Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents
AuthorGuasch, Montserrat; Cañete, Fiorella; Ordás, Ingrid; Iglesisas-Flores, Eva; Clos, Ariadna; Gisbert, Javier P.; Taxonera, Carlos; Vera Mendoza, María Isabel; Mínguez, Miguel; Guardiola, Jordi; Rivero, Montserrat; Nos, Pilar; Gomollón, Fernando; Barrio, Jesús; Francisco, Ruth de; López-Sanromán, Antonio; Martín Arranz, María Dolores; García Planella, Esther; Camargo, Raquel; García-López, Santiago; Castro, Luisa de; Calvet, Xavier; Esteve, María; Mañosa, Miriam; Doménech, Eugeni
EntityUAM. Departamento de Medicina
10.1111/jgh.15084Journal of Gastroenterology and Hepatology 35.12 (2020): 2080-2087
ISSN0815-9319 (print); 1440-1746 (online)
Subjectsinflammatory bowel disease; surgery; anti‐TNF; immunosuppressants; Medicina
NoteThis is the peer reviewed version of the following article: Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents. Journal of Gastroenterology and Hepatology (2020): 29 April, which has been published in final form at https://doi.org/10.1111/jgh.15084. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
Rights© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd
Biological therapies may be changing the natural history of inflammatory bowel diseases, 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 7,370 CD patients (2,022 in Cohort 1 and 5,348 in Cohort 2) and 8,069 UC patients (2,938 in Cohort 1 and 5,131 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), though 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 centres (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
Google Scholar:Guasch, Montserrat - Cañete, Fiorella - Ordás, Ingrid - Iglesisas-Flores, Eva - Clos, Ariadna - Gisbert, Javier P. - Taxonera, Carlos - Vera Mendoza, María Isabel - Mínguez, Miguel - Guardiola, Jordi - Rivero, Montserrat - Nos, Pilar - Gomollón, Fernando - Barrio, Jesús - Francisco, Ruth de - López-Sanromán, Antonio - Martín Arranz, María Dolores - García Planella, Esther - Camargo, Raquel - García-López, Santiago - Castro, Luisa de - Calvet, Xavier - Esteve, María - Mañosa, Miriam - Doménech, Eugeni
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