Surgeries Common for Crohn’s Disease Despite Biologics

Christian Stoss

While surgeries are still commonly needed for Crohn’s disease patients, the advent of biologics have reduced the need for many surgeries for this patient population.

A team, led by Christian Stoss, Klinikum rechts der Isar, School of Medicine, Department of Surgery, Technical University of Munich, identified current trends in Crohn’s disease surgeries and case numbers following the development of new biologics to treat the disease.

In the study, the researchers used nationwide standardized hospital discharge data between 2010-2017 in Germany from 201,165 Crohn’s disease cases.

The Analysis

The team analyzed time-related development of admission numbers, the rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases.

The total number of hospital admission increased by 10.6% within the analyzed time period (2010, n = 23,301; 2017, n = 26,069).

Patients with comorbidities, including stenosis formation (2010, 10.1%; 2017, 13.4%) or malnutrition (2010, 0.8%; 2017, 3.2%) were increasingly admitted, despite age and gender distribution remaining comparable.

In addition, the total number of all analyzed operations for the disorder increased by 7.5% (2010, n = 1567; 2018, n = 1694).

Surgeries

The average of all inpatient patients receiving ileocolonic resections was 6.8 ± 0.2%, while surgeries have become more minimally invasive (2010, n = 353; 2017, n = 687).

The number of postoperative complications following surgery for Crohn’s disease patients has remained low during the duration of the study.

“Despite the development of novel immunotherapeutics, the number of patients requiring surgery for Crohn’s disease remains stable,” the authors wrote. “Interestingly, patients have been increasingly hospitalized with stenosis and malnutrition. The trend towards more minimally invasive operations has not relevantly changed the rate of overall complications.”

Biologic-Naïve Patients

Recently, researchers from McMaster University compared the efficacy and rapidity of onset of action of infliximab and ustekinumab induction therapy for moderate to severe biologic-naïve Crohn’s disease.

In the post-hoc analysis of 2 large Crohn’s disease clinical trial programs, the researchers used patient-level data to identify 420 biologic-naïve Crohn’s disease patients.

At week 6, the researchers identified a comparable number of patients achieved clinical remission with infliximab as compared to patients treated with ustekinumab (44.9% vs. 37.9%; aOR, 1.22; 95% CI, 0.79-1.89). However, at week 6 clinical response rates were not significantly different (58.4% infliximab vs. 54.9% ustekinumab; aOR, 1.25; 95% CI, 0.82-1.90).

The researchers also did not identify significant differences between treatment groups for achieving week 6 fecal calprotectin <250 mcg/L in those with elevated values at baseline (42.3% infliximab vs. 34.7% ustekinumab; aOR. 1.34; 95% CI, 0.79-2.28).

There were similar results identified for all analyses done within the propensity matched cohort.

“Based on this post-hoc analysis, infliximab and ustekinumab appear to have similar efficacy and speed of onset in patients with Crohn’s disease who are biologic-naïve,” the authors wrote.

The study, “Real-World Utilization and Expenditure of Top-Down and Step-Up Therapy in Inflammatory Bowel Disease,” was published online in the International Journal of Colorectal Disease.