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Published on: August 1, 2019
Initial disease course and treatment in an inflammatory bowel disease inception cohort in Europe: the ECCO-EpiCom
Johan Burisch1, Natalia Pedersen, Silvja Cukovic-Cavka
11Medical Section, Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark; 2Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia; 3Nicosia Private Practice, Nicosia, Cyprus; 4IBD Center ISCARE, Charles University, Prague, Czech Republic; 5Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic; 6Department of Medicine, Amager Hospital, Amager, Denmark; 7Department of Medicine, Herning Central Hospital, Herning, Denmark; 8Medical Department, Viborg Regional Hospital, Viborg, Denmark; 9Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; 10Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; 11Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark; 12Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark; 13Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia; 14Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands; 15Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; 161st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece; 17Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland; 18Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary; 19Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College of Dublin, Dublin, Ireland; 20Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; 21U.O. Gastroenterologia, Azienda Ospedaliera, Università di Padova, Padova, Italy; 22EpiCom Northern Italy Centre based in Crema & Cremona, Padova and Reggio Emilia, Italy; 23UO Medicina 3° e Gastroenterologia, Azie
Background:
The EpiCom cohort is a prospective, population-based, inception cohort of inflammatory bowel disease (IBD) patients from 31 European centers covering a background population of 10.1 million. The aim of this study was to assess the 1-year outcome in the EpiCom cohort.
Methods:
Patients were followed-up every third month during the first 12 (±3) months, and clinical data, demographics, disease activity, medical therapy, surgery, cancers, and deaths were collected and entered in a Web-based database (www.epicom-ecco.eu).
Results:
In total, 1367 patients were included in the 1-year follow-up. In western Europe, 65 Crohn's disease (CD) (16%), 20 ulcerative colitis (UC) (4%), and 4 IBD unclassified (4%) patients underwent surgery, and in eastern Europe, 12 CD (12%) and 2 UC (1%) patients underwent surgery. Eighty-one CD (20%), 80 UC (14%), and 13 (9%) IBD unclassified patients were hospitalized in western Europe compared with 17 CD (16%) and 12 UC (8%) patients in eastern Europe. The cumulative probability of receiving immunomodulators was 57% for CD in western (median time to treatment 2 months) and 44% (1 month) in eastern Europe, and 21% (5 months) and 5% (6 months) for biological therapy, respectively. For UC patients, the cumulative probability was 22% (4 months) and 15% (3 months) for immunomodulators and 6% (3 months) and 1% (12 months) for biological therapy, respectively in the western and eastern Europe.
Discussion:
In this cohort, immunological therapy was initiated within the first months of disease. Surgery and hospitalization rates did not differ between patients from eastern and western Europe, although more western European patients received biological agents and were comparable to previous population-based inception cohorts.
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