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Early Biologic Treatment Decreases Risk of Surgery in Crohn's Disease but not in Ulcerative Colitis: Systematic

Cindy C Y Law1, Bryce Tkachuk2, Stephen Lieto3

  • 1Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Inflammatory Bowel Diseases
|July 28, 2023
PubMed

Insights

Early biologic therapy reduces surgery rates in Crohn's disease (CD) but increases colectomy risk in ulcerative colitis (UC). This systematic review analyzes long-term IBD surgery outcomes based on treatment timing.

Area of Science:

  • Gastroenterology
  • Immunology
  • Clinical Medicine

Background:

  • Inflammatory bowel disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC), often leading to significant long-term complications.
  • Early biologic treatment in IBD has shown mixed results for short-term outcomes, with conflicting data on long-term adverse events like surgery.
  • This study systematically reviews the impact of early versus late biologic intervention on IBD-related surgical rates.

Approach:

  • A comprehensive systematic search was performed in April 2022.
  • Included studies compared early (<3 years from diagnosis) versus late (>3 years from diagnosis) biologic initiation.
  • Meta-analysis of 18 studies assessed colectomy rates in UC and CD-related surgery in CD, excluding studies with <1 year follow-up.

Key Points:

  • In Crohn's disease (CD), early biologic therapy was associated with significantly lower odds of surgery (OR 0.63).
  • Conversely, in ulcerative colitis (UC), early biologic therapy was linked to increased odds of colectomy (OR 2.86).
  • These findings highlight a differential impact of early biologic intervention on surgical outcomes in distinct IBD types.

Conclusions:

  • Early biologic treatment demonstrates a protective effect against surgery in Crohn's disease patients.
  • However, early biologic therapy may be associated with a higher risk of colectomy in ulcerative colitis patients.
  • Disease severity might confound the observed association between early biologics and colectomy in UC.
Abstract

Keywords:
Crohn’s diseasebiologiccolectomyearlyulcerative colitis

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