The impact of discontinuing 5-aminosalycilates (5-ASA) in Crohn’s disease (CD) patients who initiate anti-tumour necrosis factor α (anti-TNF) biologics is unknown. We aimed to compare clinical outcomes in CD patients already on 5-ASA who started anti-TNF and then either stopped or continued 5-ASA. We analysed two national databases: the USA (U.S.) Truven MarketScan health claims database and the Denmark health registers. CD patients who started anti-TNF after having been on oral 5-ASA for at least 90 days were included. Patients were classified as stopping 5-ASA if therapy was discontinued within 90 days of starting anti-TNF. Our primary outcome was any adverse clinical event defined as a composite of new corticosteroid use, CD-related hospitalisation or surgery. We performed Kaplan–Meier analyses and multivariable Cox regression models controlling for age, gender, duration of 5-ASA treatment before anti-TNF initiation, prior CD-related surgery, disease duration (Danish database only) and healthcare utilisation (corticosteroid use, hospitalisations and emergency department visits in year prior to anti-TNF). Adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI) are reported comparing stopping 5-ASA with continuing 5-ASA. A total of 3,178 CD patients were included (2,960 USA and 218 Denmark). 1,044 patients in the US cohort and 106 patients in the Danish cohort stopped 5-ASA after starting anti-TNF. In both cohorts, cumulative rates of the adverse clinical events composite primary outcome were similar when comparing those who stopped vs. those who continued 5-ASA (Figures 1 and 2). In multivariable analysis, stopping 5-ASA after initiating anti-TNF was not associated with an increased risk of adverse clinical events in the U.S. cohort (aHR 0.89, 95% CI 0.77–1.03, p = 0.13) nor in the Danish cohort (aHR 1.13, 95% CI 0.68–1.87, p = 0.63). Results were similar in sensitivity analyses investigating concomitant immunomodulator use and duration of 5-ASA treatment before initiating anti-TNF. In two national databases, stopping 5-ASA in CD patients starting anti-TNF therapy did not increase the risk of adverse clinical events. These results should be validated in a prospective clinical trial. Figure 1. Cumulative rates of CD patients with adverse clinical events (composite of new corticosteroid use, CD-related hospitalisation or surgery) comparing those who continued or stopped 5-ASA in the USA cohort. Figure 2. Cumulative rates of CD patients with adverse clinical events (composite of new corticosteroid use, CD-related hospitalisation or surgery) comparing those who continued or stopped 5-ASA in the Danish cohort.
Aims The adoption of endoscopic submucosal dissection (ESD) as the main treatment for large colorectal lesions is still limited in the West. A recent high-quality study showed colorectal ESD has been proved equally safe and more effective than piecemeal endoscopic mucosal resection (EMR). Reproducibility outside experts centers has been questioned. Therefore, we evaluated results according to volume case load per year in a large multicentric prospective cohort of colorectal ESDs.
Aims Dysplasia is frequent in Inflammatory Bowel Disease (IBD) patients and can be managed endoscopically providing organ sparing. Endoscopic submucosal dissection (ESD) allows en-bloc resection and very low recurrence rates. We aimed to assess the efficacy of ESD in IBD patients for visible dysplasia.
