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Title: Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents.
Author: Guasch M, Cañete F, Ordás I, Iglesias-Flores E, Clos A, Gisbert JP, Taxonera C, Vera I, Mínguez M, Guardiola J, Rivero M, Nos P, Gomollón F, Barrio J, de Francisco R, López-Sanromán A, Martín-Arranz MD, Garcia-Planella E, Camargo R, García-López S, de Castro L, Calvet X, Esteve M, Mañosa M, Domènech E, GETECCU-ENEIDA registry.
Journal: J Gastroenterol Hepatol; 2020 Dec; 35(12):2080-2087. PubMed ID: 32350906.
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.

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