Baseline risk assessment of patients with ulcerative colitis: does initial treatment selection influence outcomes?
Background and Aims: Treatment of ulcerative colitis (UC) typically follows a step-up approach and targets colonic mucosal healing. Although mucosal healing reduces the risk of colectomy, whether or not early treatment of patients with 'high-risk' features using tumor necrosis factor (TNF) antagonis...
| Publicado en: | European Journal of Gastroenterology & Hepatology Vol. 31; no. 1; pp. 80 - 86 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Jan2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=136245355&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 136245355 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0954691X 8CE jtl: European Journal of Gastroenterology & Hepatology issn: 0954691X maglogo: N pubinfo: dt: Jan2019 vid: 31 iid: 1 pid: 5086 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 136245355 136245355 NLM30199472 136245355 10.1097/MEG.0000000000001249 NLM30199472 136245355 ppf: 80 ppct: 6 formats: tig: atl: Baseline risk assessment of patients with ulcerative colitis: does initial treatment selection influence outcomes? aug: au: Mosli, Mahmoud Alfaer, Sultan Almalaki, Turki Albeshry, Abdulrahman Aljehani, Saja Alshmrani, Bashaer Habib, Zaineb Jawa, Hani Qari, Yousif affil: Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. sug: subj: Intestinal Mucosa Drug Effects Tumor Necrosis Factor Antagonists and Inhibitors Antiinflammatory Agents Therapeutic Use Colon Drug Effects Biological Products Therapeutic Use Gastrointestinal Agents Therapeutic Use Colitis, Ulcerative Drug Therapy Colitis, Ulcerative Diagnosis Biological Products Adverse Effects Antiinflammatory Agents Adverse Effects Treatment Outcomes Intestinal Mucosa Immunology Hospitalization Colon Pathology Colon Immunology Decision Support Techniques Middle Age Disease Progression Gastrointestinal Agents Adverse Effects Colonoscopy Adult Risk Factors Tumor Necrosis Factor Immunology Time Factors Male Patient Selection Colitis, Ulcerative Immunology Female Intestinal Mucosa Pathology Risk Assessment Colectomy Retrospective Design Human Scales Middle Aged: 45-64 years Adult: 19-44 years Male Female ab: Background and Aims: Treatment of ulcerative colitis (UC) typically follows a step-up approach and targets colonic mucosal healing. Although mucosal healing reduces the risk of colectomy, whether or not early treatment of patients with 'high-risk' features using tumor necrosis factor (TNF) antagonists reduces the risk of colectomy is not clear. Accordingly, we aim to evaluate the effect of baseline treatment selection according to the risk profile on 5-year outcomes and identify predictors of poor outcomes.Patients and Methods: Adult patients with confirmed UC were retrospectively identified. Baseline clinical and endoscopic data were collected. Patients were assigned a risk profile on the basis of the presence or absence of 'high-risk' features within the first 6 months of diagnosis including moderate to severe endoscopic disease, frequent need for steroids, steroid dependency, and disease involving the entire colon according to endoscopy. Treatment discordance was defined as treating 'high-risk' patients with medications other than anti-TNF therapy during the first 6 months after diagnosis or treating 'low-risk' patients with anti-TNF therapy within 6 months of diagnosis. The associations between discordance and 5-year colectomy and hospitalization rates were statistically calculated through regression analysis, as were predictors of outcomes.Results: A total of 108 patients were identified and studied. The median age was 36 years (interquartile range=27-50) and the average duration of disease was 6.6 (±3.1) years. Females comprised 62% of the cohort and 30% reported cigarette smoking. Seventy three percent of the patients were placed in the 'high-risk' category. The 5-year risk of colectomy was not statistically significantly higher in patients identified as 'high-risk' compared with those who were 'low-risk' (risk ratio=0.86, 95% confidence interval=0.24-3.1, P=0.81), nor was the 5-year risk of hospitalizations (risk ratio=1.63, 95% confidence interval=0.81-3.30, P=0.15). On the basis of stepwise model selection, colectomy was significantly predicted by discordance (P=0.039), arthritis (P=0.007), baseline stool frequency (P=0.019), Adalimumab use within the first 6 months of diagnosis (P=0.006), and pyoderma gangrenosum (P=0.049); hospitalization was predicted by discordance (P=0.018), baseline albumin concentrations (P=0.005), thromboembolism (P<0.005), thiopurine use within the first 6 months of diagnosis (P<0.005), Adalimumab use within the first 6 months of diagnosis (P=0.003), nationality (P=0.016), endoscopic severity (P=0.007), arthritis (P=0.005), and pyoderma gangrenosum (P=0.025).Conclusion: Among other clinical parameters, discordance between baseline risk and treatment selection appears to be a significant predictor of outcomes in UC. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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