Long-term disease course of Crohn's disease in a prospective European population-based inception cohort - an Epi-IBD cohort study
Abstract
BACKGROUND AND AIM
The Epi-IBD cohort is a population-based inception cohort of patients with inflammatory bowel disease from 22 European centres. The aim was to assess the 10-year disease course of patients with Crohn's disease (CD) and how regional differences in treatment strategies impact the disease course.
METHODS
Patients were followed prospectively from the time of diagnosis, with uniform collection data. Associations between outcomes and covariates were analysed by multivariable Cox regressions in a propensity score-matched sub-population to address time to first intestinal resection.
RESULTS
A total of 547 CD patients were recruited (Eastern Europe:139 (25.4%), Western Europe:408 (74.6%)). 10-year cumulative rate of advanced therapy use was higher in Western (42%) compared to Eastern Europe (27%) (p<0.05). The median period until initiation of advanced treatment was shorter in Western Europe, 10 vs 46 months (p<0.001). Despite these differences, the need for surgery remained comparable in Eastern and Western Europe, with a 10-year rate of 24% (p=0.9). A similar comparability was observed for disease progression from uncomplicated disease to complicated disease (10-year rate:20%, p=0.07) and hospitalisation (10-year rate:41%, p=0.5). Use of advanced therapy, stricturing or penetrating disease at diagnosis, progression of disease behaviour, and former smoking were all associated with an increased risk of intestinal resection (all p<0.05).
CONCLUSIONS
Despite earlier…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 547 participants or records.
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