Evidence map›Paper›PMID 30448599›Full record

ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2019

Upfront Combination Therapy, Compared With Monotherapy, for Patients Not Previously Treated With a Biologic Agent Associates With Reduced Risk of Inflammatory Bowel Disease-related Complications in a Population-based Cohort Study.

Laura E Targownik, Eric I Benchimol, Charles N Bernstein, Harminder Singh, Lisa Lix, Aruni Tennakoon, Stella Leung, Antonio Aviña, Stephanie Coward, Jennifer Jones and 4 more

Abstract read
PubMed Publisher
In one paragraph

Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
3.4field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 35 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. The 2023 Impact of Inflammatory Bowel Disease in Canada: Treatment Landscape.Journal of the Canadian Association of Gastroenterology · 2023
    Review
  5. Article
  6. Review
  7. Observational
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  9. Article
  10. Article
  11. Article
  12. Bridging Gaps in Evidence-based Clinical Practice in Inflammatory Bowel Diseases: Observational Comparative Effectiveness Research for the Win.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2019
    Article
  13. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 7 institutions in 1 country.

Laura E TargownikSection of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: laura.targownik@med.umanitoba.ca.
Eric I BenchimolChildren's Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Charles N BernsteinSection of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Harminder SinghSection of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Lisa LixDepartment of Community Health Sciences, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Aruni TennakoonSection of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Stella LeungSection of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Antonio AviñaArthritis Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.
Stephanie CowardDepartment of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Jennifer JonesDepartment of Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Gil KaplanDepartment of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Sanjay K MurthyThe Ottawa Hospital IBD Centre, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Geoffrey C NguyenMount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Juan Nicolás Peña-SánchezDepartment of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
University of Manitoba · CAUniversity of Calgary · CAUniversity of Ottawa · CAArthritis Research Centre of Canada · CADalhousie University · CAMount Sinai Hospital · CAUniversity of Saskatchewan · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND &

aimsAlthough guidelines recommend inclusion of immune modulators in anti-tumor necrosis factor (TNF) initiation therapy for Crohn's disease (CD) or ulcerative colitis (UC), there are limited data on the incremental effectiveness of this treatment strategy from the real world.

methodsWe collected data from the Manitoba Inflammatory Bowel Disease (IBD) Epidemiology database on persons with CD (n=852) or UC (n=303), from 2001 through 2016, who began treatment with a TNF antagonist. New and/or continuing users of immunomodulators at the time anti-TNF therapy began were considered recipients of combination therapy. The main outcome was treatment ineffectiveness (IBD-related hospitalization, intestinal resection, corticosteroid use, or change of anti-TNF agent) during TNF antagonist-based therapy or within 90 days after the anti-TNF agent was discontinued. We used Cox proportional hazards models to assess the association between concomitant use of immunomodulators and treatment ineffectiveness.

resultsIn patients with CD, combination therapy was associated with a significant decrease in likelihood of treatment ineffectiveness (adjusted hazard ratio [aHR] for ineffectiveness, 0.62; 95% CI, 0.49-0.79). However, this association was not significant in patients with UC (aHR, 0.82; 95% CI, 0.56-1.20). In patients with CD, combination therapy was also associated with increased time to first IBD-related hospitalization (aHR 0.53; 95% CI, 0.36-0.80) and switching anti-TNF agents (aHR, 0.63; 95% CI, 0.41-0.97), but not associated with IBD-related surgery (aHR, 0.76; 95% CI, 0.51-1.12) or new or recurrent use of corticosteroids (aHR, 0.75; 95% CI, 0.55-1.04).

conclusionIn an analysis of a database of real-world patients with IBD, we associated initiation therapy with a combination immune modulators and anti-TNF agents with a decreased likelihood of treatment ineffectiveness for patients with CD but not UC.

Indexed as

AdalimumabAdultAzathioprineCohort StudiesColitis, UlcerativeCrohn DiseaseDigestive System Surgical ProceduresDrug SubstitutionDrug Therapy, CombinationFemaleGlucocorticoidsHospitalizationHumansImmunologic FactorsInflammatory Bowel DiseasesInfliximabAdalimumabAzathioprineGlucocorticoidsImmunologic FactorsInfliximabMethotrexatePrednisoneTumor Necrosis Factor InhibitorsCombinedManagementThiopurinesTreatment Comparison

Identifiers

PMID30448599
OpenAlexW2901635918

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.