Yonsei Med J.  2020 May;61(5):382-390. 10.3349/ymj.2020.61.5.382.

Similar Clinical Outcomes of Early andLate Anti-TNF Initiation for Ulcerative Colitis:A Nationwide Population-Based Study

Affiliations
  • 1Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
  • 2Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 3Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea

Abstract

Purpose
The optimal timing of anti-tumor necrosis factor (anti-TNF) initiation in patients with ulcerative colitis (UC) remains unclear. Very little is known about the clinical outcomes after the early versus late initiation of anti-TNF therapy, especially in Asian UC patients. Here we aimed to assess whether earlier anti-TNF treatment initiation results in favorable clinical outcomes in Korean UC patients.
Materials and Methods
Using the Korean National Health Insurance claims database, we studied patients who were diagnosed with UC and received anti-TNF therapy for more than 6 months between 2010 and 2016. Using a Cox proportional hazard model, clinical outcomes including colectomy, UC-related emergency room (ER) visits, UC-related hospitalizations, and the need for corticosteroids were compared between early (≤2 years of diagnosis) and late (>2 years of diagnosis) initiators of anti-TNF therapy.
Results
Among 17167 UC patients, 698 patients who received anti-TNF therapy for more than 6 months were included (420 infliximab, 242 adalimumab, and 36 golimumab). Of the 698 patients, 299 (42.8%) initiated anti-TNF therapy within 2 years of diagnosis. There were no significant differences in the risk of colectomy [adjusted hazard ratio (aHR), 0.41; 95% confidence interval (CI), 0.04–3.90], ER visits (aHR, 0.98; 95% CI, 0.50–1.92), hospitalization (aHR, 0.76; 95% CI, 0.57–1.01), and corticosteroid use (aHR, 1.04; 95% CI, 0.71–1.50) between early and late initiators of anti-TNF therapy.
Conclusion
Patients receiving early anti-TNF therapy had similar clinical outcomes to those of late initiators, suggesting that early anti-TNF therapy initiation offers little benefit in patients with UC.

Keyword

Ulcerative colitis; anti-TNF; early use; clinical outcome
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