Current concept of pathophysiological understanding and natural course of ulcerative colitis

Holtmann, Martin; Galle, Peter R.

doi:10.1007/s00423-003-0448-5

Cited by 23 publications

(21 citation statements)

References 80 publications

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“…The course of UC over time may consist of a repeated state of symptom exacerbation punctuated with periods of remission [8]. The symptomatic relapse can be associated with constant diarrhea, rectal bleeding, abdominal pain, weight loss, and fatigue [9].…”

Section: Introductionmentioning

confidence: 99%

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Medication adherence and persistence in the treatment of Canadian ulcerative colitis patients: analyses with the RAMQ database

et al. 2013

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BackgroundAlthough high non-adherence to medication has been noticed for ulcerative colitis (UC), little is known about adherence to mesalamine treatments and determinants that can predict adherence. The objective of this study was to assess adherence and persistence to mesalamine treatments and their potential determinants in mild to moderate UC patients in a real-life setting in Quebec, Canada.MethodsA retrospective prescription and medical claims analysis was conducted using a random sample of mesalamine users with UC. For inclusion, patients were required to initiate an oral mesalamine treatment between January 2005 and December 2009. Patients with a diagnosis of Crohn’s disease were excluded. Treatment adherence (medication possession ratio [MPR]) and persistence were evaluated over a 1-year period after the index prescription using the Kaplan-Meier method with log-rank test and stepwise regression to identify potential determinants.ResultsA sample of 1,681 of the new oral mesalamine users (mean age = 55.3) patients was obtained. Overall, the percentage of patients with a MPR of 80% or greater at 12 months was 27.7%, while persistence was 45.5%. Among patients treated with mesalamine delayed/extended-release tablets (Mezavant®), adherence and persistence were 40.9% and 71.9%, respectively. Predictors of high adherence included, male gender (OR=1.3; 95% confidence interval [CI]=1.1–1.6), older age (>60 years; OR=1.6; 95% CI=1.3–2.0) and current use of corticosteroids (OR=1.4; 95% CI=1.1–1.8). Predictors of high persistence included male sex (OR=1.4; 95% CI=1.1–1.7), current use of corticosteroids (OR=1.4; 95% CI=1.1–1.7) and presence of hypertension or respiratory diseases (OR=1.2; 95% CI=1.01–1.55).ConclusionsThe majority of patients with UC exhibited low adherence and persistence to mesalamine treatments. Various determinants of improved adherence and persistence were identified.

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Section: Introductionmentioning

confidence: 99%

“…However, their role remains uncertain and unconfirmed [1,7,11]. The only known risk factor associated with UC is heredity [8,12]. Other factors, such as smoking status, have been associated with UC [8,11].…”

Section: Introductionmentioning

confidence: 99%

Medication adherence and persistence in the treatment of Canadian ulcerative colitis patients: analyses with the RAMQ database

et al. 2013

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“…4,5 Approximately 50-80% of patients with UC experience a relapsing and remitting course of disease with varying disease severity. 6 Another 15-30% have a more active course of UC in which sustained remission is difficult to achieve. 6 In addition, more than 50% of patients with UC restricted to proctosigmoiditis progressed over their lifetimes, particularly during the first year.…”

Section: Introductionmentioning

confidence: 99%

“…6 Another 15-30% have a more active course of UC in which sustained remission is difficult to achieve. 6 In addition, more than 50% of patients with UC restricted to proctosigmoiditis progressed over their lifetimes, particularly during the first year. 7 Because of the chronic and recurrent nature of the disease, patients with UC often require either continuous or intermittent treatment throughout the course of their disease.…”

Section: Introductionmentioning

confidence: 99%

Systematic review: the costs of ulcerative colitis in Western countries

Cohen

et al. 2010

Aliment Pharmacol Ther

245

151

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“…Some 50% to 80% of the patients run a waxing-and-waning course, whereas a chronic active course may be observed in 15%-30%[34]. According to a reference publication: Young age, previous relapses, and presence of residual histologic disease (plasmacytosis) are all predictors of relapse[35].…”

Section: The Ibds: Natural Historymentioning

confidence: 99%

Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment

Actis

Pellicano

2017

WJGPT

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The inflammatory bowel diseases (IBD) are chronic incurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mild-moderate colitis, and do not work in Crohn’s; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn’s; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically (not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.

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Current concept of pathophysiological understanding and natural course of ulcerative colitis

Abstract: The elucidation of pathomechanisms at the level of the intestinal immune system provides the potential for novel, effective treatment strategies. Best surgical management of patients with UC, however, still remains a challenge.

Cited by 23 publications

References 80 publications

Medication adherence and persistence in the treatment of Canadian ulcerative colitis patients: analyses with the RAMQ database

Medication adherence and persistence in the treatment of Canadian ulcerative colitis patients: analyses with the RAMQ database

Systematic review: the costs of ulcerative colitis in Western countries

Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment

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