Nationwide study on clinical impact of early tumor necrosis factor-α inhibitors following first intestinal resection in biologics-naïve Crohn’s disease patients

TL;DR

This study examines whether starting anti-TNF therapy early after surgery for Crohn’s disease improves clinical outcomes compared to starting it later.

Contribution

The study provides real-world evidence on the clinical impact of early anti-TNF therapy after surgery in biologics-naïve Crohn’s disease patients.

Findings

Early anti-TNF therapy was associated with a lower surgical recurrence rate compared to late initiation.

There was no significant difference in biologics switching rates between early and late start groups.

Kaplan–Meier analysis showed no significant differences in risk of recurrence or switching between the groups.

Abstract

In Crohn’s disease (CD) patients who have undergone surgery, postoperative recurrence remains a challenge, and there is a lack of investigation into the impact of early anti-tumor necrosis factor (TNF) therapy following surgery on clinical outcomes compared to late use of anti-TNF agents. Utilizing the Health Insurance Review and Assessment database, we conducted a retrospective cohort study comprising 481 CD patients who underwent their first intestinal resection and were naïve to preoperative biological therapy from 2010 to 2018. Patients initiating anti-TNF agents early (within one year post-surgery) were compared to those starting later for prognosis. Clinical outcomes, including biologics switching and surgical recurrence, were assessed. The late start group (n = 290) exhibited a higher surgical recurrence rate (27.9% vs. 18.3%, p-value = 0.021), while biologics switching rates did not significantly differ (8.3% vs. 12.6%, p-value = 0.167) compared to the early start group (n = 191). Kaplan–Meier curves revealed no significant differences in the risk of biologics switching (p-value = 0.319) or surgical recurrence (p-value = 0.380) between the early and late start groups. This study investigated the potential role of early anti-TNF therapy after first intestinal resection in biologics-naïve CD patients compared to late initiation. Further refined prospective research is warranted to validate these comparisons.

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