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. 2022 Mar 15;16(2):216-227.
doi: 10.5009/gnl210044.

Changes in the Long-term Prognosis of Crohn's Disease between 1986 and 2015: The Population-Based Songpa-Kangdong Inflammatory Bowel Disease Cohort Study

Byong Duk Ye  1 , Sung Noh Hong  2 , Seung In Seo  3 , Ye-Jee Kim  4 , Jae Myung Cha  5 , Kyoung Hoon Rhee  6 , Hyuk Yoon  7 , Young-Ho Kim  2 , Kyung Ho Kim  3 , Sun Yong Park  8 , Seung Kyu Jeong  9 , Ji Hyun Lee  10 , Hyunju Park  11 , Joo Sung Kim  12 , Jong Pil Im  12 , Sung Hoon Kim  13 , Jisun Jang  13 , Jeong Hwan Kim  14 , Seong O Suh  15 , Young Kyun Kim  16 , Sang Hyoung Park  1 , Suk-Kyun Yang  1 ; Songpa-Kangdong Inflammatory Bowel Disease (SK-IBD) Study Group
Affiliations

Changes in the Long-term Prognosis of Crohn's Disease between 1986 and 2015: The Population-Based Songpa-Kangdong Inflammatory Bowel Disease Cohort Study

Byong Duk Ye et al. Gut Liver. .

Abstract

Background/aims: The long-term course of Crohn's disease (CD) has never been evaluated in non-Caucasian population-based cohorts. The aim of the present study was to evaluate the longterm prognosis of Korean CD patients in the well-defined population-based Songpa-Kangdong inflammatory bowel disease cohort.

Methods: Outcomes of disease and their predictors were evaluated for 418 patients diagnosed with CD between 1986 and 2015.

Results: During a median of 123 months, systemic corticosteroids, thiopurines, and anti-tumor necrosis factor (TNF) agents were administered to 58.6%, 81.3%, and 37.1% of patients, respectively. Over time, the cumulative probability of starting corticosteroids significantly decreased (p=0.001), whereas that of starting thiopurines and anti-TNFs significantly increased (both p<0.001). The cumulative probability of behavioral progression was 54.5% at 20 years, and it significantly decreased during the anti-TNF era. Intestinal resection was required for 113 patients (27.0%). The cumulative probabilities of intestinal resection at 1, 5, 10, 20, and 25 years after CD diagnosis were 12.7%, 16.5%, 23.8%, 45.1%, and 51.2%, respectively. Multivariable Cox regression analysis identified stricturing behavior at diagnosis (adjusted hazard ratio [aHR], 2.70; 95% confidence interval [CI], 1.55 to 4.71), penetrating behavior at diagnosis (aHR, 11.15; 95% CI, 6.91 to 17.97), and diagnosis of CD during the anti-TNF era (aHR, 0.51; 95% CI, 0.35 to 0.76) as independently associated with intestinal resection. The standardized mortality ratio among CD patients was 1.36 (95% CI, 0.59 to 2.68).

Conclusions: The long-term prognosis of Korean patients with CD is at least as good as that of Western CD patients, as indicated by the low intestinal resection rate. Moreover, behavioral progression and intestinal resection rates have decreased over the past 3 decades.

Keywords: Crohn disease; Korea; Prognosis; SK-IBD.

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Conflict of interest statement

CONFLICTS OF INTEREST

B.D.Y. has received a research grant from Celltrion and Pfizer Korea; consulting fees from AbbVie Korea, Celltrion, Chong Kun Dang Pharm., Daewoong Pharma., Ferring Korea, Janssen Korea, Kangstem Biotech, LG Chem., Medtronic Korea, Shire Korea, Takeda Korea, IQVIA, and Takeda; speaking fees from AbbVie Korea, Celltrion, Ferring Korea, Janssen Korea, Pfizer Korea, Shire Korea, Takeda Korea, and IQVIA. However, none of these are associated with this study. S.K.Y. received a research grant from Janssen Korea. The other authors have nothing to disclose.

J.P.I. is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Temporal trends in the cumulative probability of medication use among patients with Crohn’s disease: (A) corticosteroids, (B) thiopurines, and (C) anti-tumor necrosis factor (anti-TNF) agents.
Fig. 2
Fig. 2
Kaplan-Meier curves depicting the probabilities of remaining free of penetrating complications (upper curve) and free of stricturing or penetrating complications (lower curve) among patients with Crohn’s disease. B1, nonstricturing, nonpenetrating; B2, stricturing; B3, penetrating.
Fig. 3
Fig. 3
Cumulative risk of behavioral progression among patients with Crohn’s disease: (A) in the entire cohort and (B) in the two temporal cohorts.
Fig. 4
Fig. 4
Cumulative risk of intestinal resection among patients with Crohn’s disease: (A) in the entire cohort and (B) in the two temporal cohorts.
Fig. 5
Fig. 5
Cumulative risk of hospitalization among patients with Crohn’s disease: (A) in the entire cohort and (B) in the two temporal cohorts.
See this image and copyright information in PMC

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