Comparison of time until elective intestinal resection regarding previous anti-tumor necrosis factor exposure: a Brazilian study on patients with Crohn's disease

Abstract

Background/aims: The use of anti-tumor necrosis factor (anti-TNF) agents seems to reduce surgical rates and delay surgical procedures in prospective trials and population-based studies in the management of Crohn's disease (CD). This study aimed to identify whether preoperative anti-TNF agents influence the time from diagnosis to surgery.

Methods: An observational retrospective cohort study was conducted on patients with CD submitted to intestinal resections due to complications or medical therapy failure in a period of 7 years. The patients were allocated into 2 groups according to their previous exposure to anti-TNF agents in the preoperative period. Epidemiological aspects regarding age at diagnosis, smoking, perianal disease, and preoperative conventional therapy were considered. A Kaplan-Meier survival analysis was used to outline possible differences between the groups regarding the time to surgery.

Results: A total of 123 patients were included (71 and 52 with and without previous exposure to biologics, respectively). The overall time to surgery was 108±6.9 months (maximum, 276 months). The survival estimation revealed no difference in the mean time to intestinal resection between the groups (99.78±10.62 months in the patients without and 114.01±9.07 months in those with previous anti-TNF use) (log-rank P=0.35). There was no significant difference in the time to surgery regarding perianal CD (P=0.49), smoking (P=0.63), preoperative azathioprine (P=0.073) and steroid use (P=0.58).

Conclusions: The time from diagnosis to surgery was not influenced by the preoperative use of anti-TNF therapy in this cohort of patients.

Keywords: Crohn disease; Surgical procedures, operative; Survival analysis; Tumor necrosis factor-alpha.

Fig. 1. Study flowchart and group definition. TNF, tumor necrosis factor.

Fig. 2. Kaplan-Meier curves demonstrating different analyses. (A) Time between diagnosis and surgery according to the use of anti-tumor necrosis factor (anti-TNF) agents ([−], without; [+], with) (log-rank P=0.35). (B) Time from diagnosis to surgery between the 2 different anti-TNF agents (infliximab [IFX] and adalimumab [ADA]). The patients under ADA therapy have longer disease durations until surgery (log-rank P=0.034). (C) Time interval until surgery between the patients under ADA and conventional therapy (log-rank P=0.69). (D) Time from diagnosis to surgery between the patients with and without previous exposure to azathioprine (AZA) ([−], without; [+], with) (log-rank P=0.073). (E) Time interval until surgery between the patients with and without preoperative exposure to steroids ([−], without; [+], with) (log-rank P=0.58). (F) Time from diagnosis to surgery between the patients under preoperative monotherapy and combotherapy (log-rank P=0.35).