Long-term resection potentially better than anti-TNF treatment in CD

In early, non-perianal Crohn’s disease (CD), patients who received an index treatment of resection had a 33% lower risk of adverse, long-term outcomes than those receiving anti-TNF therapy. After 5 years of follow-up, 50% of the resected patients did not receive CD treatment.

The benefits of primary treatment with ileocaecal resection in early CD in comparison with anti-TNF therapy were demonstrated by the randomised, controlled study findings from the LIR!C trial (NTR1150) [1,2]. However, real-world data comparing the 2 treatment options remains scarce [3]. To this end, Prof. Manasi Agrawal (Icahn School of Medicine at Mount Sinai, NY, USA) aimed to shed light on the long-term benefit of ileocaecal resection in comparison with anti-TNF therapy in early CD [3]. Data was extracted from Danish registries over a 15-year period (2003–2018) that included patients with CD who were treated with 1 of these options as the primary treatment between 30 days before and 1 year after diagnosis. The primary outcome was a composite of CD-related hospitalisation, CD-related surgery, perianal CD, and the use of systemic corticosteroids.

In the study period, over 16,000 persons were diagnosed with CD. The study criteria, including the requirement of pathologically confirmed ileocaecal CD location and exclusion of perianal disease, led to a final cohort of 581 participants with resection and 698 with anti-TNF as a first-line treatment for CD. “The incidence rate for the primary outcome was 110/1,000 patient-years in the resection group and 202/1,000 patient-years in the anti-TNF group,” Prof. Agrawal stated (see Figure). The regression analysis resulted in a corresponding adjusted hazard ratio (HR) of 0.67 (95% CI 0.54–0.83) in favour of resection.

Figure: Incidence rate for the primary outcome in the anti-TNF and ICR cohort [3]



ICR, ileocaecal resection; TNF, tumour necrosis factor.

Differentiating between the individual components of the primary outcome, significant results were found for 2 of the 4 factors: exposure to systemic corticosteroids was 29% lower (HR 0.71; 95% CI 0.54–0.92) and CD-related surgery was 44% lower (HR 0.56; 95% CI 0.39–0.80) in the resection group than with anti-TNF treatment. Of note, half of the resected participants were on no treatment at 5 years post-surgery, 17% had anti-TNF therapy, and 48% were on immunomodulators.

In her summary, Prof. Agrawal highlighted that adverse, long-term outcomes were 33% lower with ileocaecal resection compared with anti-TNF therapy. “This data, which is in concordance with the LIR!C data, suggests that ileocaecal resection could be a first-line therapeutic option in early ileal and ileocaecal CD, and it may be an option that should be discussed with our patients,” she concluded.

1. Ponsioen CY, et al. Lancet Gastroenterol Hepatol. 2017;2:785–92.
2. Stevens TW, et al. Lancet Gastroenterol Hepatol. 2020;5:900–7.
3. Agrawal M. 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. OP11, ECCO 2023, 1–4 March, Copenhagen, Denmark.

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Posted on 4 May 20238 April 2024