Potential conflict of interest: L.P.B., consulting and lecture fees from Merck and Abbott.
Incidence of and impact of medications on colectomy in newly diagnosed ulcerative colitis in the era of biologics†
Article first published online: 4 DEC 2011
Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 9, pages 1641–1646, September 2012
How to Cite
Williet, N., Pillot, C., Oussalah, A., Billioud, V., Chevaux, J.-B., Bresler, L., Bigard, M.-A., Gueant, J.-L. and Peyrin-Biroulet, L. (2012), Incidence of and impact of medications on colectomy in newly diagnosed ulcerative colitis in the era of biologics. Inflamm Bowel Dis, 18: 1641–1646. doi: 10.1002/ibd.21932
- Issue published online: 9 AUG 2012
- Article first published online: 4 DEC 2011
- Manuscript Accepted: 1 OCT 2011
- Manuscript Received: 9 SEP 2011
- ulcerative colitis;
The cumulative incidence of colectomy and the impact of 5-aminosalicylates (5-ASA), azathioprine, and antitumor necrosis factor (TNF) treatment on the long-term need for surgery are unknown in ulcerative colitis (UC) in the era of biologics.
This was an observational study of a referral center cohort. The cumulative incidence of UC-related colectomy was estimated using the Kaplan–Meier method. Independent predictors of surgery were identified using Cox proportional hazards regression with propensity scores adjustment. The electronic charts of 151 incident cases of UC from Nancy University Hospital, France, diagnosed between 2000 and 2008, were reviewed through January 2010.
The median follow-up time per patient was 58 months. Twenty-one (14%) underwent surgery. The cumulative probabilities of colectomy were respectively 1.3% and 13.5% at 1 and 5 years from the time of diagnosis. The probability of receiving oral mesalamine at 5 years was 68.1%. The corresponding figures were 48.9% for azathioprine and 29.0% for infliximab. For corticosteroids, methotrexate, and cyclosporin these figures were 75%, 8.8%, and 11.5%, respectively. Using multivariate Cox proportional hazards regression analysis after propensity score adjustment, previous use of cyclosporin was the only independent predictor for colectomy (hazard ratio = 4.41; 95% confidence interval 1.75–1.13).
About one-tenth of patients still require colectomy for UC at 5 years in the era of biologics. Oral 5-ASA, azathioprine, and anti-TNF therapy are not associated with a reduced need for colectomy. (Inflamm Bowel Dis 2012)