Comparison of time until elective intestinal resection regarding previous anti-tumor necrosis factor exposure: a Brazilian study on patients with Crohn's disease

Abstract

Background/AimsThe use of anti-tumor necrosis factor (anti-TNF) agents seems to reduce surgical rates and delay surgical procedures in prospective trials and population-based studies in the management of Crohn's disease (CD). This study aimed to identify whether preoperative anti-TNF agents influence the time from diagnosis to surgery.MethodsAn observational retrospective cohort study was conducted on patients with CD submitted to intestinal resections due to complications or medical therapy failure in a period of 7 years. The patients were allocated into 2 groups according to their previous exposure to anti-TNF agents in the preoperative period. Epidemiological aspects regarding age at diagnosis, smoking, perianal disease, and preoperative conventional therapy were considered. A Kaplan-Meier survival analysis was used to outline possible differences between the groups regarding the time to surgery.ResultsA total of 123 patients were included (71 and 52 with and without previous exposure to biologics, respectively). The overall time to surgery was 108±6.9 months (maximum, 276 months). The survival estimation revealed no difference in the mean time to intestinal resection between the groups (99.78±10.62 months in the patients without and 114.01±9.07 months in those with previous anti-TNF use) (log-rank P=0.35). There was no significant difference in the time to surgery regarding perianal CD (P=0.49), smoking (P=0.63), preoperative azathioprine (P=0.073) and steroid use (P=0.58).ConclusionsThe time from diagnosis to surgery was not influenced by the preoperative use of anti-TNF therapy in this cohort of patients.

Early Initiation of Anti-TNF is Associated with Favourable Long-term Outcome in Crohn’s Disease: 10-Year-Follow-up Data from the Swiss IBD Cohort Study

“…This has previously been suggested in a study by Allocca et al [28] on stricturing CD, which showed that anti-TNF agents might prevent surgery in up to two-thirds of patients with intestinal stenosis. The beneficial effects of early anti-TNF administration seem to be selective for bowel stenosis, as neither the current study nor the previous investigations identified any effects on the overall need for surgery in CD [29][30][31].…”

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

“…In previous data from our Southern United Kingdom (Wessex) region (1997‐2014), 9% of patients with ulcerative colitis underwent colectomy prior to transition to adult service . Three other studies over a 25‐year time period (from 1996) reported colectomy rates varying between 6% and 24% . In Crohn's disease, 24% of Wessex patients underwent a surgical procedure during childhood (2002‐2012) .…”

“…13 Three other studies over a 25-year time period (from 1996) reported colectomy rates varying between 6% and 24%. [14][15][16] In Crohn's disease, 24% of Wessex patients underwent a surgical procedure during childhood (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). 12 This number was comparable with other studies reporting around 1/3 patients undergoing a surgical procedure during childhood.…”

Modern surgical strategies for perianal Crohn's disease

“…In Crohn’s disease (CD), perianal symptoms occur in up to 50% of patients with concurrent symptoms involving other portions of the gastrointestinal tract; in 5% of cases, perianal symptoms occur as the first manifestation of CD[ 1 ]. A challenging phenotype of CD is perianal fistulizing CD (PFCD), an aggressive, debilitating condition associated with significant morbidity that can negatively affect quality of life[ 2 ]. Treatment is difficult, often requiring more aggressive medical and surgical interventions than luminal disease.…”