Issue 09

Clinical Question

With the introduction of anti-TNFs, has there been a change in the annual colectomy incidence rate for medically refractory ulcerative colitis (UC)?

Editor’s Bottom Line

This Canadian study nicely demonstrates that the incidence rate of colectomy for UC has declined substantially since the introduction of anti-TNF therapy.

Reference

Reich KM, Chang HJ, Rezaie A, et al. The incidence rate of colectomy for medically refractory ulcerative colitis has declined in parallel with increasing anti-TNF use: a time-trend study. Aliment Pharmacol Ther. 2014 Sep;40(6):629–38.  https://www.ncbi.nlm.nih.gov/pubmed/25039715

Synopsis

Adults diagnosed with UC who had either an urgent or elective colectomy for medically refractory disease between 1998 and 2011 were identified in the hospital discharge database by diagnosis codes. Prescribed medications prior to, and during hospitalization, were identified and a review of medical charts was performed.

A total of 481 patients fulfilled study inclusion criteria. Prior to the introduction of anti-TNFs, there was no change in the annual incidence rate for colectomy between 1998 and 2005 (4.4% annual change). In contrast, after the introduction of anti-TNFs, from 2005–2011, the incidence rate decreased (-16.1% annual change). The change in colectomy rates mirrored the increased use of anti-TNF from 2005 onward. In 2011, the annual incidence of colectomy was 0.9 per 100 UC patients in Edmonton. The urgent colectomy incidence rate declined more sharply than that for elective colectomy following the introduction of anti-TNFs (-18.6% vs. -14.9% annual change, respectively).

Details

Study Design: Retrospective observational cohort study
Funding: Alberta Innovates-Health Solutions, Alberta IBD Consortium, and Centre of Excellence in Gastrointestinal Inflammation and Immunity Research (CEGIIR)
Allocation: n/a
Setting: Four hospitals in Edmonton, Alberta
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.