Time Trends of Crohn's Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery

Background and Aims: Data from clinical trials suggest that biological drugs may improve the outcomes in Crohn's disease (CD) by reducing the need for surgery or hospitalization. The aim of this study is to evaluate the time-trends of the use of biological drugs and other treatments for CD, and its relationship with outcomes in Catalonia. Materials and Methods: All patients with CD included in the Catalan Health Surveillance System (containing data on a population of more than 7.5 million) from 2011 to 2017 were identified. The exposures to different treatments for inflammatory bowel disease were retrieved from electronic invoicing records. Results: Between 2011 and 2017, the use of salicylates, corticosteroids and immunosuppressive treatment fell from 28.8% to 17.1%, 15.8% to 13.7%, and 32.9% to 29.6%, respectively (p < 0.001). Biological treatment use rose from 15.0% to 18.7% (p < 0.001). Ostomy rates per 1000 patients/year fell from 13.2 in 2011 to 9.8 in 2017 (p = 0.003), and surgical resection rates from 24.1 to 18.0 (p < 0.001). The rate of CD-related hospitalizations per 1000 patients/year also fell, from 92.7 to 72.2 (p < 0.001). Conclusions: Biological drug use rose from 15.0% to 18.7% between 2011 and 2017. During this period, we observed an improvement in the outcomes of CD patients

Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

Early predictors; Corticosteroid; Autoimmune hepatitisPredictors primerencs; Corticosteroides; Hepatitis autoimmunePredictores tempranos; Corticosteroide; Hepatitis autoinmuneBackground and Aims To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids. Methods This was a retrospective cohort study including all patients with AS-AIH admitted to 13 tertiary centres from January 2002 to January 2019. The composite primary outcome was death or liver transplantation within 90 days of admission. Kaplan–Meier and Cox regression methods were used for data analysis. Results Of 242 consecutive patients enrolled (mean age [SD] 49.7 [16.8] years), 203 received corticosteroids. Overall 90-day transplant-free survival was 61.6% (95% confidence interval [CI] 55.4–67.7). Corticosteroids reduced the risk of a poor outcome (adjusted hazard ratio [HR] 0.25; 95% CI 0.2–0.4), but this treatment failed in 30.5%. An internally validated nomogram composed of older age, MELD, encephalopathy and ascites at the initiation of corticosteroids accurately predicted the response (C-index 0.82; [95% CI 0.8–0.9]). In responders, MELD significantly improved from days 3 to 14 but remained unchanged in non-responders. MELD on day 7 with a cut-off of 25 (sensitivity 62.5%[95% CI: 47.0–75.8]; specificity 95.2% [95% CI: 89.9–97.8]) was the best univariate predictor of the response. Prolonging corticosteroids did not increase the overall infection risk (adjusted HR 0.75; 95% CI 0.3–2.1). Conclusion Older patients with high MELD, encephalopathy or ascites at steroid therapy initiation and during treatment are unlikely to show a favourable response and so prolonged therapy in these patients, especially if they are transplantation candidates, should be avoided.This study was supported in part by grants from the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, number PI20/01302, awarded to Agustín Albillos and number PI 21/01310, awarded to Luis Téllez. CIBEREHD is funded by the Instituto de Salud Carlos III using grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF). María Carlota Londoño received support from the Plan Nacional de I+D+I co-funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER-"Una manera de Hacer Europa") (PI17/00955). Laura Patricia Llovet received the Resident Award “Clínic-La Pedrera” granted by the Hospital Clínic de Barcelona, Research, Innovation and Education Department

Heterogeneity in pharmacological treatment and outcomes in Crohn's disease patients in Catalonia : a population-based observational study

Heterogeneity in the treatment of a disease is a marker of suboptimal quality of care. The aim of this study is to evaluate the heterogeneity in the treatment used and the outcomes for Crohn's disease (CD) in Catalonia. All patients with CD included in the Catalan Health Surveillance System (data on more than seven million individuals from 2011 to 2017) were identified. The different Catalonian health areas were grouped into 19 district groups (DG). Treatments used rates (systemic corticosteroids, non-biological and biological immunosuppressant) and outcomes rates (hospitalization and surgery) were calculated. The use of systemic corticosteroids presented a decreasing trend over the study period, with an average rate of use in the different territories between 11% and 17%. The use of non-biological immunosuppressant treatment has remained stable, with an average rate of use ranging from 22% to 40% per year depending on the DG. The use of biological immunosuppressant treatment increased with an average rate of use in the different territories ranging from 10 to 23%. Hospitalizations for any reason showed an increasing trend between 2011 and 2017 with an average rate of between 23% and 32% per year depending on the area. Hospitalizations for CD presented a decreasing trend, with an average rate of between 5% and 11% per year. Surgical treatment remained stable over time, rates per year were between 0.5% and 2%. A remarkable geographical heterogeneity in the use of different treatments and in outcomes of CD was observed between different geographical areas of Catalonia

Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis

Background: Inflammatory bowel disease (IBD) has a major economic impact on healthcare costs.Objectives: The aim of this study was to evaluate the current healthcare expenditure associated with IBD in a population-wide study in Catalonia.Design: Retrospective observational study.Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were considered eligible. The CHSS compiles data on more than 7 million individuals in 2020 (34,823 with IBD). Data on the use of healthcare resources and its economic impact were extracted applying the International Classification of Diseases, 10th revision, Clinical Modification codes (ICD-10-CM codes). Health expenditure, comorbidities, and hospitalization were calculated according to the standard costs of each service provided by the Department of Health of the Catalan government. The data on the IBD population were compared with non-IBD population adjusted for age, sex, and income level. IBD costs were recorded separately for Crohn's disease (CD) and ulcerative colitis (UC).Results: Prevalence of comorbidities was higher in patients with IBD than in those without. The risk of hospitalization was twice as high in the IBD population. The overall healthcare expenditure on IBD patients amounted to 164Meuro. The pharmacy cost represents the 60%. The average annual per capita expenditure on IBD patients was more than 3.4-fold higher (IBD 4200euro, non-IBD 1200euro). Average costs of UC were 3400euro and 5700euro for CD.Conclusion: The risk of comorbidities was twice as high in patients with IBD and their use of healthcare resources was also higher than that of their non-IBD counterparts. Per capita healthcare expenditure was approximately 3.4 times higher in the population with IBD.Trial registration: The study was not previously registered. Economic impact of inflammatory bowel disease in CataloniaThe manuscript includes data of the most recent epidemiologic data about the high economic impact of IBD in Catalonia

Estudios sobre condiciones de vida en la Argentina contemporánea

Este libro es el resultado del trabajo de un equipo de investigadores e investigadoras de diferentes universidades del país que fueron seleccionados/os a través de un concurso nacional con el fin de participar en un proyecto centrado en el análisis de la producción reciente de las ciencias sociales, en el marco del Programa de Investigación sobre la Sociedad Argentina Contemporánea (PISAC). Desde diferentes perspectivas se nos plantea un interrogante general sobre nuestras categorías de estudio: ¿qué entender por condiciones de vida y qué por bienestar? Al acercarnos a la revisión de antecedentes, salta una primera consideración general sobre el uso de los términos condiciones de vida y bienestar cuando su invocación se vuelve convencional. Por esta razón, más allá de las consideraciones generales que aquí se relevan, en cada capítulo trataremos de mostrar cómo ha variado históricamente su análisis desde aquellas constataciones objetivas hacia aquellas dimensiones no sensibles desde una simple mirada

sj-png-4-tag-10.1177_17562848231222344 – Supplemental material for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis

Supplemental material, sj-png-4-tag-10.1177_17562848231222344 for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis by Eduard Brunet-Mas, Belen Garcia-Sagué, Emli Vela, Luigi Melcarne, Laura Patricia Llovet, Caridad Pontes, Pilar García-Iglesias, Anna Puy, Sergio Lario, Maria Jose Ramirez-Lazaro, Albert Villoria, Johan Burisch, Gilaad G. Kaplan and Xavier Calvet in Therapeutic Advances in Gastroenterology</p

sj-png-3-tag-10.1177_17562848231222344 – Supplemental material for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis

Supplemental material, sj-png-3-tag-10.1177_17562848231222344 for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis by Eduard Brunet-Mas, Belen Garcia-Sagué, Emli Vela, Luigi Melcarne, Laura Patricia Llovet, Caridad Pontes, Pilar García-Iglesias, Anna Puy, Sergio Lario, Maria Jose Ramirez-Lazaro, Albert Villoria, Johan Burisch, Gilaad G. Kaplan and Xavier Calvet in Therapeutic Advances in Gastroenterology</p

sj-png-1-tag-10.1177_17562848231222344 – Supplemental material for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis

Supplemental material, sj-png-1-tag-10.1177_17562848231222344 for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis by Eduard Brunet-Mas, Belen Garcia-Sagué, Emli Vela, Luigi Melcarne, Laura Patricia Llovet, Caridad Pontes, Pilar García-Iglesias, Anna Puy, Sergio Lario, Maria Jose Ramirez-Lazaro, Albert Villoria, Johan Burisch, Gilaad G. Kaplan and Xavier Calvet in Therapeutic Advances in Gastroenterology</p

sj-png-5-tag-10.1177_17562848231222344 – Supplemental material for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis

Supplemental material, sj-png-5-tag-10.1177_17562848231222344 for Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis by Eduard Brunet-Mas, Belen Garcia-Sagué, Emli Vela, Luigi Melcarne, Laura Patricia Llovet, Caridad Pontes, Pilar García-Iglesias, Anna Puy, Sergio Lario, Maria Jose Ramirez-Lazaro, Albert Villoria, Johan Burisch, Gilaad G. Kaplan and Xavier Calvet in Therapeutic Advances in Gastroenterology</p