Preoperative Serum Vedolizumab Levels Do Not Impact Postoperative Outcomes in Inflammatory Bowel Disease

Parrish, Aaron B.; Lopez, Nicole; Truong, Adam; Zaghiyan, Karen; Melmed, Gil Y.; McGovern, Dermot; Ha, Christina; Syal, Gaurav; Bonthala, Nirupama; Jain, Anjali; Landers, Carol J.; Targan, Stephan R.; Fleshner, Phillip

doi:10.1097/dcr.0000000000001920

Cited by 11 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding vedolizumab, only one study has assessed the impact of preoperative vedolizumab drug concentrations on postoperative outcomes in patients undergoing major abdominal surgery for IBD [ 25 ]. Of the 72 patients with preoperative exposure, 38 (53%) patients had detectable (>1.6 μg/mL), and 34 (47%) had undetectable vedolizumab concentrations.…”

Section: Tdm and Postoperative Complications In Ibdmentioning

confidence: 99%

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Nones

Fleshner

Queiroz

et al. 2021

JCM

View full text Add to dashboard Cite

Despite significant development in the pharmacological treatment of inflammatory bowel diseases (IBD) along with the evolution of therapeutic targets and treatment strategies, a significant subset of patients still requires surgery during the course of the disease. As IBD patients are frequently exposed to biologics at the time of abdominal and perianal surgery, it is crucial to identify any potential impact of biological agents in the perioperative period. Even though detectable serum concentrations of biologics do not seem to increase postoperative complications after abdominal procedures in IBD, there is increasing evidence on the role of therapeutic drug monitoring (TDM) in the perioperative setting. This review aims to provide a comprehensive summary of published studies reporting the association of drug concentrations and postoperative outcomes, postoperative recurrence (POR) after an ileocolonic resection for Crohn’s disease (CD), colectomy rates in ulcerative colitis (UC), and perianal fistulizing CD outcomes in patients treated with biologics. Current data suggest that serum concentrations of biologics are not associated with an increased risk in postoperative complications following abdominal procedures in IBD. Moreover, higher concentrations of anti-TNF agents are associated with a reduction in colectomy rates in UC. Finally, higher serum drug concentrations are associated with reduced rates of POR after ileocolonic resections and increased rates of perianal fistula healing in CD. TDM is being increasingly used to guide clinical decision making with favorable outcomes in many clinical scenarios. However, given the lack of high quality data deriving mostly from retrospective studies, the evidence supporting the systematic application of TDM in the perioperative setting is still inconclusive.

show abstract

Section: Tdm and Postoperative Complications In Ibdmentioning

confidence: 99%

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Nones

Fleshner

Queiroz

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…1 and Table 2). [7][8][9][10][11]13,[16][17][18][19][20][21][22][23][24][25][26][27][28][32][33][34][35][36][38][39][40][41][42] These articles included 7 meta-analyses or systematic reviews and 5 randomized studies. Most studies included were CASP criteria for cohort studies: 1) Did the study address a clearly focused issue?…”

Section: Resultsmentioning

confidence: 99%

Impact of Biologics and Small Molecule Agents on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review

Lee,

Sizemore,

Kim

et al. 2024

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

BACKGROUND: Patients with inflammatory bowel disease may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. The question of the impact of biologic use on postoperative complications is a topic of active investigation. OBJECTIVE: A systematic literature review was performed to describe the current state of knowledge of the impact of perioperative biologic and tofacitinib use on postoperative complications in patients with inflammatory bowel disease. DATA SOURCES: PubMed and Cochrane databases were searched. STUDY SELECTION: Studies between January 2000 and January 2023, in any language, were searched, followed by a snowball search identifying further studies, in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Articles regarding pediatric or endoscopic management were excluded. INTERVENTIONS: Preoperative or perioperative exposure to biologics in inflammatory bowel disease was included. MAIN OUTCOME MEASURES: Infectious and noninfectious complications, including anastomotic leaks, surgical site infections, urinary tract infections, pneumonia, sepsis, septic shock, postoperative length of stay, readmission, and reoperation, were the main outcomes measured. RESULTS: A total of 28 studies were included for analysis in this review, including 7 meta-analyses or systematic reviews, and 5 randomized studies. Snowball search identified 11 additional studies providing topical information. Overall, tumor necrosis factor inhibitors likely do not increase risk of postoperative adverse outcomes, while data on other biologics and small molecule agents are emerging. LIMITATIONS: This is a qualitative review including all study types. The varied nature of study types precludes quantitative comparison. CONCLUSIONS: Although steroids increase postoperative infectious and noninfectious complications, tumor necrosis factor inhibitors do not appear to increase postoperative infectious and non-infectious complications. There is a need for further perioperative data for other agents. See Video.

show abstract

“…Importantly, most studies were performed in retrospective fashion, making it difficult to control for circumstances such as steroid use, acuity of surgery, and other potential confounding factors. [15][16][17][18][19] The Cochrane Database Review by Law et al identified nine studies comparing anti-integrin therapy to no antiintegrin therapy and did not show any difference in infectious complications. However, this was low-quality evidence with significant study heterogeneity.…”

Section: Tnf-α Inhibitorsmentioning

confidence: 99%

Perioperative Assessment and Optimization in Major Colorectal Surgery: Medication Management

Kane

Berry

2023

Clin Colon Rectal Surg

View full text Add to dashboard Cite

The colorectal surgeon is often faced with medications that can be challenging to manage in the perioperative period. In the era of novel agents for anticoagulation and immunotherapies for inflammatory bowel disease and malignancy, understanding how to advise patients about these medications has become increasingly complex. Here, we aim to provide clarity regarding the use of these agents and their perioperative management, with a particular focus on when to stop and restart them perioperatively. This review will begin with the management of both nonbiologic and biologic therapies used in the treatment of inflammatory bowel disease and malignancy. Then, discussion will shift to anticoagulant and antiplatelet medications, including their associated reversal agents. Upon finishing this review, the reader will have gained an increased familiarity with the management of common medications requiring modification by colorectal surgeons in the perioperative period.

show abstract

Preoperative Serum Vedolizumab Levels Do Not Impact Postoperative Outcomes in Inflammatory Bowel Disease

Cited by 11 publications

References 24 publications

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Therapeutic Drug Monitoring of Biologics in IBD: Essentials for the Surgical Patient

Impact of Biologics and Small Molecule Agents on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review

Perioperative Assessment and Optimization in Major Colorectal Surgery: Medication Management

Contact Info

Product

Resources

About