Bowel resection rates similar among patients with different TNFi treatment retention
The risk of bowel resection following treatment initiation with tumour necrosis factor inhibitor (TNFi) does not appear to differ between patients on sustained TNFi treatment beyond 12 months and those who discontinue TNFi treatment earlier.
Researchers identified 1,856 Crohn’s disease (CD) patients using data from the Swedish National Patient Register. The incidence of bowel resection after first ever dispensation of adalimumab or infliximab was assessed from 2006 up to 7 years follow-up.
At 6 months of TNFi initiation, 90 percent persisted on their treatment. This number dropped to 65 percent at 12 months. The cumulative rates of surgery in CD patients exposed to TNFi years 1 to 7 were 7, 13, 17, 20, 23, 25 and 28 percent, respectively.
Rates of bowel resection during the follow-up were similar between patients with TNFi survival <12 months and those with TNFi retention ≥12 months (p=0.27). No significant predictors (eg, sex, age, extension or duration of disease) for bowel resection were identified.
According to researchers, the similar surgical rates observed among patients with different treatment retention have several explanations, as follows: (1) the cohort persisting on TNFi for >1 year most likely represents patients with the most severe disease; (2) and that the effect of TNFi on the need for surgery in CD may be less pronounced in the long run, despite the fact that the agent has a major impact on disease activity and symptom resolution.
“An additional issue raised by our results is whether anti-TNF treatment could (in terms of risk of surgery) be safely discontinued after a period of successful treatment. This question is beyond the scope of this study to answer and requires a [randomized controlled trial],” researchers added.
The Swedish guidelines cite that TNFi discontinuation at the earliest after 1 year of treatment may be considered for CD patients who have failed immune modulating therapy and achieve clinical, biochemical and endoscopic remission after TNFi initiation. In patients naïve to immunomodulators, TNFi may be stopped before 1 year.