No Change in Surgical and Hospitalization Trends Despite Higher Exposure to Anti-Tumor Necrosis Factor in Inflammatory Bowel Disease in the Québec Provincial Database From 1996 to 2015

Author:

Verdon Christine1,Reinglas Jason1,Coulombe Janie2,Gonczi Lorant3,Bessissow Talat1ORCID,Afif Waqqas1,Vutcovici Maria1,Wild Gary1,Seidman Ernest G1,Bitton Alain1,Brassard Paul245ORCID,Lakatos Peter L13

Affiliation:

1. Division of Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada

2. Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada

3. 1st Department of Medicine, Semmelweis University, Budapest, Hungary

4. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada

5. Department of Medicine, McGill University, Montreal, Québec, Canada

Abstract

Abstract Background Crohn disease (CD) and ulcerative colitis (UC) have high health care expenditures because of medications, hospitalizations, and surgeries. We evaluated disease outcomes and treatment algorithms of patients with inflammatory bowel disease (IBD) in Québec, comparing periods before and after 2010. Methods The province of Québec’s public health administrative database was used to identify newly diagnosed patients with IBD between 1996 and 2015. The primary and secondary outcomes included time to and probability of first and second IBD-related hospitalizations, first and second major surgery, and medication exposures. Medication prescriptions were collected from the public prescription database. Results We identified 34,644 newly diagnosed patients with IBD (CD = 59.5%). The probability of the first major surgery increased after 2010 in patients with CD (5 years postdiagnosis before and after 2010: 8% [SD = 0.2%] vs 15% [SD = 0.6%]; P < 0.0001) and patients with UC (6% [SD = 0.2%] vs 10% [SD = 0.6%] ;P < 0.0001). The probability of the second major surgery was unchanged in patients with CD. Hospitalization rates remained unchanged. Patients on anti-tumor necrosis factor (anti-TNF) medications had the lowest probability of hospitalizations (overall 5-year probability in patients with IBD stratified by maximal therapeutic step: 5-aminosalicylic acids 37% [SD = 0.6%]; anti-TNFs 31% [SD = 1.8%]; P < 0.0001). Anti-TNFs were more commonly prescribed for patients with CD after 2010 (4% [SD = 0.2%] vs 16% [SD = 0.6%]; P < 0.0001) in the public health insurance plan, especially younger patients. Corticosteroid exposure was unchanged before and after 2010. Immunosuppressant use was low but increased after 2010. The use of 5-ASAs was stable in patients with UC but decreased in patients with CD. Conclusions The probability of first and second hospitalizations remained unchanged in Québec and the probability of major surgery was low overall but did increase despite the higher and earlier use of anti-TNFs.

Funder

McGill Department of Medicine

Kimberly Sue McCall Award in IBD Research

Nesbitt-McMaster Award

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology,Immunology and Allergy

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