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. 2019 Feb 1;13(2):198-208.
doi: 10.1093/ecco-jcc/jjy154.

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

Johan Burisch  1 , Konstantinos H Katsanos  2 , Dimitrios K Christodoulou  2 , Luisa Barros  3 , Fernando Magro  3   4 , Natalia Pedersen  5 , Jens Kjeldsen  6 , Zsuzsanna Vegh  7 , Peter L Lakatos  7   8 , Carl Eriksson  9 , Jonas Halfvarson  9 , Mathurin Fumery  10 , Corinne Gower-Rousseau  11   12 , Marko Brinar  13   14 , Silvija Cukovic-Cavka  13   14 , Inna Nikulina  15 , Elena Belousova  15 , Sally Myers  16 , Shaji Sebastian  16 , Gediminas Kiudelis  17 , Limas Kupcinskas  17   18 , Doron Schwartz  19 , Selwyn Odes  19 , Ioannis P Kaimakliotis  20 , Daniela Valpiani  21 , Renata D'Incà  22 , Riina Salupere  23 , Stefania Chetcuti Zammit  24 , Pierre Ellul  24 , Dana Duricova  25 , Martin Bortlik  25   26 , Adrian Goldis  27 , Hendrika Adriana Linda Kievit  28 , Alina Toca  29 , Svetlana Turcan  29 , Jóngerð Midjord  30 , Kári Rubek Nielsen  30 , Karina Winther Andersen  31 , Vibeke Andersen  31   32   33 , Ravi Misra  34 , Naila Arebi  34 , Pia Oksanen  35   36 , Pekka Collin  35   36 , Luisa de Castro  37 , Vicent Hernandez  37 , Ebbe Langholz  38 , Pia Munkholm  1 ; Epi-IBD Group
Affiliations

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

Johan Burisch et al. J Crohns Colitis. .

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 5-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 and 163 [23%] patients were hospitalised. 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 hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8].

Conclusions: Although 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 hospitalisation.

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