Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4102
Peer-review started: April 15, 2022
First decision: May 12, 2022
Revised: May 26, 2022
Accepted: July 20, 2022
Article in press: July 20, 2022
Published online: August 14, 2022
Processing time: 116 Days and 23.7 Hours
Medications for inflammatory bowel disease (IBD) have changed dramatically over time, especially following market availability of infliximab (IFX). Several attempts have been made by Western and other Asian countries to provide rough medication changes.
No study on long-term medication profiles has been conducted in Chinese population, and minimal attention has been paid to periodic changes in IBD treatment strategies. Additionally, investigating possible predictors for initial treatment strategies may help to better understand periodic changes in therapeutic patterns in patients with IBD.
This study was designed to leverage the real-world evidence in Chinese referral hospitals to provide fresh insights into temporal trends in medication prescriptions among the Chinese population with IBD for over 20 years, and to investigate long-term periodic changes in treatment paradigms and identify the possible factors that influence initial drug strategies.
A multicenter retrospective cohort study was conducted to analyze trends in medication use and therapeutic patterns. Predictors for initial drug strategies were identified using logistic regression analysis.
Of 5-aminosalicylates (5-ASA) and corticosteroids (CS) prescriptions gradually decreased, accompanied by a notable increase in immunosuppressants (IMS) and IFX prescriptions in patients with Crohn's disease (CD). Prescription rates of 5-ASA and CS were stable, whereas IMS and IFX slightly increased since 2007 in patients with ulcerative colitis (UC). Subgroup analyses showed the switch from conventional medications to IFX in patients with CD, while 5-ASA and CS were still steadily prescribed in patients with UC. Logistic regression analyses revealed that surgical history, disease behavior, and disease location were associated with initial therapeutic strategies in patients with CD. However, medications before diagnosis, disease location, and diagnostic year might affect initial strategies in patients with UC.
Parallel to increasing IMS and IFX use in IBD over the past two decades, a significant decrease in 5-ASA and CS use were observed for CD but not for UC. Long-term treatment strategies analyses provided a unique insight in switching from conventional drugs to IFX in Chinese patients with CD.
The study was based on IBD referral centers, therefore the study population only accounted for limited proportion of total Chinese patients with IBD. A well-organized national registry system in the near future will help facilitate larger clinical studies in China. In addition, clinical outcomes, including hospitalization, surgeries, or phenotype progression were not collected. Further investigation in the correlation between different drug strategies and long-term outcomes are needed in future studies.