Long-term Disease Course of Crohn’s Disease in a Prospective European Population-based Inception Cohort: An Epi-IBD Cohort Study

Abstract

Background & Aims The Epi-IBD cohort is a population-based inception cohort of patients with inflammatory bowel disease from 22 European centers. The aim was to assess the 10-year disease course of patients with Crohn’s disease (CD) and how regional differences in treatment strategies impact the disease course. Methods Patients were followed prospectively from the time of diagnosis, with uniform collection data. Associations between outcomes and covariates were analyzed by multivariable Cox regressions in a propensity score-matched sub-population to address time to first intestinal resection. Results A total of 547 patients with CD were recruited (Eastern Europe: 139 [25.4%]; Western Europe: 408 [74.6%]). Ten-year cumulative rate of advanced therapy use was higher in Western (42%) compared with Eastern Europe (27%) ( P < .05). The median period until initiation of advanced treatment was shorter in Western Europe (10 vs 46 months; P < .001). Despite these differences, the need for surgery remained comparable in Eastern and Western Europe, with a 10-year rate of 24% ( P = .9). A similar comparability was observed for disease progression from uncomplicated disease to complicated disease (10-year rate: 20%; P = .07) and hospitalization (10-year rate: 41%; P = .5). Use of advanced therapy, stricturing or penetrating disease at diagnosis, progression of disease behavior, and former smoking were all associated with an increased risk of intestinal resection (all P < .05). Conclusions Despite earlier and more frequent use of advanced therapies in Western Europe, no differences in disease outcomes were observed between Western and Eastern European patients. Ten years after diagnosis, 1 in 5 patients with uncomplicated disease at diagnosis progressed to complicated disease, and 1 in 4 needed surgery.