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. 2025 Oct 21:10.1111/apt.70432.
doi: 10.1111/apt.70432. Online ahead of print.

Treatment-Free Outcomes Following Surgery for IBD: A Nationwide Cohort Study

Adam S Faye  1 , Jordan Axelrad  1 , Jiangwei Sun  2 , Jonas Halfvarsson  3 ; SWIBREG Study Group; Par Myrelid  4 , Jonas Söderling  5 , Ola Olén  5   6 , Jonas F Ludvigsson  2   7   8
Collaborators, Affiliations

Treatment-Free Outcomes Following Surgery for IBD: A Nationwide Cohort Study

Adam S Faye et al. Aliment Pharmacol Ther. .

Abstract

Background: Surgery in select individuals with inflammatory bowel disease (IBD) may obviate the need for future IBD-related treatment.

Aims: To characterise individuals who remain treatment-free during the first 5 years after initial IBD-related surgery.

Methods: We performed a nationwide cohort study using the Swedish National Patient Register and the ESPRESSO histopathology to identify individuals undergoing first IBD-related intestinal resection for Crohn's disease (CD) or total colectomy for ulcerative colitis (UC) between 2007 and 2018. We calculated adjusted odds ratios (aORs) for the need for any IBD-related therapy within the first 5 years post surgery.

Results: We included 1709 individuals with CD and 1010 with UC. At 5 years, 21.5% with CD and 42.4% with UC remained 'treatment free'. Being 'treatment free' 5 years after surgery was more common among patients with CD who had longer preoperative disease duration and older adults with UC. It was less common among individuals with extraintestinal manifestations of disease (CD aOR 0.64, 95% CI 0.43-0.97; UC aOR 0.48, 95% CI 0.31-0.73) and patients with CD who had chronic obstructive pulmonary disease.

Conclusions: Surgery obviated the need for future therapy in 22% of patients with CD and 42% with UC. Absence of extraintestinal manifestations, older age in UC, and longer disease duration and absence of chronic obstructive pulmonary disease in CD may highlight an opportunity for precision surgery to identify those most likely to achieve long-term benefit from surgical intervention.

Keywords: Crohn's disease; inflammatory bowel disease; surgery; ulcerative colitis.

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Conflict of interest statement

The authors confirm that there are no conflicts of interest noted below that may be considered a competing interest. J.F.L. has coordinated a study on behalf of the Swedish IBD quality register (SWIBREG). That study received funding from Janssen Corporation. J.F.L. has also received financial support from Merck/MSD for an unrelated IBD study and for developing a paper reviewing national healthcare registers in China. J.F.L. has a research collaboration with Takeda on celiac disease and is discussing potential collaboration on chronic liver disease. A.S.F. has received consulting honoraria from Bristol Meyers Squibb, and has research funding support from the NIH/NIA (R03: AG078927-01), Crohn’s and Colitis Foundation, and American College of Gastroenterology. J.A. has received research grants from BioFire Diagnostics, Genentech and Janssen; consultancy fees, honoraria, or advisory board fees from Abbvie, Abivax, Adiso, Biomerieux, Bristol-Myers Squibb, Celltrion, Ferring, Fresenius, Janssen, Pfizer and Vedanta; JEA is supported by grants from the Crohn’s and Colitis Foundation, the Judith & Stewart Colton Center for Autoimmunity, and the NIH NIDDK Diseases K23DK124570. J.S. has received research grants from the Swedish Society for Medical Research (grant number: PG-23-0315-H-02), European Crohn’s and Colitis Organisation, Swedish Society of Medicine, Stiftelsen Professor Nanna Svartz Fond, Ruth and Richard Julin Foundation and Karolinska Institutet. J.H. has received consultancy, advisory board fees, or honorarium from AbbVie, Alfasigma, Aqilion, Bristol-Myers Squibb, Celgene, Celltrion, Dr. Falk Pharma and the Falk Foundation, Eli Lilly, Ferring, Galapagos, Gilead, Hospira, Index Pharma, Janssen, Johnson & Johnson, MEDA, Medivir, Merck, MSD, Olink Proteomics, Novartis, Pfizer, Prometheus Laboratories Inc., Sandoz, Shire, STADA, Takeda, Thermo Fisher Scientific, Tillotts Pharma, Vifor Pharma, UCB and has received grant support from Janssen, MSD and Takeda. P.M. has no reported conflicts of interest to report. O.O. has been PI on projects at Karolinska Institutet financed by grants from Janssen, Takeda, AbbVie, Pfizer, Vifor Pharma, Bristol-Myers Squibb and Ferring, and also reports grants from Pfizer, Galapagos, AbbVie and Janssen in the context of national safety monitoring programs. None of those studies has any relation to the present study. Karolinska Institutet has also received fees for lectures and participation on advisory boards held by O.O. from Janssen, Ferring, Takeda, Bristol-Myers Squibb, Galapagos and Pfizer regarding topics not related to the present study.

Figures

FIGURE 1 |
FIGURE 1 |
Flow chart.
FIGURE 2 |
FIGURE 2 |
Kaplan–Meier curve showing time to IBD therapy* after initial surgical resection in CD (blue) and UC (red). *IBD therapy: IBD medication (immunomodulators, advanced therapies, corticosteroids), unplanned IBD-related hospitalisation, IBD-related intestinal resection.
See this image and copyright information in PMC

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