Long, Millie D.

AbstractBackgroundGaps exist in our understanding of the clinical course of pouch-related disorders.MethodsWe evaluated baseline disease activity and longitudinal treatment patterns among patients with inflammatory conditions of the pouch.ResultsAmong 468 patients with an ileal pouch-anal anastomosis (IPAA), 94 (20%) had acute pouchitis, 96 (21%) had chronic pouchitis, and 192 (41%) had Crohn disease of the pouch. Following an IPAA, 38% of patients were treated with a biologic and 11% underwent inflammatory bowel disease- or bowel-related surgery.ConclusionsTreatment patterns after IPAA indicate that pouch-related disorders have a significant impact on individual patients and the healthcare system.

SummaryBackgroundThe impact of combination therapy on disease‐related morbidity in patients with established Crohn's disease (CD) or ulcerative colitis (UC) remains to be well‐defined.AimTo examine the effect of combination therapy on disease outcomes in CD and UC.MethodsUsing a multicenter prospective cohort, we classified CD and UC patients as being on monotherapy with anti‐TNF or on combination with an immunomodulator. The primary outcome was a composite of new IBD‐related surgery, hospitalisations, penetrating complications, need for corticosteroids or new biological at 1 year. Multivariable regression models adjusted for potential confounders.ResultsWe included 707 patients with CD (45% combination therapy) and 164 with UC (38% combination therapy). Combination therapy was not associated with reduction in the composite outcome in either CD (OR: 0.87, 95% CI: 0.63‐1.22) or UC (OR: 1.45, 95% CI: 0.63‐3.38). However, while no difference was noted in those with nonstricturing, nonpenetrating CD, a significant reduction in the likelihood of the outcome was seen in those with stricturing or penetrating CD (30% vs 39%, OR: 0.58, 95% CI: 0.37‐0.90). A stronger effect was also observed in those with disease duration <5 years (OR: 0.35, 95% CI: 0.14‐0.87) compared to those with a longer duration (OR: 0.75, 95% CI: 0.45‐1.27). A similar reduction in occurrence of composite outcome was noted with infliximab and with other anti‐TNF biologics.ConclusionThe benefit of combination immunomodulator‐biological therapy is stronger in those with complicated Crohn's disease, particularly early on in their disease course.