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Incidence of and impact of medications on colectomy in newly diagnosed ulcerative colitis in the era of biologics

Authors

  • Nicolas Williet MD,

    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
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  • Claire Pillot MD,

    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
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  • Abderrahim Oussalah MD,

    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
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  • Vincent Billioud MD,

    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
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  • Jean-Baptiste Chevaux MD,

    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
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  • Laurent Bresler MD, PhD,

    1. Department of Digestive Surgery, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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  • Marc-André Bigard MD,

    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
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  • Jean-Louis Gueant MD, PhD,

    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
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  • Laurent Peyrin-Biroulet MD, PhD

    Corresponding author
    1. Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Vandoeuvre-lès-Nancy, France
    • Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois, Université Henri Poincaré 1, Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France
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  • Potential conflict of interest: L.P.B., consulting and lecture fees from Merck and Abbott.

Abstract

Background:

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.

Methods:

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.

Results:

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).

Conclusions:

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)

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