Background & Aims: Most studies concerning the clinical course in CD are retrospective or based on selected patient groups. Our aim was to assess the course of CD in a prospective population-based follow-up study and to identify possible prognostic risk factors for complications on the basis of information obtained at initial diagnosis. Methods: From 1990–1994, a population-based cohort of 843 new cases of inflammatory bowel disease was recruited in South-Eastern Norway. The cohort was systematically followed up at 1, 5, and 10 years after diagnosis. Results: Of 237 patients classified as CD, 197 completed the 10 years of follow-up, 18 died, and 22 were lost to follow-up. The cumulative relapse rate during the first 10 years was 90% (95% confidence interval, 86%–94%), and the cumulative probability of surgery was 37.9% (95% confidence interval, 31.4%–44.4%). Terminal ileal location (P < .001), stricturing (P = .004), penetrating behavior (P < .001), and age younger than 40 years (P = .03) at diagnosis were independent risk factors for subsequent surgery. A total of 53% (n = 105) of the patients had developed stricturing or penetrating disease at 10 years. A large proportion of patients (44%) were in clinical remission during the last 5 years of follow-up. Conclusions: The prognosis for CD seems better than previously reported. The probability of surgery was low, and fewer than expected developed complicated disease behavior. Nevertheless, the cumulative relapse rate of 90% and the finding of prognostic risk factors for subsequent surgery might call for attention to early effective medical treatment strategies.
Section snippets
Material and Methods
From January 1, 1990 to December 31, 1993 all newly diagnosed patients with IBD or possible IBD were prospectively recorded in 4 geographically well-defined areas in South-Eastern Norway (Inflammatory Bowel South-Eastern Norway [IBSEN] study).
On January 1, 1992 the total study population was 966,427. All general practitioners in these areas (1236) were invited to participate in the study, and at each of the 15 participating hospitals, a senior gastroenterologist was made responsible for the
Follow-up Cohort
A complete 10-year follow-up was achieved in 197 of 237 patients (83.1%). The median follow-up time for these patients was 124 months (range, 108–144 months). Eighteen patients (7.6%) had died (median follow-up, 28 months; range, 0–83 months), and 22 patients (9.3%) were lost to follow-up (median follow-up, 53 months; range, 0–100 months). Of the patients lost to follow-up, 9 were not willing to participate further in the study, 7 had moved out of the area, 4 were untraceable, and 2 had other
Discussion
This 10-year follow-up study of newly diagnosed CD patients demonstrated the clinical phenotype, course of disease, and results of treatment in a population-based cohort. In addition, we have described potential risk factors for subsequent complications on the basis of clinical and epidemiologic variables at the time of the initial diagnosis.
This is one of few prospective population-based studies in this field,4, 16 and it has other methodologic advantages. First, the patients were uniformly
2024, Computational and Structural Biotechnology Journal
Autoimmune diseases (ADs) are characterized by their complexity and a wide range of clinical differences. Despite patients presenting with similar symptoms and disease patterns, their reactions to treatments may vary. The current approach of personalized medicine, which relies on molecular data, is seen as an effective method to address the variability in these diseases. This review examined the pathologic classification of ADs, such as multiple sclerosis and lupus nephritis, over time. Acknowledging the limitations inherent in pathologic classification, the focus shifted to molecular classification to achieve a deeper insight into disease heterogeneity. The study outlined the established methods and findings from the molecular classification of ADs, categorizing systemic lupus erythematosus (SLE) into four subtypes, inflammatory bowel disease (IBD) into two, rheumatoid arthritis (RA) into three, and multiple sclerosis (MS) into a single subtype. It was observed that the high inflammation subtype of IBD, the RA inflammation subtype, and the MS "inflammation & EGF" subtype share similarities. These subtypes all display a consistent pattern of inflammation that is primarily driven by the activation of the JAK-STAT pathway, with the effective drugs being those that target this signaling pathway. Additionally, by identifying markers that are uniquely associated with the various subtypes within the same disease, the study was able to describe the differences between subtypes in detail. The findings are expected to contribute to the development of personalized treatment plans for patients and establish a strong basis for tailored approaches to treating autoimmune diseases.
This real-world analysis evaluated the persistence and direct healthcare costs of Crohn's Disease (CD) patients treated with biologics in Italy.
A retrospective analysis on administrative databases of Italian healthcare entities, covering 10.4 million residents, was performed. Adult CD patients under biologics between 2015 and 2020 were included and attributed to first/second treatment line based on absence/presence of biologic prescriptions 5-years before index-date (first biologic prescription).
Of 16,374 CD patients identified, 1,398 (8.5%) were biologic-treated: 1,256 (89.8%) in first line and 135 (9.7%) in second line. Kaplan-Meier curves estimated a higher persistence for ustekinumab-treated patients followed by vedolizumab, infliximab and adalimumab, in both lines. Considering baseline variables and adalimumab as reference, infliximab in first line (HR: 0.537) and ustekinumab in first (HR: 0.057) and second line (HR: 0.213) were associated with significantly reduced risk of drug-discontinuation. First line total/average healthcare direct-costs were €13,637, €11,201, €17,104 and €18,340 in patients persistent on adalimumab, infliximab, ustekinumab and vedolizumab, respectively.
This real-world analysis showed differences in persistence over 12-months between biologic treatments, being higher in ustekinumab-treated group, followed by vedolizumab, infliximab and adalimumab. Patients’ management was associated with comparable direct healthcare costs among treatment lines, mainly driven by drug-related expenses.
The following members of the Inflammatory Bowel South-Eastern Norway (IBSEN) Study Group of gastroenterologists are thanked for participating in this study: Magne Henriksen, Østfold Hospital, Moss; Erling Aadland and Tomm Bernklev Aker, University Hospital, Oslo; Stein Dahler, Notodden Hospital, Øystein Kjellevold, Blefjell Hospital, and Finn Strøm, Lovisenberg Diakonale Hospital, Oslo. For help with statistical analysis we thank Milada Småstuen, Department of Biological Statistics, Rikshospitalet University Hospital.
