Hawthorne, AB; Arms-Williams, B; Cannings-John, R; Pollok, RCG; Berry, A; Harborne, P; Trivedi, A
(2024)
Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study.
BMJ Open Gastroenterol, 11 (1).
ISSN 2054-4774
https://doi.org/10.1136/bmjgast-2024-001373
SGUL Authors: Pollok, Richard Charles G
Abstract
OBJECTIVE: It is unclear whether widespread use of biologics is reducing inflammatory bowel disease (IBD) surgical resection rates. We designed a population-based study evaluating the impact of early antitumour necrosis factor (TNF) on surgical resection rates up to 5 years from diagnosis. DESIGN: We evaluated all patients with IBD diagnosed in Cardiff, Wales 2005-2016. The primary measure was the impact of early (within 1 year of diagnosis) sustained (at least 3 months) anti-TNF compared with no therapy on surgical resection rates. Baseline factors were used to balance groups by propensity scores, with inverse probability of treatment weighting (IPTW) methodology and removing immortal time bias. Crohn's disease (CD) and ulcerative colitis (UC) with IBD unclassified (IBD-U) (excluding those with proctitis) were analysed. RESULTS: 1250 patients were studied. For CD, early sustained anti-TNF therapy was associated with a reduced likelihood of resection compared with no treatment (IPTW HR 0.29 (95% CI 0.13 to 0.65), p=0.003). In UC including IBD-U (excluding proctitis), there was an increase in the risk of colectomy for the early sustained anti-TNF group compared with no treatment (IPTW HR 4.6 (95% CI 1.9 to 10), p=0.001). CONCLUSIONS: Early sustained use of anti-TNF therapy is associated with reduced surgical resection rates in CD, but not in UC where there was a paradoxical increased surgery rate. This was because baseline clinical factors were less predictive of colectomy than anti-TNF usage. These data support the use of early introduction of anti-TNF therapy in CD whereas benefit in UC cannot be assessed by this methodology.
Item Type: |
Article
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Additional Information: |
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
Keywords: |
CROHN'S DISEASE, SURGERY FOR IBD, ULCERATIVE COLITIS, Humans, Male, Female, Adult, Colectomy, Middle Aged, Tumor Necrosis Factor-alpha, Crohn Disease, Colitis, Ulcerative, Inflammatory Bowel Diseases, Infliximab, Young Adult, Treatment Outcome, Retrospective Studies, Aged, Propensity Score, Tumor Necrosis Factor Inhibitors, Humans, Colitis, Ulcerative, Inflammatory Bowel Diseases, Crohn Disease, Tumor Necrosis Factor-alpha, Treatment Outcome, Colectomy, Retrospective Studies, Adult, Aged, Middle Aged, Female, Male, Young Adult, Propensity Score, Infliximab, Tumor Necrosis Factor Inhibitors |
SGUL Research Institute / Research Centre: |
Academic Structure > Infection and Immunity Research Institute (INII) |
Journal or Publication Title: |
BMJ Open Gastroenterol |
ISSN: |
2054-4774 |
Language: |
eng |
Dates: |
Date | Event |
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22 May 2024 | Published | 2 May 2024 | Accepted |
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Publisher License: |
Creative Commons: Attribution-Noncommercial 4.0 |
PubMed ID: |
38777566 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/116553 |
Publisher's version: |
https://doi.org/10.1136/bmjgast-2024-001373 |
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