Crohn's disease treatment practices in France in1999–2013: A prospective survey in non-academic hospitals - 18/10/18
, Pierre Lahmek b , Gilles Macaigne c , Bruno Lesgourgues a , Thierry Paupard d Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | efficacy of immunomodulators and anti-TNF in the treatment of Crohn's disease are from randomized controlled trials or tertiary referral centers |
• | patients treated with immunomodulators and anti-TNF within 5 years following diagnosis both increased dramatically between 1999 and 2010–2013 in non-university hospitals in France. |
• | Confirmation that the “top down” treatment strategy is preferred over the classic “step-up” strategy may encourage clinicians to continue this trend. |
Summary |
Aims |
To describe the characteristics of patients with Crohn's disease (CD) in non-academic hospitals in France and to evaluate how therapeutic practices changed between 1999 and 2013.
Methods |
During 2 weeks in September 2013, we solicited disease and treatment information for CD patients seen by gastroenterologists in 57 French non-academic hospitals. In four groups of patients defined according to the date of CD diagnosis (<1999, 1999–2003, 2004–2008, and 2009–2013), the use of immunosuppressor (IS) and anti-TNF treatments during the first 5 years following diagnosis of CD was compared using the Kaplan–Meier method.
Results |
739 consecutive CD patients (median age at diagnosis 25.4 years) were included in the survey. CD location was ileal for 31%, colonic for 21%, and ileocolonic for 45%. CD phenotypes were non-penetrating/non-stricturing (58.7%), stricturing (26.9%), and penetrating (12.7%), with perianal lesions in 26.1%. The proportions of patients who began IS or anti-TNF treatment within 5 years of diagnosis increased significantly from 18% and 0%, respectively, in <1999 (n=170) to 52% and 23% in 1999–2003 (n=120), 66% and 70% in 2004–2008 (n=155), and 75% and 100% in 2009–2013 (n=294; P<0.0001).
Conclusions |
In this French non-academic hospital cohort of CD patients, the proportions of patients being treated with anti-TNF or IS therapy in the first 5 years after diagnosis both increased sharply since 1999.
Le texte complet de cet article est disponible en PDF.Keywords : Crohn's disease, Immunosuppressant, Anti-TNF
Abbreviations : 5-ASA, ADA, anti-TNF, CD, IBD, IFX, IQR, IS, SD, UC
Plan
Vol 42 - N° 5
P. 470-477 - octobre 2018 Retour au numéro
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