P875 Disease course of Ulcerative Colitis during the first ten years following diagnosis in a prospective European population-based inception cohort – the Epi-IBD cohort
Wewer, M.D.(1)*;Salupere, R.(2);Kievit, H.A.L.(3);Nielsen, K.R.(4);Midjord, J.(4);Domislovic, V.(5);Krznarić, Ž.(5);Pedersen, N.(6);Jens, K.(7);Eriksson, C.(8);Halfvarson, J.(8);Talbot, A.(9);Sebastian, S.(9);Goldis, A.(10);Misra, R.(11);Arebi, N.(11);Ilus, T.(12);Oksanen, P.(12,13);Neuman, A.(14);Andersen, V.(15,16,17);Skamnelos, A.(18);Katsanos, K.H.(18);Negru, I.(19);Turcan, S.(19);Borg, B.(20);Ellul, P.(20);Kupcinskas, J.(21);Kiudelis, G.(21);Yzet, C.(22);Fumery, M.(22);Kaimakliotis, I.P.(23);Lorenzon, G.(24);D’Inca, R.(24);Hernandez, V.(25,26);Fernandez, A.(27);Langholz, E.(28);Munkholm, P.(29);Burisch, J.(1);
(1)University Hospital Copenhagen – Amager and Hvidovre Hospital, Gastrounit- Medical Division, Hvidovre, Denmark;(2)Tartu University Hospital, Division of gastroenterology, Tartu, Estonia;(3)Herning central Hospital, Department of Medicine, Herning, Denmark;(4)National Hospital of the Faroe Islands, Medical Department, Thorshavn, Faroe Islands;(5)University Hospital Centre Zagreb, Department of Gastroenterology- Hepatology and Nutrition, Zagreb, Croatia;(6)Slagelse Regional Hospital, Gastroenterology Department, Slagelse, Denmark;(7)Odense University Hospital, Department of Medical Gastroenterology-, Odense, Denmark;(8)Faculty of Medicine and Health- Örebro University, Department of Gastroenterology, Örebro, Sweden;(9)Hull University Teaching Hospitals NHS Trust- Hull, Department of Gastroenterology, Hull, United Kingdom;(10)University of Medicine ‘Victor Babes’, Clinic of Gastroenterology, Timisoara, Romania;(11)Imperial College London, IBD Department, London, United Kingdom;(12)Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland;(13)Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland;(14)Viborg Hospital, Medical Department, Viborg, Denmark;(15)Institute of Regional Health Research- University Hospital of Southern Denmark, Research unit of Molecular Diagnostics and Clinical Research, Aabenraa & Sønderborg, Denmark;(16)University of Southern Denmark, Institute of Molecular Medicine, Odense, Denmark;(17)University of Southern Denmark, Institute of Regional Research, Odense, Denmark;(18)University Hospital and University of Ioannina, Division of Gastroenterology, Ioannina, Greece;(19)Nicolae Testemitanu State University of Medicine and Pharmacy of Moldova, Medical Faculty, Chisinau, Moldova- Republic Of;(20)Mater Dei Hospital, Division of Gastroenterology, Msida, Malta;(21)Lithuanian University of Health Sciences, Department of Gastroenterology, Kaunas, Lithuania;(22)Amiens University Hospital, Gastroenterology Unit, Amiens, France;(23)American Gastroenterology Center, American Gastroenterology Center, Nicosia, Cyprus;(24)University of Padua, Department of Surgical- Oncological and Gastroenterological Sciences, Padova, Italy;(25)Xerencia Xestion Integrada de Vigo- SERGAS, Department of Gastroenterology, Vigo, Spain;(26)Galicia Sur Health Research Institute IIS Galicia Sur. SERGAS-UVIGO, Research Group in Digestive Diseases, Vigo, Spain;(27)Ribera-POVISA Hospital, Department of Gastroenterology, Vigo, Spain;(28)University Hospital Copenhagen – Herlev Hospital, Department of Gastroenterology, Herlev, Denmark;(29)University Hospital Copenhagen – North Zealand Hospital, Department of Gastroenterology, Hillerød, Denmark; Epi-IBD group
The Epi-IBD cohort is a prospective European population-based cohort of 1,390 patients diagnosed in 2010 and 2011 with inflammatory bowel disease (IBD) according to Copenhagen criteria in centres from Eastern and Western European countries. The study aims at describing differences in incidence, treatment strategies, disease course and prognosis of ulcerative colitis (UC) Eastern and Western Europe.
UC patients were followed prospectively from the time of diagnosis until December 31st, 2020, death, emigration or loss of follow-up. Clinical data on surgery, hospitalizations and medical treatment were captured throughout the follow-up period and entered in a validated web-database, www.epi-ibd.org. Associations between colectomy and covariates were analysed by multivariate Cox regression analyses.
A total of 816 UC patients aged ≥15 years from 21 centres in 5 Eastern and 11 Western European countries were included. Overall, 51 (6%) patients underwent colectomy. A total of 190 (23%) patients were hospitalized at least once for their UC. Cancer was diagnosed in 28 (3%) patients, including 4 colorectal cancers. The use of medical therapy was comparable across Eastern and Western European centres (Table 1).
During follow-up, 121 out of 776 (16%) patients with limited UC (proctitis or left-sided colitis) progressed to extensive colitis. The median time to progression was 21 (IQR: 8-48) months from diagnosis. No patients from Eastern Europe were exposed to biological therapy prior to change in disease extent, compared to 6 out of 98 patients (6%) from Western Europe.
Multivariate Cox regression analysis showed no difference in risk of colectomy according to European region (Eastern vs. Western Europe, HR: 1.05, 95%CI: 0.48-2.29). Early intervention with biologicals (within 6 months) was associated with higher risk of colectomy (HR: 3.06, 95% CI: 1.23-7.58), and so was early introduction of immunomodulators (HR: 2.35, 95%CI: 1.16-4.76). Progression in disease extent to extensive colitis was significantly associated with higher risk of surgery (HR: 5.30, 95% CI: 2.36-11.90) and similarly extensive colitis at diagnosis compared to proctitis (HR: 3.48, 95% CI: 1.12-10.82).
After 10 years of follow up in this European multicentre study, only 6% percent had a colectomy performed. Despite the widespread use of immunomodulators and biologicals, 16% of patients with limited disease extent progressed to extensive colitis which was associated with higher risk of surgery. The need for early introduction of biological therapy and immunomodulators might predict risk of surgery.