Infliximab Reduces Hospitalizations and Surgery Interventions in Patients With Inflammatory Bowel Disease

Costa, João; Magro, Fernando; Caldeira, Daniel; Alarcão, Joana; Sousa, Rui Dinis; Carneiro, António Vaz

doi:10.1097/mib.0b013e31829936c2

Cited by 111 publications

(72 citation statements)

References 66 publications

(110 reference statements)

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“…Compared to cohort A, cohort B had more patients on immunomodulators (cohort A vs cohort B: 21.4% vs 56.1%, P < 0.0001) and less patients on 5-aminosalysilic acid (53.6% vs 29.8%, P = 0.001). There was a shift from inflammatory to stricturing and penetrating phenotypes (B1/B2/B3 38.8% vs 12.3%, 31.8% vs 45.6%, 29.4% vs 42.1%, P < 0.0001).…”

Section: Resultsmentioning

confidence: 99%

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Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Hong

Round

et al. 2014

WJG

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AIM:To evaluate the impact of medical therapy on Crohn's disease patients undergoing their first surgical resection. METHODS:We retrospectively evaluated all patients with Crohn's disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul's Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients' hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using timedependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those without while controlling for gender, disease phenotype, smoking status, and immunomodulator use. RESULTS: CONCLUSION:Significant changes in patient phenotypes and medication exposures were observed between the two surgical cohorts separated by a decade.

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Section: Resultsmentioning

confidence: 99%

“…A recent meta-analysis showed infliximab reduces hospitalization and major surgery [29] . Our study found that anti-TNF agents and combination therapy extend time from CD disease diagnosis to first surgical resection in CD patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Hong

Round

et al. 2014

WJG

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“…Biological therapy such as Infliximab has been demonstrated to reduce the risk of hospitalisation and need for surgery in UC. 31 However, personal experience as well as the results from the national IBD audit indicate use of rescue therapy to have been low in Scotland during study Period 2: of 26 UC patients who did not respond to steroid, only four received infliximab (75% of whom responded) and none received ciclosporin during the audit period. 3 Overall, the uptake of rescue therapy and biological treatments in Scotland in the 2010 UK IBD Audit was less than 5% in severe UC, compared with over 20% elsewhere in the UK.…”

Section: Discussionmentioning

confidence: 99%

Comparison of mortality following hospitalisation for ulcerative colitis in Scotland between 1998–2000 and 2007–2009

Ventham

Kennedy

Duffy

et al. 2014

Aliment Pharmacol Ther

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“…In a very recent meta-analysis, Costa et al [34] analyzed the association between IFX therapy and hospitalization risk. Twenty-seven studies (9 RCT and 18 observational studies) were included.…”

Section: Efficacy Beyond Clinical Remission: Hospitalization Surgerymentioning

confidence: 99%

Have Biologics Changed the Natural History of Crohn's Disease?

Mandel

Miheller

Müllner

et al. 2014

Dig Dis

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Crohn's disease (CD) is a progressive condition, with most patients developing a penetrating or stricturing phenotype over time. The introduction of anti-tumor necrosis factor (TNF) therapies over the past 10-15 years, which was supported by accumulating evidence both from trials and clinical practice, has led to a significant change in patient management, monitoring, and treatment algorithms. Anti-TNF therapy was demonstrated to be effective for both luminal and fistulizing disease. Regular therapy with both infliximab and adalimumab was shown to increase the likelihood of clinical remission and mucosal healing, as well as to reduce the need for surgery and hospitalization in both clinical trials and clinical practice, especially in patients with pediatric-onset CD, shorter disease duration, and when used in combination with immunosuppressives. This has led to new treatment goals and to the use of early aggressive medical therapy in a selected group of patients with a worse prognosis. Exploratory clinical trials are underway to determine if further optimization of therapies and treatment beyond clinical remission leads to superior disease outcomes. However, more long-term clinical data are needed to assess whether an early, aggressive therapeutic strategy employing anti-TNF, alone or in combination with biologicals, can further improve long-term disease outcomes in both pediatric patients and young adults.

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Infliximab Reduces Hospitalizations and Surgery Interventions in Patients With Inflammatory Bowel Disease

Cited by 111 publications

References 66 publications

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Comparison of mortality following hospitalisation for ulcerative colitis in Scotland between 1998–2000 and 2007–2009

Have Biologics Changed the Natural History of Crohn's Disease?

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