番茄社区

AUSTIN -- Fewer colectomies are being performed among newly hospitalized patients with ulcerative colitis in the era of modern biologics, according to an analysis of 2009-2017 data.

Among patients at Kaiser Permanente healthcare systems, there was a 54% reduction in the number of colectomy procedures performed in the last 2 years of the study compared to the first year (odds ratio 0.46, 95% CI 0.22-0.96, P=0.038), reported Fernando Velayos, MD, MPH, of Kaiser Permanente, San Francisco.

"Our data imply optimism that the natural history of colectomy in acute severe ulcerative colitis may be different and modifiable compared to the past," Velayos said during a presentation of top clinical science at the annual Crohn's & Colitis Congress (CCC).

Although some other agents, like adalimumab (Humira), were available during this study period, infliximab (Remicade) is often the primary biologic administered in hospital settings, said Edward Barnes, MD, MPH, of the University of North Carolina at Chapel Hill, who moderated the CCC session.

In this study, 16.3% of patients received infliximab in the hospital and 36.3% received the agent within a year of admission, Velayos reported.

However, in the past 5 years, many new biologics have been introduced to treat Crohn's disease and ulcerative colitis, including golimumab (Simponi) for patients not responding to other agents and drugs with a different mechanism, like vedolizumab (Entyvio).

Because of this, the rate at which colectomies are being performed may be delayed -- and therefore not captured in this analysis -- if patients who are not responding to infliximab or other first-line therapies are started on a second, third, or even fourth agent, Barnes explained.

"We might just be postponing patients out past a year, but you might still get a colectomy at 18 months, or 24 months, that were not captured in this data," Barnes told 番茄社区. "We have more agents available now, whereas at the beginning of the study, you might have just failed that first agent and then have gotten a colectomy."

For this retrospective study, participants with ulcerative colitis were enrolled from Kaiser Permanente facilities at the time of first hospitalization with intravenous corticosteroids, and followed for 1 year. Patients were excluded if they had prior ulcerative colitis-related hospitalizations, prior biologic therapy, or recorded Clostridium difficile or cytomegalovirus infection during hospitalization or 30 days prior.

The group was 49% male, 40% non-white, and relatively young, with 55% under age 50. A majority had been on aminosalicylates, immunomodulators, or steroids in the year prior.

Overall, 5.3% of patients had a colectomy at index hospitalization across the study period, 9% had colectomies at 3 months, and 11.9% had them at 12 months, Velayos said.

Comparatively, between 1998 and 2004, 20% of patients with ulcerative colitis underwent a colectomy during index hospitalization, and 30% of patients did at the 1-year mark in an analysis of patients at the same hospital systems, he said.

Moreover, the proportion of patients undergoing colectomy declined from 6.5% in years 2009-2019 to 3.4% in years 2015-2017, he noted. Those occurring in the first year also declined from 15.7% in years 2009-2011 to 10.1% in the last 2 years of the study.

Compared with patients ages 18-34, those ages 35-49 were at twice the risk for colectomy (adjusted OR 2.2, 95% CI 1.0-4.9, P=0.04). Meanwhile, Hispanic patients were at a decreased risk compared with white patients (aOR 0.3, 95% CI 0.1-0.80, P=0.02), the authors reported.

Not surprisingly, infliximab use was also associated with a two-fold the risk of colectomy (aOR 2.1, 95% CI 1.1-4.1, P=0.02), they added.

The study was limited by the nature of the claims data used, which did not capture disease severity, Velayos said.

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