Journal of Crohn's and Colitis, 2022, 16, 778–785 https://doi.org/10.1093/ecco-jcc/jjab204 Advance access publication 14 November 2021 Original Article © The Author(s) 2021. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com Improved Outcomes of Paediatric and Adult Crohn’s Disease and Association With Emerging Use of Biologics–A Nationwide Study From the Epi-IIRN Ohad Atia, a, , Esther Orlanski-Meyer, a Rona Lujan, a Natan Ledderman, b Shira Greenfeld, c Revital Kariv, a Saleh Daher, d Henit Yanai, e Yiska Loewenberg Weisband, f Hagit Gabay, f Eran Matz, g Daniel Nevo, h, , Eran Israeli, i Doron Schwartz, j Yehuda Chowers, k Iris Dotan, e Dan Turner a a Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel b Meuhedet Health Services, Meuhedet Research Institute, Tel-Aviv, Israel c Maccabi Health Services, Maccabi Research Institute, Tel-Aviv, Israel, and the Sackler Faculty of Medicine, Tel Aviv University, Israel d Israel Defense Forces Medical Corps, Department of Medical Services, Jerusalem, Israel, and Hadadsah-Hebrew University Medical Center, Institute of Gastrointestinal and Liver Diseases, Jerusalem, Israel e Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Israel f Clalit Health Services, Clalit Research Institute, Tel-Aviv, Israel g Leumit Health Services, Leumit Research Institute, Tel-Aviv, Israel h Department of Statistics and Operations Research, Tel Aviv University, Israel. i Institute of Gastroenterology and Liver Diseases, E. Wolfson Medical Center, Holon, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Israel j Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel k Technion Israel Institute of Technology, Department of Gastroenterology, Rambam Healthcare Campus, Bruce Rappaport School of Medicine, Haifa, Israel Corresponding author: Dan Turner MD, PhD, Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Hebrew University; P.O.B 3 + 235, Jerusalem 91031, Israel. Tel.: +972-50-8685841; fax: +972-2-6555756; email: turnerd@szmc.org.il Abstract Background: The effectiveness of biologics for improving long-term outcomes in patients with Crohn’s disease [CD] is still controversial. In this nationwide study, we aimed to evaluate trends of long-term outcomes in all CD patients in Israel during the biologics era. Methods: Trends of outcomes were analysed using data from the four Israeli health maintenance organisations, covering 98% of the population; joinpoint regression models were used to explore changes of these trends over 2005 to 2019. Results: A total of 16 936 patients were diagnosed with CD in Israel since 2005 (2932 [17%] paediatric onset, 14 004 [83%] adult onset) with 114 947 person-years of follow-up. The cumulative rate of any CD related surgery was 5%, 9%, 11%, and 14% at 1, 3, 5, and 10 years from diag- nosis. The increase in use of biologics was sharp (from 8.9% to 36%; average annual percent change [AAPC], 14.3%), and the time to biologics was shorter in recent years (median time of 4.8 [1.9–8.1] years in those diagnosed in 2005–2008 compared with 0.5 [0.2–1.1] years in those diagnosed in 2015–2018; p < 0.001). A significant decrease was noted in the hazard of hospitalisations (1.3 [0.1–4.6] years compared with 0.2 [0.02–0.9] years; p < 0.001), steroid dependency (1.5 [0.2–5.4] years compared with 0.1 [0.02–0.4] years; p < 0.001), and intestinal surgeries [4.7 [1.6–8.2] years compared with 0.6 [0.2–1.4] years; p < 0.001), but not of perianal surgery (4.2 [1.1–7.7] years compared with 0.6 [0.2–1.4] years; p = 0.2). Outcomes were consistently worse in paediatric onset compared with adults. Conclusions: The rates of hospitalisations, steroid dependency, and intestinal resections decreased in association with increased use of biologics both in children and in adults, but not the rate of perianal surgeries. Key Words: Crohn’s disease; biologics; outcomes 1. Introduction Crohn’s disease [CD] is associated with numerous long-term complications, most notably hospitalisations and intestinal resections. In population-based studies, the rate of patients requiring at least one hospitalisation was 36%–44% at 5 years from diagnosis, 1–3 and 12–17% of patients underwent surgical resection during that period. 1,4 It is believed that long-term disease complications are as- sociated with the degree of mucosal and transmural infam- mation. 5 Since biologics are the most effective treatments for reducing bowel infammation in CD, guidelines recommend early intensifed treatment in high-risk patients, in both chil- dren and adults. 6,7 Consequently, there has been a sharp increase in the use of biologics during the frst year after Downloaded from https://academic.oup.com/ecco-jcc/article/16/5/778/6427791 by guest on 12 December 2023