Anti‐TNF treatment in Crohn's disease and risk of bowel resection—a population based cohort study

Abstract

The risk of bowel resection after start of anti-TNF treatment is higher in regular health care than in published RCTs. Patients on sustained TNFi treatment beyond 12 months have bowel resection rates similar to those who discontinue TNFi treatment earlier.

Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

“…A potential confounding variable, accounting for an increase in time from diagnosis to surgery is improved, earlier diagnosis. However within this cohort referral patterns to the Southampton paediatric IBD referral centre have not changed over the study period, routine use of faecal calprotectin in children was not introduced to the region until 2016‐2017 and we have not observed a reduction in the disease severity at diagnosis . Additionally, data recently published do not indicate a general shift to earlier diagnosis or improved diagnostics in children with IBD, with significant diagnostic delay remaining common in recent years .…”

“…However within this cohort referral patterns to the Southampton paediatric IBD referral centre have not changed over the study period, routine use of faecal calprotectin in children was not introduced to the region until 2016-2017 and we have not observed a reduction in the disease severity at diagnosis. 31 Additionally, data recently published do not indicate a general shift to earlier diagnosis or improved diagnostics in children with IBD, with significant diagnostic delay remaining common in recent years. 32,33 41,42 There is a trend towards top-down medicine when treating IBD in adult populations, with early initiation of anti-TNF therapy aiming to modify disease course.…”

Is the need for inflammatory bowel disease surgery diminishing in the biologic era?

“…The rate of surgery in this cohort is 2.7 times higher for those receiving biologic therapy . Real‐world Swedish nationwide data show that Crohn's resection rates are higher than in clinical trials, with similar rates of surgery independent of the length of anti‐TNF treatment . The Epi‐IBD European population‐based inception cohorts concluded at five years that there was no statistically significant association between biologic use and luminal resection for CD or UC .…”

Letter: anti‐TNF therapy and intestinal resections in Crohn’s disease—are we just delaying the inevitable?

“…This hypothesis makes the report from Murthy et al even more intriguing, with similar data also demonstrating that anti-TNF therapy does not affect bowel resections in the long-term management of CD. 8 It is possible that these results are explained by anti-TNF agents merely delaying resection through shrinking the inflammatory component of disease. In patients with the stricturing phenotype, the introduction of anti-TNF therapy would not reduce the number of intestinal resections as the molecular cause for stricturing disease is, at least in part, distinct from the inflammatory aetiology.…”