title: Impact of New Treatments on Hospitalisation, Surgery, Infection, and Mortality in IBD: a Focus Paper by the Epidemiology Committee of ECCO.
abstract: The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biological therapy. To what extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue, an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in inflammatory bowel disease [IBD] patients. Preference was given to population-based studies but, when data from these sources were limited, large cohort studies and randomised controlled trials were also considered. In general, data on hospitalisation rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biological agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-tumour necrosis factor alpha [TNFα] agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer [absolute risk: low], whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature do not reveal any increase in mortality with immunosuppressant therapy or biologicals/anti-TNF agents.
authors.affiliation: Emergency Department, Gastroenterology Unit, AOU Careggi, Florence, Italy annesev@aou-careggi.toscana.it.
authors.forename: Vito
authors.initials: V
authors.lastname: Annese
authors.affiliation: Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE a.s. and Charles University in Prague, Prague, Czech Republic.
authors.forename: Dana
authors.initials: D
authors.lastname: Duricova
authors.affiliation: Epidemiology Unit, Lille University and Hospital, Université Lille Nord de France, Lille, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Gower-Rousseau
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, National Center for Health Data and Disease Control, Copenhagen, Denmark.
authors.forename: Tine
authors.initials: T
authors.lastname: Jess
authors.affiliation: Department of Medicine, Gentofte Hospital, Hellerup, Denmark.
authors.forename: Ebbe
authors.initials: E
authors.lastname: Langholz
mesh_terms: D013505:Digestive System Surgical Procedures / Q000639:trends*; D014943:Global Health; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Crohn’s disease; Ulcerative colitis; anti-tumour necrosis factor α; cancer; hospitalisation; immunosuppressant therapy; infections; mortality; surgery