Compared with anti-TNF treatment, unfavorable outcomes were 33% lower when patients with early, non-perianal CD underwent resection as index therapy.
Manasi Agrawal, MD, MS, of the Icahn School of Medicine at Mount Sinai, and colleagues wanted to shed light on the long-term benefit of ileocecal resection in comparison with anti-TNF therapy in early CD. They used data from Danish registries over a 15-year period (2003–2018) that included patients with CD who were treated with one of these options as primary treatment between 30 days before and 1 year after diagnosis. The primary outcome consisted of a composite of CD-related hospitalization, CD-related surgery, perianal CD, and use of systemic corticosteroids.
Within the study period, over 16,000 persons received a diagnosis of CD. The study criteria requiring pathology-confirmed ileocecal CD location and exclusion of perianal disease led to a final study cohort of 581 patients with resection and 698 with first-line anti-TNF treatment. “The incidence rate for the primary outcome was 110/1,000 patient years in the resection group and 202/1,000 patient years in the anti-TNF group,” Dr. Agrawal stated. The regression analysis resulted in a corresponding adjusted HR of 0.67 (95%, CI 0.54-0.83) in favor of resection.
Differentiating between the individual components of the primary outcome, significant results were found for two out of the four factors: exposure to systemic corticosteroids was 29% lower (HR, 0.71; 95% CI, 0.54-0.92) and CD-related surgery was 44% lower (HR, 0.56; 95% CI, 0.39-0.80) in the resection group compared with anti-TNF treatment. Of note, half of the patients who underwent resection were on no treatment at 5 years post-surgery, 17% had anti-TNF therapy, and 48% were on immunomodulators.
In her summary, Prof. Agrawal highlighted that adverse long-term outcomes were 33% lower with ileocecal resection compared with anti-TNF therapy. She suggested discussing the option of ileocecal resection as a first-line therapeutic option with patients with early ileal and ileocecal CD.
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