Veranderingen in de behandeling van ziekte van Crohn*

Objective

To study changes in treatment and disease course in patients with Crohn’s disease (CD) in the South Limburg region of the Netherlands between 1991 and 2014.

Design

Population-based cohort study.

Methods

All 1162 CD patients in the ‘IBD South Limburg cohort’ were divided across three subcohorts on the basis of year of diagnosis: 1991-1998 (N = 316), 1999-2005 (N = 387) and 2006-2011 (N = 459). We compared the risk of hospitalization, bowel resection and the development of strictures and/or fistulas across the subcohorts. We also compared cumulative corticosteroid use and the relationship between the outcome measures and maintenance medication.

Results

In the period 1991-2014 there was an increase in the number of patients treated within 5 years with immunomodulators from 30.6% to 70.8%. For treatment with biologicals there was an increase from 3.1% to 41.2%. In parallel, the risk of hospitalization decreased from 65.9% to 44.2% and the risk of bowel resection decreased from 42.9% to 17.4%. The risk of developing strictures or fistulas remained stable (21.2%). There was no significant association between the outcome measures and the use of immunomodulators or biologicals. Furthermore, corticosteroid use decreased over time; this was linked to use of immunomodulators and biologicals.

Conclusion

Treatment of Crohn’s disease has changed over the past two decades, and the disease course has improved. We found no association between changes in maintenance medication and disease course.

Conflict of interest and financial support: this study was financially supported by grants from the European 7th Framework Programme. ICMJE forms provided by the authors are available online along with the full text of this article.