Conventional versus biological therapy for prevention of postoperative endoscopic recurrence in patients with Crohn's disease: an international, multicenter, and observational study

Postoperative endoscopic recurrence (PER) occurs in nearly 80% of patients 1 year after ileocecal resection in patients with Crohn's disease (CD). Biological agents were more effective in reducing the rates of PER in comparison with conventional therapy, in prospective trials. The aim of this study was to compare the PER rates of biological versus conventional therapy after ileocecal resections in patients with CD in real-world practice. The MULTIPER (Multicenter International Postoperative Endoscopic Recurrence) database is a retrospective analysis of PER rates in CD patients after ileocecal resection, from 7 referral centers in 3 different countries. All consecutive patients who underwent ileocecal resections between 2008 and 2012 and in whom colonoscopies had been performed up to 12 months after surgery, were included. Recurrence was defined as Rutgeerts' score ≥i2. The patients were allocated to either biological or conventional therapy after surgery, and PER rates were compared between the groups. Initially, 231 patients were evaluated, and 63 were excluded. Of the 168 patients in the database, 96 received anti-tumor necrosis factor agents and 72 were treated with conventional therapy after resection. The groups were comparable regarding age, gender, and perianal disease. There was longer disease duration, more previous resections, and more open surgical procedures in patients on biologicals postoperatively. PER was identified in 25/96 (26%) patients on biological therapy and in 24/72 (33.3%) patients on conventional therapy (P=0.310). In this retrospective observational analysis from an international database, no difference was observed between biological and conventional therapy in preventing PER after ileocecal resections in CD patients.

ESSAYS ON INTERNATIONAL RESEARCH AND DEVELOPMENT SPILLOVERS

The dissertation consists of three essays on international research and development spillovers. In the first essay, I investigate the degree to which differences in institutional arrangements among Sub-Saharan African countries determine the extent of benefits they derive from foreign research and development spillovers. In particular, I compare the international research and development spillovers for English common law and French civil law Sub-Saharan African countries. I show that differences in the legal origin of the company law or commercial codes in these countries may reflect the extent of barriers they place in the paths of firms that engage in the investment process. To tests this hypothesis, I constructed foreign R&D spillovers variable using imports as weights and employed the endogenous growth framework to estimate elasticities of productivity with respect to foreign R&D spillovers for a sample of 17 English common law and French Civil law Sub-Saharan African countries over the period 1980-2004. My results find support for the hypothesis. In particular, foreign R&D spillovers were higher in the English common law countries than in the French civil law countries. In the second essay, I examine the question of whether technical cooperation grants and overseas development assistance grants induce R&D knowledge spillovers in Sub-Saharan African countries. I test this hypothesis using data for 11 Sub-Saharan African countries over the period 1980-2004. I constructed foreign R&D spillovers using the technical cooperation grants and overseas development assistance grants as weights and employed the endogenous growth framework to provide quantitative estimates of foreign R&D spillover effects in 11 Sub-Saharan African countries. I find that technical cooperation grants and overseas development assistance grants are major mechanisms through which returns to R&D investments in G7 countries flows to Sub-Saharan African countries. However, their influence has declined over the years. Finally, the third essay tests the hypothesis that the relationship between a country's exporters and their foreign purchasing agents may lead to the exchange of ideas and thereby improve the manufacturing process and productivity in the exporting country. I test this hypothesis using disaggregated export data from OECD countries. The foreign R&D capital stock in this essay was constructed as exports weighted average of domestic R&D capital stock. I find empirical support for the hypothesis. In particular, capital goods exports generate more learning effects and therefore best explain productivity in OECD countries than non-capital goods exports.