Accelerated treatment strategy, including tight disease control and early aggressive therapy with immunosuppressives (IS) and biological agents have become increasingly common in inflammatory bowel disease (IBD). The aim of the present study was to estimate the early treatment strategy and outcomes in newly diagnosed patients with Crohn’s disease (CD) between 2004 and 2008 and 2009–2015 in the whole IBD population in Hungary based on the administrative database of the National Health Insurance Fund (OEP).
We used the administrative database of the OEP, the only nationwide state-owned health insurance provider in Hungary. Patients were identified through previously reported algorithms using the ICD-10 codes for CD in the out-, inpatient (medical, surgical) non-primary care records and drug prescription databases between 2004 and 2015. Patients were stratified according to the year of diagnosis and maximum treatment steps during the first 3 years after diagnosis.
A total of 6173 (male/female: 46.12%/53.87%) newly diagnosed CD patients with physician-diagnosed IBD were found in the period of 2004–2015. The use of 5-ASA and steroids remained common in the biological era, while immunosuppressives and biologicals were started earlier and became more frequent among patients diagnosed after 2009. The probability of biological therapy was 2.9%/6.4% and 8.4%/13.7% after 1 and 3 years in patients diagnosed in 2004–2008/2009–2015. The probability of hospitalization in the first 3 years after diagnosis was different before and after 2009, according to the maximal treatment step (overall 55.7%vs. 47.4% (p = 0.001), anti-TNF: 73%vs. 66.7% (p = 0.103), IS: 64.6% vs. 56.1% (p = 0.001), steroid: 44.2%vs. 36.8% (p < 0.007), 5-ASA: 32.6% vs. 26.7% p = 0.157)). In contrast, surgery rates were not significantly different in patients diagnosed before and after 2009 according to the maximum treatment step (overall 16.0%vs.15.3%(p = 0.672) anti-TNF 26.7%vs.27.2% (p = 0.993), IS: 24.1%vs22.2% (p = 0.565), steroid 8.1%vs.7.9% (p = 0.896), 5-ASA 10%vs. 11% (p = 0.816)).
IS and biological exposure became more frequent, while hospitalization decreased and surgery remained low but constant during the observation period.
Use of steroids and 5-ASA remained high after 2009. The association between the maximal treatment step and hospitalization/surgery rates suggests that maximal treatment step can be regarded as proxy severity marker in patients with IBD.
Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54. [PMID: 22001864. https://doi.org/10.1053/j.gastro.2011.10.001. CrossRefPubMed
Burisch J, Jess T, Martinato M, Lakatos PL, ECCO-EpiCom. The burden of inflammatory bowel disease in Europe. J Crohns Colitis. 2013;7:322–37. [PMID: 23395397. https://doi.org/10.1016/j.crohns.2013.01.010. CrossRefPubMed
Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, D'Haens G, Dotan I, Dubinsky M, Feagan B, Fiorino G, Gearry R, Krishnareddy S, Lakatos PL, Loftus EV Jr, Marteau P, Munkholm P, Murdoch TB, Ordás I, Panaccione R, Riddell RH, Ruel J, Rubin DT, Samaan M, Siegel CA, Silverberg MS, Stoker J, Schreiber S, Travis S, Van Assche G, Danese S, Panes J, Bouguen G, O'Donnell S, Pariente B, Winer S, Hanauer S, Colombel JF. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110:1324–38. [PMID: 26303131. https://doi.org/10.1038/ajg.2015.233. CrossRefPubMed
Mandel MD, Balint A, Golovics PA, Vegh Z, Mohas A, Szilagyi B, Szabo A, Kurti Z, Kiss LS, Lovasz BD, Gecse KB, Farkas K, Molnar T, Lakatos PL. Decreasing trends in hospitalizations during anti-TNF therapy are associated with time to anti-TNF therapy: results from two referral centres. Dig Liver Dis. 2014;46:985–90. [PMID: 25156871. https://doi.org/10.1016/j.dld.2014.07.168. CrossRefPubMed
Bernstein CN, Loftus EV, Ng SC, Lakatos PL, Moum B. Epidemiology and natural history task force of the International Organization for the Study of inflammatory bowel disease (IOIBD). Hospitalisations and surgery in Crohn's disease. Gut. 2012;61:622–9. [PMID: 22267595. https://doi.org/10.1136/gutjnl-2011-301397. CrossRefPubMed
Nguyen GC, Nugent Z, Shaw S, Bernstein CN. Outcomes of patients with Crohn's disease improved from 1988 to 2008 and were associated with increased specialist care. Gastroenterology. 2011;141:90–7. [PMID: 21458455. https://doi.org/10.1053/j.gastro.2011.03.050. CrossRefPubMed
Gomollón F, Dignass A, Annese TH, Van Assche G, Lindsay JO, Peyrin-Biroulet L, Cullen GJ, Daperno M, Kucharzik T, Rieder F, Almer S, Armuzzi A, Harbord M, Langhorst J, Sans M, Chowers Y, Fiorino G, Juillerat P, Mantzaris GJ, Rizzello F, Vavricka S, Gionchetti P, ECCO. 3rd European evidence-based consensus on the diagnosis and Management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis. 2017;11:3–25. PMID: 27660341 doi: https://doi.org/10.1093/ecco-jcc/jjw168 CrossRefPubMed
Burisch J, Pedersen N, Čuković-Čavka S, Brinar M, Kaimakliotis I, Duricova D, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Andersen V, Krabbe S, Dahlerup JF, Salupere R, Nielsen KR, Olsen J, Manninen P, Collin P, Tsianos EV, Katsanos KH, Ladefoged K, Lakatos L, Björnsson E, Ragnarsson G, Bailey Y, Odes S, Schwartz D, Martinato M, Lupinacci G, Milla M, De Padova A, D'Incà R, Beltrami M, Kupcinskas L, Kiudelis G, Turcan S, Tighineanu O, Mihu I, Magro F, Barros LF, Goldis A, Lazar D, Belousova E, Nikulina I, Hernandez V, Martinez-Ares D, Almer S, Zhulina Y, Halfvarson J, Arebi N, Sebastian S, Lakatos PL, Langholz E, Munkholm P, EpiCom-group. East–west gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut. 2014;63:588–97. [PMID: 23604131. https://doi.org/10.1136/gutjnl-2013-304636. CrossRefPubMed
Vegh Z, Burisch J, Pedersen N, Kaimakliotis I, Duricova D, Bortlik M, Avnstrøm S, Vinding KK, Olsen J, Nielsen KR, Katsanos KH, Tsianos EV, Lakatos L, Schwartz D, Odes S, Lupinacci G, De Padova A, Jonaitis L, Kupcinskas L, Turcan S, Tighineanu O, Mihu I, Barros LF, Magro F, Lazar D, Goldis A, Fernandez A, Hernandez V, Niewiadomski O, Bell S, Langholz E, Munkholm P, Lakatos PL, EpiCom-group. Incidence and initial disease course of inflammatory bowel diseases in 2011 in Europe and Australia: results of the 2011 ECCO-EpiCom inception cohort. J Crohns Colitis. 2014;8:1506–15. [PMID: 24998983. https://doi.org/10.1016/j.crohns.2014.06.004. CrossRefPubMed
Vegh Z, Burisch J, Pedersen N, Kaimakliotis I, Duricova D, Bortlik M, Vinding KK, Avnstrøm S, Olsen J, Nielsen KR, Katsanos KH, Tsianos EV, Lakatos L, Schwartz D, Odes S, D'Incà R, Beltrami M, Kiudelis G, Kupcinskap L, Jucov A, Turcan S, Barros LF, Magro F, Lazar D, Goldis A, de Castro L, Hernandez V, Niewiadomski O, Bell S, Langholz E, Munkholm P, Lakatos PL, EpiCom-group. Treatment steps, surgery, and hospitalization rates during the first year of follow-up in patients with inflammatory bowel diseases from the 2011 Ecco-EpiCom inception cohort. J Crohns Colitis. 2015;9:747–53. PMID: 26055976 doi: https://doi.org/10.1093/ecco-jcc/jjv099 CrossRefPubMed
Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV Jr. Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol. 2017;15:857–63. [PMID: 27856364. https://doi.org/10.1016/j.cgh.2016.10.039. CrossRefPubMed
Lakatos L, Kiss LS, David G, Pandur T, Erdelyi Z, Mester G, Balogh M, Szipocs I, Molnar C, Komaromi E, Lakatos PL. Incidence, disease phenotype at diagnosis, and early disease course in inflammatory bowel diseases in western Hungary, 2002–2006. Inflamm Bowel Dis. 2011;17:2558–65. [PMID: 22072315. https://doi.org/10.1002/ibd.21607. CrossRefPubMed
Lakatos PL, Golovics PA, David G, Pandur T, Erdelyi Z, Horvath A, Mester G, Balogh M, Szipocs I, Molnar C, Komaromi E, Veres G, Lovasz BD, Szathmari M, Kiss LS, Lakatos L. Has there been a change in the natural history of Crohn’s disease? Surgical rates and medical management in a population-based inception cohort from western Hungary between 1977–2009. Am J Gastroenterol. 2012;107:579–88. [PMID: 22233693. https://doi.org/10.1038/ajg.2011.448. CrossRefPubMed
Kurti Z, Vegh Z, Golovics PA, Fadgyas-Freyler P, Gecse KB, Gonczi L, Gimesi-Orszagh J, Lovasz BD, Lakatos PL. Nationwide prevalence and drug treatment practices of inflammatory bowel diseases in Hungary: a population-based study based on the National Health Insurance Fund database. Dig Liver Dis. 2016;48:1302–7. [PMID: 27481587. https://doi.org/10.1016/j.dld.2016.07.012. CrossRefPubMed
Frolkis AD, Dykeman J, Negrón ME, Debruyn J, Jette N, Fiest KM, Frolkis T, Barkema HW, Rioux KP, Panaccione R, Ghosh S, Wiebe S, Kaplan GG. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2013;145:996–1006. [PMID: 23896172. https://doi.org/10.1053/j.gastro.2013.07.041. CrossRefPubMed
Solberg IC, Vatn MH, Høie O, Stray N, Sauar J, Jahnsen J, Moum B, Lygren I, IBSEN Study Group. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007;5:1430–8. [PMID: 18054751. https://doi.org/10.1016/j.cgh.2007.09.002. CrossRefPubMed
Magro F, Dias CC, Coelho R, Santos PM, Fernandes S, Caetano C, Rodrigues Â, Portela F, Oliveira A, Ministro P, Cancela E, Vieira AI, Barosa R, Cotter J, Carvalho P, Cremers I, Trabulo D, Caldeira P, Antunes A, Rosa I, Moleiro J, Peixe P, Herculano R, Gonçalves R, Gonçalves B, Tavares Sousa H, Contente L, Morna H, Lopes S. Impact of early surgery and Immunosuppression on Crohn's disease disabling outcomes. Inflamm Bowel Dis. 2017;23:289–97. [PMID: 28107278. https://doi.org/10.1097/MIB.0000000000001007. CrossRefPubMed
Chatu S, Saxena S, Subramanian V, Curcin V, Yadegarfar G, Gunn L, Majeed A, Pollok RC. The impact of timing and duration of thiopurine treatment on first intestinal resection in Crohn's disease: national UK population-based study 1989–2010. Am J Gastroenterol. 2014;109:409–16. [PMID: 24469612. https://doi.org/10.1038/ajg.2013.462. CrossRefPubMed
Mao EJ, Hazlewood GS, Kaplan GG, Peyrin-Biroulet L, Ananthakrishnan AN. Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther. 2017;45:3–13. [PMID: 27862107. https://doi.org/10.1111/apt.13847. CrossRefPubMed
Domènech E, Zabana Y, Garcia-Planella E, López San Román A, Nos P, Ginard D, Gordillo J, Martínez-Silva F, Beltrán B, Mañosa M, Cabré E, Gassull MA. Clinical outcome of newly diagnosed Crohn's disease: a comparative, retrospective study before and after infliximab availability. Aliment Pharmacol Ther. 2010;31:233–9. [PMID: 19832727. https://doi.org/10.1111/j.1365-2036.2009.04170.x. PubMed
Burisch J, Halfvarson J, Kupcinskas L, Hernandez V, Kaimakliotis I, Valpiani D, Pedersen N, Duricova D, Kievit L, Dahlerup JF, Fumery M, Salupere R, Arebi N, Nielsen KR, Giannotta M, Oksanen P, Katsanos KH, Vegh Z, Ellul P, Schwartz D, Čuković-Čavka S, D'Incà R, Turcan S, Magro F, Goldis A, Langholz E, Lakatos PL, Munkholm P, EpiCom Study Group. Disease course during the first five years following diagnosis in a prospective European population-based inception cohort – the ECCO-EpiCom cohort. J Crohns Colitis. 2017;11(suppl_1):S435–6. doi: https://doi.org/10.1093/ecco-jcc/jjx002.818 CrossRef
Herrinton LJ, Liu L, Fireman B, Lewis JD, Allison JE, Flowers N, Hutfless S, Velayos FS, Abramson O, Altschuler A, Perry GS. Time trends in therapies and outcomes for adult inflammatory bowel disease, northern California, 1998–2005. Gastroenterology. 2009;137:502–11. [PMID: 19445944. https://doi.org/10.1053/j.gastro.2009.04.063. CrossRefPubMed
Odes S, Vardi H, Friger M, Wolters F, Russel MG, Riis L, Munkholm P, Politi P, Tsianos E, Clofent J, Vermeire S, Monteiro E, Mouzas I, Fornaciari G, Sijbrandij J, Limonard C, Van Zeijl G, O'morain C, Moum B, Vatn M, Stockbrugger R, European Collaborative Study on Inflammatory Bowel Disease. Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation. Gastroenterology. 2006;131:719–28. [PMID: 16952541. https://doi.org/10.1053/j.gastro.2006.05.052. CrossRefPubMed
Ott C, Takses A, Obermeier F, Schnoy E, Salzberger B, Müller M. How fast up the ladder? Factors associated with immunosuppressive or anti-TNF therapies in IBD patients at early stages: results from a population-based cohort. Int J Color Dis. 2014;29:1329–38. [PMID: 25179426. https://doi.org/10.1007/s00384-014-2002-z. CrossRef
Rencz F, Péntek M, Bortlik M, Zagorowicz E, Hlavaty T, Śliwczyński A, Diculescu MM, Kupcinskas L, Gecse KB, Gulácsi L, Lakatos PL. Biological therapy in inflammatory bowel diseases: access in central and Eastern Europe. World J Gastroenterol. 2015;21:1728–37. [PMID: 25684937. https://doi.org/10.3748/wjg.v21.i6.1728. CrossRefPubMedPubMedCentral
- Therapeutic preferences and outcomes in newly diagnosed patients with Crohn’s diseases in the biological era in Hungary: a nationwide study based on the National Health Insurance Fund database
Petra A. Golovics
Barbara D. Lovasz
Peter L. Lakatos
- BioMed Central
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