Appropriateness of early management of newly diagnosed Crohn's disease in a European population-based cohort

Abstract

Objective. The European Panel on the Appropriateness of Crohn's disease Therapy (EPACT) has developed appropriateness criteria. We have applied these criteria retrospectively to the population-based inception cohort of Crohn's disease (CD) patients of the European Collaborative Study Group on Inflammatory Bowel Disease (EC-IBD). Material and methods. A total of 426 diagnosed CD patients from 13 European centers were enrolled at the time of diagnosis (first flare, naive patients). We used the EPACT definitions to identify 247 patients with active luminal CD. We then assessed the appropriateness of the initial drug prescription according to the EPACT criteria. Results. Among the cohort patients 163 suffered from mild-to-moderate CD and 84 from severe CD. Among the mild-to-moderate disease group, 96 patients (59%) received an appropriate treatment, whereas for 66 patients (40%) the treatment was uncertain and in one case (1%) inappropriate. Among the severe disease group, 86% were treated medically and 14% required surgery. 59 (70%) were appropriately treated, whereas for one patient (1%) the procedure was considered uncertain and for 24 patients (29%) inappropriate. Conclusion. Initial treatment was appropriate in the majority of cases for non-complicated luminal CD. Inappropriate or uncertain treatment was given in a significant minority of patients, with an increased potential risk of adverse events.

Key Words::

• Appropriateness
• Crohn's disease
• inflammatory bowel disease
• RAND appropriateness method
• therapy

Acknowledgements

We gratefully acknowledge the contribution of all the gastroenterologists and investigators who are listed in the Appendix and Miss Susan Giddons for editorial assistance. This study was supported by the Swiss National Science Foundation (SNF): grants N° 3347CO-108792/1 and N° PBLAP3-124341. The IBDT2K follow-up study was supported by a grant from the European Commission (fifth framework) N° QLG4-CT-2000-01414.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes