Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents.

Autor: Guasch M; Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain., Cañete F; Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain., Ordás I; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.; Hospital Clínic and IDIBAPS (Barcelona, Catalonia), Madrid, Spain., Iglesias-Flores E; Hospital Reina Sofía (Córdoba), Córdoba, Spain., Clos A; Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain., Gisbert JP; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.; Hospital de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (Madrid), Madrid, Spain., Taxonera C; Hospital Clínico San Carlos, Instituto de Investigación del Hospital Clínico San Carlos (IdISSC) (Madrid), Madrid, Spain., Vera I; Hospital Universitario Puerta de Hierro (Madrid), Majadahonda, Spain., Mínguez M; H. Clínico de Valencia i Universitat de València (València), Valencia, Spain., Guardiola J; Hospital Universitari de Bellvitge IDIBELL and Universitat de Barcelona (L'Hospitalet del Llobregat, Catalonia), Llobregat, Spain., Rivero M; Hospital Marqués de Valdecilla and IDIVAL (Santander), Santander, Spain., Nos P; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.; Hospital Universitari i Politècnic La Fe (Valencia), Valencia, Spain., Gomollón F; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.; IIS Aragón, Hospital Clínico Lozano Blesa (Zaragoza), Zaragoza, Spain., Barrio J; H. Río Hortega (Valladolid), Spain., de Francisco R; Hospital Universitario Central de Asturias e Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) (Oviedo), Spain., López-Sanromán A; Hospital Ramón y Cajal (Madrid), Madrid, Spain., Martín-Arranz MD; Hospital La Paz and Instituto de Investigación La Paz (IdiPaz) (Madrid), Madrid, Spain., Garcia-Planella E; Hospital de la Santa Creu i Sant Pau (Barcelona, Catalonia), Spain., Camargo R; Hospital Clínico Virgen de la Victoria (Málaga), Spain., García-López S; Hospital Universitario Miguel Servet (Zaragoza), Spain., de Castro L; Complejo Hospitalario Universitario de Vigo (Vigo), Spain., Calvet X; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.; Hospital Parc Taulí (Sabadell, Catalonia), Spain., Esteve M; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.; Hospital Mútua Terrassa (Terrassa, Catalonia), Spain., Mañosa M; Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain., Domènech E; Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.
Jazyk: angličtina
Zdroj: Journal of gastroenterology and hepatology [J Gastroenterol Hepatol] 2020 Dec; Vol. 35 (12), pp. 2080-2087. Date of Electronic Publication: 2020 May 10.
DOI: 10.1111/jgh.15084
Abstrakt: Background and Aim: Biological therapies may be changing the natural history of inflammatory bowel diseases (IBDs), reducing the need for surgical intervention. We aimed to assess whether the availability of anti-TNF agents impacts the need for early surgery in Crohn's disease (CD) and ulcerative colitis (UC).
Methods: Retrospective, cohort study of patients diagnosed within a 6-year period before and after the licensing of anti-TNFs (1990-1995 and 2007-2012 for CD; 1995-2000 and 2007-2012 for UC) were identified in the ENEIDA Registry. Surgery-free survival curves were compared between cohorts.
Results: A total of 7370 CD patients (2022 in Cohort 1 and 5348 in Cohort 2) and 8069 UC patients (2938 in Cohort 1 and 5131 in Cohort 2) were included. Immunosuppressants were used significantly earlier and more frequently in both CD and UC post-biological cohorts. The cumulative probability of surgery was lower in CD following anti-TNF approval (16% and 11%, 22% and 16%, and 29% and 19%, at 1, 3, and 5 years, respectively P < 0.0001), although not in UC (3% and 2%, 4% and 4%, and 6% and 5% at 1, 3, and 5 years, respectively; P = 0.2). Ileal involvement, older age at diagnosis and active smoking in CD, and extensive disease in UC, were independent risk factors for surgery, whereas high-volume IBD centers (in both CD and UC) and immunosuppressant use (in CD) were protective factors.
Conclusions: Anti-TNF availability was associated with a reduction in early surgery for CD (driven mainly by earlier and more widespread immunosuppressant use) but not in UC.
(© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
Databáze: MEDLINE
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