Pablo Olivera1, Antonino Spinelli, Corinne Gower-Rousseau, Silvio Danese, Laurent Peyrin-Biroulet. 1. aDepartment of Internal Medicine, Gastroenterology Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina bColon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano Milan, Italy cDepartment of Biomedical Science, Humanitas University, Rozzano Milan, Italy dPublic Health Unit, Epimad Registry and LIRIC-UMR 995 Inserm, Lille University Hospital, Université Lille 2, Lille, France eDepartment of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano Milano, Italy fINSERM U954 and Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France.
Abstract
PURPOSE OF REVIEW: The aim of this review is to summarize data regarding surgical trends in inflammatory bowel disease in the prebiologic and biologic era, with a focus on population-based studies and randomized controlled trials (RCTs). RECENT FINDINGS: There is paucity of data in RCTs regarding surgical rates, with only a few clinical trials reporting them. From the available data, meta-analyses of RCTs have concluded that antitumor necrosis α agents (anti-TNF) reduce surgical rates in ulcerative colitis and Crohn's disease. A large body of evidence from population-based studies from different regions of the world is available to evaluate surgical trends before and after the introduction of anti-TNF agents. The risk of surgery decreased significantly over the past six decades; these decreasing trends continued in the biologic era, which might indicate a potential beneficial disease-modifying effect of biologics. There is lack of data with nonanti-TNF biologics (i.e. anti-integrins and ustekinumab) regarding the risk of surgery. SUMMARY: Although data from population-based studies and available RCTs suggest a protective effect from surgery of anti-TNF agents, definitive conclusions should be drawn only when more disease-modifying trials with different biologics and treatment strategies become available.
PURPOSE OF REVIEW: The aim of this review is to summarize data regarding surgical trends in inflammatory bowel disease in the prebiologic and biologic era, with a focus on population-based studies and randomized controlled trials (RCTs). RECENT FINDINGS: There is paucity of data in RCTs regarding surgical rates, with only a few clinical trials reporting them. From the available data, meta-analyses of RCTs have concluded that antitumor necrosis α agents (anti-TNF) reduce surgical rates in ulcerative colitis and Crohn's disease. A large body of evidence from population-based studies from different regions of the world is available to evaluate surgical trends before and after the introduction of anti-TNF agents. The risk of surgery decreased significantly over the past six decades; these decreasing trends continued in the biologic era, which might indicate a potential beneficial disease-modifying effect of biologics. There is lack of data with nonanti-TNF biologics (i.e. anti-integrins and ustekinumab) regarding the risk of surgery. SUMMARY: Although data from population-based studies and available RCTs suggest a protective effect from surgery of anti-TNF agents, definitive conclusions should be drawn only when more disease-modifying trials with different biologics and treatment strategies become available.
Authors: Sang Hyoung Park; Satimai Aniwan; W Scott Harmsen; William J Tremaine; Amy L Lightner; William A Faubion; Edward V Loftus Journal: Inflamm Bowel Dis Date: 2019-05-04 Impact factor: 5.325
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Authors: Lieke M Spekhorst; Bas Oldenburg; Ad A van Bodegraven; Dirk J de Jong; Floris Imhann; Andrea E van der Meulen-de Jong; Marieke J Pierik; Janneke C van der Woude; Gerard Dijkstra; Geert D'Haens; Mark Löwenberg; Rinse K Weersma; Eleonora A M Festen Journal: World J Gastroenterol Date: 2017-12-14 Impact factor: 5.742
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