Perianal Crohn’s Disease Is Associated With Poor Disease Outcome: A Nationwide Study From the epiIIRN Cohort

Atia, Ohad; Asayag, N; Focht, Gili; Lujan, R; Ledder, Oren; Greenfeld, Shira; Kariv, Revital; Dotan, Iris; Gabay, Hagit; Balicer, Ran D.; Haklai, Ziona; Nevo, Daniel; Turner, Dan

doi:10.1016/j.cgh.2021.04.007

Cited by 21 publications

(14 citation statements)

References 21 publications

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“…Nevertheless, similar to our observations, the risk of any IBD-related cancer was similar in patients with and without CPF. 15 Our observational study has a number of notable strengths.…”

Section: Discussionmentioning

confidence: 99%

Malignancy rates in Crohn's disease patients with perianal fistula: A German retrospective cohort study

Podmore¹,

Beier

Burisch

et al. 2023

UEG Journal

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Background Patients with inflammatory bowel disease are at increased risk of colorectal and extra‐intestinal cancer. However, the overall cancer risk in patients with Crohn's disease (CD) with perianal fistulas (PF) (CPF) and those with CD without PF (non‐PF CD) is unclear. Objective To describe the prevalence and incidence of cancer in patients with CPF and non‐PF CD, and to estimate incidence rate ratio (IRR) of cancer between CPF and non‐PF CD groups. Methods A retrospective cohort study was conducted using the German InGef (Institute for Applied Health Research Berlin) research database. Patients with a CD record and PF from 1 January 2013 to 31 December 2014 were identified and followed up from 1 January 2015 until the first occurrence of cancer, end of health insurance contributing data, death, or end of study period (31 December 2020). Prevalence of any type of cancer including patients with CD diagnosed with cancer in the selection period and incidence of cancer excluding patients with CD diagnosed with cancer in the selection period were calculated. Results In total, 10,208 patients with CD were identified. Of 824 patients with CPF (8.1%), 67 had had a malignancy (6‐year period crude malignancy prevalence 8.13% [95% confidence interval (CI) 6.36%–10.21%]), which was lower than patients with non‐PF CD (19.8% [95% CI 19%–20.6%]). Incidence (per 100,000 person‐years) in patients with CPF was 1184 (95% CI 879–1561) and in non‐PF CD was 2365 (95% CI 2219–2519). There was no significant difference in the adjusted IRR of cancer for the CPF group compared with the non‐PF CD group (0.83 [95% CI 0.62–1.10]; p = 0.219). Conclusion There was no significant difference in the incidence of any cancer in patients with CPF compared with non‐PF CD. However, patients with CPF had a higher numerical risk of cancer than the general German population.

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“…Nevertheless, similar to our observations, the risk of any IBD-related cancer was similar in patients with and without CPF. 15 Our observational study has a number of notable strengths.…”

Section: Discussionmentioning

confidence: 99%

Malignancy rates in Crohn's disease patients with perianal fistula: A German retrospective cohort study

Podmore¹,

Beier

Burisch

et al. 2023

UEG Journal

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“…The development and validation of the case ascertainment algorithm to identify patients with perianal disease has been previously described (1) and is based on a combination of codes of perianal abscesses/fistula or perianal surgical procedures (sensitivity 76% and specificity 96%; Ta ble 1, Supplemental Digital Content, http://links.lww.com/MPG/C723 ). Furthermore, we developed a separate algorithm to identify severe versus non-severe fistulizing perianal disease according to a combination of medications, number of perianal codes, perianal procedures and radiologic tests (sensitivity 72%, specificity 74%; Ta ble 2, Supplemental Digital Content, http://links.lww.com/MPG/C723 ) (1).…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, disease course was similar among those with non-severe PCD and those without perianal involvement at all. T he prevalence of perianal involvement in Crohn disease (CD) ranges from 12% to 47% after 10 years from CD diagnosis (1)(2)(3). The wide range of prevalence rates is a result of referral bias in some studies, various definitions of perianal disease, and different ethnicities under study (1,4).…”

Section: What Is Newmentioning

confidence: 99%

“…T he prevalence of perianal involvement in Crohn disease (CD) ranges from 12% to 47% after 10 years from CD diagnosis (1)(2)(3). The wide range of prevalence rates is a result of referral bias in some studies, various definitions of perianal disease, and different ethnicities under study (1,4). In Asians, for instance, perianal involvement is reported to be as high as 40% at 5 years from CD diagnosis (4).…”

Section: What Is Newmentioning

confidence: 99%

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Perianal Crohn Disease Is More Common in Children and Is Associated With Complicated Disease Course Despite Higher Utilization of Biologics

Atia

Focht

Lujan

et al. 2022

J. pediatr. gastroenterol. nutr.

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Background and Objectives:Both perianal and pediatric-onset Crohn disease (CD) disease are associated with complicated disease course and higher drug utilization. we aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course.Methods:We included all patients with newly diagnosed CD from 2005 to 2019 at two Israeli Health Maintenance Organizations, covering 78% of the population. A combination of ICD-9 codes, radiology and procedures was used to define fistulizing perianal CD (PCD) and its severity according to the association with simple and complex perianal disease.Results:A total of 12,905 patients were included (2186 [17%] pediatric-onset, 10,719 [83%] adults), with a median follow-up of 7.8 years. PCD was diagnosed in 1530 (12%) patients, with higher incidence in children (308 [14%] children vs 1222 adults [11%]; P < 0.001). Children had higher incidence of severe PCD (141/308 [47%] vs 433/1222 [35%]; P < 0.001). At 5 years, children with PCD were more likely than adults to be treated with biologics (212 [69%] vs 515 [42%]; odds ratio [OR] 2.6 [95% confidence interval (CI) 1.6–4.0]; P < 0.001) and immunomodulators (238 [74%] vs 643 [53%]; OR 2.8 [95% CI 2.1–3.6]; P < 0.001). PCD in children was still associated with poorer disease outcomes as shown for surgeries (36 [12%] vs 93 [8%]; P = 0.02) and steroid-dependency (52 [17%] vs 156 [13%]; P < 0.001). Multivariable modeling indicated that the severity of PCD is a stronger predictor of disease course than age.Conclusion:PCD is more common in pediatric-onset CD and is associated with higher drug utilization and worse disease outcomes, in large due to higher rate of severe PCD in children.

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“…For predictors of therapy persistence, we explored: sex, year of diagnosis, age at CD diagnosis, perianal disease at diagnosis (determined by an algorithm previously developed and validated for the epi-IIRN cohort 24 ) and the grading of the laboratory abnormality at diagnosis. Laboratory abnormality grading was based on hierarchical clustering analysis and categorisation of the population into three grades (mild, moderate and severe) based on available laboratory tests before diagnosis (Table S3).…”

Section: Data Definitionsmentioning

confidence: 99%

5‐aminosalicylate maintenance is not superior to no maintenance in patients with newly diagnosed Crohn's disease—A nationwide cohort study

Atia

Goren

Fischler

et al. 2023

Aliment Pharmacol Ther

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Background: 5-aminosalicylates (5-ASA) are widely used in Crohn's disease (CD) despite guidelines advising otherwise. We aimed to assess in nationwide study the outcomes of first-line 5-ASA maintenance therapy (5-ASA-MT) compared with no maintenance treatment (no-MT) in patients with newly diagnosed CD. Methods:We utilised data from the epi-IIRN cohort, including all patients with CD diagnosed in Israel between 2005 and 2020. Propensity score (PS) matching was utilised to compare outcomes in the 5-ASA-MT versus no-MT groups.Results: Of the 19,264 patients diagnosed with CD, 8610 (45%) fulfilled the eligibility criteria (3027 [16%] received 5-ASA-MT and 5583 [29%] received no-MT). Both strategies declined over the years; 5-ASA-MT from 21% of CD patients diagnosed in 2005 to 11% in 2019 (p < 0.001) and no-MT from 36% to 23% (p < 0.001). The probability of maintaining therapy at 1, 3 and 5 years from diagnosis: 5-ASA-MT-78%, 57% and 47% and no-MT-76%, 49% and 38% respectively (p < 0.001). PS analysis successfully matched 1993 pairs of treated and untreated patients and demonstrated comparable outcomes of time to: biologic (p = 0.2), steroid dependency (p = 0.9), hospitalisation (p = 0.5) and CD-related surgery (p = 0.1). Rates of acute kidney injury (5.2% vs. 3.3%; p < 0.001) and pancreatitis (2.4% vs. 1.8%; p = 0.03) were higher in the 5-ASA-MT group compared with the no-MT group but after PS matching the rates of adverse events were similar. Conclusion:First-line 5-ASA monotherapy was not superior to no-MT but associated with a slightly higher rates of adverse events, while both strategies have declined over the years. These findings suggest that a subset of patients with mild CD may be offered a watchful waiting approach.

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Perianal Crohn’s Disease Is Associated With Poor Disease Outcome: A Nationwide Study From the epiIIRN Cohort

Cited by 21 publications

References 21 publications

Malignancy rates in Crohn's disease patients with perianal fistula: A German retrospective cohort study

Malignancy rates in Crohn's disease patients with perianal fistula: A German retrospective cohort study

Perianal Crohn Disease Is More Common in Children and Is Associated With Complicated Disease Course Despite Higher Utilization of Biologics

5‐aminosalicylate maintenance is not superior to no maintenance in patients with newly diagnosed Crohn's disease—A nationwide cohort study

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