Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel.
Meuhedet Health Services, Meuhedet Research Institute, Tel-Aviv, Israel.
J Crohns Colitis. 2022 Jun 24;16(5):778-785. doi: 10.1093/ecco-jcc/jjab204.
The effectiveness of biologics for improving long-term outcomes in patients with Crohn's disease [CD] is still controversial. In this nationwide study, we aimed to evaluate trends of long-term outcomes in all CD patients in Israel during the biologics era.
Trends of outcomes were analysed using data from the four Israeli health maintenance organisations, covering 98% of the population; joinpoint regression models were used to explore changes of these trends over 2005 to 2019.
A total of 16 936 patients were diagnosed with CD in Israel since 2005 (2932 [17%] paediatric onset, 14 004 [83%] adult onset) with 114 947 person-years of follow-up. The cumulative rate of any CD related surgery was 5%, 9%, 11%, and 14% at 1, 3, 5, and 10 years from diagnosis. The increase in use of biologics was sharp (from 8.9% to 36%; average annual percent change [AAPC], 14.3%), and the time to biologics was shorter in recent years (median time of 4.8 [1.9-8.1] years in those diagnosed in 2005-2008 compared with 0.5 [0.2-1.1] years in those diagnosed in 2015-2018; p < 0.001). A significant decrease was noted in the hazard of hospitalisations (1.3 [0.1-4.6] years compared with 0.2 [0.02-0.9] years; p < 0.001), steroid dependency (1.5 [0.2-5.4] years compared with 0.1 [0.02-0.4] years; p < 0.001), and intestinal surgeries [4.7 [1.6-8.2] years compared with 0.6 [0.2-1.4] years; p < 0.001), but not of perianal surgery (4.2 [1.1-7.7] years compared with 0.6 [0.2-1.4] years; p = 0.2). Outcomes were consistently worse in paediatric onset compared with adults.
The rates of hospitalisations, steroid dependency, and intestinal resections decreased in association with increased use of biologics both in children and in adults, but not the rate of perianal surgeries.
生物制剂在改善克罗恩病 [CD] 患者的长期预后方面的疗效仍存在争议。在这项全国性研究中，我们旨在评估以色列所有 CD 患者在生物制剂时代的长期预后趋势。
使用来自以色列四个健康维护组织的数据分析了结果趋势，这些组织覆盖了 98%的人口；使用 joinpoint 回归模型探讨了 2005 年至 2019 年这些趋势的变化。
自 2005 年以来，以色列共有 16936 名患者被诊断为 CD（2932 名儿童发病，14004 名成人发病），随访时间为 114947 人年。诊断后 1、3、5 和 10 年，任何与 CD 相关的手术的累积发生率分别为 5%、9%、11%和 14%。生物制剂的使用急剧增加（从 8.9%到 36%；平均年变化百分比[APC]，14.3%），近年来生物制剂的应用时间缩短（中位数时间从 2005-2008 年诊断的 4.8[1.9-8.1]年缩短至 2015-2018 年诊断的 0.5[0.2-1.1]年；p<0.001）。住院的风险显著降低（1.3[0.1-4.6]年与 0.2[0.02-0.9]年相比；p<0.001），类固醇依赖（1.5[0.2-5.4]年与 0.1[0.02-0.4]年相比；p<0.001）和肠手术（4.7[1.6-8.2]年与 0.6[0.2-1.4]年相比；p<0.001），但肛周手术没有变化（4.2[1.1-7.7]年与 0.6[0.2-1.4]年相比；p=0.2）。儿童发病的预后始终比成人差。
在儿童和成人中，生物制剂的使用增加与住院、类固醇依赖和肠切除术的发生率降低有关，但与肛周手术的发生率无关。
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