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

Authors
 Yoon Suk Jung  ;  Minkyung Han  ;  Sohee Park  ;  Jae Hee Cheon 
Citation
 KOREAN JOURNAL OF INTERNAL MEDICINE, Vol.35(5) : 1104-1113, 2020-09 
Journal Title
 KOREAN JOURNAL OF INTERNAL MEDICINE 
ISSN
 1226-3303 
Issue Date
2020-09
Keywords
Crohn disease ; Immunotherapy ; Tumor necrosis factor-alpha
Abstract
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. Conclusion: 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.
Files in This Item:
T202004230.pdf Download
DOI
10.3904/kjim.2020.001
Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Park, So Hee(박소희) ORCID logo https://orcid.org/0000-0001-8513-5163
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Han, Minkyung(한민경) ORCID logo https://orcid.org/0000-0002-5011-5557
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180150
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