2921 Correlation Between the Cumulative Risk of Surgery and Timing of Anti-TNF Initiation in Crohn's Disease

Abstract

INTRODUCTION: Despite their effectiveness in the management of Crohn's disease (CD), anti-tumor necrosis factor medications' use is often delayed until patients fail conventional therapy. There is more evidence in the literature that the early use of anti-TNF in the disease course may improve the long-term outcomes and decrease the risk of complications. However, the optimal time to start these agents is not well defined. In our study, using patient data at the University of Kansas Medical Center, we aimed to determine the cumulative risk of surgery based on the use of anti-TNF agents during the disease course. METHODS: A retrospective cohort study was conducted evaluating CD patients on anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) seen at the University of Kansas Medical Center until May 2018. The primary outcome was the cumulative risk of surgery based on anti-TNF initiating time. RESULTS: A total of 229 patients with CD were enrolled, 143 in the early anti-TNF alpha group and 86 in the late group. Total of 128/229 required surgery. Our analysis demonstrated a positive correlation between the cumulative incidence of surgery and the duration between diagnosis and initiating anti-TNF alpha therapy. In fact, initiating anti TNF at the time of diagnosis prevented the need for surgery for 80-100% of patients. Whereas initiating anti TNF within 10 years of diagnosis prevented the need for surgery in 50% of the patients and more than 80% of patients who started anti-TNF alpha therapy after 20 years of diagnosis had a need for surgery. CONCLUSION: Our study suggests an increased risk of surgery in Crohn's disease patients with the late use of anti-TNF. Early initiation of anti-TNF alpha therapy at the time of diagnosis was associated with the least risk of the need for surgery.