Document Detail


[The effect of early immunosuppressive therapy on the rate of resections performed in patients with Chron's disease, in Veszprém county, Hungary, a population-based cohort study].
MedLine Citation:
PMID:  22450143     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Medical therapy for Crohn's disease has changed significantly over the past 20 years with the increasing use of immunosuppressants. In contrast, surgery rates are still high and evidence about the the changes in the outcome of Crohn's disease over the past decades is scarce. Aims: The objective of this study was to analyze the evolution of the surgical rates and medical therapy in the population-based Veszprém county database. Methods: Data of 506 Crohn's disease patients were analyzed (age at diagnosis: 31.5 years, SD: 13.8 years). Both hospital and outpatient records were collected and comprehensively reviewed. The study population was divided into three groups based on the year of diagnosis (cohort A: 1977-1989, cohort B: 1990-1998 and cohort C: 1999-2008). Results: Overall azathioprine, systemic steroid, and biological (only available after 1998) exposure was 45.8, 68.6, and 9.5%, respectively. The 1 and 5-year probabilities of azathioprine use were 3.2 and 6.2% in cohort A, 11.4 and 29.9% in cohort B, and 34.8 and 46.2% in cohort C. In multivariate analysis, decade of diagnosis (P<0.001), age at onset (P = 0.008), disease behavior at diagnosis (P<0.001), and need for systemic steroids (P<0.001) were significantly associated with the time to initiation of azathioprine therapy. Early azathioprine use was significantly associated with the time to intestinal surgery in Crohn's disease patients; in a multivariate Cox analysis (HR: 0.43, 95% confidence interval (CI): 0.28-0.65) and after matching on propensity scores for azathioprine use (HR: 0.42,95% CI:0.26-0.67). Conclusions: This population-based inception cohort showed that reduction in surgical rates was independently associated with increased and earlier azathioprine use. Orv. Hetil., 2012, 153, 541-552.
Authors:
Petra Anna Golovics; Péter László Lakatos; Gyula Dávid; Tünde Pandur; Zsuzsanna Erdélyi; Agnes Horváth; Gábor Mester; Mihály Balogh; István Szipocs; Csaba Molnár; Erzsébet Komáromi; Barbara Dorottya Lovász; Miklós Szathmári; Lajos S Kiss; László Lakatos
Publication Detail:
Type:  English Abstract; Journal Article    
Journal Detail:
Title:  Orvosi hetilap     Volume:  153     ISSN:  0030-6002     ISO Abbreviation:  Orv Hetil     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376412     Medline TA:  Orv Hetil     Country:  Hungary    
Other Details:
Languages:  hun     Pagination:  541-52     Citation Subset:  IM    
Affiliation:
Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest Korányi S. u. 2/A 1083.
Vernacular Title:
A korai immunszuppresszív kezelés hatása a reszekciós műtétek arányára Crohn-betegekben, Veszprém megyében, populációs alapú kohorszvizsgálat alapján.
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