Medical treatment options and strategies for Crohn’s disease (CD) have changed over the past decades.
Dr Steven Jeuring and colleagues from the Netherlands assessed its impact, and studied the evolution of the long-term disease outcome in the Dutch Inflammatory Bowel Disease South Limburg (IBDSL) cohort.
In total, 1,162 CD patients were included.
The team distinguished between 3 eras, including 1991–1998, 1999–2005, and 2006–2011, and patients were followed until 2014.
Medication exposure and the rates of hospitalization, surgery, and phenotype progression were estimated using Kaplan–Meier survival analyses and compared between eras by multivariable Cox regression models.
Second, propensity score matching was used to assess the relation between medication use and the long-term outcome.
|Biological exposure increased to 41% in the 2006–2011 era|
|American Journal of Gastroenterology|
Over time, the team noted that the immunomodulator exposure rate increased from 31% in the era 1991–1998 to 71% in the era 2006–2011 at 5 years.
The researchers observed that similar, biological exposure increased from 3% to 41% in the 2006–2011 era.
In parallel, the hospitalization rate attenuated from 66% to 44%, and the surgery rate from 43% to 17% at 5 years, respectively.
The team observed that progression to a complicated phenotype has not changed over time.
Immunomodulator users had a similar risk of hospitalization, surgery, or phenotype progression as propensity score-matched nonusers.
The team found similar results for biological users.
Dr Jeuring's team concludes, "Between 1991 and 2014, the hospitalization and surgery rates decreased, whereas progression to complicated disease is still common in CD."
"These improvements were not significantly related to the use of immunomodulators and biologicals."