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Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates
Author(s) -
Eberhardson Michael,
Myrelid Pär,
Söderling Jonas K.,
Ekbom Anders,
Everhov Åsa H.,
Hedin Charlotte R. H.,
Neovius Martin,
Ludvigsson Jonas F.,
Olén Ola
Publication year - 2022
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.16021
Subject(s) - medicine , infliximab , adalimumab , inflammatory bowel disease , incidence (geometry) , crohn's disease , cohort , surgery , hazard ratio , abdominal surgery , cohort study , observational study , colorectal surgery , disease , confidence interval , physics , optics
Aim Surgery is an important therapeutic option for Crohn's disease. The need for first bowel surgery seems to have decreased with the introduction of tumour necrosis factor inhibitors (TNFi; adalimumab or infliximab). However, the impact of TNFi on the need for intestinal surgery in Crohn's disease patients irrespective of prior bowel resection is not known. The aim of this work is to compare the incidence of bowel surgery in Crohn's disease patients who remain on TNFi treatment versus those who discontinue it. Method We performed a nationwide register‐based observational cohort study in Sweden of all incident and prevalent cases of Crohn's disease who started first‐line TNFi treatment between 2006 and 2017. Patients were categorized according to TNFi treatment retention less than or beyond 1 year. The study cohort was evaluated with regard to incidence of bowel surgery from 12 months after the first ever TNFi dispensation. Results We identified 5003 Crohn's disease patients with TNFi exposure: 3748 surgery naïve and 1255 with bowel surgery prior to TNFi initiation. Of these patients, 7% ( n = 353) were subjected to abdominal surgery during the first 12 months after the start of TNFi and were subsequently excluded from the main analysis. A majority (62%) continued TNFi for 12 months or more. Treatment with TNFi for less than 12 months was associated with a significantly higher surgery rate compared with patients who continued on TNFi for 12 months or more (hazard ratio 1.26, 95% CI 1.09–1.46; p = 0.002). Conclusion Treatment with TNFi for less than 12 months was associated with a higher risk of bowel surgery in Crohn's disease patients compared with those who continued TNFi for 12 months or more.