IBD Watch^®

^{Timely Information for Practicing Physicians}

JANUARY 2008

Mortality by inflammatory bowel disease (IBD) medication use. Hutfless and colleagues conducted a retrospective, population-based cohort study evaluating mortality by IBD medication use among patients enrolled in a Kaiser Permanente Northern California IBD Registry. The cohort included 9032 patients who had received at least one inpatient diagnosis or two outpatient diagnoses of IBD between 1996 and 2002. Mortality among patients with Crohn’s disease (CD) but not ulcerative colitis (UC) was higher than that of patients without IBD (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2 to 1.6). The OR associated with CD mortality by medication use was 1.3 (95% CI, 0.9 to 1.9) for immunomodulators but 0.7 and 1.0 for aminosalicylates and corticosteroids, respectively. The increased mortality in patients with CD was associated with infectious diseases, septicemia, small intestinal cancer, respiratory diseases, digestive diseases other than IBD, and liver diseases. UC was associated with increased mortality from digestive diseases other than IBD. These data show that patients with CD have an increased risk of death and that IBD medication use has varying associations with mortality. (Hutfless SM, et al. Gastroenterology 2007;133:1779–1786.) Editor’s note:  These data for CD were not adjusted for smoking that could contribute to several adverse outcomes.

Prevalence and geographic distribution. Kappelman and others determined the prevalence of CD and UC by an analysis of health insurance claims pooled from 87 health plans in 33 states. Cases of CD and UC were identified using diagnosis codes. The prevalence of CD and UC in adults was found to be 201 (95% CI, 197 to 204) and 238 (95% CI, 234 to 241) per 100,000 people, respectively. In children, the prevalence of CD and UC was 43 (95% CI, 40 to 45) and 28 (95% CI, 26 to 30) per 100,000 people, respectively. The prevalence of IBD was lower in the South than elsewhere in the United States. IBD was more common in individuals insured commercially than in those insured by Medicaid. These data can be used to help quantify the burden of IBD and aid in the planning of clinical services. (Kappelman MD, et al. Clin Gastroenterol Hepatol 2007;5:1424–1429.)

Parenteral nutrition. Nguyen and associates studied the use of parenteral nutrition during the management of IBD. Parenteral nutrition was found to be associated with higher rates of inpatient mortality and higher costs. The authors conclude that guidelines are needed for the judicious use of parenteral nutrition in the management of IBD. (Nguyen GC, et al. Aliment Pharmacol Ther 2007;26:1499–1507.)

Clinical course of CD. Solberg and co-workers prospectively assessed the clinical course of CD in 237 patients diagnosed between 1990 and 1994. The cohort was followed up at 1, 5, and 10 years after diagnosis. Among these patients, 197 completed 10 years of follow-up, 22 were lost to follow-up, and 18 died. The cumulative relapse rate was 90% and the cumulative probability of surgery was 37.9%. Terminal ileal disease, stricturing, penetrating disease, and age <40 years at diagnosis were independent risk factors for subsequent surgery. More than half the patients (53%) developed stricturing or penetrating disease. Forty-four percent of patients achieved clinical remission during the last 5 years of follow-up. The relapse rate of 90% highlights the need for effective new agents to treat CD. (Solberg IC, et al. Clin Gastroenterol Hepatol 2007;5:1430–1438.)

Cost effectiveness of starting adalimumab vs infliximab dose escalation. Patients with CD treated with standard-dose infliximab (5 mg/kg) who relapse may regain a response by receiving an increased dose of 10 mg/kg of infliximab or adalimumab as rescue therapy. Kaplan and colleagues used a decision-analysis model to determine whether infliximab dose escalation was a cost-effective strategy compared with the introduction of adalimumab. The time horizon was 1 year. Infliximab dose escalation yielded more quality-adjusted life years than did adalimumab (QALYs; 0.79 vs 0.76). The incremental cost-effectiveness ratio was $332,032 per QALY. The cost of the agents was the most significant variable in the model. In this analysis, although the cost was considerable, the infliximab dose-escalation strategy resulted in the greater QALYs. (Kaplan GG, et al. Aliment Pharmacol Ther 2007;26:1509–1520.)

This web site is supported through educational grants from     

Note: By clicking on the above logos you are leaving this educational site

Comments or requests to unsubscribe can be e-mailed to info@ibdwatch.com