Incidence and adverse clinical events of primary sclerosing cholangitis with ulcerative colitis

In Sub Han; Dong Hoon Baek; Seung Min Hong; Bong Eun Lee; Moon Won Lee; Gwang Ha Kim; Geun Am Song

doi:10.1007/s00384-023-04464-z

Incidence and adverse clinical events of primary sclerosing cholangitis with ulcerative colitis

Int J Colorectal Dis. 2023 Jun 23;38(1):175. doi: 10.1007/s00384-023-04464-z.

Authors

In Sub Han¹, Dong Hoon Baek², Seung Min Hong¹, Bong Eun Lee¹, Moon Won Lee¹, Gwang Ha Kim¹, Geun Am Song¹

Affiliations

¹ Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea.
² Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, 49421, Busan, South Korea. dhbeak77@gmail.com.

PMID: 37349585
DOI: 10.1007/s00384-023-04464-z

Abstract

Purpose: The aim of this study was to conduct a nationwide population-based study to estimate the incidence of primary sclerosing cholangitis in patients with ulcerative colitis (UC-PSC) and investigate healthcare use, medication use, surgery, cancer, and death as adverse clinical events of UC-PSC.

Methods: We identified incident cases of UC with (UC-PSC) or without PSC (UC-alone) between 2008 and 2018 using health insurance claims data in Korea. Univariate (crude hazard ratio (HR)) and multivariate analyses were performed to compare the risk of adverse clinical events between groups.

Results: A total of 14,406 patients with UC using population-based claims data were detected in the cohort. Overall, 3.38% (487/14,406) of patients developed UC-PSC. During a mean follow-up duration of approximately 5.92 years, the incidence of PSC in patients with UC was 185 per 100,000 person-years. The UC-PSC group showed statistically more frequent healthcare use (hospitalization and emergency department visits: HRs, 5.986 and 9.302, respectively; P < .001), higher immunomodulator and biologic use (azathioprine, infliximab, and adalimumab: HRs, 2.061, 3.457, and 3.170, respectively; P < .001), and higher surgery rate (operation for intestinal obstruction, and colectomy: HRs, 9.728 and 2.940, respectively; P < .001) than did the UC-alone group. The UC-PSC group also showed significantly higher colorectal cancer and biliary tract cancer (HRs, 2.799 and 36.343, respectively; P < .001) and mortality (HR, 4.257) rates than did the UC-alone group.

Conclusion: Patients with UC-PSC have higher risks of colorectal cancer, biliary tract cancer, and death than do patients with UC-alone. Although considered a rare disease, managing this complex and costly disease requires recognition of the impact of increased burden on healthcare services.

Keywords: Adverse clinical events; Incidence; Primary sclerosing cholangitis; Ulcerative colitis.

MeSH terms

Azathioprine
Cholangitis, Sclerosing* / complications
Cholangitis, Sclerosing* / epidemiology
Colectomy / adverse effects
Colitis, Ulcerative* / complications
Colitis, Ulcerative* / epidemiology
Colitis, Ulcerative* / surgery
Humans
Incidence

Substances

Azathioprine

Grants and funding

(MSIT; approval number, 2019R1G1A1100749)/This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government