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Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates

Eberhardson, Michael ; Myrelid, Pär ; Söderling, Jonas K. ; Ekbom, Anders ; Everhov, Åsa H. ; Hedin, Charlotte R.H. ; Neovius, Martin ; Ludvigsson, Jonas F. and Olén, Ola (2022) In Colorectal Disease 24(4). p.470-483
Abstract

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... (More)

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.

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Strid, Hans ; Hjortswang, Henrik ; Olsson, Malin ; Björk, Jan ; Bengtsson, Jonas L. ; Halfvarson, Jonas ; Andersson, Marie A. ; Karling, Pontus ; Rejler, Martin ; Jäghult, Susanna ; Fagerberg, Ulrika L. ; LU and Nordenvall, Caroline
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Colorectal Disease
volume
24
issue
4
pages
470 - 483
publisher
Wiley-Blackwell
external identifiers
  • pmid:34905282
  • scopus:85123500311
ISSN
1462-8910
DOI
10.1111/codi.16021
language
English
LU publication?
yes
additional info
Funding Information: ME has received honoraria for lectures and consultancy from AbbVie, Merck (MSD), Takeda, Ferring, Orion Pharma, Otsuka, Tillotts, ITH, Novartis, Pfizer and Janssen, and received research funding from AbbVie and MSD. JKS has served as an external consultant to Parexel and Janssen. OO has been Principal Investigator on projects at Karolinska Institutet partly financed by investigator‐initiated grants from Janssen and Ferring, and also reports a grant from Pfizer in the context of a national safety monitoring program. None of those studies have any relation to the present study. Karolinska Institutet also has received fees for OO's lectures and participation on advisory boards from Janssen, Ferring, Takeda and Pfizer regarding topics not related to the present study. PM has received honoraria for lectures from Ferring, AbbVie and Takeda and has served as an external consultant to Janssen and AbbVie and has been Principal Investigator for a research project partly funded by Takeda. CH has received honoraria for lectures from Ferring, AbbVie, Janssen and Takeda and has served as an external consultant to Pfizer. ÅHE has worked on projects at Karolinska Institutet and SWIBREG partly financed by grants from Ferring and Jansen. Funding Information: ME was supported by the Bengt Ihre Research Fellowship and Stockholm County Council ALF (project number 20180565). OO was supported by the SFO Young Scholar Award at Karolinska Institutet, the Swedish Research Council (Dnr 2020‐02002) and the Swedish Society of Medicine. OO was funded by Stockholm County Council ALF (project numbers 20170720 and 20190638 respectively). CH was funded by a Bengt Ihre Fellowship and a Stockholm County Council postdoctoral fellowship. ÅHE was supported by grants from the Bengt Ihre Foundation and the Bengt Ihre Research Fellowship. None of the funding organizations has had any role in the design and conduct of the study; in the collection, management and analysis of the data; or in the preparation, review and approval of the manuscript. Publisher Copyright: © 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
id
adef9445-08f0-4d3e-a5cc-b897f3105e60
date added to LUP
2022-03-02 11:07:41
date last changed
2022-06-30 07:39:21
@article{adef9445-08f0-4d3e-a5cc-b897f3105e60,
  abstract     = {{<p>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.</p>}},
  author       = {{Eberhardson, Michael and Myrelid, Pär and Söderling, Jonas K. and Ekbom, Anders and Everhov, Åsa H. and Hedin, Charlotte R.H. and Neovius, Martin and Ludvigsson, Jonas F. and Olén, Ola}},
  issn         = {{1462-8910}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{470--483}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Colorectal Disease}},
  title        = {{Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates}},
  url          = {{http://dx.doi.org/10.1111/codi.16021}},
  doi          = {{10.1111/codi.16021}},
  volume       = {{24}},
  year         = {{2022}},
}