Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2022; 28(30): 4102-4119
Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4102
Trends in medication use and treatment patterns in Chinese patients with inflammatory bowel disease
Ling-Ya Yao, Bu-Le Shao, Feng Tian, Mei Ye, Yu-Qin Li, Xiao-Lei Wang, Lin Wang, Shao-Qi Yang, Xiao-Ping Lv, Yan Jia, Xue-Hong Wang, Xiao-Qi Zhang, Yan-Ling Wei, Qian Cao
Ling-Ya Yao, Bu-Le Shao, Qian Cao, Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Feng Tian, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
Mei Ye, Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
Yu-Qin Li, Department of Gastroenterology, Bethune First Affiliated Hospital of Jilin University, Changchun 130000, Jilin Province, China
Xiao-Lei Wang, Department of Gastroenterology, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China
Lin Wang, Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361000, Fujian Province, China
Shao-Qi Yang, Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
Xiao-Ping Lv, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi Zhuang Autonomous Region, China
Yan Jia, Department of Gastroenterology, The 7th Medical Center of Chinese PLA General Hospital, Beijing 100000, China
Xue-Hong Wang, Department of Gastroenterology, Second Xiangya Hospital, Changsha 410011, Hunan Province, China
Xiao-Qi Zhang, Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing 210000, Jiangsu Province, China
Yan-Ling Wei, Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing 400000, China
Author contributions: Cao Q formulated the research idea; Yao LY developed the study protocol; Yao LY, Tian F, Ye M, Li YQ, Wang XL, Wang L, Yang SQ, Lv XP, Jia Y, Wang XH, Zhang XQ and Wei YL conducted the patient identification and data collection; Shao BL and Yao LY conducted the data analysis; Yao LY, Shao BL and Cao Q developed the manuscript; and all authors have read and approve the final manuscript.
Institutional review board statement: The study protocol was reviewed and approved by Sir Run Run Shaw Hospital, College of Medicine Zhejiang University Institutional Review Board with approval for all hospitals involved in the study, No. 20210714-31.
Informed consent statement: The requirement for patient informed consent was waived due to the retrospective nature of this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Qian Cao, PhD, Chief Doctor, Chief Physician, Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine Zhejiang University, No. 3 East Qingchun Road, Shangcheng District, Hangzhou 310016, Zhejiang Province, China.
Received: April 15, 2022
Peer-review started: April 15, 2022
First decision: May 12, 2022
Revised: May 26, 2022
Accepted: July 20, 2022
Article in press: July 20, 2022
Published online: August 14, 2022
Research background

Medications for inflammatory bowel disease (IBD) have changed dramatically over time, especially following market availability of infliximab (IFX). Several attempts have been made by Western and other Asian countries to provide rough medication changes.

Research motivation

No study on long-term medication profiles has been conducted in Chinese population, and minimal attention has been paid to periodic changes in IBD treatment strategies. Additionally, investigating possible predictors for initial treatment strategies may help to better understand periodic changes in therapeutic patterns in patients with IBD.

Research objectives

This study was designed to leverage the real-world evidence in Chinese referral hospitals to provide fresh insights into temporal trends in medication prescriptions among the Chinese population with IBD for over 20 years, and to investigate long-term periodic changes in treatment paradigms and identify the possible factors that influence initial drug strategies.

Research methods

A multicenter retrospective cohort study was conducted to analyze trends in medication use and therapeutic patterns. Predictors for initial drug strategies were identified using logistic regression analysis.

Research results

Of 5-aminosalicylates (5-ASA) and corticosteroids (CS) prescriptions gradually decreased, accompanied by a notable increase in immunosuppressants (IMS) and IFX prescriptions in patients with Crohn's disease (CD). Prescription rates of 5-ASA and CS were stable, whereas IMS and IFX slightly increased since 2007 in patients with ulcerative colitis (UC). Subgroup analyses showed the switch from conventional medications to IFX in patients with CD, while 5-ASA and CS were still steadily prescribed in patients with UC. Logistic regression analyses revealed that surgical history, disease behavior, and disease location were associated with initial therapeutic strategies in patients with CD. However, medications before diagnosis, disease location, and diagnostic year might affect initial strategies in patients with UC.

Research conclusions

Parallel to increasing IMS and IFX use in IBD over the past two decades, a significant decrease in 5-ASA and CS use were observed for CD but not for UC. Long-term treatment strategies analyses provided a unique insight in switching from conventional drugs to IFX in Chinese patients with CD.

Research perspectives

The study was based on IBD referral centers, therefore the study population only accounted for limited proportion of total Chinese patients with IBD. A well-organized national registry system in the near future will help facilitate larger clinical studies in China. In addition, clinical outcomes, including hospitalization, surgeries, or phenotype progression were not collected. Further investigation in the correlation between different drug strategies and long-term outcomes are needed in future studies.