Temporal Trends in Surgical Resection Rates and Biologic Prescribing in Crohn's Disease: A Population-based Cohort...

Area of Science:

• Gastroenterology
• Immunology
• Clinical Medicine

Background:

• Biologic therapy use in Crohn's disease (CD) is evolving, but its impact on surgical needs remains unclear.
• Assessing trends in biologic prescription and surgery over time is crucial for understanding CD management.
• Population-based data provides valuable insights into real-world treatment outcomes.

Purpose of the Study:

• To evaluate the association between biologic therapy trends and surgical requirements in Crohn's disease patients.
• To analyze changes in biologic prescription and CD-related surgery over a defined period.
• To determine if earlier or more aggressive biologic treatment impacts the need for surgery.

Main Methods:

• Retrospective cohort study of 1753 patients diagnosed with Crohn's disease in Lothian, Scotland (2000-2017).
• Electronic health records were reviewed to identify CD-related surgeries and biologic prescriptions.
• Cumulative probabilities and hazard ratios for surgery and biologic use were calculated and compared across diagnosis year cohorts.

Main Results:

• The 5-year cumulative risk of surgery decreased significantly over time, from 20.4% (2000-2004) to 13.0% (2014-2017).
• Concurrently, the 5-year cumulative risk of biologic prescription increased substantially, from 5.7% (2000-2004) to 44.9% (2014-2017).
• These trends were statistically significant (p <0.001).

Conclusions:

• Earlier and increased use of biologic therapy in Crohn's disease patients is associated with a reduced need for surgery.
• Adopting a 'top-down' or accelerated 'step-up' treatment approach may effectively lower surgery rates in newly diagnosed CD patients.
• These findings support optimizing biologic treatment strategies for improved long-term outcomes in Crohn's disease management.