Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents.

Abstract

BACKGROUND AND AIM:

Biological therapies may be changing the natural history of inflammatory bowel diseases (IBDs), reducing the need for surgical intervention. We aimed to assess whether the availability of anti-TNF agents impacts the need for early surgery in Crohn's disease (CD) and ulcerative colitis (UC).

METHODS:

Retrospective, cohort study of patients diagnosed within a 6-year period before and after the licensing of anti-TNFs (1990-1995 and 2007-2012 for CD; 1995-2000 and 2007-2012 for UC) were identified in the ENEIDA Registry. Surgery-free survival curves were compared between cohorts.

RESULTS:

A total of 7370 CD patients (2022 in Cohort 1 and 5348 in Cohort 2) and 8069 UC patients (2938 in Cohort 1 and 5131 in Cohort 2) were included. Immunosuppressants were used significantly earlier and more frequently in both CD and UC post-biological cohorts. The cumulative probability of surgery was lower in CD following anti-TNF approval (16% and 11%, 22% and 16%, and 29% and 19%, at 1, 3, and 5 years, respectively P < 0.0001), although not in UC (3% and 2%, 4% and 4%, and 6% and 5% at 1, 3, and 5 years, respectively; P = 0.2). Ileal involvement, older age at diagnosis and active smoking in CD, and extensive disease in UC, were independent risk factors for surgery, whereas high-volume IBD centers (in both CD and UC) and immunosuppressant use (in CD) were protective factors.

CONCLUSIONS:

Anti-TNF availability was associated with a reduction in early surgery for CD (driven mainly by earlier and more widespread immunosuppressant use) but not in UC.

• Authors: Montserrat Guasch, Fiorella Cañete, Ingrid Ordás, Eva Iglesias-Flores, Ariadna Clos, Javier P Gisbert, Carlos Taxonera, Isabel Vera, Miguel Mínguez, Jordi Guardiola, Montserrat Rivero, Pilar Nos, Fernando Gomollón, Jesús Barrio, Ruth de Francisco, Antonio López-Sanromán, M Dolores Martín-Arranz, Esther Garcia-Planella, Raquel Camargo, Santiago García-López, Luisa de Castro, Xavier Calvet, Maria Esteve, Míriam Mañosa, Eugeni Domènech, GETECCU-ENEIDA registry
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 35 Issue 12 Pg. 2080-2087 (Dec 2020) ISSN: 1440-1746 [Electronic] Australia
• PMID: 32350906 (Publication Type: Journal Article)
• Copyright: © 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Chemical References

• Biological Factors
• Gastrointestinal Agents
• Immunosuppressive Agents
• Tumor Necrosis Factor-alpha
• Infliximab

Topics

• Adult
• Age Factors
• Biological Factors (therapeutic use)
• Colitis, Ulcerative (drug therapy, mortality, surgery)
• Crohn Disease (drug therapy, mortality, surgery)
• Disease-Free Survival
• Female
• Gastrointestinal Agents (pharmacology, therapeutic use)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Infliximab (pharmacology, therapeutic use)
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Time Factors
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Young Adult