title: [The effect of early immunosuppressive therapy on the rate of resections performed in patients with Chron's disease, in Veszprém county, Hungary, a population-based cohort study].
abstract: Medical therapy for Crohn's disease has changed significantly over the past 20 years with the increasing use of immunosuppressants. In contrast, surgery rates are still high and evidence about the the changes in the outcome of Crohn's disease over the past decades is scarce.
  
  
  OBJECTIVE
  The objective of this study was to analyze the evolution of the surgical rates and medical therapy in the population-based Veszprém county database.
  
  
  METHODS
  Data of 506 Crohn's disease patients were analyzed (age at diagnosis: 31.5 years, SD: 13.8 years). Both hospital and outpatient records were collected and comprehensively reviewed. The study population was divided into three groups based on the year of diagnosis (cohort A: 1977-1989, cohort B: 1990-1998 and cohort C: 1999-2008).
  
  
  RESULTS
  Overall azathioprine, systemic steroid, and biological (only available after 1998) exposure was 45.8, 68.6, and 9.5%, respectively. The 1 and 5-year probabilities of azathioprine use were 3.2 and 6.2% in cohort A, 11.4 and 29.9% in cohort B, and 34.8 and 46.2% in cohort C. In multivariate analysis, decade of diagnosis (P<0.001), age at onset (P = 0.008), disease behavior at diagnosis (P<0.001), and need for systemic steroids (P<0.001) were significantly associated with the time to initiation of azathioprine therapy. Early azathioprine use was significantly associated with the time to intestinal surgery in Crohn's disease patients; in a multivariate Cox analysis (HR: 0.43, 95% confidence interval (CI): 0.28-0.65) and after matching on propensity scores for azathioprine use (HR: 0.42,95% CI:0.26-0.67).
  
  
  CONCLUSIONS
  This population-based inception cohort showed that reduction in surgical rates was independently associated with increased and earlier azathioprine use.
authors.affiliation: Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest Korányi S. u. 2/A 1083.
authors.forename: Petra Anna
authors.initials: PA
authors.lastname: Golovics
authors.forename: Péter László
authors.initials: PL
authors.lastname: Lakatos
authors.forename: Gyula
authors.initials: G
authors.lastname: Dávid
authors.forename: Tünde
authors.initials: T
authors.lastname: Pandur
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Erdélyi
authors.forename: Agnes
authors.initials: A
authors.lastname: Horváth
authors.forename: Gábor
authors.initials: G
authors.lastname: Mester
authors.forename: Mihály
authors.initials: M
authors.lastname: Balogh
authors.forename: István
authors.initials: I
authors.lastname: Szipocs
authors.forename: Csaba
authors.initials: C
authors.lastname: Molnár
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Komáromi
authors.forename: Barbara Dorottya
authors.initials: BD
authors.lastname: Lovász
authors.forename: Miklós
authors.initials: M
authors.lastname: Szathmári
authors.forename: Lajos S
authors.initials: LS
authors.lastname: Kiss
authors.forename: László
authors.initials: L
authors.lastname: Lakatos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D019804:Mesalamine; D015122:Mercaptopurine; D001379:Azathioprine