Biologics and surgical outcomes in Crohn’s disease: is there a direct relationship?

Quaresma, Abel Botelho; Yamamoto, Takayuki; Kotze, Paulo Gustavo

doi:10.1177/1756284820931738

Cited by 18 publications

(26 citation statements)

References 58 publications

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“…The preliminary data of several meta-analyses showed a higher risk of complications in IBD patients treated with anti-TNF, especially in those with CD [24,25]. In contrast to these data, the administration of preoperative infliximab was not related to the appearance of early postoperative complications in recent meta-analyses for CD [26,27]. Furthermore, the only two studies that evaluated this effect prospectively showed that neither anti-TNF administration nor anti-TNF drug levels during the preoperative period was associated with postoperative complications in IBD; therefore, the complete withdrawal of biological therapy during the preoperative period is not necessary to reduce the frequency of postoperative complications [28,29].…”

Section: Discussionmentioning

confidence: 89%

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

García¹,

Rivero²,

Miranda-Bautista³

et al. 2021

JCM

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Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered “exposed”. The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2–2.0), urgent surgery (OR: 1.6; 95% CI: 1.2–2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1–1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3–2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97–1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03–2.27). Conclusion: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections.

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Section: Discussionmentioning

confidence: 89%

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

García¹,

Rivero²,

Miranda-Bautista³

et al. 2021

JCM

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“…In conclusion, direct cause–effect relationship of biologics alone leading to increased rates of complications was not demonstrated and different studies results are controversial [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

et al. 2021

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Background Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons. Method A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019. Conclusions Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.

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“…It is noteworthy that different confounding factors can impact the rates of postoperative complications after colectomy in patients with UC. The most important are the previous use of corticosteroids, an impaired nutritional status, and unfavorable systemic conditions, such as anemia [ 2 , 50 ]. Overall, most patients undergoing colectomy for UC are already using biological agents at the moment of surgery, and more than one of these factors may also be additionally present.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery is an important tool in the current therapeutic armamentarium, and is still needed in a significant proportion of patients with UC [ 1 ]. Colectomy represents a great challenge to the surgeon due to the severity of the disease and associated disease-related factors, such as malnutrition, infections, anemia, and previous use of corticosteroids [ 2 ]. Currently, most patients undergoing an elective colectomy for UC have usually been previously exposed to some type of biological agent [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, most patients undergoing an elective colectomy for UC have usually been previously exposed to some type of biological agent [ 1 ]. Despite this common scenario, after two decades of using these medications in the treatment of IBD, a cause and effect relationship has not yet been established between a possible increase in surgical complications as a consequence of preoperative exposure to these agents, neither in Crohn’s disease (CD) nor in UC [ 2 , 3 , 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

Quaresma

Baraúna

Teixeira

et al. 2021

JCM

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Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

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Biologics and surgical outcomes in Crohn’s disease: is there a direct relationship?

Cited by 18 publications

References 58 publications

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

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