Which first? Surgery or biologic therapy for ileocolic Crohn's disease in the real world

A laparoscopic ileocolic resection could lead to a better outcome to infliximab for ileocolic Crohn's disease. The aim of this study was to explore real world clinical outcomes in biologic-naïve patients with ileocolic Crohn's disease.

All patients with ileocolic Crohn's disease treated at our institution between January 2011 and December 2018 with biologics or surgical resection were included.

Overall, 222 patients were included, of which 149 (67%) underwent surgery before biologic therapy. Among these, 54 patients (36%) required post-operative biologic therapy. Seventy-three patients were treated with biologics first, of which 29 (40%) subsequently required a surgical resection (p = 0.60). There were 95 patients (43%) who were successfully treated with a surgery-first approach alone. Median follow-up was 73 months (0-406). Characteristics associated on multivariable analysis with change from surgery to biologics were: gender (female) (p = 0.010), presence of obstructive symptoms (p = 0.028), and smoking (p = 0.030). Characteristics associated with changing from biologics to surgery were: isolated terminal ileum disease (p = 0.001) and the presence of obstructive symptoms (p = 0.003).

In our cohort, the risk of recurrent ileocolic Crohn's disease was similar whether patients were treated with a 'surgery first' or 'biologic first' approach.