Systematic Review and Meta-Analysis: Risk of Hospitalization in Patients with Ulcerative Colitis and Crohn’s Disease in Population-Based Cohort Studies

Tsai, Lester; Nguyen, Nghia; Ma, Christopher; Prokop, Larry J.; Sandborn, William J.; Singh, Siddharth

doi:10.1007/s10620-021-07200-1

Cited by 22 publications

(14 citation statements)

References 30 publications

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“…We classified older patients as age older than 50 years compared with age older than 65 years in the study by Kochar and colleagues 20 ; however, our findings were stable in subgroup analysis by age. Cumulative 1-year risk of IBD-related hospitalization in population-based inception cohorts of older adults have been 20% to 40%, 3,21 more consistent with findings in our cohort, and significantly higher than rates observed by Kochar et al 20 Similarly, the rate of IBD-related surgery is approximately 10% to 15% among the general…”

Section: 53supporting

confidence: 91%

“…We classified older patients as age older than 50 years compared with age older than 65 years in the study by Kochar and colleagues; however, our findings were stable in subgroup analysis by age. Cumulative 1-year risk of IBD-related hospitalization in population-based inception cohorts of older adults have been 20% to 40%, more consistent with findings in our cohort, and significantly higher than rates observed by Kochar et al Similarly, the rate of IBD-related surgery is approximately 10% to 15% among the general population of older patients, with conceivably higher rates among patients with moderate to severe disease requiring biologic therapy . In a Veterans Affairs cohort of older patients with IBD, Khan and colleagues observed that the 1-year cumulative risk of IBD-related hospitalization and IBD-related surgery among patients treated with vedolizumab was 11.3% and 3.9%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Outcomes and Safety of Vedolizumab vs Tumor Necrosis Factor Antagonists for Older Adults With Inflammatory Bowel Diseases

et al. 2022

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ImportanceObservational comparative effectiveness studies can inform the positioning of biologic therapies for older patients with inflammatory bowel disease (IBD) who are underrepresented in clinical trials.ObjectiveTo compare the effectiveness and safety of vedolizumab vs tumor necrosis factor (TNF) for older patients with IBD.Design, Setting, and ParticipantsThis active comparator, new-user design, comparative effectiveness study was conducted between January 1, 2005, and December 31, 2018, among 754 older patients (aged ≥50 years) with IBD from the Danish National Patient Register. The mean follow-up after treatment initiation took place at 32 to 40 weeks. Statistical analysis was performed from February 1 to April 27, 2022.InterventionsTreatment with vedolizumab or TNF antagonists.Main Outcomes and MeasuresThe primary effectiveness outcome was treatment failure, defined as the composite risk of IBD-related hospitalization, IBD-related surgery, or a new corticosteroid prescription more than 6 weeks after initiation of treatment with biologic therapy. Secondary effectiveness outcomes were time to each individual component of the composite effectiveness outcome. The primary safety outcome was the risk of serious infections, defined as infections requiring hospitalization. A 1:1 propensity score–matched analysis was conducted, accounting for patient-, disease-, and treatment-associated factors.ResultsThe study compared 377 older patients with IBD with incident use of vedolizumab (202 women [53.6%]; mean [SD] age, 61.2 [8.3] years; 177 [46.9%] with Crohn disease) vs 377 patients with incident use of TNF antagonists (206 women [54.6%]; mean [SD] age, 61.3 [8.1] years; 182 [48.3%] with Crohn disease). Overall, vedolizumab was associated with an increased risk of treatment failure compared with TNF antagonists (1-year risk, 45.4% vs 34.7%; adjusted hazard ratio [HR], 1.31; 95% CI, 1.02-1.69), including higher risk of IBD-related hospitalization (1-year risk, 27.8% vs 16.3%; adjusted HR, 1.48; 95% CI, 1.03-2.15) and IBD-related major abdominal surgery (1-year risk, 21.3% vs 8.0%; adjusted HR, 2.39; 95% CI, 1.45-3.94). In subgroup analysis by IBD phenotype, among patients with Crohn disease, vedolizumab was associated with a 77% higher risk of treatment failure (adjusted HR, 1.77; 95% CI, 1.21-2.58), while no difference in risk of treatment failure was seen among patients with ulcerative colitis (adjusted HR, 1.04; 95% CI, 0.75-1.43; P = .03 for interaction). There was no significant difference in the risk of serious infections, overall (1-year risk, 8.2% vs 8.7%; adjusted HR, 1.04; 95% CI, 0.58-1.85) and by IBD phenotype.Conclusions and RelevanceIn this comparative effectiveness study of older patients with IBD, vedolizumab was associated with a higher risk of treatment failure compared with TNF antagonists, particularly among patients with Crohn disease, without offering a significant safety advantage.

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Section: 53supporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Comparative Outcomes and Safety of Vedolizumab vs Tumor Necrosis Factor Antagonists for Older Adults With Inflammatory Bowel Diseases

et al. 2022

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“…Interestingly, coinciding with a significant increase in the number of patients treated with biologics, studies show that in Cataluña, the rate of CD-related hospitalisations decreased between 2011 and 2017 [ 52 ]. A recent meta-analysis corroborates these results reporting that patients with CD and UC diagnosed in the biological era (after 2000) had a lower cumulative incidence of hospitalisation [ 66 ]. Earlier and improved diagnosis of IBD, the introduction of biological agents and their early use could be driving the reduction of the hospitalisation rate observed in the last decades.…”

Section: Discussionmentioning

confidence: 56%

Epidemiological, Clinical, Patient-Reported and Economic Burden of Inflammatory Bowel Disease (Ulcerative colitis and Crohn’s disease) in Spain: A Systematic Review

et al. 2023

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Introduction This study describes the epidemiological, clinical, patient-reported and economic burden of inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), in Spain. Methods A systematic review was performed of observational studies reporting the epidemiological, clinical, patient-reported and economic burden of IBD in the Spanish population, from 2011 to 2021. Original articles and conference abstracts published in English or Spanish were eligible. Results A total of 45 publications were included in the review. The incidence of IBD in adults ranged from 9.6 to 44.3 per 100,000 inhabitants (4.6 to 18.5 for CD and 3.4 to 26.5 for UC). The incidence increased between 1.5- and twofold from 2000 to 2016 (regionally). Up to 6.0% (CD) and 3.0% (UC) IBD-associated mortality was reported. Disease onset predominantly occurs between 30 and 40 years (more delayed for UC than CD). Most frequently reported gastrointestinal manifestations are rectal bleeding in UC and weight loss in CD. Extraintestinal manifestations (EIM) have been described in up to 47.4% of patients with CD and 48.1% of patients with UC. Psychiatric comorbidities were frequently reported in both CD and UC (depression up to 20% and anxiety up to 11%). Reduced health-related quality of life (HRQoL) compared to the general population was reported. Significant symptomatology was associated with high levels of anxiety, depression, stress and lower HRQoL. Main healthcare resources reported were emergency department visits (24.0%), hospitalization (14.7%), surgery (up to 11%) and use of biologics (up to 60%), especially in CD. Direct and indirect annual costs per patient with UC were €1754.1 and €399.3, respectively. Conclusion Patients with CD and UC present a high disease burden which negatively impacts their HRQoL, leading to elevated use of resources. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02473-6.

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“…On meta-regression analysis, the study found younger age at onset was associated with increased risk of hospitalization in UC and ileal-dominant and perianal disease was associated with increased risk of hospitalization in CD [4].…”

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confidence: 94%

“…The study by Tsai et al published in this issue of Digestive Diseases and Sciences is a systematic review and metaanalysis of population-based inception cohort studies (published up to September 3, 2019) designed to estimate the cumulative risk of IBD-related and all-cause hospitalization in patients with ulcerative colitis (UC) and Crohn's disease (CD) [4]. They included 6 cohorts of patients with UC (17,190 patients) finding the cumulative 1-, 3-and 5-year risk of UC-related hospitalization to be 10.4% (95% CI, 8.2-13.2), 17.0% (95% CI, 14.0-20.4) and 21.5% (95% CI, 18.0-25.4), respectively.…”

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confidence: 99%

Impatience with Inpatients: Are Hospitalization Rates Declining for IBD Patients?

Kumar

Swaminath

2021

Dig Dis Sci

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Systematic Review and Meta-Analysis: Risk of Hospitalization in Patients with Ulcerative Colitis and Crohn’s Disease in Population-Based Cohort Studies

Cited by 22 publications

References 30 publications

Comparative Outcomes and Safety of Vedolizumab vs Tumor Necrosis Factor Antagonists for Older Adults With Inflammatory Bowel Diseases

Comparative Outcomes and Safety of Vedolizumab vs Tumor Necrosis Factor Antagonists for Older Adults With Inflammatory Bowel Diseases

Epidemiological, Clinical, Patient-Reported and Economic Burden of Inflammatory Bowel Disease (Ulcerative colitis and Crohn’s disease) in Spain: A Systematic Review

Impatience with Inpatients: Are Hospitalization Rates Declining for IBD Patients?

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