Almost half of the patients with Crohn disease (CD) who undergo primary treatment with surgical resection do well without medications for more than 15 years, Manasi Agrawal, MD, said during an abstract presentation at the Digestive Disease Week (DDW) 2023 in Chicago. More research is still needed to understand what factors predict long term success with surgery and no medications.

Dr Agrawal is an assistant professor of medicine and a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York, New York.

The findings of the population-based study support “the role of ileocecal resection (ICR) as an index treatment for ileocecal CD and challenge the current paradigm of reserving surgery for complicated CD refractory or intolerant to medications,” the inflammatory bowel disease specialist explained as she and her team of fellow researchers seek alternatives to conventional escalation of medical therapy. “Further studies will help identify characteristics of individuals who needed no treatment after ICR.”

Using cross-linked Danish nationwide registers, Dr Agrawal et colleagues identified 16,443 patients diagnosed with ileocecal CD between 2003 and 2018. Of those, 581 underwent ileocecal resection (ICR) and 698 received anti-tumor necrosis factor therapy within 1 year of diagnosis.

The primary outcome was a composite of CD-related hospitalization, systemic corticosteroid exposure, CD-related surgery, and perianal CD diagnosis. They also determined individuals initiated on immunomodulator, anti-TNF, or no therapy at 5 years after ICR.

The team found the primary outcome in 273 patients who underwent ICR (IR = 110.3/100,000 person-years) and 318 patients who received anti-TNFs (IR = 201.9/100,000 person-years). After adjusting for demographic and clinical variables, the risk for composite outcome was 33% lower in the ICR group vs. the anti-TNF group (adjusted HR = 0.67; 95% CI, 0.54-0.83).

Furthermore, it was evident that “ICR was associated with a reduced risk for systemic corticosteroid exposure and CD-related surgery but not CD-related hospitalization or perianal CD diagnosis.”

Half of these patients (50.3%) who underwent ICR did not start any treatment after a 5-year follow up. About 47.5% were on immunomodulators, and 17.1% were on anti-TNFs.

ICR was initially believed to be a therapeutic option generally reserved for complicated cases of CD. However, these findings prove ICR in the early stages of CD, too, can provide long-term favorable outcomes.
 

—Priyam Vora

Reference:
Agrawal M. Presentation #13. Ileocecal resection for recently diagnosed ileocecal Crohn’s disease is associated with improved long-term outcomes compared to anti-tumor necrosis factor therapy: A population-based study. Digestive Disease Week 2023. Chicago, Illinois.