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.
- crohn’s disease
- surgery for Ibd
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Contributors All authors participated in the study design and data acquisition, have critically reviewed the draft manuscript for content and approved the final version for publication. JB had full access to the data in the study and takes full responsibility for its veracity and statistical analysis. JB and PM analysed and interpreted the data. JB drafted the manuscript. PM supervised the study.
Funding Unrestricted grant support has been received from Kirsten og Freddy Johansens Fond as well as from Nordsjællands Hospital Forskningsråd.
Disclaimer The study sponsors have made no contributions to the study design, analysis, data interpretation or publication.
Competing interests JB: consulting fees from Celgene, Janssen-Cilag, AbbVie A/S and Ferring and lecture fees from Abbvie A/S, Pfizer, MSD and Takeda Pharma A/S. VA: consultancy for Janssen and MSD. RS: consulting fees and/or lecture fees from AbbVie, MSD, Takeda, Janssen-Cilag. RD’I: consulting fees from Abbvie, Biocure and lecture fees from Takeda and Mundipharma. MF: speaker/lecture fees for Abbvie, Ferring, MSD, Takeda, Boehringer and Hospira. CG-R: lecture fees from Takeda, MSD, Ferring and Tillots. CE: lecture fees from Takeda. JH: research grants from Janssen, MSD and Takeda and lecture and/or consultancy fees from Abbvie, Cellgene, Ferring, Hospira, Janssen, Medivir, MSD, Pfizer, Vifor Pharma, Takeda and Tillotts Pharma. EL: lecture or consultancy fees from MSD, Abbvie and Ferring Pharmaceuticals. DD: lecture or consultancy fees from AbbVie, Takeda and Janssen. NA: lecture fees from MSD and Jansen. VH: personal fees, non-financial support and other from MSD, AbbVie, Ferring, Faes Farma, Shire, Falk Pharma, Tillots, Otsuka, Hospira Biologicals, Takeda, Jansen and Kernpharma Biologics. AF: personal fees and non-financial support from MSD, AbbVie, Shire and Tillots. SČ-Č: lecture fees from Takeda, MSD, Abbvie.
Ethics approval All centres obtained approval from their respective, local ethical committees.
Provenance and peer review Not commissioned; externally peer reviewed.
Collaborators Ola Niewiadomski (Australia), Sally Bell (Australia), Niksa Turk (Croatia), Silvija Cukovic-Cavka (Croatia), Ioannis Kaimakliotis (Cyprus), Anastasia Nicolaou (Cyprus), Dana Duricova (Czech Republic), Milan Lukas (Czech Republic), Martin Bortlík (Czech Republic), Olga Shonová (Czech Republic), Johan Burisch (Denmark), Pia Munkholm (Denmark), Ebbe Langholz (Denmark), Birgitte Blichfeldt (Denmark), Dorte Marker (Denmark), Katrine Carlsen (Denmark), Petra Weimers (Denmark), Natalia Pedersen (Denmark), Jens Kjeldsen (Denmark), Clays Aalykke (Denmark), Jens Frederik Dahlerup (Denmark), Karen Kudsk (Denmark), Vibeke Andersen (Denmark), Ida Vind (Denmark), Niels Thorsgaard (Denmark), Riina Salupere (Estonia), Jóngerð Olsen (Faroe Islands), Kári Rubek Nielsen (Faroe Islands), Pia Oksanen (Finland), Pekka Collin (Finland), Konstantinnos H Katsanos (Greece), Dimitrios K Christodoulou (Greece), Alexandros Skamnelos (Greece), Dimitrios Politis (Greece), Karin Ladefoged (Greenland), Peter Laszlo Lakatos (Hungary), Zsuzsanna Vegh (Hungary), Laszlo Lakatos (Hungary), Peterne Demenyi (Hungary), Szabina Nemethne Kramli (Hungary), Colm O’Morain (Ireland), Giualia Dal Piaz (Italy), Alessia Santini (Italy), Giulia Girardin (Italy), Renata D’Inca (Italy), Doron Schwartz (Israel), Selwyn Odes (Israel), Limas Kupcinskas (Lithuania), Laimas Jonaitis (Lithuania), Gediminas Kiudelis (Lithuania), Irena Valantiene (Lithuania), Romanas Zykus (Lithuania).