Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden.
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Colorectal Dis. 2022 Apr;24(4):470-483. doi: 10.1111/codi.16021. Epub 2022 Jan 22.
Surgery is an important therapeutic option for Crohn's disease. The need for first bowel surgery seems to have decreased with the introduction of tumour necrosis factor inhibitors (TNFi; adalimumab or infliximab). However, the impact of TNFi on the need for intestinal surgery in Crohn's disease patients irrespective of prior bowel resection is not known. The aim of this work is to compare the incidence of bowel surgery in Crohn's disease patients who remain on TNFi treatment versus those who discontinue it.
We performed a nationwide register-based observational cohort study in Sweden of all incident and prevalent cases of Crohn's disease who started first-line TNFi treatment between 2006 and 2017. Patients were categorized according to TNFi treatment retention less than or beyond 1 year. The study cohort was evaluated with regard to incidence of bowel surgery from 12 months after the first ever TNFi dispensation.
We identified 5003 Crohn's disease patients with TNFi exposure: 3748 surgery naïve and 1255 with bowel surgery prior to TNFi initiation. Of these patients, 7% (n = 353) were subjected to abdominal surgery during the first 12 months after the start of TNFi and were subsequently excluded from the main analysis. A majority (62%) continued TNFi for 12 months or more. Treatment with TNFi for less than 12 months was associated with a significantly higher surgery rate compared with patients who continued on TNFi for 12 months or more (hazard ratio 1.26, 95% CI 1.09-1.46; p = 0.002).
Treatment with TNFi for less than 12 months was associated with a higher risk of bowel surgery in Crohn's disease patients compared with those who continued TNFi for 12 months or more.
手术是克罗恩病的重要治疗选择。随着肿瘤坏死因子抑制剂（TNFi；阿达木单抗或英夫利昔单抗）的引入，首次肠道手术的需求似乎有所下降。然而，TNFi 对无论是否先前进行过肠道切除术的克罗恩病患者肠道手术需求的影响尚不清楚。本研究旨在比较继续接受 TNFi 治疗与停止接受 TNFi 治疗的克罗恩病患者的肠道手术发生率。
我们在瑞典进行了一项全国范围内基于登记的观察性队列研究，纳入了所有在 2006 年至 2017 年期间首次接受一线 TNFi 治疗的克罗恩病新发病例和现患病例。根据 TNFi 治疗保留时间（少于或超过 1 年）对患者进行分类。从首次 TNFi 给药后 12 个月开始，评估研究队列的肠道手术发生率。
我们确定了 5003 例接受 TNFi 暴露的克罗恩病患者：3748 例手术初治和 1255 例 TNFi 治疗前有肠道手术史。其中，7%（n=353）患者在开始 TNFi 后 12 个月内接受了腹部手术，因此被排除在主要分析之外。大多数（62%）患者继续接受 TNFi 治疗 12 个月或更长时间。与继续接受 TNFi 治疗 12 个月或更长时间的患者相比，接受 TNFi 治疗少于 12 个月与手术率显著升高相关（风险比 1.26，95%CI 1.09-1.46；p=0.002）。
与继续接受 TNFi 治疗 12 个月或更长时间的患者相比，接受 TNFi 治疗少于 12 个月与克罗恩病患者发生肠道手术的风险更高相关。
