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Visuri, I., Eriksson, C., Mårdberg, E., Grip, O., Gustavsson, A., Hjortswang, H., . . . Halfvarson, J. (2019). Anti-TNF agent drug survival in patients with IBD: real-world comparisons of individual anti-TNF agents based on the Swedish National Quality Registry for IBD (SWIBREG). Journal of Crohn's & Colitis, 13(Suppl. 1), S443-S444
Open this publication in new window or tab >>Anti-TNF agent drug survival in patients with IBD: real-world comparisons of individual anti-TNF agents based on the Swedish National Quality Registry for IBD (SWIBREG)
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2019 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no Suppl. 1, p. S443-S444Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-73336 (URN)10.1093/ecco-jcc/jjy222.773 (DOI)000460544502205 ()
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved
Burisch, J., Chetcuti Zammit, S., Ellul, P., Turcan, S., Duricova, D., Bortlik, M., . . . Epi-IBD, g. (2019). Disease course of inflammatory bowel disease unclassified in a European population-based inception cohort: an Epi-IBD study. Journal of Gastroenterology and Hepatology, 34(6), 996-1003
Open this publication in new window or tab >>Disease course of inflammatory bowel disease unclassified in a European population-based inception cohort: an Epi-IBD study
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2019 (English)In: Journal of Gastroenterology and Hepatology, ISSN 0815-9319, E-ISSN 1440-1746, Vol. 34, no 6, p. 996-1003Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A definitive diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) is not always possible and a proportion of patients will be diagnosed as inflammatory bowel disease unclassified (IBDU). The aim of the study was to investigate the prognosis of patients initially diagnosed with IBDU and the disease course during the following five years.

METHODS: The Epi-IBD study is a prospective population-based cohort of 1,289 IBD patients diagnosed in centres across Europe. Clinical data were captured prospectively throughout the follow-up period.

RESULTS: Overall, 476 (37%) patients were initially diagnosed with CD, 701 (54%) with UC, and 112 (9%) with IBDU. During follow-up, 28 (25%) IBDU patients were changed diagnoses to either UC (n=20, 71%) or CD (n=8, 29%) after a median of six months (IQR: 4-12), while 84 (7% of the total cohort) remained IBDU. A total of 17 (15%) IBDU patients were hospitalized for their IBD during follow-up, while 8 (7%) patients underwent surgery. Most surgeries (n=6, 75%) were performed on patients whose diagnosis was later changed to UC; three of these colectomies led to a definitive diagnosis of UC. Most patients (n=107, 96%) received 5-aminosalicylic acid, while 11 (10%) patients received biologicals, of whom five remained classified as IBDU.

CONCLUSIONS: In a population-based inception cohort, 7% of IBD patients were not given a definitive diagnosis of IBD after five years of follow-up. One in four patients with IBDU eventually were classified as CD or UC. Overall, the disease course and medication burden in IBDU patients were mild.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Inflammatory bowel disease unclassified, prognosis, treatment
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-70825 (URN)10.1111/jgh.14563 (DOI)000470791800010 ()30562421 (PubMedID)2-s2.0-85060325984 (Scopus ID)
Note

Funding Agencies:

Kirsten og Freddy Johansens Fond  

Nordsjaellands Hospital Forskningsrad  

Available from: 2018-12-21 Created: 2018-12-21 Last updated: 2019-07-23Bibliographically approved
Eriksson, C., Rundquist, S., Cao, Y., Montgomery, S. & Halfvarson, J. (2019). Impact of thiopurines on the natural history and surgical outcome of ulcerative colitis: a cohort study. Gut, 68(4), 623-632
Open this publication in new window or tab >>Impact of thiopurines on the natural history and surgical outcome of ulcerative colitis: a cohort study
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2019 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 68, no 4, p. 623-632Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Thiopurines are used as maintenance therapy in ulcerative colitis (UC), but whether these drugs influence the natural history of the disease is unknown. We aimed to assess the effect of thiopurines in terms of colectomy, hospital admission, progression in disease extent and anti-tumour necrosis factor (TNF) therapy within 10 years from initiation.

DESIGN: Patients diagnosed with UC within the Örebro University Hospital catchment area, during 1963-2010, who initiated thiopurines (n=253) were included. To overcome the risk of confounding by indication, we compared patients who stopped treatment within 12 months because of an adverse reaction (n=76) with patients who continued therapy or discontinued due to other reasons (n=177) and assessed long-term outcomes using Cox regression with adjustment for potential confounding factors.

RESULTS: The cumulative probability of colectomy within 10 years was 19.5% in tolerant patients compared with 29.0% in intolerant (adjusted HR 0.49; 95% CI 0.21 to 0.73). The probability of hospital admission was 34.0% in tolerant versus 56.2% in intolerant patients (adjusted HR 0.36; 95% CI 0.23 to 0.56). The risk for progression in disease extent was 20.4% in tolerant patients compared with 48.8% in intolerant (adjusted HR 0.47; 95% CI 0.21 to 1.06). Within 10 years, 16.1% of tolerant and 27.5% of intolerant patients received anti-TNF therapy (adjusted HR 0.49; 95% CI 0.26 to 0.92).

CONCLUSION: Based on the novel approach of comparing patients tolerant and intolerant to thiopurines, we reveal that thiopurines have a profound beneficial impact of the natural history and long-term colectomy rates of UC.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
6-mercaptopurine, azathioprine, chronic ulcerative colitis, tnf-alpha
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-66417 (URN)10.1136/gutjnl-2017-315521 (DOI)000471830300008 ()29618498 (PubMedID)2-s2.0-85062170737 (Scopus ID)
Note

Funding Agency:

Swedish government's agreement on medical training and research  OLL-549221

Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2019-07-22Bibliographically approved
Burisch, J., Kiudelis, G., Kupcinskas, L., Kievit, H. A., Andersen, K. W., Andersen, V., . . . Munkholm, P. (2019). Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut, 68(3), 423-433
Open this publication in new window or tab >>Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study
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2019 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 68, no 3, p. 423-433Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD).

DESIGN: Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis.

RESULTS: In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5).

CONCLUSION: Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Crohn’s disease, epidemiology, surgery for Ibd
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-64714 (URN)10.1136/gutjnl-2017-315568 (DOI)000471828800008 ()29363534 (PubMedID)2-s2.0-85048295105 (Scopus ID)
Note

Funding Agencies:

Kirsten og Freddy Johansens Fond  

Nordsjaellands Hospital Forskningsrad

Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2019-07-22Bibliographically approved
Burisch, J., Katsanos, K. H., Christodoulou, D. K., Barros, L., Magro, F., Pedersen, N., . . . Munkholm, P. (2019). 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. Journal of Crohn's & Colitis, 13(2), 198-208
Open this publication in new window or tab >>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
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2019 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no 2, p. 198-208Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
Ulcerative colitis, surgery, hospitalisation, prognosis, treatment, biologics
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-69337 (URN)10.1093/ecco-jcc/jjy154 (DOI)000459356300008 ()30289522 (PubMedID)2-s2.0-85061058790 (Scopus ID)
Note

Funding Agencies:

Kirsten og Freddy Johansens Fond  

Nordsjaellands Hospital Forskningsrad 

Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2019-06-19Bibliographically approved
Moens, A., van der Woude, C., Julsgaard, M., Sebastian, S., Arebi, N., Alzinaty, M., . . . Ferrante, M. (2019). Pregnancy outcomes in IBD patients treated with vedolizumab, anti-TNF, or conventional therapy. Journal of Crohn's & Colitis, 13(Suppl. 1), S41-S42
Open this publication in new window or tab >>Pregnancy outcomes in IBD patients treated with vedolizumab, anti-TNF, or conventional therapy
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2019 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no Suppl. 1, p. S41-S42Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-73334 (URN)10.1093/ecco-jcc/jjy222.063 (DOI)000460544500063 ()
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved
Rundquist, S., Eriksson, C., Nilsson, L., Angelison, L., Jäghult, S., Björk, J., . . . Halfvarson, J. (2018). Clinical effectiveness of golimumab in Crohn´s disease – an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG). In: : . Paper presented at 26th United European Gastroenterology Week, Vienna, Austria, October 20-24, 2018.
Open this publication in new window or tab >>Clinical effectiveness of golimumab in Crohn´s disease – an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)
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2018 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-66281 (URN)
Conference
26th United European Gastroenterology Week, Vienna, Austria, October 20-24, 2018
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2019-04-02Bibliographically approved
Rundquist, S., Eriksson, C., Nilsson, L., Angelison, L., Jäghult, S., Björk, J., . . . Halfvarson, J. (2018). Clinical effectiveness of golimumab in Crohn's disease: an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG). Scandinavian Journal of Gastroenterology, 53(10-11), 1257-1263
Open this publication in new window or tab >>Clinical effectiveness of golimumab in Crohn's disease: an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)
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2018 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 10-11, p. 1257-1263Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The effectiveness of golimumab in Crohn's disease (CD) is largely unknown as it is not approved for the treatment of the disease. We aimed to identify the population of CD patients treated with golimumab in Sweden, to assess the effectiveness of golimumab (defined as the drug retention rate), and to identify predictors of drug discontinuation.

METHODS: Patients with CD who received at least one injection of golimumab were identified through the Swedish National Quality Registry for Inflammatory Bowel Disease, which includes prospectively collected clinical information. Cox regression models were used to identify predictors of golimumab discontinuation.

RESULTS: The study cohort involved 94 patients of whom the majority (96.8%) had previously discontinued at least one anti-tumour necrosis factor (anti-TNF) agent. The drug retention rate at 12 weeks was 85.1%. Predictors of golimumab discontinuation at 12 weeks were previous surgery (adjusted HR = 7.52, 95% CI: 1.12-50.36), concomitant corticosteroid use at baseline (adjusted HR = 5.70, 95% CI: 1.13-28.68) and female sex (adjusted HR = 6.59; 95% CI: 1.04-41.62). The median duration of follow-up was 89 (IQR: 32-158) weeks. The drug retention at the most recent follow-up was 35.1%. Predictors of golimumab discontinuation at the most recent follow-up were corticosteroid use at baseline (adjusted HR = 2.60, 95% CI: 1.17-5.79) and female sex (adjusted HR = 2.24; 95% CI: 1.19-4.23).

CONCLUSION: Patients with CD treated with golimumab were a treatment-refractory group. Despite this, more than one-third of the patients appeared to have had clinical benefit after a median follow-up of more than 1.5 years.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Crohn’s disease, Golimumab, IBD, SWIBREG, biological treatment
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-69893 (URN)10.1080/00365521.2018.1519597 (DOI)000457980900016 ()30353751 (PubMedID)2-s2.0-85055482894 (Scopus ID)
Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-02-25Bibliographically approved
Eriksson, C., Bergemalm, D., Vigren, L., Nilsson, L., Visuri, I., Hjortswang, H., . . . Halfvarson, J. (2018). Clinical effectiveness of golimumab: Interim analysis of the observational study of patients with ulcerative colitis on golimumab in the Swedish National Quality Registry for IBD-GO-SWIBREG. Paper presented at 13th Congress of ECCO – European Crohn’s and Colitis Organisation, Vienna, Austria, February 14-17, 2018. Journal of Crohn's & Colitis, 12(Suppl. 1), S409-S410
Open this publication in new window or tab >>Clinical effectiveness of golimumab: Interim analysis of the observational study of patients with ulcerative colitis on golimumab in the Swedish National Quality Registry for IBD-GO-SWIBREG
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2018 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, no Suppl. 1, p. S409-S410Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-66750 (URN)000427318901372 ()
Conference
13th Congress of ECCO – European Crohn’s and Colitis Organisation, Vienna, Austria, February 14-17, 2018
Note

Funding Agency:

MSD

Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-08-31Bibliographically approved
Eriksson, C., Rundquist, S., Lykiardopoulos, V., Karlen, P., Grip, O., Söderman, C., . . . Halfvarson, J. (2018). Clinical effectiveness of vedolizumab: Interim analysis of the Swedish observational study on vedolizumab assessing effectiveness and healthcare resource utilisation in patients with Crohn's disease (SVEAH CD). Journal of Crohn's & Colitis, 12(Suppl. 1), S494-S495
Open this publication in new window or tab >>Clinical effectiveness of vedolizumab: Interim analysis of the Swedish observational study on vedolizumab assessing effectiveness and healthcare resource utilisation in patients with Crohn's disease (SVEAH CD)
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2018 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, no Suppl. 1, p. S494-S495Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-66751 (URN)000427318902141 ()
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-08-30Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1046-383x

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