{'fraction_non_alphanumeric': 0.0501918158567775, 'fraction_numerical': 0.03676470588235294, 'mean_word_length': 4.70985401459854, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 2, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 1, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The Colectomy and Mortality Rates in Inflammatory Bowel Disease Patients with Clostridium Difficile Associated Disease: A Nationwide Analysis from 2000‐2008.: P‐43 YI

determine whether the earlier use of anti-TNF therapy was associated with better short-term outcomes in a biologic-naı̈ve cohort. METHODS: A retrospective cohort of patients with biopsy-proven UC or CD, naı̈ve to biologic therapy, who started therapy with infliximab (IFX), adalimumab (ADA) or certolizumab (CTZ) between 2000-2011, was selected. Subjects with a prior history of IBD-related surgery were excluded. Primary non-responders to biologic therapy, individuals who were on corticosteroids beyond the biologic induction period, and subjects with less than six months of continuous follow-up were also excluded. Subjects were followed for a maximum of three years or until lost to follow up. The primary outcome of interest was the occurrence of any IBD-related hospitalization, surgery or corticosteroid use (after biologic induction) during follow-up. Subjects were stratified according to whether they started a biologic early (within 1 year of IBD diagnosis) or late (>1 year since diagnosis). Multivariable logistic regression was performed with the composite outcome as the dependent variable of interest. A survival analysis was also performed comparing early versus late initiators and their time to the composite outcome with subjects censored at three years or when lost to follow up. RESULTS: Early initiators (N 1⁄4 34) were younger (mean age D 5.4 years) than late initiators (N 1⁄4 78) (P 1⁄4 0.02), and had a higher frequency of ADA/CTZ use than the late initiators (38.2% versus 15.4%, P 1⁄4 0.03). They were also more likely to be on corticosteroids at the time of biologic initiation (64.7% versus 42.3%, P 1⁄4 0.03) and less likely to be on aminosalicylates (8.8% versus 28.2%, P 1⁄4 0.02). The groups did not differ by sex distribution, mean body weight, immunomodulator use, presence of extra-intestinal disease, tobacco use or IBD subtype (including clinical phenotype among CD patients or extent of colitis among UC patients) (P>0.10). The mean follow-up time between groups did not differ (719 days [SE 57.9] in the early group versus 774 days [SE 41.1] in the late group, P 1⁄4 0.45). After multivariable adjustment, there was a higher likelihood of the composite outcome in late initiators of biologic therapy (adjusted OR 6.6, SE 5.5, P 1⁄4 0.02). When initiation was considered as a continuous function, it remained significantly associated with the composite outcome (adjusted OR 1.1 per year since diagnosis, SE 0.06, P 1⁄4 0.05). When modeled as a survival function, the adjusted hazard ratio for the composite outcome was 4.9 in the late initiators (SE 3.8, P 1⁄4 0.04). CONCLUSION(S): Early initiation of anti-TNF therapy in patients with IBD who already have indications for its use may be associated with better outcomes. These findings support a possible role for ‘top-down’ therapy in IBD treatment. This is in line with other emerging data that the early use of anti-TNF agents may alter the natural history of IBD.