Impact of thiopurines and anti-tumour necrosis factor therapy on hospitalisation and long-term surgical outcomes in ulcerative colitis

Table 2 Summary of key research investigating impact of thiopurines and tumour necrosis factor inhibitors therapy on hospitalisation in ulcerative colitis

	Ref.	Study design	Population	n	Key findings
Thiopurines	Actis et al[61]	Retrospective study comparing hospitalisation before and after AZA induction	Severe UC	17	Significant decrease in hospitalisation for patients with UC up to 5.8 yr following AZA induction
					Most of patients were also treated with ciclosporin at AZA induction
	Herrinton et al[62]	Population based cohort study of prescribing trends in UC	Unselected UC	5895	150% increase in immuno-modulator use in UC between 1998-2005
					Concurrent reduction in UC hospitalisations in the same period by a third
	Vester-Andersen et al[63]	Prospective descriptive study of IBD inception cohort	Unselected UC	300	26% exposure to immuno-modulator during follow up
					Hospitalisation rates decreased from 4.7 d/person-years in year 1 after diagnosis to 0.4 d in year 5
					Immuno-modulator therapy found not to be significant in predicting need for hospitalisation
aTNF	Carter et al[65]	Medical insurance cost analysis study	Unselected UC	420	UC patients with a prescription for infliximab for > 80% of the study period had less hospitalisation requirement, lower admission costs and shorter inpatient stays
	Oussalah et al[37]	Multicentre retrospective study on outcomes in UC patients post aTNF	Unselected UC	191	Estimated hospitalisation-free survival at 1, 2, 3 and 6 yr were 66.7%, 60.2%, 57.1% and 44.6% respectively
					Earlier use of aTNF predictive of need for hospitalisation
	Sandborn et al[19]	ACT 1 and 2 RCT comparing IFX with placebo	Moderate to severe UC	728	Of patients treated with IFX, 84% remained free of hospitalisation at 54 wk, compared to 75% in the placebo group
	Feagan et al[41]	ULTRA 1 and 2 RCT comparing ADA with placebo	Moderate to severe UC	963	Significantly reduced all-cause and UC-related admissions at both 8 wk and 52 wk in patients treated with ADA compared to placebo
	Lopez et al[47]	Meta-analysis of aTNF in UC outcomes	Moderate to severe UC	964	aTNF therapy was superior to placebo in reducing UC-related hospitalisations, with a relative risk of 0.71 (95%CI: 0.56-0.90)

UC: Ulcerative colitis; aTNF: Tumour necrosis factor inhibitors; RCT: Randomised controlled tria; AZA: Azathioprine; IFX: Infliximab; ADA: Adalimumab; IBD: Inflammatory bowel disease; ACT: Active ulcerative colitis trials; ULTRA: Ulcerative colitis long-term remission and maintenance with adalimumab.