Gastroenterology

The study find that the the treatment of inflammatory bowel diseases (IBD); did not result in lower rates of hospitalizations or intestinal surgeries among patients living with IBD in Ontario; but according to a study published by authors from several Canadian hospitals and ICES in the journal Gut.

Inflammatory bowel diseases

The authors studied trends in hospitalizations; surgeries and drug costs among individuals with Crohn’s disease and ulcerative colitis, collectively termed IBD; living in Ontario between 1995 and 2012. They compare trends following the introduction of infliximab in Ontario to trends that would have been expect had the drug not been introduce.

Infliximab is a type of anti-immune (anti-TNF) therapy that blocks inflammation in the gut and other organs. It is used to treat a variety of inflammatory diseases ; and became available in Ontario for Crohn’s disease in 2001 and for ulcerative colitis in 2006. Therefore The researchers found that even among people with Crohn’s disease who receive infliximab; there were no significant reductions in disease-relate hospitalization or surgery rates compared to what would have been expected with conventional therapies alone.

Disease-related hospitalization

People with ulcerative colitis who received infliximab also did not experience lower surgery rates, but they did see some improvement in hospitalization rates following infliximab introduction. “These findings are disappointing for a class of therapy that has demonstrated benefit in reducing IBD-related hospitalizations and surgeries in clinical trials;” said Dr. Sanjay Murthy, lead author on the study and an IBD specialist and associate scientist at The Ottawa Hospital.

“We had expected to see larger declines in these adverse health events because they are more common in IBD patients with severe disease; and these are the same patients that we should be targeting with this therapy early in their disease to prevent hospitalizations and surgeries.”

Other important health

The study did not take into account the impact of this therapy on other important health outcomes; such as quality of life or workplace attendance and productivity. Because “Clinicians have seen how anti-TNF therapy can dramatically improve their patients’ symptoms; and in many cases even lead to complete bowel healing;” said Dr. Murthy; who is also an assistant professor at the University of Ottawa.

“But even though the drug clearly helps some individuals; we are not seeing some of the important benefits we would expect at a broader population level. This suggests that we may need to improve how we are using this drug in clinical practice to realize greater benefits.”In addition; annual bowel resection rates among IBD patients were already low in Ontario at the time that infliximab is introduce about four per cent for Crohn’s disease patients ;and two% for ulcerative colitis patients which may have left little room for further improvement.