P316 Impact of anti-TNF therapy in the number of hospitalizations and surgeries - Overview of clinical practice in a tertiary referral center
P. Sousa*1, P. Santos1, S. Fernandes1, C. Moura1, A. Gonçalves1, A. Valente1, N. Fatela1, C. Baldaia1, F. Serejo1, P. Moura Santos1, J. Malaquias2, L. Correia1, J. Velosa1
1Centro Hospitalar Lisboa Norte, Gastrenterology, Lisbon, Portugal, 2Centro Hospitalar Lisboa Norte, Surgery, Lisbon, Portugal
Anti-TNF therapy has represented a major breakthrough in the medical treatment of moderate to severe Ulcerative Colitis (CU) and Crohn's Disease (CD). Hospitalization and surgery are important outcomes and drivers of healthcare costs in these patients.
Our aim was to evaluate the impact of anti-TNF therapy in the number and length of hospitalizations and surgical procedures in patients with inflammatory bowel disease (IBD).
Retrospective study including patients with IBD assigned to start anti-TNF therapy (infliximab [IFX], adalimumab [ADA] or golimumab [GM]). Patients were evaluated in two different time cohorts: before anti-TNF therapy (A), after starting anti-TNF therapy (B). Period of observation comprehended 25 years (July 1989-October 2014). Endpoints included number and length of hospitalizations and surgeries. Statistical analysis was performed with SPSS v 20.0 IBM statistics.
164 patients met our inclusion criteria, 131 with CD, 33 with UC.
Anti-TNF therapy included IFX (127), ADA (35) and GM (2). The average age of diagnosis was 29 years. Mean age of starting anti-TNF was 37 years. Over 50% of patients were diagnosed before 24 years and were started on biologics before 35 years old.
The average age at anti-TNF induction was significantly lower in patients with CD than in UC (34.3 ± 11.2 years versus 41.3 ± 13.1 years, p=0.0001).
During our follow-up time a total of 870 hospitalizations occurred, 739 (85%) in patients with CD. Anti-TNF therapy was also associated with both a reduction in the number of admissions (60.0% versus 40.0%, p=0.0001) and in the length of hospitalizations (8.2 ± 15.7 days versus 4.3 ± 8.3 days, p= 0.0001).
In patients with CD, IFX was associated with shorter hospitalizations than ADA (6.3 ± 14.3 days versus 9.7 ± 13.2 days, p=0.034). Disease behavior also influenced the number and length of hospitalizations with penetrating or stricturing disease being associated with more hospitalizations (182 versus 535, p=0.003) and longer lengths of stay (4.6 ± 10.2 days versus 7.4 ± 15.5 days, p=0.023).
During the study period 98 surgeries were performed in these patients; 94 in patients with DC and 4 in patients with UC. The majority of surgeries were performed before patients were started on anti-TNF therapy (72.4% versus 27.6%, p=0.0001). The length of hospitalizations was not significantly different between the two times cohorts.
Our series clearly demonstrate a trend for reduction in hospitalizations and surgeries since introduction of anti-TNF therapy. These findings reinforce the dramatic role of anti-TNF therapy in the progression of both CD and UC.