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Anti-TNF treatment in Crohns disease and risk of bowel resection-a population based cohort study
Danderyd Hospital, Sweden; Karolinska Institute, Sweden.
Karolinska Institute, Sweden.
Karolinska Institute, Sweden.
Public Healthcare Serv, Sweden; Uppsala University, Sweden.
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2017 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 6, 589-598 p.Article in journal (Refereed) Published
Abstract [en]

Background: TNF inhibitors (TNFi) have been shown to reduce the need for surgery in Crohns disease, but few studies have examined their effect beyond the first year of treatment. Aim: To conduct a register-based observational cohort study in Sweden 2006-2014 to investigate the risk of bowel resection in bowel surgery naive TNFi-treated Crohns disease patients and whether patients on TNFi amp;gt;= 12 months are less likely to undergo bowel resection than patients discontinuing treatment before 12 months. Methods: We identified all individuals in Sweden with Crohns disease through the Swedish National Patient Register 1987-2014 and evaluated the incidence of bowel resection after first ever dispensation of adalimumab or infliximab from 2006 and up to 7 years follow-up. Results: We identified 1856 Crohns disease patients who had received TNFi. Among these patients, 90% treatment retention was observed at 6 months after start of TNFi and 65% remained on the drug after 12 months. The cumulative rates of surgery in Crohns disease patients exposed to TNFi years 1-7 were 7%, 13%, 17%, 20%, 23%, 25% and 28%. Rates of bowel resection were similar between patients with TNFi survival amp;lt; 12 months and amp;gt;= 12 months respectively (P=.27). No predictors (eg, sex, age, extension or duration of disease) for bowel resection were identified. Conclusions: The risk of bowel resection after start of anti-TNF treatment is higher in regular health care than in published RCTs. Patients on sustained TNFi treatment beyond 12 months have bowel resection rates similar to those who discontinue TNFi treatment earlier.

Place, publisher, year, edition, pages
WILEY , 2017. Vol. 46, no 6, 589-598 p.
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-140500DOI: 10.1111/apt.14224ISI: 000407673500003PubMedID: 28752637OAI: oai:DiVA.org:liu-140500DiVA: diva2:1140150
Note

Funding Agencies|Bengt Ihre Research Fellowship; Ihre Grant; Stockholm County Council ALF; Swedish Medical Society (Projektmedel); Swedish Medical Society (Gastroenterologisk forskningsfond); Swedish Medical Society (Ihre fonden); Mjolkdroppen Foundation; Jane and Dan Olsson Foundation; Magtarmfonden; Stockholm County Council ALF project [LS1211-1460, LS2015-1198]

Available from: 2017-09-11 Created: 2017-09-11 Last updated: 2017-09-11

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Myrelid, Pär
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Surgery in Linköping
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