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Asian, Western IBD patients have comparable early disease course
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The early course of inflammatory bowel disease was found to be comparable between patients in Asia and the West, according to results from an ongoing prospective Asia-Pacific population-based study.
IBD “incidence is increasing in Asia,” the researchers wrote. “However, our current knowledge of the natural history of IBD in Asia remains limited because data are scarce at a population level and are derived mainly from referral centers and/or small-size series. Such data are biased toward more severe disease.”
Researchers evaluated early clinical outcomes of 413 adult IBD patients enrolled in the Asia-Pacific Crohn’s and Colitis Epidemiology study, which was initiated in 2011 to prospectively collect incident IBD cases from eight Asian countries and Australia. In the current study, they assessed disease course and severity, risk factors for medical therapy and surgery, and cancer mortality rates in patients diagnosed with IBD between April 2011 and March 2013.
Ten of the patients were diagnosed with unclassified IBD, 222 with ulcerative colitis and 181 with Crohn’s disease, and the median age at diagnosis was 37 (IQR = 25-49) years. Patients were prospectively followed up every 3 months after diagnosis for a follow-up period of at least 6 months (total follow-up, 627.25 person-years; median follow-up, 18 [IQR = 12-23] months).
They found that the cumulative probability of Crohn’s disease behavior changing from inflammatory to stricturing or penetrating disease was 20.4% (95% CI, 12.3%-28.4%) in Asia and 16.9% (95% CI, 2.4%-31.4%) in Australia.
In Asia, the cumulative probabilities for use of mesalamine, corticosteroids, immunosuppressants and anti-tumor necrosis factor agents were 60%, 44%, 63% and 12% for Crohn’s disease, and 88%, 25%, 13% and 1% for UC, respectively.
Independent factors associated with immunosuppressant use in the first year after Crohn’s diagnosis within Asia included male sex (HR = 1.72; 95% CI, 1.33-2.22), stricturing disease (HR = 1.62; 95% CI, 1.16-2.26) and ileocolonic disease (HR = 1.17; 95% CI, 1.05-1.3). Independent factors associated with anti-TNF use in the first year after Crohn’s diagnosis included male sex (HR = 2.37; 95% CI, 1.1-5.1) and perianal disease (HR = 2.97; 95% CI, 1.09-8.09). Extensive colitis vs. proctitis was associated with a higher risk for immunosuppressant use in UC patients (HR = 2.85; 95% CI, 1.65-4.91).
The cumulative probabilities for surgical resection 1 year after diagnosis were 8% and 12.2% for patients with Crohn’s disease in Asia and Australia, respectively, and 1.1% and 0% for patients with UC, respectively.
Crohn’s patients with penetrating disease had more than a sevenfold increased risk for surgery compared with patients with inflammatory disease (HR = 7.67; 95% CI, 3.93-14.96).
The overall mortality rate was 0.7%.
Gilaad G. Kaplan
These results “showed that the early disease course for [Crohn’s disease] in Asia can be as severe as in the West [and] may help to develop therapeutic strategies aimed at modifying the clinical course of IBD and provide clear and comprehensive information to the patient about disease prognosis,” the researchers concluded.
The findings from this study “are important because they suggest the prognosis of patients with IBD living in Asia may be similar to those living in the Western world,” Gilaad G. Kaplan, MD, from University of Calgary, and Tine Jess, MD, from Statens Serum Institut in Denmark, wrote in a related editorial. “This means gastroenterologists in Asia can look across to Europe and North America to visualize how their clinics will evolve over the next decade as the number of patients with IBD increase in their practices. The findings from this study confirm, at least in the short term, that patients with IBD in Asia require the same aggressive, complex, and expensive care.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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