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
Icahn School of Medicine at Mount Sinai, New York

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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