernière modification de la notice
03/03/2018 19:35
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