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OP009 Unchanged surgery and hospitalization rates in an East-West European inception cohort despite differences in use of biologicals - 3-year follow-up of the ECCO-EpiCom cohort

J. Burisch*1, I. Kaimakliotis2, D. Duricova3, L. Kievit4, J.F. Dahlerup5, R. Salupere6, K.R. Nielsen7, P. Manninen8, E.V. Tsianos9, Z. Vegh10, S. Odes11, R. D'Inca12, L. Kupcinskas13, S. Turcan14, F. Magro15, 16, 17, A. Goldis18, V. Hernandez19, J. Halfvarson20, N. Arebi21, E. Langholz22, P.L. Lakatos10, P. Munkholm23

1Hvidovre University Hospital, Gastrounit, Medical section, Hvidovre, Denmark, 2Nicosia Private practice, Nicosia Private practice, Nicosia, Cyprus, 3Charles University, IBD Center ISCARE, Prague, Czech Republic, 4Herning Central Hospital, Department of medicine, Herning, Denmark, 5Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark, 6Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia, 7The National Hospital of the Faroe Islands, Medical Department, Thorshavn, Faroe Islands, 8Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland, 9University Hospital, Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 10Semmelweis University, 1st Department of Medicine, Budapest, Hungary, 11Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel, 12On behalf of the EpiCom Northern Italy, Florence, Forlì, and Padova, Northern Italy, Italy, 13Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 14State University of Medicine and Pharmacy of the Republic of Moldova, Department of Gastroenterology, Chisinau, Moldova, Republic of, 15University of Porto, Institute for molecular and cell biology, Porto, Portugal, 16Hospital de São João, Department of Gastroenterology, Porto, Portugal, 17Oporto Medical School, Institute of Pharmacology and Therapeutics, Porto, Portugal, 18University of Medicine ←Victor Babes→, Clinic of Gastroenterology, Timisoara, Romania, 19Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 20Faculty of Medicine and Health, Örebro University, Department of Gastronterology, Örebro, Sweden, 21St Mark's Hospital, Gastroenterology, London, United Kingdom, 22Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark, 23Herlev University Hospital, Department of gastroenterology, Herlev, Denmark

Background

The EpiCom-cohort is a European prospective population-based cohort of unselected, uniformly diagnosed patients with inflammatory bowel disease (IBD) diagnosed in 2010 in centres from Western and Eastern European countries [1] [2] . The cohort aims at describing differences in occurrence, treatment strategies, disease course and prognosis within Europe.

Methods

Patients were followed from diagnosis and each 3rd month for the first year of follow-up and then according to the treating physician for the 2nd and 3rd year of follow-up. Clinical data on surgery, biological treatment, hospitalization and medical treatment were captured prospectively throughout the follow-up period and entered in a validated, web-based database, www.epicom-ecco.eu. The aim of the study was to investigate differences in disease outcome and the use of biologics between Eastern and Western Europe.

Results

A total of 923 patients aged 15 years or older from 19 centres (13 Western, 6 Eastern European) were eligible for follow-up of whom 482 (52%) had ulcerative colitis (UC), 340 (37%) had Crohn's disease (CD), and 101 (11%) had IBD unclassified (IBDU). At 3-years follow up 86 patients had undergone 1st surgery (resections or colectomy) (16 from Eastern Europe, 70 from Western Europe), 136 had received biological therapy (13 from Eastern Europe, 123 from Western Europe) and 191 were hospitalized (32 from Eastern Europe, 159 from Western Europe). Crude annual rates for surgery, biological treatment and hospitalization are shown in Table 1. Significantly more patients in Western Europe received biological therapy (p<0.05), while surgery and hospitalization rates did not differ between the regions at both 1 and 3-year follow-up. The risks of surgery and treatment with biological agents were higher for CD than UC patients (p<0.01). Cox regression analysis revealed that stricturing or penetrating disease carried the highest risk for surgery, hospitalization and receiving biological therapy for CD, and extensive disease carried the highest risk for hospitalization in UC.

Crude rates for surgery, biological therapy and hospitalization after 1 and 3 years follow-up in the EpiCom-cohort.

Biological treatmentSurgeryHospitalization
1 year3 years1 year3 years1 year3 years
Crohn’s diseaseEastern Europe5 (6%)8 (10%)10 (13%)14 (18%)15 (19%)19 (24%)
Crohn’s diseaseWestern Europe52 (20%)72 (27%)28 (11%)43 (16%)48 (18%)66 (25%)
Ulcerative colitisEastern Europe1 (1%)5 (5%)1 (1%)2 (2%)6 (6%)13 (13%)
Ulcerative colitisWestern Europe22 (6%)40 (11%)11 (3%)21 (6%)51 (13%)76 (20%)

Conclusion

In an era of early and aggressive immunological therapy, surgery and hospitalization rates for CD and UC patients were similar in Eastern and Western Europe and comparable to population-based cohorts from the past decade and pre-biological era. This similar disease course was in spite of more early and aggressive treatment with biologics, with significantly more CD and UC patients in Western Europe receiving biologics.

References:

[1]Burisch J et al., (2014), East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort., Gut

[2]Burisch J, (2014), Crohn's disease and ulcerative colitis. Occurrence, course and prognosis during the first year of disease in a European population-based inception cohort., Danish medical journal