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Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study

A Barney Hawthorne1,2, Bradley Arms-Williams3, Rebecca Cannings-John4

  • 1Department of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UK abhawth@aol.com.

BMJ Open Gastroenterology
|May 22, 2024
PubMed

Insights

Early anti-tumour necrosis factor (TNF) therapy reduces surgery for Crohn's disease (CD) but paradoxically increases colectomy risk in ulcerative colitis (UC). This impacts IBD treatment strategies.

Area of Science:

  • Gastroenterology
  • Immunology
  • Clinical Medicine

Background:

  • Widespread use of biologics in inflammatory bowel disease (IBD) necessitates evaluating their impact on surgical resection rates.
  • The effect of early anti-tumour necrosis factor (TNF) therapy on long-term surgical outcomes in IBD remains unclear.

Purpose of the Study:

  • To assess the impact of early, sustained anti-TNF therapy on surgical resection rates in IBD patients up to five years post-diagnosis.
  • To compare surgical resection rates between patients receiving early anti-TNF therapy and those receiving no therapy.

Main Methods:

  • Population-based study of 1250 IBD patients diagnosed in Wales (2005-2016).
  • Propensity score matching and inverse probability of treatment weighting (IPTW) used to balance baseline characteristics and mitigate bias.
  • Analysis focused on Crohn's disease (CD) and ulcerative colitis (UC) including IBD unclassified (IBD-U), excluding proctitis.

Main Results:

  • Early sustained anti-TNF therapy was associated with a significantly reduced likelihood of resection in CD (IPTW HR 0.29, p=0.003).
  • Conversely, in UC (including IBD-U), early sustained anti-TNF therapy showed a significantly increased risk of colectomy (IPTW HR 4.6, p=0.001).

Conclusions:

  • Early sustained anti-TNF therapy demonstrates a benefit in reducing surgical resection rates for Crohn's disease.
  • A paradoxical increase in colectomy risk was observed with early anti-TNF use in ulcerative colitis, suggesting baseline clinical factors are less predictive than treatment.
  • These findings support early anti-TNF introduction in CD but indicate current methodology may not adequately assess its benefit in UC.
Abstract

Keywords:
CROHN'S DISEASESURGERY FOR IBDULCERATIVE COLITIS

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