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Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study

BACKGROUND/AIMS: The optimal timing for initiation of anti-tumor necrosis factor (TNF) therapy in Crohn’s disease (CD) is still debated. Little is known about the clinical outcomes of early versus late administration of anti-TNF agents, especially in Asian CD patients. We aimed to evaluate the impac...

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Autores principales: Jung, Yoon Suk, Han, Minkyung, Park, Sohee, Cheon, Jae Hee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association of Internal Medicine 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487310/
https://www.ncbi.nlm.nih.gov/pubmed/32306709
http://dx.doi.org/10.3904/kjim.2020.001
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author Jung, Yoon Suk
Han, Minkyung
Park, Sohee
Cheon, Jae Hee
author_facet Jung, Yoon Suk
Han, Minkyung
Park, Sohee
Cheon, Jae Hee
author_sort Jung, Yoon Suk
collection PubMed
description BACKGROUND/AIMS: The optimal timing for initiation of anti-tumor necrosis factor (TNF) therapy in Crohn’s disease (CD) is still debated. Little is known about the clinical outcomes of early versus late administration of anti-TNF agents, especially in Asian CD patients. We aimed to evaluate the impact of early anti-TNF therapy on clinical outcomes in Korean CD patients. METHODS: Using the Korean National Health Insurance Claims database, we collected data on patients diagnosed with CD who received anti-TNF therapy for more than 6 months between 2010 and 2016. Early initiation of anti-TNF therapy was defined as those starting infliximab or adalimumab therapy within 1 year of diagnosis. The following outcomes were assessed using a Cox proportional hazard model: abdominal surgery, CD-related emergency room (ER) visit, CD-related hospitalization, and new corticosteroid use. RESULTS: Among 1,207 patients, 609 were early initiators of anti-TNF. Late anti-TNF initiation (> 1 year after diagnosis) was associated with increased risk of surgery (adjusted hazard ratio [aHR], 1.64; 95% confidence interval [CI], 1.05 to 2.55) and tended to be associated with increased risk of ER visit (aHR, 1.38; 95% CI, 0.99 to 1.94). However, there were no significant differences in the risk of hospitalization and corticosteroid use between early and late initiators. CONCLUSIONS: Early anti-TNF therapy among Korean CD patients within 1 year of diagnosis was associated with better clinical outcomes than late therapy, such as lower surgery and ER visit rates. Our results suggest that aggressive medical intervention in the early stages of CD may potentially change the course of this disease.
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spelling pubmed-74873102020-09-21 Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study Jung, Yoon Suk Han, Minkyung Park, Sohee Cheon, Jae Hee Korean J Intern Med Original Article BACKGROUND/AIMS: The optimal timing for initiation of anti-tumor necrosis factor (TNF) therapy in Crohn’s disease (CD) is still debated. Little is known about the clinical outcomes of early versus late administration of anti-TNF agents, especially in Asian CD patients. We aimed to evaluate the impact of early anti-TNF therapy on clinical outcomes in Korean CD patients. METHODS: Using the Korean National Health Insurance Claims database, we collected data on patients diagnosed with CD who received anti-TNF therapy for more than 6 months between 2010 and 2016. Early initiation of anti-TNF therapy was defined as those starting infliximab or adalimumab therapy within 1 year of diagnosis. The following outcomes were assessed using a Cox proportional hazard model: abdominal surgery, CD-related emergency room (ER) visit, CD-related hospitalization, and new corticosteroid use. RESULTS: Among 1,207 patients, 609 were early initiators of anti-TNF. Late anti-TNF initiation (> 1 year after diagnosis) was associated with increased risk of surgery (adjusted hazard ratio [aHR], 1.64; 95% confidence interval [CI], 1.05 to 2.55) and tended to be associated with increased risk of ER visit (aHR, 1.38; 95% CI, 0.99 to 1.94). However, there were no significant differences in the risk of hospitalization and corticosteroid use between early and late initiators. CONCLUSIONS: Early anti-TNF therapy among Korean CD patients within 1 year of diagnosis was associated with better clinical outcomes than late therapy, such as lower surgery and ER visit rates. Our results suggest that aggressive medical intervention in the early stages of CD may potentially change the course of this disease. The Korean Association of Internal Medicine 2020-09 2020-04-21 /pmc/articles/PMC7487310/ /pubmed/32306709 http://dx.doi.org/10.3904/kjim.2020.001 Text en Copyright © 2020 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Jung, Yoon Suk
Han, Minkyung
Park, Sohee
Cheon, Jae Hee
Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study
title Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study
title_full Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study
title_fullStr Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study
title_full_unstemmed Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study
title_short Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study
title_sort impact of early anti-tnf use on clinical outcomes in crohn’s disease: a nationwide population-based study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487310/
https://www.ncbi.nlm.nih.gov/pubmed/32306709
http://dx.doi.org/10.3904/kjim.2020.001
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