Crohn's disease treatment practices in France in1999-2013: A prospective survey in non-academic hospitals

Aims: To describe the characteristics of patients with Crohn's disease (CD) in non-academic hospitals in France and to evaluate how therapeutic practices changed between 1999 and 2013.

Methods: During 2 weeks in September 2013, we solicited disease and treatment information for CD patients seen by gastroenterologists in 57 French non-academic hospitals. In four groups of patients defined according to the date of CD diagnosis (<1999, 1999-2003, 2004-2008, and 2009-2013), the use of immunosuppressor (IS) and anti-TNF treatments during the first 5 years following diagnosis of CD was compared using the Kaplan-Meier method.

Results: 739 consecutive CD patients (median age at diagnosis 25.4 years) were included in the survey. CD location was ileal for 31%, colonic for 21%, and ileocolonic for 45%. CD phenotypes were non-penetrating/non-stricturing (58.7%), stricturing (26.9%), and penetrating (12.7%), with perianal lesions in 26.1%. The proportions of patients who began IS or anti-TNF treatment within 5 years of diagnosis increased significantly from 18% and 0%, respectively, in <1999 (n=170) to 52% and 23% in 1999-2003 (n=120), 66% and 70% in 2004-2008 (n=155), and 75% and 100% in 2009-2013 (n=294; P<0.0001).

Conclusions: In this French non-academic hospital cohort of CD patients, the proportions of patients being treated with anti-TNF or IS therapy in the first 5 years after diagnosis both increased sharply since 1999.