title: The incidence rate of colectomy for medically refractory ulcerative colitis has declined in parallel with increasing anti-TNF use: a time-trend study.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To determine whether the colectomy incidence rate for medically refractory ulcerative colitis has changed since the introduction of anti-TNF therapy.
  
  
  METHODS
  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 1 January 1998 and 31 December 2011 were identified. Log-linear regression was used to estimate the annual percent change in the total colectomy incidence rate (urgent and elective combined) and the urgent and elective incidence rates individually, before and after 2005, the year infliximab was approved for use in ulcerative colitis. Temporal trends of drug utilisation in this study population were also described.
  
  
  RESULTS
  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 4.4% (95% confidence interval (CI): -1.12% to 10.16%). From 2005-2011, following the approval and increasing use of anti-TNF therapy, the total colectomy incidence rate decreased by 16.1% (95% CI: -21.32% to -10.54%) every year to 0.9 per 100 ulcerative colitis patients in 2011.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada.
authors.forename: K M
authors.initials: KM
authors.lastname: Reich
authors.forename: H-J
authors.initials: HJ
authors.lastname: Chang
authors.forename: A
authors.initials: A
authors.lastname: Rezaie
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.forename: K J
authors.initials: KJ
authors.lastname: Goodman
authors.forename: G G
authors.initials: GG
authors.lastname: Kaplan
authors.forename: L W
authors.initials: LW
authors.lastname: Svenson
authors.forename: G
authors.initials: G
authors.lastname: Lees
authors.forename: R N
authors.initials: RN
authors.lastname: Fedorak
authors.forename: K I
authors.initials: KI
authors.lastname: Kroeker
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab