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Impact of Early Surgery and Immunosuppression on Crohn's Disease Disabling Outcomes
Fernando Magro1, Cláudia C Dias, Rosa Coelho
11Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; 2MedInUP-Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal; 3MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; 4CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal; 5Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; 6Gastroenterology Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Portugal; 7Gastroenterology Department, Centro Hospitalar do Porto, Portugal; 8Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Portugal; 9Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Portugal; 10Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal; 11Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; 12Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital S. Bernardo, Portugal; 13Department of Biomedical Sciences and Medicine, University of Algarve; 14Gastroenterology Department, Hospital de Faro, Portugal; 15Instituto Português de Oncologia de Lisboa; 16Gastroenterology Department, Centro Hospitalar Lisboa Oriental, Portugal; 17Gastroenterology Department, Hospital de Braga, Portugal; 18Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portugal; and 19Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal.
Background And Aims:
The definition of early therapeutic strategies to control Crohn's disease aggressiveness and prevent recurrence is key to improve clinical practice. This study explores the impact of early surgery and immunosuppression onset in the occurrence of disabling outcomes.
Methods:
This was a multicentric and retrospective study with 754 patients with Crohn's disease, who were stratified according to the need for an early surgery (group S) or not (group I) and further divided according to the time elapsed from the beginning of the follow-up to the start of immunosuppression therapy.
Results:
The rate of disabling events was similar in both groups (S: 77% versus I: 76%, P = 0.700). The percentage of patients who needed surgery after or during immunosuppression therapy was higher among group S, both for first surgeries after the index event (38% of groups S versus 21% of group I, P < 0.001) and for reoperations (38% of groups S versus 12% of group I, P < 0.001). The time elapsed to reoperation was shorter in group I (HR = 2.340 [1.367-4.005]), stratified for the onset of immunosuppression. Moreover, reoperation was far more common among patients who had a late start of immunosuppression (S36: 50% versus S0-6: 27% and S6-36: 25%, P < 0.001) and (I36: 16% versus I0-6: 5% and I6-36: 7%, P < 0.001).
Conclusions:
Although neither early surgery nor immunosuppression seem to be able to prevent global disabling disease, an early start of immunosuppression by itself is associated with fewer surgeries and should be considered in daily practice as a preventive strategy.
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