Impact of Early Surgery and Immunosuppression on Crohnʼs Disease Disabling Outcomes

Abstract

Although neither early surgery nor immunosuppression seem to be able to prevent global disabling disease, an early start of immunosuppression by itself is associated with fewer surgeries and should be considered in daily practice as a preventive strategy.

Temporal trend of disease recognition, treatment paradigm, and clinical outcomes of Crohn disease in Thailand from 2000 through 2017

“…Even though some observational studies showed no benefits, [ 4 , 19 , 37 , 39 , 42 ] 1 meta-analysis [ 5 ] and other observational studies did show benefit of early use in reducing CD-related surgeries. [ 11 , 17 , 18 , 20 , 23 , 32 , 34 , 38 , 40 , 43 ] In this cohort, we performed subgroup analysis to determine this effect. To ensure the benefits of thiopurines, only those who took the medicine for at least 3 months were included.…”

Prolonged azathioprine treatment reduces the need for surgery in early Crohn's disease

“…The cumulative probability of remaining free of CD‐related bowel surgery at 5 years was less than 15% in patients receiving AZA > 36 months, that is, lower than the previous studies . Interestingly, a recent multicentric and retrospective study with 754 patients showed that an early start of immunosuppression (< 6 months) is associated with fewer surgeries compared with late start of immunosuppression (> 36 months) . However, the optimal length of AZA therapy necessary to alter long term outcomes in CD is still a matter of debate.…”

“…8,25,26 Interestingly, a recent multicentric and retrospective study with 754 patients showed that an early start of immunosuppression (< 6 months) is associated with fewer surgeries compared with late start of immunosuppression (> 36 months). 24 However, the optimal length of AZA therapy necessary to alter long term outcomes in CD is still a matter of debate. Chebli et al demonstrated a breakthrough of symptoms during continuous AZA therapy was common, particularly after 48 months on AZA.…”

“…To investigate a potential influence of treatment duration with AZA on disease progression, a prespecified stratification of the patient population into group < 36 and ≥ 36 months was used …”

“…To investigate a potential influence of treatment duration with AZA on disease progression, a prespecified stratification of the patient population into group < 36 and ≥ 36 months was used. 23,24 The SPSS 15.0 software (SPSS Inc., Chicago, IL, USA) was used to perform all appropriate statistical analyses. Demographic and clinical parameters were compiled, and summary statistics were calculated.…”