title: Incidence of and impact of medications on colectomy in newly diagnosed ulcerative colitis in the era of biologics.
abstract: BACKGROUND
  The cumulative incidence of colectomy and the impact of 5-aminosalicylates (5-ASA), azathioprine, and antitumor necrosis factor (TNF) treatment on the long-term need for surgery are unknown in ulcerative colitis (UC) in the era of biologics.
  
  
  METHODS
  This was an observational study of a referral center cohort. The cumulative incidence of UC-related colectomy was estimated using the Kaplan-Meier method. Independent predictors of surgery were identified using Cox proportional hazards regression with propensity scores adjustment. The electronic charts of 151 incident cases of UC from Nancy University Hospital, France, diagnosed between 2000 and 2008, were reviewed through January 2010.
  
  
  RESULTS
  The median follow-up time per patient was 58 months. Twenty-one (14%) underwent surgery. The cumulative probabilities of colectomy were respectively 1.3% and 13.5% at 1 and 5 years from the time of diagnosis. The probability of receiving oral mesalamine at 5 years was 68.1%. The corresponding figures were 48.9% for azathioprine and 29.0% for infliximab. For corticosteroids, methotrexate, and cyclosporin these figures were 75%, 8.8%, and 11.5%, respectively. Using multivariate Cox proportional hazards regression analysis after propensity score adjustment, previous use of cyclosporin was the only independent predictor for colectomy (hazard ratio = 4.41; 95% confidence interval 1.75-1.13).
  
  
  CONCLUSIONS
  About one-tenth of patients still require colectomy for UC at 5 years in the era of biologics. Oral 5-ASA, azathioprine, and anti-TNF therapy are not associated with a reduced need for colectomy.
authors.affiliation: Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Williet
authors.forename: Claire
authors.initials: C
authors.lastname: Pillot
authors.forename: Abderrahim
authors.initials: A
authors.lastname: Oussalah
authors.forename: Vincent
authors.initials: V
authors.lastname: Billioud
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Chevaux
authors.forename: Laurent
authors.initials: L
authors.lastname: Bresler
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Bigard
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gueant
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015122:Mercaptopurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019804:Mesalamine / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha; C488629:azathiopurine; D019804:Mesalamine; D015122:Mercaptopurine