Changes in medical treatment and surgery rates in inflammatory bowel disease: a nationwide cohort study 1979-2011.
BACKGROUND
Treatment possibilities have changed in inflammatory bowel disease (IBD). We assessed changes in medical treatment and surgery over time and impact of medications on risk of surgery in a population-based cohort.


METHODS
48 967 individuals were diagnosed with IBD (Crohn's disease (CD), 13 185; ulcerative colitis (UC), 35 782) during 1979-2011. Cumulative probability of receiving 5-aminosalicylic acids (5-ASA), topical, oral corticosteroids, thiopurines, and tumour necrosis factor-α (TNF-α) blockers, and of first minor or major surgery according to period of diagnosis, was estimated. Medication use and risk of surgery was examined by Cox regression.


RESULTS
5-year cumulative probability of first major surgery decreased from 44.7% in cohort (1979-1986) to 19.6% in cohort (2003-2011) (p < 0.001) for CD, and from 11.7% in cohort (1979-1986) to 7.5% in cohort (2003-2011) (p < 0.001) for UC. Minor surgery risk decreased significantly in CD. From cohort (1995-2002) to cohort (2003-2011), a significant increase in use of thiopurines and TNF-α blockers was observed, paralleled by a significant decrease in use of 5-ASA and corticosteroids. Comparing use of azathioprine (or oral corticosteroids) to never-use, no convincing surgery-sparing effect was found. Comparing use in 3+ months of a given drug with use <3 months, only 3+ months use of oral corticosteroids reduced the risk of surgery in patients with disease duration of >1 year.


CONCLUSIONS
Parallel to an increasing use of thiopurines and TNF-α blockers in IBD over time, a persistent significant decrease in surgery rates was observed along with a significant decrease in use of 5-ASA and corticosteroids. However, no convincing surgery-sparing effect of newer medications was found.
Department of Epidemiology Research, National Center for Health Data and Disease Control, Copenhagen, Denmark.
Christine
C
Rungoe
Department of Internal Medicine, Gentofte University Hospital, Hellerup, Denmark.
Ebbe
E
Langholz
Department of Epidemiology Research, National Center for Health Data and Disease Control, Copenhagen, Denmark.
Mikael
M
Andersson
Department of Epidemiology Research, National Center for Health Data and Disease Control, Copenhagen, Denmark.
Saima
S
Basit
Department of Epidemiology Research, National Center for Health Data and Disease Control, Copenhagen, Denmark.
Nete M
NM
Nielsen
Department of Epidemiology Research, National Center for Health Data and Disease Control, Copenhagen, Denmark.
Jan
J
Wohlfahrt
Department of Epidemiology Research, National Center for Health Data and Disease Control, Copenhagen, Denmark.
Tine
T
Jess
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000627:therapeutic use; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003718:Denmark; D013505:Digestive System Surgical Procedures / Q000639:trends*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
D005938:Glucocorticoids; D019804:Mesalamine; D001379:Azathioprine
CROHN'S DISEASE; IBD; SURGERY FOR IBD; ULCERATIVE COLITIS