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- Title
Practical Strategy for Optimizing the Timing of Anti-Tumor Necrosis Factor-Alpha Therapy in Crohn's Disease: A Nationwide Population-Based Study.
- Authors
Sang Youn Shin; Jae Myung Cha; Min Seob Kwak; Jun Ki Min; Min Kyu Chae; Ji Hyun Ahn; Sa Ra Jeong; Ye Rim Cho
- Abstract
Background/Aims There is little consensus on the optimal timing of anti-tumor necrosis factor (TNF) therapy to decrease the rates of hospitalization and surgery in Crohn's disease. We aimed to assess the real-world outcomes of anti-TNF therapy and estimate the optimal timing of anti-TNF therapy in Korean patients with Crohn's disease. Methods Claims data were extracted from the Korean Health Insurance Review and Assessment Service database. Incident patients diagnosed with Crohn's disease between 2009 and 2016, with at least one anti-TNF drug prescription, and with follow-up duration >6 months were stratified according to the number of relapses prior to initiation of anti- TNF therapy: groups A (≤1 relapse), B (2 relapses), C (3 relapses), and D (≥4 relapses). The cumulative survival curves free from emergency hospitalization and surgery were compared across groups. Results Among the 2,173 patients analyzed, the best and worst prognoses were noted in groups A and D, respectively. The incidences of emergency hospitalization and surgery decreased significantly as the use of anti-TNF agents increased. The 5-year rate of hospitalization was significantly lower in group A than in groups C and D (p=0.004 and p=0.020, respectively), but similar between groups A and B. The 5-year rate of surgery was lower in group A than in group C (p=0.024), but similar among groups A, B, and D. Conclusion In Asian patients with Crohn's disease, anti-TNF therapy reduces the risk of emergency hospitalization and surgery and should be considered before three relapses, regardless of disease duration.
- Subjects
CROHN'S disease; DISEASE duration; SURGICAL emergencies; DRUG prescribing; NECROSIS; ANAL diseases
- Publication
Gut & Liver, 2019, Vol 13, Issue 6(suppl. 1), p186
- ISSN
1976-2283
- Publication type
Article