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Dissertation
The role of biologics in the treatment of ulcerative colitis
Doctor of Philosophy (Ph.D.), Drexel University
May 2014
DOI:
https://doi.org/10.17918/etd-4548
Abstract
Background: Of the many options for the management of pediatric ulcerative colitis (UC), infliximab is promising in reducing the need for colectomy, but lacks sufficient evidence in the pediatric inpatient setting. We aimed to develop and implement a disease risk score (DRS) to estimate the association between infliximab and colectomy among children hospitalized with UC. Methods: A DRS, which represents the probability of outcome given baseline covariates, was used to control for confounding by indication. Multivariate logistic regression was used to incorporate the DRS and adjust for additional indicators of worsening clinical course to estimate the odds ratio (OR) of colectomy across treatment groups. Results: Over the 10-year study period, length of stay decreased by 1.5 days, colectomy rate decreased by 3.9%, while infliximab use increased by 1.5% and was started earlier by 1.8 days. In stratified analyses adjusting for baseline risk of colectomy as well as indicators of worsening clinical course during admission, the OR of colectomy was 0.48 (95% CI: 0.29-0.79) in the highest risk octile comparing those treated with infliximab to those not treated with infliximab. Conclusion: Variation in the management for severe UC appears to be decreasing, a trend led largely by high caseload hospitals. In a nationally representative cohort from real clinical practice at 42 large pediatric hospitals, high-risk pediatric UC patients had reduced odds of colectomy from the use of infliximab during their admission.
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Details
- Title
- The role of biologics in the treatment of ulcerative colitis
- Creators
- Andrew James Klink - DU
- Contributors
- Brian K. Lee (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics [Historical]; School of Public Health (2002-2015); Drexel University
- Other Identifier
- 4548; 991014632430904721