Background

Few data are available at the population level on the impact of the changes in therapeutic strategies over the last decades on inflammatory bowel diseases (IBD) long-term outcomes. We have evaluated the impact of immunosuppressants (IS) and anti-TNF introduction on intestinal resection rate, hospitalisation, and Crohn’s disease (CD) behaviour progression in a large population-based paediatric-onset IBD cohort.

Methods

Paediatric-onset IBD (<17 years) were issued from a prospective population-based study in France between 1988 and 2011 and were retrospectively followed until 2013. Risks for intestinal resection, hospitalisation and complicated CD behaviour (stricturing or penetrating) were compared between three diagnostic periods: 1988–1993 (P1), 1994–2000 (P2) and 2001–2011 (P3) using Kaplan–Meier survival analyses.

Results

One thousand and sixty-one patients diagnosed with CD (n = 800) or ulcerative colitis (UC, n = 261) were followed up during a median of 8.9 years (IQR: 5.0–14.7). Median age at diagnosis was 14.3 years (IQR: 11.8–16.0) and half of patients were female (n = 530, 50%). Over time, in CD, the IS and anti-TNF exposure rate increased from, respectively, 32% (P1) to 75% (P3) and from 0% (P1) to 51% (P3) at 5 years. In UC, IS and anti-TNF exposure increased from, respectively, 9% (P1) to 65% (P3) and from 0% (P1) to 40% (P3) at 5 years. In parallel, risk for intestinal resection at 5 years significantly declined in CD (P1: 35%, P2: 30%, P3: 20%, p < 0.05). No significant change in 5-year colectomy risk in UC was observed (P1: 14%, P2: 19%, P3: 9%, p = 0.08). Exposure to corticosteroid at 5 years of diagnosis did not change over time (P1: 10%, P2: 10%, P3: 8%, p = 0.54). Risk for IBD-flare-related hospitalisation at 5 years was similar over time in CD (P1: 43%, P2: 45%, P3: 43%, p = 0.60) and UC (P1: 31%, P2: 46%, P3: 52%, p = 0.10). Progression to a complicated behaviour in CD at 5 years did not change over time (P1: 31%, P2: 33%, P3: 25%, p = 0.20).

Conclusion

In parallel with the increased use of IS and anti-TNF agents, risk for intestinal resection within 5 years after diagnosis decreased in paediatric CD, whereas risks for flare-related hospitalisation and behaviour progression remained unchanged over a 24-year period.

中文翻译：

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OP02治疗策略对小儿炎症性肠病肠切除率的影响：一项基于人群的队列研究，历时24年（1988-2011年）

背景

在过去的几十年中，很少有关于人群治疗策略改变对炎症性肠病（IBD）长期结果影响的数据。我们已经评估了免疫抑制剂（IS）和抗TNF的引入对以人群为基础的小儿发作性IBD队列中肠道切除率，住院和克罗恩病（CD）行为进展的影响。

方法

儿科发作性IBD（<17岁）是由1988年至2011年在法国进行的一项前瞻性人群研究得出的，回顾性研究一直持续到2013年。比较了三者的肠切除，住院和复杂CD行为（狭窄或穿透）风险。诊断期：使用Kaplan-Meier生存分析的1988–1993（P1），1994–2000（P2）和2001–2011（P3）。

结果

在中位时间为8.9年（IQR：5.0–14.7），对1,61名被诊断为CD（n = 800）或溃疡性结肠炎（UC，n = 261）的患者进行了随访。诊断时的中位年龄为14.3岁（IQR：11.8-16.0），一半患者为女性（n = 530，50％）。随着时间的流逝，在5年时，CD的IS和抗TNF暴露率分别从32％（P1）增至75％（P3）和0％（P1）增至51％（P3）。在UC中，IS和抗TNF暴露在5年时分别从9％（P1）增至65％（P3）和从0％（P1）增至40％（P3）。同时，CD 5年时肠切除的风险显着降低（P1：35％，P2：30％，P3：20％，p <0.05）。UC的5年结肠切除术风险没有显着变化（P1：14％，P2：19％，P3：9％，p = 0.08）。诊断5年后皮质类固醇的暴露量并没有随时间变化（P1：10％，P2：10％，P3：8％，p = 0.54）。CD（P1：43％，P2：45％，P3：43％，p = 0.60）和UC（P1：31％，P2：46％， P3：52％，p ＝ 0.10）。在5年后，CD复杂行为的进展没有随时间变化（P1：31％，P2：33％，P3：25％，p = 0.20）。

结论

与IS和抗TNF药物使用量的增加同时，小儿CD诊断后5年内肠切除的风险降低，而与耀斑相关的住院和行为进展的风险在24年内保持不变。