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. 2025 May;61(10):1649-1661.
doi: 10.1111/apt.70069. Epub 2025 Mar 10.

Substantial Reduction of Systemic Corticosteroid Use After Primary Ileocaecal Resection in Swedish Patients With Crohn's Disease: A Population-Based Cohort Study

Vilhelm Hjälte  1   2 , Pär Myrelid  3 , Henrik Hjortswang  1   2 , Martin Rejler  4   5 ; SWIBREG Study Group; Jonas F Ludvigsson  6   7 , Anders Forss  8 , Marcus Bendtsen  2 , Ola Olén  8 , Åsa H Everhov  8   9 , Michael Eberhardson  2
Collaborators, Affiliations

Substantial Reduction of Systemic Corticosteroid Use After Primary Ileocaecal Resection in Swedish Patients With Crohn's Disease: A Population-Based Cohort Study

Vilhelm Hjälte et al. Aliment Pharmacol Ther. 2025 May.

Abstract

Background: The corticosteroid-sparing effects of ileocaecal resection have not been thoroughly investigated in a population-based cohort.

Aim: To investigate systemic corticosteroid use before and after primary ileocaecal resection in patients with Crohn's disease.

Methods: Through nationwide registries, we identified 1565 patients with Crohn's disease undergoing primary ileocaecal resection in Sweden 2006-2019. We stratified patients according to mean annual systemic corticosteroid (prednisolone equivalents) use in the last 5 years before surgery and compared Crohn's disease treatment after surgery.

Results: Some 19% (290/1565) of the patients had a mean annual corticosteroid use of ≥ 1000 mg up to 5 years pre-operatively, of whom 33% (97/290) had ≥ 2000 mg. Mean annual pre-operative CS use did not decrease during the study period (p = 0.35). Compared with patients with < 1000 mg/year pre-operative steroid use, patients with ≥ 1000 mg/year had more frequent previous bowel surgery (10% vs. 16%), exposure to biologics (29% vs. 38%), and immunomodulators (56% vs. 83%). Patients with a pre-operative mean annual corticosteroid use of ≥ 1000 mg had a mean annual reduction in corticosteroid use of 1354 mg after ileocaecal resection (1847 mg pre-operative versus 493 mg post-operative). During follow-up (median 6.8 years), exposure to biologics was similar among patients with different levels of pre-operative corticosteroid use.

Conclusion: Our results suggest a significant corticosteroid-sparing effect of ileocaecal resection in Crohn's disease patients with high pre-operative use, indicating a beneficial outcome of earlier surgical intervention. Despite increasing use of biologics, pre-operative corticosteroid use was consistent over the study period.

Keywords: Crohn's disease; bowel surgery; corticosteroids; ileocaecal resection.

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Conflict of interest statement

Vilhelm Hjälte, Martin Rejler, Marcus Bendtsen and Åsa H. Everhov: these authors declare no conflicts of interest. Pär Myrelid: Myrelid has received honoraria for lectures from Ferring, AbbVie and Takeda and has served as an external consultant to Janssen and AbbVie and has been PI for a research project partly funded by Takeda. Henrik Hjortswang: Hjortswang has served as a speaker and advisory board member for Abbvie, Fresenius Kabi, Janssen, Norgine, Pfizer, Pharmacosmos, Takeda and Tillots Pharma. Jonas F. Ludvigsson: Ludvigsson has coordinated an unrelated study on behalf of the Swedish IBD quality register (SWIBREG). That study received funding from Janssen Corporation. Ludvigsson has also received financial support from MSD for developing a paper reviewing national healthcare registers in China. Ludvigsson has an ongoing research collaboration on celiac disease with Takeda. Anders Forss: Forss has served as a speaker and advisory board member for Janssen Cilag AB and Tillotts Pharma. Ola Olén: Olén has been PI on projects at Karolinska Institutet partly financed by investigator‐initiated grants from Janssen and Ferring, and also reports grants from Pfizer, Janssen, AbbVie, and Alfasigma in the context of a national safety monitoring programs. None of those studies have any relation to the present study. Karolinska Institutet also has received fees for Olén's lectures and participation on advisory boards from Janssen, Ferring, Takeda, and Pfizer regarding topics not related to the present study. Michael Eberhardson: Eberhardson is employed by AstraZeneca and has shares in AstraZeneca. Eberhardson has received honoraria for lectures and consultancy from AbbVie, Merck (MSD), Takeda, Ferring, Orion Pharma, Otsuka, Tillotts, ITH, Novartis, Pfizer, Oxion Biologics, Janssen, Bristol‐Myers Squibb, and Galapagos and received research funding from AbbVie and MSD.

Figures

FIGURE 1
FIGURE 1
Flowchart of identified patients with Crohn's disease and an ileocaecal resection 2006–2019 with a diagnosis of inflammatory bowel disease 1967–2019 in the Swedish National Patient Register. CD, Crohn's disease; IBD, inflammatory Bowel disease.
FIGURE 2
FIGURE 2
(A) Patients stratified according to the mean annual systemic corticosteroid† dose dispensed up to 5 years preceding primary ileocaecal resection. (B) Mean annual corticosteroid consumption calculated for the 5 years before and after ileocaecal resection, excluding 40 days post‐surgery. The mean dosage was only calculated for years with complete data coverage. CS, corticosteroids; ICR, ileocaecal resection; Postop, post‐operative; Preop, pre‐operative. †Low preoperative annual CS consumption < 1000 mg prednisolone equivalents. Intermediate preoperative annual CS consumption ≥ 1000 and < 2000 mg prednisolone equivalents. High preoperative annual CS consumption ≥ 2000 mg prednisolone equivalents. *With > 1 year since first IBD diagnosis and > 1 year of available data from the Swedish National Prescribed Drug Register.
FIGURE 3
FIGURE 3
Change in the annual mean consumption† of corticosteroids 5 years prior to compared to 5 years after primary ileocaecal resection in 1565 patients with Crohn's disease. Patients categorised as low users (defined as < 1000 mg, n = 1265) pre‐operatively are excluded. †Low annual CS consumption ≤ 1000 mg prednisolone equivalents. Intermediate annual CS consumption ≥ 1000 and < 2000 mg prednisolone equivalents. High annual CS consumption ≥ 2000 mg prednisolone equivalents. CS, corticosteroids.
FIGURE 4
FIGURE 4
Biological therapy exposure before and after primary ileocaecal resection in 1533 Crohn's disease patients with at least 1 year since the first inflammatory bowel disease diagnosis and 1 year of available pre‐operative biological therapy exposure data. At least 2 years of post‐operative data was available for all patients. Due to the small number of patients with pre‐operative exposure to multiple biologics, these patients are excluded from the chart (n = 32). A. High dose corticosteroid (CS) users (≥ 2000 mg annually), B. Intermediate dose CS users (≥ 1000 and < 2000 mg), C. Low dose CS users (< 1000). Post‐operative exposure was categorised based on the cumulative number of biological agents each patient was exposed to during follow‐up. Bio, biological therapy; CS, corticosteroids; Postop, post‐operatively; Preop, pre‐operatively.
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