Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Abstract

Background Despite advances in the medical management of inflammatory bowel disease (IBD), a subset of patients may require extensive surgery, leading to short‐bowel syndrome/intestinal failure requiring long‐term home parenteral nutrition (PN) or customized intravenous fluid (IVF) support. Our aim was to further define the characteristics of IBD patients requiring home PN/IVF. Methods This is an observational study from a prospective IBD research registry. Patients receiving long‐term home PN/IVF support during 2009–2015 were identified and compared with remaining IBD patients. Demographics, surgical history, smoking, narcotic use, IBD treatment, healthcare charges, and presence of biomarkers were reviewed. The IBD‐PN group was stratified into 3 groups based on median healthcare charges. Results Of 2359 IBD patients, there were 25 (1%, 24 with Crohn's disease) who required home PN/IVF, and 250 randomly selected IBD patients matched for disease type formed the control population. Median duration of PN use was 27 months (interquartile range, 11–66). PN use was significantly associated with smoking, narcotic use, IBD‐related operations, and lower quality‐of‐life scores. Among IBD‐PN patients, 7 of 25 (28%, 3 after use of teduglutide) were able to successfully discontinue this modality. Median healthcare charges in the IBD‐PN group were $51,456 annually. Median charges in the controls were $3427. Period prevalence mortality was 11.5% in IBD‐PN and 3.8% in controls. Conclusions IBD patients requiring long‐term home PN/IVF support are a small minority in the present era of immunomodulator/biologic therapy. These refractory patients have a 15‐fold increase in annual median healthcare charges compared with control IBD patients.

Characterization of American teduglutide consumers from 2015 to 2020: A large database study

“…A large percentage of our patient cohort had documented tobacco use. Smoking has been associated with IF in inflammatory bowel disease 13 ; our study offers further support to the notion that smoking may be a risk factor for development of severe malnutrition requiring PS in patients with SBS.…”

The Natural History of Crohn’s Disease Leading to Intestinal Failure: A Longitudinal Cohort Study from 1973 to 2018

“…The reason for not trialling biologics was unclear, but we postulate that a perceived futility and concern for infective complications in the setting of intestinal stulae or impending surgeries may have impacted clinicians' and/or patients' willingness to initiate a new therapy, especially when biologics were still novel. Only a few studies have reported on the use of biologics in CDIF patients before the onset of IF, with wide-ranging rates from 4% to 80%, 10,37 and one study found non-use of anti-TNF was associated with developing IF. 18 Limited e cacy of biologics in preventing surgery has been found in CDIF patients after IF onset.…”

“…Intestinal failure (IF), de ned as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, 1 is a rare but severe end-organ sequelae of Crohn's disease (CD). [2][3][4] While IF affects at most 80 people per million, 5 30-46% of IF is caused by CD, [6][7][8][9][10][11][12] and signi cant resources and expertise are required to manage IF patients with home parenteral support (HPS). [13][14][15] Previous studies reported long-term cumulative incidences of IF from CD from 3.4-18.4%, [16][17][18] indicating a non-negligible risk.…”

Glucagon-like peptide-2 analogues for Crohn’s disease patients with short bowel syndrome and intestinal failure

“…They described that HPN use was significantly associated with smoking, narcotic use, IBD-related surgeries, and lower quality-of-life scores. They found that these refractory patients had a 15-fold increase in annual median health care charges compared to control IBD patients[ 28 ].…”