Effect of Age on the Initiation of Biologic Agent Therapy in Patients With Inflammatory Bowel Disease: Korean Common Data Model Cohort Study

Youn I Choi; Yoon Jae Kim; Jun-Won Chung; Kyoung Oh Kim; Hakki Kim; Rae Woong Park; Dong Kyun Park

doi:10.2196/15124

Effect of Age on the Initiation of Biologic Agent Therapy in Patients With Inflammatory Bowel Disease: Korean Common Data Model Cohort Study

JMIR Med Inform. 2020 Apr 15;8(4):e15124. doi: 10.2196/15124.

Authors

Youn I Choi¹, Yoon Jae Kim^#¹, Jun-Won Chung¹, Kyoung Oh Kim¹, Hakki Kim², Rae Woong Park³, Dong Kyun Park¹

Affiliations

¹ Department of Gastroenterology, Gil Medical Center, Gachon University College of Internal Medicine, Incheon, Republic of Korea.
² Health IT Research Center, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
³ Ajou Medical Center, Suwon, Republic of Korea.

^# Contributed equally.

PMID: 32293578
PMCID: PMC7191339
DOI: 10.2196/15124

Abstract

Background: The Observational Health Data Sciences and Informatics (OHDSI) network is an international collaboration established to apply open-source data analytics to a large network of health databases, including the Korean common data model (K-CDM) network.

Objective: The aim of this study is to analyze the effect that age at diagnosis has on the prognosis of inflammatory bowel disease (IBD) in Korea using a CDM network database.

Methods: We retrospectively analyzed the K-CDM network database from 2005 to 2015. We transformed the electronic medical record into the CDM version 5.0 used in OHDSI. A worsened IBD prognosis was defined as the initiation of therapy with biologic agents, including infliximab and adalimumab. To evaluate the effect that age at diagnosis had on the prognosis of IBD, we divided the patients into an early-onset (EO) IBD group (age at diagnosis <40 years) and a late-onset (LO) IBD group (age at diagnosis ≥40 years) with the cutoff value of age at diagnosis as 40 years, which was calculated using the Youden index method. We then used the logrank test and Cox proportional hazards model to analyze the effect that age at diagnosis (EO group vs LO group) had on the prognosis in patients with IBD.

Results: A total of 3480 patients were enrolled. There was 2017 patients with ulcerative colitis (UC) and 1463 with Crohn's disease (CD). The median follow up period was 109.5 weeks. The EO UC group was statistically significant and showed less event-free survival (ie, experiences of biologic agents) than the LO UC group (P<.001). In CD, the EO CD group showed less event-free survival (ie, experiences of biologic agents) than the LO CD group. In the Cox proportional hazard analysis, the odds ratio (OR) of the EO UC group on experiences of biologic agents compared with the LO UC group was 2.3 (95% CI 1.3-3.8, P=.002). The OR of the EO CD group on experiences of biologic agents compared with the LO CD group was 5.4 (95% CI 1.9-14.9, P=.001).

Conclusions: The EO IBD group showed a worse prognosis than the LO IBD group in Korean patients with IBD. In addition, this study successfully verified the CDM model in gastrointestinal research.

Keywords: Crohn’s disease; common data model; early-onset; late-onset; ulcerative colitis.

©Youn I Choi, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Hakki Kim, Rae Woong Park, Dong Kyun Park. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 15.04.2020.