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Meta-Analysis
. 2024 Jul 3;30(7):1080-1086.
doi: 10.1093/ibd/izad149.

Early Biologic Treatment Decreases Risk of Surgery in Crohn's Disease but not in Ulcerative Colitis: Systematic Review and Meta-Analysis

Cindy C Y Law  1 , Bryce Tkachuk  2 , Stephen Lieto  3 , Neeraj Narula  4 , Samantha Walsh  5 , Jean-Frédéric Colombel  1 , Ryan C Ungaro  1
Affiliations
Meta-Analysis

Early Biologic Treatment Decreases Risk of Surgery in Crohn's Disease but not in Ulcerative Colitis: Systematic Review and Meta-Analysis

Cindy C Y Law et al. Inflamm Bowel Dis. .

Abstract

Background and aims: Inflammatory bowel disease (IBD) can lead to long-term complications that significantly impact patients' quality of life and healthcare resource utilization. Prior studies have demonstrated improved short-term outcomes to early exposure of biologics in patients with Crohn's disease (CD) but not in patients with ulcerative colitis (UC). However, there are conflicting data on impact of early intervention on longer-term adverse events. Therefore, we conducted a systematic review and meta-analysis assessing the impact of early biologic treatment on rates of IBD-related surgery.

Methods: A systematic search was conducted in April 2022. Studies were included if biologic initiation was compared between patients starting early (<3 years of diagnosis or top-down treatment) vs later (>3 years of diagnosis or step-up treatment). Studies with <1 year of follow-up were excluded. The outcomes were colectomy and CD-related surgery for patients with UC and CD, respectively. Random-effects analyses were conducted to compare rates of IBD surgery between early and late biologic treatment.

Results: Eighteen studies were included in the meta-analysis. Three studies included patients with UC and 15 studies included patients with CD. In patients with CD, early biologic therapy was associated with lower odds of surgery (odds ratio, 0.63; 95% confidence interval, 0.48-0.84) compared with late treatment. Conversely, in patients with UC, the odds of colectomy were increased (odds ratio, 2.86; 95% confidence interval, 1.30-6.30).

Conclusions: Early biologic treatment is associated with lower rates of surgery in patients with CD. In contrast, early biologic therapy appears to be associated with higher rates of colectomy in patients with UC, which may be confounded by disease severity.

Keywords: Crohn’s disease; biologic; colectomy; early; ulcerative colitis.

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Conflict of interest statement

N.N. has received honoraria for serving on the speakers bureau or advisory board from Janssen, AbbVie, Takeda, Pfizer, Organon, Sandoz, Novartis, Mylan, Fresenius Kabi, Innomar Strategies, Iterative Health, Amgen, and Ferring. J.-F.C. has received research grants from AbbVie, Janssen Pharmaceuticals, Takeda, and Bristol Myers Squibb; has received payment for lectures from AbbVie and Takeda; has received consulting fees from AbbVie, Amgen, AnaptysBio, Allergan, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene Corporation, Celltrion, Eli Lilly, Ferring Pharmaceuticals, Galmed Research, Glaxo Smith Kline, Genentech (Roche), Janssen Pharmaceuticals, Kaleido Biosciences, Immunic, Iterative Scopes, Merck, Landos, Microba Life Science, Novartis, Otsuka Pharmaceutical, Pfizer, Protagonist Therapeutics, Sanofi, Takeda, TiGenix, and Vifor; and holds stock options in Intestinal Biotech Development. R.C.U. has served as a consultant for or received speaker fees from AbbVie, Bristol Myers Squibb, Janssen, Lilly, Pfizer, and Takeda; and received research support from AbbVie, Boehringer Ingelheim, Lilly, and Pfizer.

Figures

Figure 1.
Figure 1.
Flowchart of the search strategy for the systematic review. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Forest plot demonstrating the risk of inflammatory bowel disease-related surgery among patients with Crohn’s disease and ulcerative colitis treated with early vs late biologic therapy. CI, confidence interval; 2M-H, Mantel-Haenszel.
See this image and copyright information in PMC

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