Introduction

Inflammatory bowel disease (IBD) prevalence is steadily increasing worldwide, particularly in developed countries. In parallel, the medical treatment of IBD evolved significantly with the marketing approval of advanced therapies over the last decade. The aim of this study was to describe the epidemiology of IBD and to assess treatment patterns in real-life management in France.

Aims & Methods

This was an observational study using the French National Health Databases (SNDS) including all adult patients diagnosed with Crohn disease (CD) or ulcerative colitis (UC) meeting at least one of the following criteria between 2014 and 2021: i) long term disease (LTD) related to IBD ii) at least 2 hospital stays for IBD iii) one hospital stay for IBD and 3 or more IBD treatment deliveries. A look-back period of at least 5 years prior to index date was considered to assess epidemiology and patients’ characteristics, and a follow-up period of at least 12 months to describe treatment patterns.

Results

In the study period, 274,694 IBD patients were identified: 139,001 CD patients (including 45,939 (33.0%) incident patients), and 135,693 UC patients (including 53,939 (39.8%) incident patients). CD prevalence varied from 193.5 per 100,000 person-years (py) in 2014 to 234.4 per 100,000 py in 2021, while incidence varied from 12.1 to 9.7 per 100,000 py respectively. UC prevalence and incidence varied respectively from 173.1 to 229.2 per 100,000 py and from 13.7 to 11.8 per 100,000 py.
Prevalent CD patients were 56.7% female, median age was 42 years (IQR 31-56) and median follow-up was 8.0 years (IQR 4.6-8.0). Among patients with at least 1 year of follow up, 42.3% were exposed to at least one biologic: 96.9% received an anti-TNF in first line, 1.6% an anti-interleukin, 1.4% an anti-integrin and 36.4% received a concomitant immunosuppressant. Among incident CD patients (54.6% female, median age of 37 years (IQR 26-53) and median follow-up of 3.9 years (IQR 2.0-5.9)), 50.8% of patients with at least 1 year of follow-up were exposed to at least one biologic. The treatment distribution in first line was similar to prevalent patients.
Prevalent UC patients were 50.8% male, median age was 49 years (IQR 36-62) and median follow-up was 8.0 years (IQR 3.9-8.0). Among patients with at least 1 year of follow up, 20.3% were exposed to at least one biologic: 94.0% received an anti-TNF in first line, 5.3% received an anti-integrin, 0.4% an anti-interleukin, 0.3% a JAK inhibitor (JAKi) and 34.5% received a concomitant immunosuppressant. Among incident UC patients (50.9% male, median age of 43 years (IQR 31-58) and median follow-up of 3.8 years (IQR 1.9-5.8)), 23.5% of patients with at least 1 year of follow-up were exposed to at least one biologic, with comparable treatment distribution in first line as in prevalent patients.
After a switch or a swap from an anti-TNF in first line for CD, the use of anti-TNF in second line tends to decrease (from 92.8% in 2014 to 36.2% in 2020) in favor of anti-integrins (from 2.3% to 16.7%) and anti-interleukins (from 4.9% to 47.1%). The same trend is observed for UC, for anti-TNF (from 93.8% to 30.0%), mostly in favor of anti-integrins (from less than 5.6% to 57.0%).

Conclusion

This study reports an increase in prevalence and a slight decrease in incidence of IBD in France between 2014 and 2021. Treatment patterns evolved with an increased use of advanced therapies and a swap out of class in the second line.

Disclosure

LV received fees from abbvie, amgen, MSD, Ferring, Takeda, Pfizer, Janssen, Lilly, Galapagos, Celltrion, Viatris
LPB received fees from Abbvie, Abivax, Alimentiv, Alma Bio Therapeutics, Amgen, Applied Molecular Transport, Arena, Biogen, BMS, Celltrion, Connect Biopharm, Cytoki Pharma, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Gossamer Bio, GSK, Hac Pharma, IAC Image Analysis, Index Pharmaceuticals, Inotrem, Janssen, Lilly, Medac, Mopac, Morphic, MSD
Norgine, Novartis, OM Pharma, ONO Pharma, OSE Immunotherapeuthics, Pandion Therapeuthics, Par' Immune, Pfizer, Prometheus, Protagonist, Roche, Roivant, Samsung, Sandoz, Sanofi, Takeda, Theravance, Thermo Fischer, Tigenix, Tillots, Viatris, Vifor, Vectivbio, Ventyx, Ysopia
JK received fees from Janssen, Takeda, Lilly, Abbvie, Pfizer, Tillots, Amgen, Celltrion, Roche, Gilead, Galapagos
SC, HO, LG, KS, LC works for Janssen-Cilag
PR, GB, TN works for IQVIA

Introduction

Inflammatory bowel disease (IBD) is a chronic autoinflammatory disease with no known cure, characterized by chronic inflammation and ulcers in the gastrointestinal tract.[1] IBD has historically been observed in industrialized societies and is now on the rise in regions undergoing rapid industrialization.[2] Measuring and describing IBD trends are crucial due to the high disease burden, healthcare costs, and impact on quality of life. Accurate descriptions of disease patterns can inform research and public health agendas, and improve healthcare preparedness worldwide.

Aims & Methods

This report focuses on the temporal and geographical trends of IBD in terms of incidence and prevalence. Prevalence and incidence data of ulcerative colitis (UC) and Crohn’s disease (CD) are extracted from population-based studies identified through a series of systematic literature reviews. A total of 92 sources of prevalence and 174 sources of incidence were identified. We analyzed all data using DisMod-MR 2.1, a Bayesian meta-regression tool to estimate both prevalence and incidence.[3] We also conducted a decomposition analysis to evaluate the impact of population growth and aging in the prevalence changes between 1990 and 2021.

Results

In 2021, 3.84 million (95% Uncertainty level 3.29 to 4.43) people were estimated to be living with IBD globally. Of these, 1.43 million (1.16 to 1.73) were living with CD and 2.41 million (2.02 to 2.95) with UC. The global all-age prevalence of CD, UC, and IBD in 2021 were 18.1 (14.6 to 21.8), and 30.5 (25.5 to 37.3), 48.6 (41.6 to 55.9) per 100,000, respectively. The global all-age incidence of IBD increased from 3.7 (3.3 to 4.4) per 100,000 in 1990 to 4.8 (4.2 to 5.6) per 100,000 In 2021. The incidence of IBD has shown a slight increase in high-income super-region, resulting in a relatively small rise in prevalence in this region. The all-age IBD incidence rate in high-income super-region increased by 23.2% from 12.5 (11.1 to 14.3) per 100,000 in 1990 to 15.4 (13.8 to 17.4) per 100,000 in 2021, and the all-age prevalence rate in this region also increased by 25.5% from 157 (139 to 175) per 100,000 in 1990 to 197 (171 to 221) per 100,000 in 2021. In contrast, our study found that low-income regions, such as Southeast Asia, East Asia, and Oceania, experienced a much larger increase in the incidence and prevalence rates of IBD over the same period. The all-age IBD incidence rate in this region rapidly increased by 118.3% from 0.646 (0.546 to 0.783) per 100,000 to 1.41 (1.23 to 1.69) per 100,000, and the all-age IBD prevalence rate more than doubled from 5.32 (4.54 to 6.32) per 100,000 to 11.8 (9.8 to 14.0) per 100,000.

Conclusion

Overall, IBD is becoming more prevalent globally. Although incidence and prevalence of IBD in high-income countries have been relatively stable, with rising mean estimates but overlapping 95% uncertainty intervals, many lower-income countries have experienced a notable rise in both measures. This larger increase may be attributable to changes in lifestyle and diet associated with industrialization and urbanization. Population growth in low-income countries, such as sub-Saharan Africa, played a significant role in driving the increase in prevalent IBD cases, while population aging was the dominant factor in high-income countries, particularly in Europe. These findings highlight the complex interplay between socio-demographic factors and IBD prevalence and emphasize the need for tailored interventions in different regions based on their unique characteristics.

References

1. Meenakshi Bewtra, Chinyu Su, and James D. Lewis, “Trends in Hospitalization Rates for Inflammatory Bowel Disease in the United States,” Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association 5, no. 5 (May 2007): 597–601, https://doi.org/10.1016/j.cgh.2007.01.015.
2. Gilaad G. Kaplan and Siew C. Ng, “Globalisation of Inflammatory Bowel Disease: Perspectives from the Evolution of Inflammatory Bowel Disease in the UK and China,” The Lancet. Gastroenterology & Hepatology 1, no. 4 (December 2016): 307–16, https://doi.org/10.1016/S2468-1253(16)30077-2.
3. Theo Vos et al., “Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990–2019: A Systematic Analysis for the Global Burden of Disease Study 2019,” The Lancet 396, no. 10258 (October 2020): 1204–22, https://doi.org/10.1016/S0140-6736(20)30925-9.

Introduction

Patients with Inflammatory Bowel Disease (IBD) encounter a wide range of symptoms, from the bowel and other non-specific symptoms. Physicians tend to focus on mucosal healing as a treatment target while little is known about issues important to patients. The aim of our study is to identify critical aspects of the daily burden impacting patients with IBD.

Aims & Methods

Ten dimensions of IBD-related disability were assessed in a cross-sectional survey, including patients followed and hospitalized between April and September 2023, using the self-administered IBD-Disk questionnaire. Patients were then required to select the three items they perceived as the main therapeutic goals and the three items they deemed least important. Disease clinical activity was assessed using Partial Mayo Clinic for Ulcerative colitis (UC) and Harvey Bradshaw Index for Crohn’s disease (CD). Percentages were compared using the Chi-square test.

Results

We included 81 patients, 60.5% were male and 71.6% had CD. The mean age was 38.9 ± 12.6 and 59.3% were ≤ 40 at the time of inclusion. Life in urban areas was observed in 71.6% of the patients, a tertiary education in 40.7% and a high socio-economic level in 38.3% of the cases. The IBD was clinically active in 58% of the patients and 65.8% were on biotherapy. The items most frequently perceived as therapeutic goals were “Regulating defecation”, “Abdominal pain” and “Energy” with a selection rate of 60.5%, 43.2% and 42.0% respectively. “Interpersonal interaction”, “Sexual functions” and “Body image” were the most frequently selected items as least important disability dimensions with a 56.8%, 45.7% and 42.0% respective rate. Men and patients ≤ 40 tended to perceive “Education and work” as more important than women and patients > 40 (80.8% vs 19.2%, p=0.010, 84.6% vs 15.4%, p=0.001 respectively). CD patients tended to select “Abdominal pain” (82.9% vs 17.1%, p=0.050) and “Regulating defecation” (63.3% vs 36.7%, p=0.039) more frequently than UC patients as therapeutic goals. Furthermore, patients undergoing biotherapy were significantly more concerned about “Interpersonal interaction” than other patients (100% vs 0%, p=0.013). Patients living in urban areas appeared to perceive “Regulating defecation” as a main treatment target more frequently than patients living in rural areas (63.3% vs 36.7%, p=0.039). In addition, patients with active disease tended to prioritize “Sleep” more often than patients with clinical remission (81% vs 19%, p=0.013). In our study, tertiary education and high socio-economic level did not seem to significantly influence the treatment priorities to IBD patients.

Conclusion

The findings from this study would contribute to the understanding of the challenges faced by individuals living with IBD, offering valuable insights for physicians to prioritize areas of concern and narrow the perception gap between healthcare providers and patients. This increased understanding has the potential to alleviate the overall disease burden experienced by individuals with IBD.

Introduction

Renal disorders are among the extra-intestinal manifestations of inflammatory bowel disease (IBD), and treatments may also lead to renal failure. However, the incidence of end-stage renal disease (ESRD), defined as the need for renal replacement therapy (dialysis and/or renal transplantation (RT)), is poorly known. The primary objective of our study was to assess the incidence of ESRD in IBD patients, and to compare it with the general health insurance scheme population.

Aims & Methods

We conducted a prognostic cohort study based on data from the French National Health Insurance Database(SNDS). Prevalent cases of IBD affiliated to the general health insurance scheme during the period 2011-2020 were identified on the basis of declarations long-term diseases ALD 24 or the presence of 2 hospital stays for IBD with ICD-10 codes or a single stay with reimbursement of specific treatments. Incident cases of ESRD were identified on the basis of a stay with a RT or a period with dialysis sessions for at least 45 days. Crude incidence rates of ESRD were calculated over the period for the IBD and the non-IBD population, with their 95% confidence intervals.

Results

A total of 280,283 IBD patients were included in the study over the period 2011-2020, 134,567 with ulcerative colitis(UC) and 145,716 with Crohn’s disease(CD). The mean age at study inclusion was 39.8 (± 17.1) years. The M/F sex ratio was 0.9. The mean age at incidence of ESRD in the non-IBD population was 65.0 (±17.0) years, the M/F sex ratio cases was 1.7.
Among IBD patients, 534 patients began replacement therapy by dialysis or RT, they were younger than non-IBD patients (60.3(±16.7)years, P<0.001).The mean incidence rate of ESRD over the period was 26.4 per 100,000 person-years (IC95% 23.1-29.6), 480 (89.9%) patients entered ESRD by dialysis, and 54 (10.1%) by preemptive RT. In the non-IBD population the mean rate of ESRD was 15.9 per 100,000 person-years (IC95% 14.8- 17.1; P<0.0001 compared with IBD): 79,606 (94.5%) patients entered ESRD by dialysis, and 4,634 (5.5%) by RT (as compared with IBD,P<0.001). In subgroup analysis, the mean incidence rate of ESRD was 22.8 per 100,000 person-years (IC95% 18.9-26.7) in UC patients and 29.5 (IC95% 25.3-33.6) in CD patients (P<0,0001). The rates of preemptive RT were 12.4% in UC patients (87.6% dialysis) and 8.6% in CD patients (91.4% dialysis).
Over a median follow-up of 6.8 years, the survival rate after ESRD was 40.8% in ESRD-IBD patients VS 34.2% in ESRD non-IBD patients (P<0.001). This difference remained significant for patients under 65 (p<0.0073).
No significant difference for the risk of re-hospitalization after RT (p=0.84), of retransplantation during the follow-up period in RT patients (p=0.67), or for the risk of hospitalization for severe infection (p=0.97) after RT in patients from the general population compared with IBD patients. The same was true for the type of severe infections after RT (p= 0.068) and for the risk of solid and haematological cancer after RT (p=0.48). However, there was a significant difference in the type of first severe infection after RT(p=0.003), but we are waiting for the results to tell us which one.

Conclusion

The incidence of ESRD is significantly higher in IBD than in the general data base population, confirming the need for regular monitoring of renal function in our patients.
Survival after ESRD onset, is higher in IBD patients.
The high incidence of RT in the IBD population confirms that access to transplantation is not restricted in this
population.

References

Kirchgesner et al, Gastroenterology 2018
Meyer et al, Aliment Pharmacol Ther. 2020
Tuppin et al, Nephrol Ther 2016

Introduction

Most of the data concerning the epidemiology of inflammatory bowel disease (IBD) in Asia originated from the Eastern population and there are limited studies conducted in the Middle East. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the middle east.

Aims & Methods

We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn’s and Colitis (IRCC) recruited from 2017 until 2022. IRCC is a nationwide registry with at least one center in every province of Iran.¹ More than 400 gastroenterologists collaborated with IRCC, which was reported as approximately 87% of total gastroenterologists working in Iran. Demographics characteristics, past medical history, family history of IBD, disease extent and location, clinical behavior, extraintestinal manifestations, IBD medications, IBD activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions in the past 3 months, emergency visits in the past 12 months, history of colon cancer, and IBD-related surgeries were gathered.

Results

Overall, 9746 patients with confirmed IBD, including 7793 patients with ulcerative colitis (UC) and 1953 patients with Crohn’s disease (CD) were reported. The ratio of UC to CD patients was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. 17.9% of patients with UC had a positive family history. Majority of patients with UC had pancolitis (47%). The most common treatment received by patients was 5-ASA (93.5%) followed by immunomodulator, prednisolone, and anti-TNF. Among patients who received immunomodulators, 96.2% was azathioprine followed by 6-mercaptopurine (2.8%) and methotrexate (1%). Of patients who used anti-TNF, 68.8% were adalimumab and 31.2% were infliximab. Among patients with CD, only one peak was observed in the distribution of age at diagnosis at 30-40 years. Male to female ratio was 1.28 in patients with CD. Patients with CD most commonly had ileocolonic involvement (43.7%) and stricturing behavior prevalence was 4.6%. Moreover, 38.4% of patients with CD had been treated with anti-TNF. Among patients who received immunomodulators, 90.4% was azathioprine followed by 6-mercaptopurine (4.6%) and methotrexate (5%). Of patients who used anti-TNF, 71.9% were adalimumab and 28.1% were infliximab.

Conclusion

This first report of IBD behavior, clinical outcome, and medication usage from the Iranian Registry of Crohn’s and Colitis as a representative population of the Middle East highlights the differences in IBD characteristics based on geographical location.

References

1. Malekzadeh MM, Sima A, Alatab S, et al. Iranian Registry of Crohn's and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East. Intest Res. 2019;17(3):330-339