ABSTRACT
BACKGROUND: A proportion of patients with initial presentation of ulcerative proctitis (UP) progress to more extensive colitis. We sought to characterize the natural history and identify clinical predictors of extension in UP. METHODS: We performed a retrospective cohort study of participants with a new diagnosis of UP from January 2000 to December 2015. We used Cox proportional hazard modeling to identify predictors of disease extension. RESULTS: We identified 169 new cases of UP with a median age of diagnosis of 40 years (range: 16-91 yr) and a median follow-up of 4.3 years (range: 3.3-15.1 yr). Fifty-three (31%) patients developed extension over the follow-up time. Compared with nonextenders, the need for immunosuppressive or biologic therapy was significantly higher among extenders (34% versus 2.6%, P < 0.001). In multivariable analyses, compared with UP cases with body mass index <25, the adjusted hazard ratios of extension were 1.75 (95% confidence interval [CI], 0.95-3.23) and 2.77 (95% CI, 1.07-7.14) among overweight and obese patients, respectively (Ptrend = 0.03). Similarly, patients with a history of appendectomy or endoscopic finding of moderate to severe disease had a higher risk of extension (adjusted hazard ratio = 2.74, 95% CI, 1.07-7.01 and 1.96, 95% CI, 1.05-3.67, respectively). CONCLUSIONS: In a retrospective cohort study, we show that appendectomy, body mass index, and endoscopic activity at the time of diagnosis of proctitis are associated with an increased risk of extension. In addition, our data suggest that extenders are more likely to require immunosuppressive or biologic therapy.
Subject(s)
Colitis, Ulcerative/drug therapy , Disease Progression , Immunosuppressive Agents/therapeutic use , Proctitis/drug therapy , Proctitis/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy/adverse effects , Biological Therapy , Body Mass Index , Endoscopy, Gastrointestinal , Female , Follow-Up Studies , Humans , Male , Massachusetts , Middle Aged , Multivariate Analysis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Young AdultABSTRACT
Inflammatory bowel diseases Crohn's disease and ulcerative colitis are complex multifactorial diseases that involve the interaction between innate and adaptive immunity. TNF-α is a potent proinflammatory cytokine with pleiotrophic effects on cells of the innate and adaptive immune system. Medical therapies that block TNF have changed the clinical management of inflammatory bowel disease. This review will discuss the new recommendations for the use of anti-TNF agents in the treatment of inflammatory bowel disease, as well as insights into immunogenicity and the safety of these agents. In addition, new biologic therapies that inhibit various elements in the leukocyte infiltration process and others that target proinflammatory cytokines will be addressed. This review will cover key studies examining the use of biologic agents in the treatment of Crohn's disease and ulcerative colitis.
