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Similar Clinical Outcomes of Early and Late Anti-TNF Initiation for Ulcerative Colitis: A Nationwide Population-Based Study

Yonsei Medical Journal 2020년 61권 5호 p.382 ~ 390
한민경 ( Han Min-Kyung ) - Yonsei University College of Medicine Department of Biomedical Systems Informatics

정윤석 ( Jung Yoon-Suk ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Internal Medicine
천재희 ( Cheon Jae-Hee ) - Yonsei University College of Medicine Department of Internal Medicine
박소희 ( Park So-Hee ) - Yonsei University Graduate School of Public Health Department of Biostatistics

Abstract


Purpose: The optimal timing of anti-tumor necrosis factor (anti-TNF) initiation in patients with ulcerative colitis (UC) remains unclear. Very little is known about the clinical outcomes after the early versus late initiation of anti-TNF therapy, especially in Asian UC patients. Here we aimed to assess whether earlier anti-TNF treatment initiation results in favorable clinical outcomes in Korean UC patients.

Materials and Methods: Using the Korean National Health Insurance claims database, we studied patients who were diagnosed with UC and received anti-TNF therapy for more than 6 months between 2010 and 2016. Using a Cox proportional hazard model, clinical outcomes including colectomy, UC-related emergency room (ER) visits, UC-related hospitalizations, and the need for corticosteroids were compared between early (≤2 years of diagnosis) and late (>2 years of diagnosis) initiators of anti-TNF therapy.

Results: Among 17167 UC patients, 698 patients who received anti-TNF therapy for more than 6 months were included (420 infliximab, 242 adalimumab, and 36 golimumab). Of the 698 patients, 299 (42.8%) initiated anti-TNF therapy within 2 years of diagnosis. There were no significant differences in the risk of colectomy [adjusted hazard ratio (aHR), 0.41; 95% confidence interval (CI), 0.04?3.90], ER visits (aHR, 0.98; 95% CI, 0.50?1.92), hospitalization (aHR, 0.76; 95% CI, 0.57?1.01), and corticosteroid use (aHR, 1.04; 95% CI, 0.71?1.50) between early and late initiators of anti-TNF therapy.

Conclusion: Patients receiving early anti-TNF therapy had similar clinical outcomes to those of late initiators, suggesting that early anti-TNF therapy initiation offers little benefit in patients with UC.

키워드

Ulcerative colitis; anti-TNF; early use; clinical outcome
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