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Colectomy for refractory ulcerative colitis has declined with increasing anti-TNF use

The incidence rate of colectomy for medically refractory ulcerative colitis has declined in parallel with increasing anti-TNF use: a time-trend study, reports the latest issue of Alimentary Pharmacology & Therapeutics.

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Medical therapy is standard treatment for ulcerative colitis with colectomy reserved for medically refractory disease or malignancy.

The introductions of ciclosporin in 1994 and anti-TNF therapy in 2005 have extended medical management options.

Dr Kroeker and colleagues from Canada determined whether the colectomy incidence rate for medically refractory ulcerative colitis has changed since the introduction of anti-TNF therapy.

Adult patients with a diagnosis of ulcerative colitis and who subsequently underwent an urgent or elective colectomy for medically refractory disease in Edmonton, Canada between 1998 and 2011 were identified.

The total colectomy incidence rate decreased by 16% every year with the use of anti-TNF therapy
Alimentary Pharmacology & Therapeutics

Log-linear regression was used to estimate the annual percent change in the total colectomy incidence rate and the urgent and elective incidence rates individually, before and after 2005, the year infliximab was approved for use in ulcerative colitis.

The researchers described temporal trends of drug utilization in this study population.

During 1998–2011, 481 patients with ulcerative colitis underwent a colectomy for medically refractory disease.

There was negligible change in the total colectomy incidence rate from 1998 to 2005, with an annual percent change of 4%.

From 2005-2011, following the approval and increasing use of anti-TNF therapy, the total colectomy incidence rate decreased by 16% every year to 0.9 per 100 ulcerative colitis patients in 2011.

Dr Kroeker's team concludes, "Total incidence rate of colectomy for medically refractory ulcerative colitis has declined substantially since 2005, paralleling the increased use of anti-TNF therapy in this patient population."

Aliment Pharmacol Ther 2014: 40(6): 629–638
04 September 2014

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