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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
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., 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
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 ulcerative colitis (SVEAH UC). Journal of Crohn's & Colitis, 12(Suppl. 1), S382-S383
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 ulcerative colitis (SVEAH UC)
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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. S382-S383Article 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-66753 (URN)000427318901324 ()
Note

Funding Agency:

Takeda

Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-08-30Bibliographically approved
Eriksson, C., Rundquist, S., Cao, Y., Montgomery, S. & Halfvarson, J. (2018). The impact of thiopurine drugs on the natural history and surgical outcome of ulcerative colitis: A cohort study. Journal of Crohn's & Colitis, 12(Suppl. 1), S481-S481
Open this publication in new window or tab >>The impact of thiopurine drugs on the natural history and surgical outcome of ulcerative colitis: A cohort study
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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. S481-S481Article 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-66752 (URN)000427318902114 ()
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-07-19Bibliographically approved
Eriksson, C., Rundquist, S., Lykiardopoulos, B., Karlén, P., Grip, O., Söderman, C., . . . Halfvarson, J. (2017). A Swedish observational study (SVEAH) on vedolizumab assessing effectiveness and healthcare resource utilization in patients with inflammatory bowel disease. Journal of Crohn's & Colitis, 11(Suppl. 1), S262-S263
Open this publication in new window or tab >>A Swedish observational study (SVEAH) on vedolizumab assessing effectiveness and healthcare resource utilization in patients with inflammatory bowel disease
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2017 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 11, no Suppl. 1, p. S262-S263Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford University Press, 2017
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-57782 (URN)10.1093/ecco-jcc/jjx002.489 (DOI)000398606900471 ()28172603 (PubMedID)
Available from: 2017-05-23 Created: 2017-05-23 Last updated: 2018-09-06Bibliographically approved
Eriksson, C., Cao, Y., Rundquist, S., Zhulina, Y., Henriksson, I., Montgomery, S. & Halfvarson, J. (2017). Changes in medical management and colectomy rates: a population-based cohort study on the epidemiology and natural history of ulcerative colitis in Orebro, Sweden, 1963-2010. Alimentary Pharmacology and Therapeutics, 46(8), 748-757
Open this publication in new window or tab >>Changes in medical management and colectomy rates: a population-based cohort study on the epidemiology and natural history of ulcerative colitis in Orebro, Sweden, 1963-2010
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2017 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 8, p. 748-757Article in journal (Refereed) Published
Abstract [en]

Background: Whether the epidemiology of ulcerative colitis (UC) has changed during recent decades is partly unknown.

Aim: To depict temporal trends in the epidemiology and medical treatment of UC as well as the long-term risk of progression in disease extent and colectomy, during 1963-2010.

Methods: Patients were identified by evaluation of all medical records in the archive of the Colitis Clinic, Orebro University Hospital. Comparisons were made between three time periods, 1963-1975, 1976-1990 and 1991-2005.

Results: The annual age-standardised incidence increased from 3.5 to 18.5 per 100 000 during the study period (P < .01). Correspondingly, the prevalence increased from 44 to 474 per 100 000 between 1965 and 2010. A higher proportion of males than females had extensive colitis at diagnosis (odds ratio: 1.55; 95% CI 1.17-2.05; P < .01). The risk for progression in disease extent was 34.5% and 18.5% at 10 years, for patients with proctitis and left-sided colitis, respectively (P < .01). The use of 5-aminosalicylates, within 10 years, rise from 79% to 92% between 1963-1975 and 1976-1990 (P < .01). Thiopurine use increased from 7% in 1976-1990 to 34% during 1991-2005 (P < .01). The colectomy rate at 10 years was 13.5% (95% CI 11.1%-15.8%), and the risk was lower among patients diagnosed in 1991-2005 compared to 1963-1975 (adjusted hazard ratio: 0.61; 95% CI 0.39-0.94; P = .02).

Conclusion: The incidence and prevalence of UC increased over time, and the observed prevalence in 2010 is among the highest reported. In parallel, a decrease in colectomy rates was observed during the most recent decades, potentially reflecting improved medical treatment.

Place, publisher, year, edition, pages
Hoboken, USA: John Wiley & Sons, 2017
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-61349 (URN)10.1111/apt.14268 (DOI)000411717800005 ()28833287 (PubMedID)2-s2.0-85029232492 (Scopus ID)
Note

Funding Agency:

Swedish Government's Agreement for Medical Training and Research  OLL-549221

Available from: 2017-10-09 Created: 2017-10-09 Last updated: 2018-08-06Bibliographically approved
Eriksson, C., Cao, Y., Rundquist, S., Zhulina, Y., Henriksson, I., Montgomery, S. & Halfvarson, J. (2017). Editorial: do thiopurines and biologics decrease the risk of colectomy? Authors' reply. Alimentary Pharmacology and Therapeutics, 46(9), 897-898
Open this publication in new window or tab >>Editorial: do thiopurines and biologics decrease the risk of colectomy? Authors' reply
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2017 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 9, p. 897-898Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
National Category
Gastroenterology and Hepatology Pharmacology and Toxicology
Identifiers
urn:nbn:se:oru:diva-61920 (URN)10.1111/apt.14336 (DOI)000412754500018 ()29023888 (PubMedID)2-s2.0-85030863815 (Scopus ID)
Available from: 2017-10-24 Created: 2017-10-24 Last updated: 2019-03-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4923-3169

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