O. Ziegler1, C. J. Soderman3, A. C. Greene1, M. J. Stack1, M. J. Deutsch2, J. S. Scow2, A. S. Kulaylat2 1Penn State Hershey Medical Center, Department Of General Surgery, Hershey, PA, USA 2Penn State Hershey Medical Center, Division Of Colon And Rectal Surgery, Hershey, PA, USA 3Penn State University College Of Medicine, Hershey, PA, USA
Introduction:
Disease modifying drugs (DMDs), including biologic agents and small molecule inhibitors, have altered the natural history of inflammatory bowel disease (IBD). Despite these agents, many patients still require surgical resection. Use patterns of DMDs in the period leading up to resection remain understudied, despite their high cost and side effect profile.
Methods:
Using an institutional database, we identified patients with Crohn’s disease or ulcerative colitis who underwent total abdominal colectomy or proctocolectomy at our tertiary academic medical center between 2003 and 2022. Patients undergoing surgery for indications other than medically refractory disease (e.g., dysplasia) were excluded. Charts were reviewed for number, type, and duration of DMDs used preceding colectomy and demographic data. Linear regression and t-test were used to examine relationships between DMD use and colectomy, with p< 0.05 considered statistically significant.
Results:
487 patients met inclusion criteria, most of whom had UC (77.8%) and were male (57.1%), mean age at diagnosis was 32.1 years. Mean time between diagnosis and resection was 8.6 years. The majority of patients were ASA class II (39%) or III (32%). The most common reason for discontinuation of the first DMD was refractory disease (74.7%). 280 patients’ first DMD was an anti-TNF agent; on t-test we find no significant difference in time from diagnosis to colectomy between those who initially received an anti-TNF or non-anti-TNF agent (8.29 years vs. 8.86 years, p = 0.387). DMD use over time increased; linear regression demonstrated that with each decade patients used about 1.5 additional DMDs (R2 = 0.478, p < 0.0001). Over the course of the study, the trend towards longer time interval between time of diagnosis and colectomy was not found to be significant, with each year associated with longer time to colectomy by 1.74 months (p = 0.065). Compared to the mean time between diagnosis and colectomy of 8.6 years, further linear regression showed that each additional DMD used was only associated with 8.2 months of additional time between diagnosis and colectomy (p = 0.056) and was not statistically significant.
Conclusion:
Over a 20-year period, patients with IBD-associated colitis received increasing numbers of DMDs prior to eventual surgery, with only a non-significant trend towards increasing time between diagnosis and colectomy. Number of DMDs used did not significantly delay time to colectomy, nor did initial non-anti-TNF agent choice. These data suggest that patients are using increasing numbers of DMDs that do not afford them meaningful time in delaying colectomy. Further work is needed to predict which patients do not benefit from trials of additional biologic agents.
