Appropriateness of initial treatment for severe Crohn's disease: application of EPACT criteria to the EC-IBD European cohort

TitleAppropriateness of initial treatment for severe Crohn's disease: application of EPACT criteria to the EC-IBD European cohort
Publication TypeConference Paper
Year of Publication2008
AuthorsJuillerat, P, Pittet, V, Froehlich, F, Gonvers, J-J, Mottet, C, Felley, C, Burnand, B, Vader, J-P, Stockbruegger, R, Michetti, P
Conference NameDigestive Disease Week and 109th Annual Meeting of the AGA Institute, May 17-22, 2008, San Diego
ISBN Number0016-5085
Accession Numberserval:BIB_C3993BDC6E7A
Abstract

Background: The appropriateness of use of therapy for severe active luminal Crohn's disease (CD) cases has never been formally assessed. The European panel on the appropriateness of Crohn's disease therapy [EPACT (http://www.epact.ch)] developed appropriateness criteria. We have applied these criteria to the EC-IBD prospectively assembled, uniformly diagnosed European population-based inception cohort of Inflammatory Bowel Disease (IBD) patients diagnosed between 1991 and 1993.
Methods: 426 CD patients from 13 European participating centers (10 countries) were included at the time of diagnosis (first flare, naive patients, no maintenance treatment, no steroids). We used the EPACT definition of the severe active luminal CD, agreed upon by the panel experts (acute flare, hospitalized patient, without documented fistula or stenosis and who did not undergo surgery for abscess drainage or a fistulectomy). The various treatments were analyzed to determine the appropriateness of the medical decision, according to the EPACT criteria.
Results: 84 (20%) patients met the inclusion criteria. Considering at least one appropriate (A) treatment as appropriate: 60 patients (71%) received an appropriate treatment, 24 patients (29%) an inappropriate treatment (I). Furthermore, in 87% of the cases with one appropriate treatment an additional mostly inappropriate treatment was added or continued. Detailed results are indicated in the table below.
Conclusion: In the EC-IBD cohort, the treatment for severe active luminal CD was appropriate for more than 70% of the patients, but frequently an inappropriate treatment was continued or added, thus increasing the risk of adverse reactions, drugs interactions and costs.

Notes

oai:serval.unil.ch:BIB_C3993BDC6E7A

DOI10.1016/S0016-5085(08)62219-2
WOS ID (UT)

Publié

Citation Key / SERVAL ID3986

                         

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