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

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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.

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