B. P. Kline1, T. Weaver1, A. Berg2, W. Koltun1 1Penn State University College Of Medicine,Deparment Of Surgery, Division Of Colon And Rectal Surgery,Hershey, PA, USA 2Penn State University College Of Medicine,Department Of Public Health Sciences,Hershey, PA, USA
Introduction:
Biologic medications are often prescribed to patients with Crohn’s disease after ileocolectomy to decrease the incidence of recurrent disease. Previous studies have focused primarily on their effect on recurrence of clinical symptoms or on endoscopic recurrence. There has been relatively little data on whether these biologics actually increase the time to a recurrent ileocolectomy or protect against the need for repeat surgery.
Methods:
A 28 year retrospective chart review was performed on 409 patients with Crohn’s disease who had undergone ileocolectomy and had been prospectively recruited into the Colorectal Diseases Biobank at our institution. The study cohort was made up of 241 of these patients who were biologic therapy naive prior to their initial ileocolectomy. 106 patients received biologics (infliximab, adalimumab, certolizumab pegol, vedolizumab, or ustekinumab) after their initial surgery (ICB group) and were compared to 135 patients who did not receive biologics (IC group). Clinical characteristics including sex, race, family history of IBD, smoking history, age of onset, date of diagnosis, Montreal classification, number of ileocolectomies, date of each ileocolectomy, and date of last visit were documented. Multivariate Cox proportional-hazards was used to model time to recurrent ileocolectomy after initial surgery. Covariates included the presence of biologics, smoking, sex, family history, and Montreal classification.
Results:
There was no significant difference in sex, race, family history, smoking history, age of diagnosis, or Montreal classification between the two groups. The mean follow up time was 11.8 years in the ICB group vs 14.8 years in the IC group. Only 34 of the 106 patients in the ICB group had subsequent surgeries compared to 65 of the 135 in the IC group (32% vs 48%, p = 0.017). On multivariate analysis, the presence of biologics reduced the hazard ratio (risk of a second surgery) by 40% (confidence interval: 7%-61%, p = 0.023). No other covariates had a significant impact on risk of recurrent surgery. The probability of a 2nd ileocolectomy over time is shown in the attached time to event figure.
Conclusion:
Patients who were placed on biologics after an initial ileocolectomy had a 40% decreased risk of requiring a second surgery. This led to both a lower number of subsequent ileocolectomies and an extended interval between surgeries in those patients that received biologics. This study confirms the effect of biologics in increasing the interval to a second ileocolectomy in patients with Crohn’s disease.
