Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study
Objective It is unclear whether widespread use of biologics is reducing inflammatory bowel disease (IBD) surgical resection rates. We designed a population-based study evaluating the impact of early antitumour necrosis factor (TNF) on surgical resection rates up to 5 years from diagnosis.Design We e...
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BMJ Publishing Group
2024-07-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/11/1/e001373.full |
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| author | Richard C G Pollok Rebecca Cannings-John Philip Harborne A Barney Hawthorne Bradley Arms-Williams Alexander Berry Anjali Trivedi |
| author_facet | Richard C G Pollok Rebecca Cannings-John Philip Harborne A Barney Hawthorne Bradley Arms-Williams Alexander Berry Anjali Trivedi |
| author_sort | Richard C G Pollok |
| collection | DOAJ |
| description | Objective It is unclear whether widespread use of biologics is reducing inflammatory bowel disease (IBD) surgical resection rates. We designed a population-based study evaluating the impact of early antitumour necrosis factor (TNF) on surgical resection rates up to 5 years from diagnosis.Design We evaluated all patients with IBD diagnosed in Cardiff, Wales 2005–2016. The primary measure was the impact of early (within 1 year of diagnosis) sustained (at least 3 months) anti-TNF compared with no therapy on surgical resection rates. Baseline factors were used to balance groups by propensity scores, with inverse probability of treatment weighting (IPTW) methodology and removing immortal time bias. Crohn’s disease (CD) and ulcerative colitis (UC) with IBD unclassified (IBD-U) (excluding those with proctitis) were analysed.Results 1250 patients were studied. For CD, early sustained anti-TNF therapy was associated with a reduced likelihood of resection compared with no treatment (IPTW HR 0.29 (95% CI 0.13 to 0.65), p=0.003). In UC including IBD-U (excluding proctitis), there was an increase in the risk of colectomy for the early sustained anti-TNF group compared with no treatment (IPTW HR 4.6 (95% CI 1.9 to 10), p=0.001).Conclusions Early sustained use of anti-TNF therapy is associated with reduced surgical resection rates in CD, but not in UC where there was a paradoxical increased surgery rate. This was because baseline clinical factors were less predictive of colectomy than anti-TNF usage. These data support the use of early introduction of anti-TNF therapy in CD whereas benefit in UC cannot be assessed by this methodology. |
| format | Article |
| id | doaj-art-e39ea2817b794b1ca022eccb53dd827e |
| institution | OA Journals |
| issn | 2054-4774 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-e39ea2817b794b1ca022eccb53dd827e2025-08-20T02:12:47ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742024-07-0111110.1136/bmjgast-2024-001373Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based studyRichard C G Pollok0Rebecca Cannings-John1Philip Harborne2A Barney Hawthorne3Bradley Arms-Williams4Alexander Berry5Anjali Trivedi6Institute for Infection and Immunity, St George`s University of London, London, UKCentre for Trials Research, Cardiff University, Cardiff, UKDepartment of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UKDepartment of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UKDepartment of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UKDepartment of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UKDepartment of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UKObjective It is unclear whether widespread use of biologics is reducing inflammatory bowel disease (IBD) surgical resection rates. We designed a population-based study evaluating the impact of early antitumour necrosis factor (TNF) on surgical resection rates up to 5 years from diagnosis.Design We evaluated all patients with IBD diagnosed in Cardiff, Wales 2005–2016. The primary measure was the impact of early (within 1 year of diagnosis) sustained (at least 3 months) anti-TNF compared with no therapy on surgical resection rates. Baseline factors were used to balance groups by propensity scores, with inverse probability of treatment weighting (IPTW) methodology and removing immortal time bias. Crohn’s disease (CD) and ulcerative colitis (UC) with IBD unclassified (IBD-U) (excluding those with proctitis) were analysed.Results 1250 patients were studied. For CD, early sustained anti-TNF therapy was associated with a reduced likelihood of resection compared with no treatment (IPTW HR 0.29 (95% CI 0.13 to 0.65), p=0.003). In UC including IBD-U (excluding proctitis), there was an increase in the risk of colectomy for the early sustained anti-TNF group compared with no treatment (IPTW HR 4.6 (95% CI 1.9 to 10), p=0.001).Conclusions Early sustained use of anti-TNF therapy is associated with reduced surgical resection rates in CD, but not in UC where there was a paradoxical increased surgery rate. This was because baseline clinical factors were less predictive of colectomy than anti-TNF usage. These data support the use of early introduction of anti-TNF therapy in CD whereas benefit in UC cannot be assessed by this methodology.https://bmjopengastro.bmj.com/content/11/1/e001373.full |
| spellingShingle | Richard C G Pollok Rebecca Cannings-John Philip Harborne A Barney Hawthorne Bradley Arms-Williams Alexander Berry Anjali Trivedi Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study BMJ Open Gastroenterology |
| title | Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study |
| title_full | Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study |
| title_fullStr | Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study |
| title_full_unstemmed | Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study |
| title_short | Impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease: a population-based study |
| title_sort | impact of antitumour necrosis factor therapy on surgery in inflammatory bowel disease a population based study |
| url | https://bmjopengastro.bmj.com/content/11/1/e001373.full |
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