Introduction of anti-TNF has reduced colectomies, corticosteroid use in UC
Since the introduction of anti-TNF therapy in 2004, colectomy rates and corticosteroid use has gone down among patients with ulcerative colitis in Denmark, according to results of a nationwide cohort study.
Ken Lund, of the Center for Clinical Epidemiology at Odense University Hospital in Denmark, and colleagues wrote that early results have shown the benefit of anti-TNF in patients with UC, but more data are needed.
“There is, however, a continuous need for real life data to document and determine the long-term efficacy of anti-TNF alpha therapy in terms of a risk for colectomy and cessation of corticosteroids,” they wrote. “Evidence on these aspects will provide important knowledge to support clinical decision making and to support the choice of treatment strategies.”
Researchers analyzed data from 3,001 patients aged 20 years and younger who were diagnosed with UC between 1995 and 2015 to evaluate whether the introduction of anti-TNF had an impact on colectomy rates or corticosteroid use. They separated patients into two cohorts based on whether they were diagnosed before (1995–2003, n = 945) or after (2004–2015, n = 2,056) the introduction of anti-TNF.
In the second cohort, the 5-year cumulative proportion of colectomy was 9.7% (95%C CI, 8.4%–11.1%) compared with 12.3% (95% CI, 10.4%–14.6%) in the first cohort. The adjusted 5-year hazard ratios for colectomy in the second group was 0.76 (95% CI, 0.6–0.96) compared with 0.66 (95% CI 0.470.93) in the first group.
Among 334 patients who received anti-TNF treatments, 16.8% received prescriptions for corticosteroids within 3 months. At 6 and 12 months of follow-up, that corticosteroid treatment declined to 5.4% and 1.3%, respectively.
“We suggest that anti-TNF alpha therapy among patients with response have a reduction in corticosteroid use, and that should lead to an increased focus on an earlier introduction of anti-TNF alpha therapy,” Lund and colleagues wrote. “This reduction in corticosteroid use applies especially for children with delayed growth and call for further research on the timing for introduction of anti-TNF alpha therapy.” – by Alex Young
Disclosures: Lund reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.