Ileocecal resection may have role as ‘primary treatment’ in recently diagnosed Crohn’s
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CHICAGO — Patients who underwent ileocecal resection for Crohn’s disease had a 33% lower risk for hospitalization, repeat surgery, systemic corticosteroid exposure and perianal CD, according to a presenter at Digestive Disease Week.
“The LIR!C trial has demonstrated comparable quality of life with ileocecal resection compared to infliximab as a first-line treatment for limited, non-stricturing ileocecal CD,” Manasi Agrawal, MD, MS, assistant professor of medicine at Icahn School of Medicine and gastroenterologist at Mount Sinai Hospital, told Healio. “However, real-world data on the long-term impact of primary ileocecal resection for CD, compared to medical therapy, are limited.”
Agrawal and colleagues conducted a population-based study at the Aalborg University Center for Molecular Prediction of IBD in Copenhagen and used cross-linked nationwide registers to identify 16,443 patients diagnosed with ileocecal CD between 2003 and 2018. Of those, 581 underwent ileocecal resection (ICR) and 698 received anti-tumor necrosis factor therapy within 1 year of diagnosis.
Researchers compared long-term outcomes and determined the proportion of patients started on immunomodulators or anti-TNFs or who ceased therapy 5 years after ICR. The primary outcome of interest was a composite of hospitalization, repeat CD-related surgery, systemic corticosteroid exposure and diagnosis of perianal CD.
According to results, the composite outcome occurred in 273 patients who underwent ICR (IR = 110.3/100,000 person-years) and 318 patients who received anti-TNFs (IR = 201.9/100,000 person-years). Following adjustment for demographic and clinical variables, the risk for composite outcome was 33% lower in the ICR group vs. the anti-TNF group (adjusted HR = 0.67; 95% CI, 0.54-0.83).
When analyzing individual outcomes, researchers reported that ICR was associated with a reduced risk for systemic corticosteroid exposure and CD-related surgery but not CD-related hospitalization or perianal CD diagnosis.
At the 5-year follow-up, 47.5% of patients who underwent ICR were on immunomodulators, 17.1% were on anti-TNFs and 50.3% had not started treatment.
“These data suggest that ICR may have a role as primary treatment for recently diagnosed ileal/ileocecal CD,” Agrawal said. “Additional research is needed to understand features associated with lack of post-operative CD progression. This will help determine which patients who benefit most from early ICR and improve personalized treatment of CD.”
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Agrawal M, et al. Abstract 13: Ileocecal resection for recently diagnosed ileocecal Crohn’s disease is associated with improved long-term outcomes compared to anti-tumor necrosis factor therapy: A population-based study. Presented at: Digestive Disease Week; May 5-9, 2023; Chicago, (hybrid).
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