Introduction Crohn's disease affects 50–100 patients per 100 000 in the population and typically follows a progressive course, with an estimated 33% of patients with active disease developing complications requiring hospitalisation or surgery in the first year of diagnosis. Up to 80% of patients require surgery at some point during the course of their disease. This retrospective study assessed the rates of emergency hospitalisation and surgery for a large UK cohort of patients before and after infliximab therapy.
Methods 18 UK centres participated in the study, including data from a total of 380 individuals with Crohn's disease who had received their first infusion of infliximab after 1 January 2003. Patients were eligible for inclusion with 12 months data prior to, and 24 months data post infliximab initiation, in their clinical record. Data on all investigations, clinic appointments, admissions and operations were extracted from the patient record in a standardised manner by members of the local clinical team. A prespecified statistical analysis plan compared healthcare resource utilisation at 12, 18 and 24 months after the introduction of infliximab with resource utilisation during the 12 months prior to starting treatment.
Results In the 12-month period before initiation of infliximab therapy there were a total of 12 emergency admissions for surgical procedures. There were 176 unplanned emergency admissions in the same period to manage complications such as bowel obstruction or flare. In the 24-month period following initiation of infliximab therapy there were significantly fewer cumulative emergency admissions for surgical procedures (8 total, p=0.0184) and management of complications (220 total, p<0.0001). The most common complications resulting in unplanned admissions included abscess, flare and intestinal obstruction which were reduced by half in the first year of infliximab therapy.
Conclusion In a large UK cohort of Crohn's disease patients, treatment with infliximab was shown to significantly reduce rates of emergency admissions for either surgical intervention or management of complications.
Competing interests C Wheeler: Employee of: MSD, R Chipperfield: Employee of: MSD, T Orchard: Grant/Research Support from: MSD, Warner Chilcott, Johnson and Johnson, Consultant for: Warner Chilcott, Ferring, Shire, Speaker bureau with: Warner Chilcott, Ferring, Shire, J Lindsay Grant/Research Support from: MSD, Abbott, Shire, Consultant for: MSD, Abbott, Shire, GSK, Ferring, Warner Chilcott, Atlantic Healthcare, Speaker bureau with: MSD, Abbott, Shire, Ferring, Warner Chilcott.
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