Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort—An Epi-IBD Study

Abstract

Background and aims: Few population-based cohort studies have assessed the disease course of ulcerative colitis (UC) in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the five-year outcome and disease course of patients with UC in the Epi-IBD cohort. Methods: In a prospective, population-based inception cohort of unselected patients with UC patients were followed-up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results: A total of 717 patients were included in the study. During follow-up, 43 (6%) patients underwent a colectomy, while 163 (23%) patients were hospitalized. Of patients with limited colitis (distal to the left flexure), 90 (21%) progressed to extensive colitis. In addition, 92 (27%) patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalization (HR: 0.5 CI95% 0.3-0.8). Overall, patients were treated similarly in both geographical regions and 80 (11%) patients needed biological therapy while 210 (29%) patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalization (HR: 0.5 CI95% 0.3-0.8). Conclusions: While patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes including colectomy rates were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalization.

The epidemiology of inflammatory bowel disease: East meets west

“…In Europe, North America and Australia, 23–34% of UC patients presented with proctitis and 34–51% presented with left‐sided colitis . The findings are similar in Asia, where 35–37% and 32–45% of patients presented with proctitis and left‐sided colitis respectively.…”

“…In the West, the overall risk of proximal extension in UC patients ranged from 11–28% . Furthermore, the risk of progression in UC was comparable across different western regions.…”

“…Studies from Europe have shown a large variation in the frequency of EIMs ranging between 16–43% and 7–31% of CD and UC patients, respectively. Only a few population‐based studies have reported the prevalence of EIMs in the East. In the ACCESS cohort, 19% of Asian IBD patients presented with EIMs .…”

Disease course of inflammatory bowel disease unclassified in a European population‐based inception cohort: An Epi‐IBD study

“…Immunomodulators (azathioprine, 6‐mercaptopurine, cyclosporine, and methotrexate) were combined in one category, as more than 90% of patients treated with immunomodulators received thiopurines. The highest level of treatment was compared with patients from the same cohort diagnosed with a definite diagnosis of either CD or UC …”

“…Continuous variables are expressed as the median (interquartile range [IQR]), unless otherwise stated. In order to compare the risks of surgery and hospitalization among patients with IBDU with CD and UC patients, a logistic regression model was used for the entire IBD cohort and included the following covariates: age at diagnosis (continuous variable), sex, smoking status (never, currently, and former), and diagnostic delay (continuous variable). First exposures to medical treatments were visualized using Kaplan–Meier plots.…”