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  • 1.
    Burisch, Johan
    et al.
    Department of gastroenterology, North Zealand Hospital, University of Copenhagen, Denmark.
    Chetcuti Zammit, Stefania
    Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.
    Ellul, Pierre
    Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.
    Turcan, Svetlana
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
    Duricova, Dana
    IBD clinical and research centre, ISCARE., Prague, Czech Republic.
    Bortlik, Martin
    IBD clinical and research centre, ISCARE., Prague, Czech Republic; Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague, Prague.
    Winther Andersen, Karina
    Medical Department, Regional Hospital of Viborg, Viborg, Denmark.
    Andersen, Vibeke
    Medical Department, Regional Hospital of Viborg, Viborg, Denmark; Focused research unit for Molecular Diagnostic and Clinical Research (MOK), IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
    Kaimakliotis, Ioannis P.
    Nicosia private practice, Nicosia, Cyprus.
    Fumery, Mathurin
    Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France.
    Gower-Rousseau, Corinne
    Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France; Lille Inflammation Research International Center LIRIC, Lille University, Lille, France.
    Girardin, Giulia
    Department of Surgical, Oncological and gastroenterological Sciences, Azienda, University of Padua, Padua, Italy.
    Valpiani, Daniela
    U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy.
    Goldis, Adrian
    Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania.
    Brinar, Marko
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia.
    Čuković-Čavka, Silvija
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia.
    Oksanen, Pia
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland.
    Collin, Pekka
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland.
    Barros, Luisa
    Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.
    Magro, Fernando
    Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal.
    Misra, Ravi
    IBD Department, St Marks Hospital, Imperial College London, London, UK.
    Arebi, Naila
    IBD Department, St Marks Hospital, Imperial College London, London, UK.
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Kievit, Hendrika Adriana Linda
    Department of Medicine, Herning Central Hospital, Herning, Denmark.
    Pedersen, Natalia
    Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark.
    Kjeldsen, Jens
    Gastroenterology Department, Odense University Hospital, Odense, Denmark.
    Myers, Sally
    IBD Unit, Hull & East Yorkshire NHS Trust, Hull, UK.
    Sebastian, Shaji
    IBD Unit, Hull & East Yorkshire NHS Trust, Hull, UK.
    Katsanos, Konstantinos H.
    Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.
    Christodoulou, Dimitrios K.
    Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.
    Midjord, Jóngerð
    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands.
    Nielsen, Kári Rubek
    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands.
    Kiudelis, Gediminas
    Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kupcinskas, Limas
    Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Nikulina, Inna
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
    Belousova, Elena
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
    Schwartz, Doron
    Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
    Odes, Selwyn
    Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
    Salupere, Riina
    Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
    Carmona, Amalia
    Department of Gastroenterology. Hospital POVISA, Vigo, Spain.
    Pineda, Juan R.
    Department of Gastroenterology. Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain.
    Vegh, Zsuzsanna
    1st Department of Medicine, Semmelweis University, Budapest, Hungary.
    Lakatos, Peter L.
    1st Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, Canada.
    Langholz, Ebbe
    Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.
    Munkholm, Pia
    Department of gastroenterology, North Zealand Hospital, University of Copenhagen, Denmark.
    Epi-IBD, group
    Disease course of inflammatory bowel disease unclassified in a European population-based inception cohort: an Epi-IBD study2019In: Journal of Gastroenterology and Hepatology, ISSN 0815-9319, E-ISSN 1440-1746, Vol. 34, no 6, p. 996-1003Article in journal (Refereed)
    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.

  • 2.
    Burisch, Johan
    et al.
    Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark.
    Katsanos, Konstantinos H.
    Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.
    Christodoulou, Dimitrios K.
    Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.
    Barros, Luisa
    Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.
    Magro, Fernando
    Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal.
    Pedersen, Natalia
    Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark.
    Kjeldsen, Jens
    Gastroenterology Department, Odense University Hospital, Odense, Denmark.
    Vegh, Zsuzsanna
    First Department of Medicine, Semmelweis University, Budapest, Hungary.
    Lakatos, Peter L.
    First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada.
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Fumery, Mathurin
    Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Amiens University Hospital, Amiens, France.
    Gower-Rousseau, Corinne
    Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France; Lille Inflammation Research International Center LIRIC, Lille University, Lille, France.
    Brinar, Marko
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
    Čuković-Čavka, Silvija
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
    Nikulina, Inna
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
    Belousova, Elena
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
    Myers, Sally
    IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK.
    Sebastian, Shaji
    IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK.
    Kiudelis, Gediminas
    Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kupcinskas, Limas
    Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Schwartz, Doron
    Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer Sheva, Israel; Ben Gurion University of the Negev; Beer Sheva, Israel.
    Odes, Selwyn
    Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer Sheva, Israel; Ben Gurion University of the Negev; Beer Sheva, Israel.
    Kaimakliotis, Ioannis P.
    Nicosia Private Practice, Nicosia, Cyprus.
    Valpiani, Daniela
    U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy.
    D'Incà, Renata
    Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padova, Italy.
    Salupere, Riina
    Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia.
    Zammit, Stefania Chetcuti
    Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.
    Ellul, Pierre
    Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.
    Duricova, Dana
    IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.
    Bortlik, Martin
    IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
    Goldis, Adrian
    Clinic of Gastroenterology, University of Medicine ‘Victor Babes’, Timisoara, Romania.
    Kievit, Hendrika Adriana Linda
    Department of Medicine, Herning Central Hospital, Herning, Denmark.
    Toca, Alina
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
    Turcan, Svetlana
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
    Midjord, Jóngerð
    Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands.
    Nielsen, Kári Rubek
    Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands.
    Andersen, Karina Winther
    Medical Department, Regional Hospital of Viborg, Viborg, Denmark.
    Andersen, Vibeke
    Medical Department, Regional Hospital of Viborg, Viborg, Denmark; Focused Research Unit for Molecular Diagnostic and Clinical Research [MOK], IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
    Misra, Ravi
    IBD Department, St Mark’s Hospital, London, UK.
    Arebi, Naila
    IBD Department, St Mark’s Hospital, London, UK.
    Oksanen, Pia
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland.
    Collin, Pekka
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland.
    de Castro, Luisa
    Department of Gastroenterology, Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain.
    Hernandez, Vicent
    Department of Gastroenterology, Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain.
    Langholz, Ebbe
    Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
    Munkholm, Pia
    Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark.
    Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort-An Epi-IBD Study2019In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no 2, p. 198-208Article in journal (Refereed)
    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.

  • 3.
    Burisch, Johan
    et al.
    Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark.
    Kiudelis, Gediminas
    Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kupcinskas, Limas
    Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kievit, Hendrika Adriana Linda
    Department of Medicine, Herning Central Hospital, Herning, Denmark.
    Andersen, Karina Winther
    Medical Department, Regional Hospital of Viborg, Viborg, Denmark.
    Andersen, Vibeke
    Medical Department, Regional Hospital of Viborg, Viborg, Denmark; Focused research unit for Molecular Diagnostic and Clinical Research (MOK), IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark.
    Salupere, Riina
    Division of Gastroenterology, Tartu University Hospital, University of Tartyu, Tartu, Estonia.
    Pedersen, Natalia
    Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark.
    Kjeldsen, Jens
    Gastroenterology Department, Odense University Hospital, Odense, Denmark.
    D'Incà, Renata
    Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padova, Italy.
    Valpiani, Daniela
    U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy.
    Schwartz, Doron
    Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
    Odes, Selwyn
    Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
    Olsen, Jóngerð
    Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Denmark.
    Nielsen, Kári Rubek
    Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Denmark.
    Vegh, Zsuzsanna
    1st Department of Medicine, Semmelweis University, Budapest, Hungary.
    Lakatos, Peter Laszlo
    1st Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, Canada.
    Toca, Alina
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
    Turcan, Svetlana
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
    Katsanos, Konstantinos H.
    Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.
    Christodoulou, Dimitrios K
    Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece.
    Fumery, Mathurin
    Gastroenterology Unit, Epimad Registry, Centre hospitalier universitaire (CHU) Amiens Sud, Amiens University Hospital, Amiens, France.
    Gower-Rousseau, Corinne
    Public Health, Epidemiology and Economic Health, Registre Epimad, Lille Hospital, Lille University, Lille, France; Lille Inflammation Research International Center (LIRIC), Lille University, Lille, France.
    Zammit, Stefania Chetcuti
    Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.
    Ellul, Pierre
    Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magro, Fernando Jose
    Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine, Porto University, Porto, Portugal.
    Duricova, Dana
    IBD Clinical and Research Centre (ISCARE), Prague, Czech Republic.
    Bortlik, Martin
    IBD Clinical and Research Centre (ISCARE), Prague, Czech Republic; Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
    Fernandez, Alberto
    Department of Gastroenterology, Hospital POVISA, Vigo, Spain.
    Hernández, Vicent
    Department of Gastroenterology, Hospital Alvaro Cunqueiro. Instituto Investigación Sanitaria Galicia Sur. EOXI de Vigo, Vigo, Spain.
    Myers, Sally
    IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK.
    Sebastian, Shaji
    IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK.
    Oksanen, Pia
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland.
    Collin, Pekka
    University of Tampere, Tampere, Finland.
    Goldis, Adrian
    Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania.
    Misra, Ravi
    IBD Department, Imperial College London, London, UK.
    Arebi, Naila
    IBD Department, Imperial College London, London, UK.
    Kaimakliotis, Ioannis P.
    Nicosia private practice, Nicosia, Cyprus.
    Nikuina, Inna
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
    Belousova, Elena
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
    Brinar, Marko
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia.
    Cukovic-Cavka, Silvija
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia.
    Langholz, Ebbe
    Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
    Munkholm, Pia
    Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark.
    Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study2019In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 68, no 3, p. 423-433Article in journal (Refereed)
    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.

  • 4.
    Eriksson, Carl
    Örebro University, School of Medical Sciences.
    Epidemiological and therapeutic aspects of Inflammatory Bowel Disease2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: The two main forms of inflammatory bowel disease (IBD) are Crohn’s disease and ulcerative colitis. These are chronic inflammatory disorders, mainly affecting the gastrointestinal tract.

    Aims: The overall aims of this thesis were to study the epidemiology of ulcerative colitis in Örebro, Sweden; to examine certain aspects of anaemia in IBD; and to determine the clinical effectiveness of medical treatments.

    Material and methods: Cohort studies with the sampling frame defined by the geographic boundaries of the primary catchment area of Örebro University Hospital (Papers I‒III), or by the entire IBD population in Sweden registered in the Swedish national quality registry for IBD (SWIBREG; paper IV), were performed to determine the epidemiology of ulcerative colitis, the incidence and prevalence of anaemia in IBD, and the clinical effectiveness of thiopurine drugs and vedolizumab in routine care.

    Results: A fivefold increase in the incidence and a tenfold increase in the prevalence of ulcerative colitis was observed in Örebro during the past 50 years. In parallel, the prognosis, in terms of risk for colectomy within 10 years from diagnosis, improved during the same time period. Earlier and more widespread use of thiopurine drugs may have contributed to the decrease in colectomies. Anaemia is common in IBD, particularly in Crohn’s disease. Vedolizumab, a new drug targeting leucocyte migration to the gut, appears to be well tolerated and effective in Swedish real-world IBD care.

    Conclusion: Ulcerative colitis is on the rise, and data from Örebro indicate that the number of IBD patients in Sweden already exceeds 70,000. Improved knowledge of long-term outcomes of medical therapy may have far-reaching implications for future IBD management.

    List of papers
    1. 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
    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
    Show others...
    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
    2. Incidence, prevalence, and clinical outcome of anaemia in inflammatory bowel disease: A population-based cohort study
    Open this publication in new window or tab >>Incidence, prevalence, and clinical outcome of anaemia in inflammatory bowel disease: A population-based cohort study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Identifiers
    urn:nbn:se:oru:diva-66679 (URN)
    Available from: 2018-04-19 Created: 2018-04-19 Last updated: 2018-04-19Bibliographically approved
    3. Impact of thiopurines on the natural history and surgical outcome of ulcerative colitis: a cohort study
    Open this publication in new window or tab >>Impact of thiopurines on the natural history and surgical outcome of ulcerative colitis: a cohort study
    Show others...
    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
    4. Long-term effectiveness of vedolizumab in inflammatory bowel disease: a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)
    Open this publication in new window or tab >>Long-term effectiveness of vedolizumab in inflammatory bowel disease: a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)
    Show others...
    2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 6-7, p. 722-729Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness.

    Materials and methods: Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index<5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index<3 in ulcerative colitis (UC).

    Results: Two-hundred forty-six patients (147CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p<.0001 in both groups). Faecal-calprotectin decreased in CD (p<.0001) and in UC (p=.001), whereas CRP decreased in CD (p=.002) but not in UC (p=.11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48).

    Conclusion: Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keywords
    Vedolizumab, clinical practice, inflammatory bowel disease, Crohn's disease, ulcerative colitis
    National Category
    Gastroenterology and Hepatology
    Identifiers
    urn:nbn:se:oru:diva-57787 (URN)10.1080/00365521.2017.1304987 (DOI)000399808100018 ()28362144 (PubMedID)2-s2.0-85018512957 (Scopus ID)
    Note

    Funding Agencies:

    Swedish Government  OLL-549221  OLL-526131  ALFSKANE-539811 

    Hedlund Foundation  

    Österlund Foundation  

    Available from: 2017-05-23 Created: 2017-05-23 Last updated: 2018-07-31Bibliographically approved
  • 5.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences.
    Bergemalm, Daniel
    Örebro University, School of Medical Sciences.
    Vigren, L.
    Dept Med, Div Gastroenterol, Hosp Trelleborg, Trelleborg, Sweden.
    Nilsson, L.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Visuri, Isabella
    Örebro University, School of Medical Sciences.
    Hjortswang, H.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden; Dept Clin & Expt Med, Linköping, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Almer, S.
    Dept Med, Gastrocentrum, Karolinska Inst, Stockholm, Sweden.
    Seddighzadeh, M.
    Merck Sharp & Dohme Ltd, Stockholm, Sweden.
    Hertervig, E.
    Dept Gastroenterol, Skane Univ Hosp, Lund, Sweden.
    Karlen, P.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Strid, H.
    Dept Internal Med, Södra Älvsborgs Hosp, Borås, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    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-SWIBREG2018In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, no Suppl. 1, p. S409-S410Article in journal (Other academic)
  • 6.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Rundquist, Sara
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Zhulina, Yaroslava
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Ida
    Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK .
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Changes in medical management and colectomy rates: a population-based cohort study on the epidemiology and natural history of ulcerative colitis in Orebro, Sweden, 1963-20102017In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 8, p. 748-757Article in journal (Refereed)
    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.

  • 7.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Rundquist, Sara
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Zhulina, Yaroslava
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Ida
    Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Editorial: do thiopurines and biologics decrease the risk of colectomy? Authors' reply2017In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 9, p. 897-898Article in journal (Other academic)
  • 8.
    Eriksson, Carl
    et al.
    Dept Med, Div Gastroenterol, Örebro Univ Hosp, Örebro, Sweden.
    Gustavsson, Anders
    Örebro University, School of Health and Medical Sciences.
    Kronvall, Thomas
    Dept Cardiol, Örebro Univ Hosp, Örebro, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Hepatotoxicity by bosentan in a patient with portopulmonary hypertension: a case-report and review of the literature2011In: Journal of Gastrointestinal and Liver Diseases, ISSN 1841-8724, E-ISSN 1842-1121, Vol. 20, no 1, p. 77-80Article in journal (Refereed)
    Abstract [en]

    Bosentan is an endothelin receptor antagonist approved for treatment of pulmonary arterial hypertension. Mild liver reactions occur in about 10% of treated patients but severe hepatotoxicity is rare. We present clinical data and treatment outcome of a severe drug induced liver injury due to bosentan in a patient with non-cirrhotic portopulmonary hypertension. After 18 months of uncomplicated therapy with bosentan 125 mg b.i.d., the patient developed a severe mixed hepatic injury. Serum levels of bilirubin were 316 µmol/l (ref. value <20 micromol/l), AST 14 µkat/l (ref. value < 0.9 µkat/l), ALT 10 µkat/l (ref. value < 0.9 µkat/l), ALP 8 µkat/l (ref. value <1.8 µkat/l) and INR 1.8 (ref. value 0.9-1.1). Complete diagnostic work-up disclosed no other cause of hepatotoxicity. Treatment with prednisolone 40 mg/day in tapering doses was ultimately added and the patient made a full recovery. Subsequent treatment with sildenafil and ambrisentan for pulmonary arterial hypertension was well tolerated and liver function tests have remained normal during 12 months' follow-up. A review of the literature revealed three other women with severe hepatotoxicity due to bosentan. Bosentan may cause severe liver injury, even after long uneventful therapy, and current recommendations on regular monitoring of liver function tests are reinforced. Ambrisentan may be a therapeutic alternative in patients with pulmonary arterial hypertension and hepatotoxicity by bosentan.

  • 9.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences.
    Henriksson, Ida
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Zhulina, Yaroslava
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Nyhlin, Nils
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden; University College London, London, United Kingdom.
    Incidence, prevalence, and clinical outcome of anaemia in inflammatory bowel disease: A population-based cohort studyManuscript (preprint) (Other academic)
  • 10.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Henriksson, Ida
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Zhulina, Yaroslava
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Nyhlin, Nils
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population-based cohort study2018In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 48, no 6, p. 638-645Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The incidence and short-term outcome of anaemia in inflammatory bowel disease (IBD) are largely unknown.

    AIM: To determine the incidence, prevalence and clinical outcome of anaemia in terms of resolution of anaemia within 12 months. We also planned to assess risk factors for anaemia in IBD.

    METHODS: A random sample of 342 patients was obtained from the population-based IBD cohort of Örebro University Hospital, Sweden, consisting of 1405 patients diagnosed between 1963 and 2010. Haemoglobin measurements recorded from 1 January 2011 to 31 December 2013 were extracted from the Clinical Chemistry data system.

    RESULTS: In Crohn's disease, the incidence rate of anaemia was 19.3 (95% CI: 15.4-23.7) per 100 person-years and the prevalence was 28.7% (CI: 22.0-36.2), compared with 12.9 (CI: 9.8-16.5) and 16.5% (CI: 11.2-22.9) for ulcerative colitis. Crohn's disease was associated with an increased incidence (OR = 1.60; CI: 1.02-2.51) and prevalence of anaemia (OR = 2.04; CI: 1.20-3.46) compared to ulcerative colitis. Stricturing disease phenotype in Crohn's disease (HR = 2.59; CI: 1.00-6.79) and extensive disease in ulcerative colitis (HR = 2.40; CI: 1.10-5.36) were associated with an increased risk of anaemia. Despite a higher probability of receiving specific therapy within 3 months from the diagnosis of anaemia, Crohn's disease patients had a worse outcome in terms of resolution of anaemia within 12 months (56% vs 75%; P = 0.03).

    CONCLUSIONS: Anaemia is a common manifestation of IBD even beyond the first years after the diagnosis of IBD. Crohn's disease is associated with both an increased risk and a worse outcome.

  • 11.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology, Faculty of Medicine and Health, Örebro university, Örebro, Sweden.
    Marsal, Jan
    Immunology Section, Lund University, Lund, Sweden; Department of Gastroenterology, Skåne University Hospital, Lund, Sweden.
    Bergemalm, Daniel
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Vigren, Lina
    Department of Internal Medicine, Ystad Hospital, Ystad, Sweden.
    Björk, Jan
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden.
    Eberhardson, Michael
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden.
    Karling, Pontus
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Söderman, Charlotte
    Department of Internal Medicine, St Göran Hospital, Stockholm, Sweden.
    Myrelid, Pär
    Department of Clinical and Experimental Medicine, Linköping University and Department of Surgery, Linköping University Hospital, Linköping, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sjöberg, Daniel
    Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Thörn, Mari
    Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden.
    Karlén, Per
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Hertervig, Erik
    Department of Gastroenterology, Skåne University Hospital, Lund, Sweden.
    Strid, Hans
    Department of Internal Medicine, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Almer, Sven
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Long-term effectiveness of vedolizumab in inflammatory bowel disease: a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)2017In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 6-7, p. 722-729Article in journal (Refereed)
    Abstract [en]

    Objectives: Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness.

    Materials and methods: Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index<5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index<3 in ulcerative colitis (UC).

    Results: Two-hundred forty-six patients (147CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p<.0001 in both groups). Faecal-calprotectin decreased in CD (p<.0001) and in UC (p=.001), whereas CRP decreased in CD (p=.002) but not in UC (p=.11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48).

    Conclusion: Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.

  • 12.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Rundquist, Sara
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Impact of thiopurines on the natural history and surgical outcome of ulcerative colitis: a cohort study2019In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 68, no 4, p. 623-632Article in journal (Refereed)
    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.

  • 13.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences.
    Rundquist, Sara
    Örebro University, School of Medical Sciences.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    The impact of thiopurine drugs on the natural history and surgical outcome of ulcerative colitis: A cohort study2018In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, no Suppl. 1, p. S481-S481Article in journal (Other academic)
  • 14.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Rundquist, Sara
    Örebro University, School of Medical Sciences.
    Lykiardopoulos, B.
    Department of Gastroenterology, Linköping University, Linköping, Sweden.
    Karlén, P.
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Grip, O.
    Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Söderman, C.
    Department of Internal Medicine, St Göran Hospital, Stockholm, Sweden.
    Almer, S.
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Hertervig, E.
    Department of Gastroenterology, Skåne University Hospital, Lund, Sweden.
    Gunnarsson, J.
    Department of Internal Medicine, Kungsbacka Hospital, Kungsbacka, Sweden.
    Delin, J.
    Department of Gastroenterology, Ersta hospital, Stockholm, Sweden.
    Strid, H.
    Department of Internal Medicine, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Sjöberg, M.
    Department of Internal Medicine, Skaraborgs Hospital, Lidköping, Sweden.
    Öberg, D.
    Department of Internal Medicine, Sunderby Hospital, Sunderbyn, Sweden.
    Hjortswang, H.
    Department of Gastroenterology, Linköping University, Linköping, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    A Swedish observational study (SVEAH) on vedolizumab assessing effectiveness and healthcare resource utilization in patients with inflammatory bowel disease2017In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 11, no Suppl. 1, p. S262-S263Article in journal (Refereed)
  • 15.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences.
    Rundquist, Sara
    Örebro University, School of Medical Sciences.
    Lykiardopoulos, V.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden.
    Karlen, P.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Grip, O.
    Dept Gastroenterol, Skane Univ Hosp, Malmö, Sweden.
    Söderman, C.
    Dept Internal Med, St Goran Hosp, Stockholm, Sweden.
    Almer, S.
    Dept Med, Karolinska Inst, Stockholm, Sweden.
    Hertervig, E.
    Dept Gastroenterol, Skåne Univ Hosp, Lund, Sweden.
    Gunnarsson, J.
    Dept Internal Med, Kungsbacka Hosp, Kungsbacka, Sweden.
    Malmgren, C.
    Takeda Pharma AB, Solna, Sweden.
    Delin, J.
    Dept Gastroenterol, Ersta Hosp, Stockholm, Sweden.
    Strid, H.
    Dept Internal Med, Södra Älvsborgs Hosp, Borås, Sweden.
    Sjöberg, M.
    Dept Internal Med, Skaraborgs Hosp, Lidköping, Sweden.
    Öberg, D.
    Dept Internal Med, Sunderby Hosp, Sunderbyn, Sweden.
    Bergemalm, Daniel
    Örebro University, School of Medical Sciences.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Hjortswang, H.
    Dept Gastroenterol, Linköping Univ, Linöping, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    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)2018In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, no Suppl. 1, p. S494-S495Article in journal (Other academic)
  • 16.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences.
    Rundquist, Sara
    Örebro University, School of Medical Sciences.
    Lykiardopoulos, V.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden.
    Karlen, P.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Grip, O.
    Dept Gastroenterol, Skåne Univ Hosp, Malmö, Sweden.
    Söderman, C.
    Dept Internal Med, St Göran Hosp, Stockholm, Sweden.
    Almer, S.
    Dept Med, Karolinska Inst, Stockholm, Sweden.
    Hertervig, E.
    Dept Gastroenterol, Skåne Univ Hosp, Lund, Sweden.
    Gunnarsson, J.
    Dept Internal Med, Kungsbacka Hosp, Kungsbacka, Sweden.
    Malmgren, C.
    Takeda Pharma AB, Solna, Sweden.
    Delin, J.
    Dept Gastroenterol, Ersta Hosp, Stockholm, Sweden.
    Strid, H.
    Dept Internal Med, Södra Älvsborgs Hosp, Borås, Sweden.
    Sjöberg, M.
    Dept Internal Med, Skaraborgs Hosp, Lidköping, Sweden.
    Öberg, D.
    Dept Internal Med, Sunderby Hosp, Sunderbyn, Sweden.
    Bergemalm, Daniel
    Örebro University, School of Medical Sciences.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Hjortswang, H.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    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)2018In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, no Suppl. 1, p. S382-S383Article in journal (Other academic)
  • 17.
    Moens, A.
    et al.
    University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium; Catholic University Leuven, Chronic Diseases, Metabolism and Ageing, Leuven, Belgium.
    van der Woude, C.
    Erasmus MC, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands.
    Julsgaard, M.
    Aarhus University Hospital, Department of Gastroenterology and Hepatology, Aarhus, Denmark.
    Sebastian, S.
    Hull and East Yorkshire NHS Trust, IBD Unit, Hull, UK; University of Hull and York, Hull York Medical School, Hull, UK.
    Arebi, N.
    St. Marks Hospital, Department of Gastroenterology, London, UK.
    Alzinaty, M.
    St. Marks Hospital, Department of Gastroenterology, London, UK.
    Humblet, E.
    Ziekenhuis Oost-Limburg – Campus Sint-Jan, Department of Gastroenterology, Genk, Belgium.
    Kok, K. B.
    Barts Health NHS Trust, Department of Gastroenterology, London, UK.
    Sheridan, J.
    St. Vincent’s University Hospital, Department of Gastroenterology, Dublin, Ireland.
    De Saint-Joseph, C. Gilletta
    Hop Rangueil, Dept Gastroenterol, Toulouse, France..
    Nancey, S.
    CHU Lyon, Department of Gastroenterology and Hepatology, Lyon, France.
    Rahier, J. -F
    CHU UCL Namur, Université catholique de Louvain, Deparment of Gastroenterology, Yvoir, Belgium.
    Bossuyt, P.
    Imeldaziekenhuis, Department of Gastroenterology, Bonheiden, Belgium.
    Cremer, A.
    Hôpital Erasme, Université Libre de Bruxelles, Department of Gastroenterology, Brussels, Belgium.
    Dewit, S.
    Mariaziekenhuis Noord-Limburg, Department of Gastroenterology, Overpelt, Belgium.
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Hoentjen, F.
    Radboud UMC, Department of Gastroenterology, Nijmegen, The Netherlands.
    Krause, T.
    Opernstrasse, Department of Gastroenterology, Kassel, Germany.
    Louis, E.
    CHU Liège, Department of Gastroenterology, Liège, Belgium.
    Macken, E.
    Universiteit ziekenhuis Antwerpen, Department of Gastroenterology, Antwerpen, Belgium.
    Milenkovic, Z.
    Military Medical Academy Belgrade, Department of Gastroenterology, Belgrade, Serbia.
    Nijs, J.
    Sint-Trudo Ziekenhuis, Department of Gastroenterology, St-Truiden, Belgium.
    Posen, A.
    AZ Vesalius, Department of Gastroenterology, Tongeren, Belgium.
    Van Hootegem, A.
    AZ Klina, Department of Gastroenterology, Brasschaat, Belgium.
    Van Moerkercke, W.
    AZ Groeninge, Department of Gastroenterology, Kortrijk, Belgium.
    Vermeire, S.
    University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium; Catholic University Leuven, Chronic Diseases, Metabolism and Ageing, Leuven, Belgium.
    Shitrit, A. Bar-Gil
    Shaare Zedek Medical Center, Hebrew University Jerusalem, Digestive diseases institute, Jerusalem, Israel.
    Ferrante, M.
    University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium; Catholic University Leuven, Chronic Diseases, Metabolism and Ageing, Leuven, Belgium.
    Pregnancy outcomes in IBD patients treated with vedolizumab, anti-TNF, or conventional therapy2019In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no Suppl. 1, p. S41-S42Article in journal (Other academic)
  • 18.
    Rundquist, Sara
    et al.
    Örebro University, School of Medical Sciences.
    Eriksson, Carl
    Örebro University, School of Medical Sciences.
    Nilsson, Linda
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Angelison, Leif
    Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.
    Jäghult, Susanna
    Stockholm Gastro Center, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Björk, Jan
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Grip, Olof
    Department of Gastroenterology, Skåne University Hospital Malmö, Malmö, Sweden.
    Hjortswang, Henrik
    Department of Gastroenterology, Linköping University, Linköping, Sweden.
    Strid, Hans
    Department of Internal Medicine, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Karlén, Per
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    Clinical effectiveness of golimumab in Crohn´s disease – an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)2018Conference paper (Other academic)
  • 19.
    Rundquist, Sara
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Nilsson, Linda
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Angelison, Leif
    Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.
    Jäghult, Susanna
    Stockholm Gastro Center, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Björk, Jan
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Grip, Olof
    Department of Gastroenterology, Skåne University Hospital Malmö, Malmö, Sweden.
    Hjortswang, Henrik
    Department of Gastroenterology, Linköping University, Linköping, Sweden.
    Strid, Hans
    Department of Internal Medicine, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Karlén, Per
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Clinical effectiveness of golimumab in Crohn's disease: an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)2018In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 10-11, p. 1257-1263Article in journal (Refereed)
    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.

  • 20.
    Visuri, Isabella
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Mårdberg, E.
    Örebro University, Department of Gastroenterology, Faculty of Medicine and Health, Örebro, Sweden.
    Grip, O.
    Skåne University Hospital, Department of Gastroenterology, Malmö, Sweden.
    Gustavsson, A.
    Central Hospital, Department of Internal Medicine, Karlstad, Sweden.
    Hjortswang, H.
    Linköping University, Department of Clinical and Experimental Medicine, Linköping, Sweden; Linköping University, Department of Gastroenterology, Linköping, Sweden.
    Karling, P.
    Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Örebro University Hospital. University College London, Department of Epidemiology and Public Health, London, UK; Karolinska Institutet, Clinical Epidemiology Unit, Department of Medicine Solna, Stockholm, Sweden.
    Myrelid, P.
    Linköping University, Department of Clinical and Experimental Medicine, Linköping, Sweden; Linköping University Hospital, Department of Surgery, Linköping, Sweden.
    Olén, O.
    Karolinska Institutet, Clinical Epidemiology Unit, Department of Medicine Solna, Stockholm, Sweden; Stockholm South General Hospital, Sachs’ Children and Youth Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Science and Education Södersjukhuset, Stockholm, Sweden .
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden; Örebro University Hospital, Department of Pediatrics, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    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)2019In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no Suppl. 1, p. S443-S444Article in journal (Other academic)
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