Clinical characteristics of patients with difficult-to-treat ulcerative colitis: a nested case-control study using a Japanese claims database.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY

Intestinal Research Pub Date : 2025-04-25 DOI:10.5217/ir.2024.00119

Katsuyoshi Matsuoka, Ataru Igarashi, Noriko Sato, Naomi Mizuno, Manabu Ishii, Masato Iizuka, Katsuhiko Iwasaki, Ayako Shoji, Tadakazu Hisamatsu

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引用次数: 0

Abstract

Background/aims: Despite the advent of advanced therapies, cases of so-called "difficult-to-treat" (D2T) ulcerative colitis (UC) persist. This study aims to clarify the epidemiological and clinical characteristics of patients with D2T UC.

Methods: We conducted a nested case-control study using the Medical Data Vision Claims Database in patients with UC who began an advanced therapy (biologics, advanced small molecules, calcineurin inhibitors) from January 2018 through April 2023. D2T UC patients were defined as having 2 or more switches of advanced therapies, or as undergoing surgery for UC, within 2 years after the first advanced therapy.

Results: Four hundred and one (16.7%) and 1,996 patients (83.3%) met the definitions of patients with D2T UC and non-D2T UC, respectively. After 1:1 matching by index year, 355 patients per group were included in the analysis. Multivariate logistic regression analyses, including sensitivity analyses based on follow-up period after the first advanced therapy, showed that a prescribed corticosteroid dose of ≥ 30 mg/day during the 6-month baseline period was associated with D2T UC. In D2T UC patients, median duration of the first advanced therapy was 99 days, and median number of advanced therapies per year was 1.7. The first advanced therapy was continued for 2 years in 78% of patients with non-D2T UC.

Conclusions: The proportion of D2T UC patients among UC patients starting advanced therapy was 16.7%. The factor most associated with D2T UC was the need for a corticosteroid dose ≥ 30 mg/day during the 6 months before initiation of advanced therapy.

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难治性溃疡性结肠炎患者的临床特征：使用日本索赔数据库的巢式病例对照研究。

背景/目的：尽管出现了先进的治疗方法，但所谓的“难以治疗”（D2T）溃疡性结肠炎（UC）的病例仍然存在。本研究旨在阐明D2T型UC患者的流行病学及临床特点。方法：我们使用医疗数据视觉索赔数据库对2018年1月至2023年4月开始接受高级治疗（生物制剂、高级小分子、钙调磷酸酶抑制剂）的UC患者进行了巢式病例对照研究。D2T型UC患者被定义为在第一次先进治疗后2年内接受了2次或更多的先进治疗，或接受了UC手术。结果：符合D2T型UC和非D2T型UC定义的患者分别为101例（16.7%）和1996例（83.3%）。按指标年1:1匹配，每组355例纳入分析。多变量logistic回归分析，包括基于第一次高级治疗后随访期的敏感性分析，显示在6个月的基线期，处方皮质类固醇剂量≥30mg /天与D2T UC相关。在D2T UC患者中，首次高级治疗的中位持续时间为99天，每年高级治疗的中位次数为1.7次。在78%的非d2t型UC患者中，第一次高级治疗持续了2年。结论：D2T型UC患者在开始晚期治疗的UC患者中所占比例为16.7%。与D2T UC最相关的因素是在开始高级治疗前6个月内需要≥30mg /天的皮质类固醇剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.40

自引率

10.20%

发文量

审稿时长

38 weeks

期刊介绍： Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.