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
© 2019 John Wiley & Sons Ltd..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:50 |
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| Enthalten in: |
Alimentary pharmacology & therapeutics - 50(2019), 10 vom: 30. Nov., Seite 1077-1085 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lund, Ken [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 25.05.2020 Date Revised 25.05.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/apt.15510 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM301872570 |
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| 100 | 1 | |a Lund, Ken |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a 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 |
| 264 | 1 | |c 2019 | |
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| 500 | |a Date Completed 25.05.2020 | ||
| 500 | |a Date Revised 25.05.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2019 John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: The long-term effects of anti-TNFα therapy in ulcerative colitis are debatable | ||
| 520 | |a AIM: To examine whether anti-TNFα therapy changed the colectomy proportion and reduced the use of corticosteroids | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 650 | 7 | |a Antibodies, Monoclonal |2 NLM | |
| 650 | 7 | |a TNF protein, human |2 NLM | |
| 650 | 7 | |a Tumor Necrosis Factor-alpha |2 NLM | |
| 700 | 1 | |a Larsen, Michael Due |e verfasserin |4 aut | |
| 700 | 1 | |a Knudsen, Torben |e verfasserin |4 aut | |
| 700 | 1 | |a Kjeldsen, Jens |e verfasserin |4 aut | |
| 700 | 1 | |a Nielsen, Rasmus Gaardskjaer |e verfasserin |4 aut | |
| 700 | 1 | |a Nørgård, Bente Mertz |e verfasserin |4 aut | |
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