The impact of anti-TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis-a nationwide study from 1995 to 2015

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Resumé

BACKGROUND: The long-term effects of anti-TNFα therapy in ulcerative colitis are debatable.

AIM: To examine whether anti-TNFα therapy changed the colectomy proportion and reduced the use of corticosteroids.

METHODS: A nationwide cohort study among patients (age 0-20) diagnosed with ulcerative colitis through 1995-2015 from Danish health registries. We calculated the cumulative 5-year risk of colectomy after diagnosis and used a Cox regression model for comparison between a historical pre-anti-TNFα cohort 1 (1995-2003) and a cohort 2 for the era of anti-TNFα (2004-2015). Based on anti-TNFα users, defined as patients who had at least four anti-TNFα treatments within 4 months, we examined the subsequent need for corticosteroids.

RESULTS: We identified 3001 patients from 1995 to 2015. The 5-year cumulative proportion of colectomy in cohort 2 was 9.7% (95% confidence interval [CI] 8.4-11.1) and 12.3% (95% CI 10.4-14.6) in cohort 1. The adjusted 5-year hazard ratio (HR) was 0.76 (95% CI 0.60-0.96) for colectomy in cohort 2 compared to cohort 1. A total of 334 patients received anti-TNFα treatments, and 16.8% (56/334) were prescribed corticosteroids in the subsequent 3-month period. Corticosteroid treatment declined with follow-up after 6 and 12 months, 5.4% and 1.2%, respectively.

CONCLUSION: In patient's ≤20 years, the HR for colectomy within a period of 5 years from the time of diagnosis was reduced in the era of anti-TNFα compared to a historical cohort. In patients treated with anti-TNFα, prescriptions of corticosteroids were virtually ceased after 12 months.

OriginalsprogEngelsk
TidsskriftAlimentary Pharmacology and Therapeutics
Vol/bind50
Udgave nummer10
Sider (fra-til)1077-1085
ISSN0269-2813
DOI
StatusUdgivet - nov. 2019

Fingeraftryk

Ulcerative Colitis
Adrenal Cortex Hormones
Pediatrics
Confidence Intervals
Proportional Hazards Models
Prescriptions
Registries
Cohort Studies
Health

Citer dette

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title = "The impact of anti-TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis-a nationwide study from 1995 to 2015",
abstract = "BACKGROUND: The long-term effects of anti-TNFα therapy in ulcerative colitis are debatable.AIM: To examine whether anti-TNFα therapy changed the colectomy proportion and reduced the use of corticosteroids.METHODS: A nationwide cohort study among patients (age 0-20) diagnosed with ulcerative colitis through 1995-2015 from Danish health registries. We calculated the cumulative 5-year risk of colectomy after diagnosis and used a Cox regression model for comparison between a historical pre-anti-TNFα cohort 1 (1995-2003) and a cohort 2 for the era of anti-TNFα (2004-2015). Based on anti-TNFα users, defined as patients who had at least four anti-TNFα treatments within 4 months, we examined the subsequent need for corticosteroids.RESULTS: We identified 3001 patients from 1995 to 2015. The 5-year cumulative proportion of colectomy in cohort 2 was 9.7{\%} (95{\%} confidence interval [CI] 8.4-11.1) and 12.3{\%} (95{\%} CI 10.4-14.6) in cohort 1. The adjusted 5-year hazard ratio (HR) was 0.76 (95{\%} CI 0.60-0.96) for colectomy in cohort 2 compared to cohort 1. A total of 334 patients received anti-TNFα treatments, and 16.8{\%} (56/334) were prescribed corticosteroids in the subsequent 3-month period. Corticosteroid treatment declined with follow-up after 6 and 12 months, 5.4{\%} and 1.2{\%}, respectively.CONCLUSION: In patient's ≤20 years, the HR for colectomy within a period of 5 years from the time of diagnosis was reduced in the era of anti-TNFα compared to a historical cohort. In patients treated with anti-TNFα, prescriptions of corticosteroids were virtually ceased after 12 months.",
author = "Ken Lund and Larsen, {Michael Due} and Torben Knudsen and Jens Kjeldsen and Nielsen, {Rasmus Gaardskjaer} and N{\o}rg{\aa}rd, {Bente Mertz}",
note = "{\circledC} 2019 John Wiley & Sons Ltd.",
year = "2019",
month = "11",
doi = "10.1111/apt.15510",
language = "English",
volume = "50",
pages = "1077--1085",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
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TY - JOUR

T1 - The impact of anti-TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis-a nationwide study from 1995 to 2015

AU - Lund, Ken

AU - Larsen, Michael Due

AU - Knudsen, Torben

AU - Kjeldsen, Jens

AU - Nielsen, Rasmus Gaardskjaer

AU - Nørgård, Bente Mertz

N1 - © 2019 John Wiley & Sons Ltd.

PY - 2019/11

Y1 - 2019/11

N2 - BACKGROUND: The long-term effects of anti-TNFα therapy in ulcerative colitis are debatable.AIM: To examine whether anti-TNFα therapy changed the colectomy proportion and reduced the use of corticosteroids.METHODS: A nationwide cohort study among patients (age 0-20) diagnosed with ulcerative colitis through 1995-2015 from Danish health registries. We calculated the cumulative 5-year risk of colectomy after diagnosis and used a Cox regression model for comparison between a historical pre-anti-TNFα cohort 1 (1995-2003) and a cohort 2 for the era of anti-TNFα (2004-2015). Based on anti-TNFα users, defined as patients who had at least four anti-TNFα treatments within 4 months, we examined the subsequent need for corticosteroids.RESULTS: We identified 3001 patients from 1995 to 2015. The 5-year cumulative proportion of colectomy in cohort 2 was 9.7% (95% confidence interval [CI] 8.4-11.1) and 12.3% (95% CI 10.4-14.6) in cohort 1. The adjusted 5-year hazard ratio (HR) was 0.76 (95% CI 0.60-0.96) for colectomy in cohort 2 compared to cohort 1. A total of 334 patients received anti-TNFα treatments, and 16.8% (56/334) were prescribed corticosteroids in the subsequent 3-month period. Corticosteroid treatment declined with follow-up after 6 and 12 months, 5.4% and 1.2%, respectively.CONCLUSION: In patient's ≤20 years, the HR for colectomy within a period of 5 years from the time of diagnosis was reduced in the era of anti-TNFα compared to a historical cohort. In patients treated with anti-TNFα, prescriptions of corticosteroids were virtually ceased after 12 months.

AB - BACKGROUND: The long-term effects of anti-TNFα therapy in ulcerative colitis are debatable.AIM: To examine whether anti-TNFα therapy changed the colectomy proportion and reduced the use of corticosteroids.METHODS: A nationwide cohort study among patients (age 0-20) diagnosed with ulcerative colitis through 1995-2015 from Danish health registries. We calculated the cumulative 5-year risk of colectomy after diagnosis and used a Cox regression model for comparison between a historical pre-anti-TNFα cohort 1 (1995-2003) and a cohort 2 for the era of anti-TNFα (2004-2015). Based on anti-TNFα users, defined as patients who had at least four anti-TNFα treatments within 4 months, we examined the subsequent need for corticosteroids.RESULTS: We identified 3001 patients from 1995 to 2015. The 5-year cumulative proportion of colectomy in cohort 2 was 9.7% (95% confidence interval [CI] 8.4-11.1) and 12.3% (95% CI 10.4-14.6) in cohort 1. The adjusted 5-year hazard ratio (HR) was 0.76 (95% CI 0.60-0.96) for colectomy in cohort 2 compared to cohort 1. A total of 334 patients received anti-TNFα treatments, and 16.8% (56/334) were prescribed corticosteroids in the subsequent 3-month period. Corticosteroid treatment declined with follow-up after 6 and 12 months, 5.4% and 1.2%, respectively.CONCLUSION: In patient's ≤20 years, the HR for colectomy within a period of 5 years from the time of diagnosis was reduced in the era of anti-TNFα compared to a historical cohort. In patients treated with anti-TNFα, prescriptions of corticosteroids were virtually ceased after 12 months.

U2 - 10.1111/apt.15510

DO - 10.1111/apt.15510

M3 - Journal article

VL - 50

SP - 1077

EP - 1085

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 10

ER -