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Earlier Anti-TNF Initiation Leads to Long-term Lower Health Care Utilization in Crohn's Disease but Not in Ulcerative Colitis.
Targownik, Laura E; Bernstein, Charles N; Benchimol, Eric I; Kaplan, Gilaad G; Singh, Harminder; Tennakoon, Aruni; Nugent, Zoann; Coward, Stephanie B; Kuenzig, M Ellen; Murthy, Sanjay K.
Afiliación
  • Targownik LE; Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: laura.targownik@sinaihealth.ca.
  • Bernstein CN; Section of Gastroenterology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
  • Benchimol EI; SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada; Department of Paediatrics and Institute of Health Policy, Management and Eval
  • Kaplan GG; Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
  • Singh H; Section of Gastroenterology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine,
  • Tennakoon A; Section of Gastroenterology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
  • Nugent Z; Section of Gastroenterology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
  • Coward SB; Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
  • Kuenzig ME; SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada.
  • Murthy SK; ICES, Toronto, Ontario, Canada; The Ottawa Hospital IBD Centre, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Clin Gastroenterol Hepatol ; 20(11): 2607-2618.e14, 2022 11.
Article en En | MEDLINE | ID: mdl-35247552
BACKGROUND & AIMS: The timing of initiating biologic therapy in persons with Crohn's disease (CD) and ulcerative colitis (UC) is an area of ongoing controversy. In particular, there is concern that delaying the initiation of biologic therapy may lead to more treatment-resistant disease, which can result in more complications and hospitalizations. METHODS: We used health administrative data from Manitoba, Canada to identify all persons with a new diagnosis of inflammatory bowel disease (IBD) between 2001 and 2018 who received tumor necrosis factor antagonists (anti-TNF) therapy and had at least 1 year of post anti-TNF initiation follow-up. We measured the rates of hospitalization, surgery, and outpatient visits, prior to and for up to 5 years following anti-TNF initiation. We compared the rates of these health care utilization outcomes between persons receiving anti-TNFs within 2 years following diagnosis and those receiving anti-TNFs more than 2 years following IBD diagnosis. We used inverse probability treatment weighting to adjust for baseline differences in risk between the 2 groups. RESULTS: Among 742 persons with CD, early anti-TNF initiators had fewer IBD-specific and overall hospitalizations over the 5 years following the start of therapy. Incidence of resective surgery was also lower in earlier anti-TNF initiators with CD if the first year following initiation was excluded from the analysis. In 318 cases of UC, there was no impact of the timing of anti-TNF therapy on the rates of hospitalization and surgery. CONCLUSIONS: Earlier administration of anti-TNF therapy is associated with reduced downstream health care resource utilization in CD, though these impacts are not evident in UC.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aceptación de la Atención de Salud / Colitis Ulcerosa / Enfermedad de Crohn / Inhibidores del Factor de Necrosis Tumoral Tipo de estudio: Prognostic_studies Aspecto: Implementation_research Límite: Humans Idioma: En Revista: Clin Gastroenterol Hepatol Asunto de la revista: GASTROENTEROLOGIA Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aceptación de la Atención de Salud / Colitis Ulcerosa / Enfermedad de Crohn / Inhibidores del Factor de Necrosis Tumoral Tipo de estudio: Prognostic_studies Aspecto: Implementation_research Límite: Humans Idioma: En Revista: Clin Gastroenterol Hepatol Asunto de la revista: GASTROENTEROLOGIA Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos