Anti-tumor necrosis factor therapy decreases the risk of initial intestinal surgery after diagnosis of Crohn’s disease of inflammatory type

Yutaka Nagata, Motohiro Esaki, Moriyama Tomohiko, Atsushi Hirano, Junji Umeno, Yuji Maehata, takehiro torisu, Takayuki Matsumoto, Takanari Kitazono

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Abstract

Background: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn’s disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. Methods: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. Results: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P < 0.0001). The hazard ratio in the TNF group was 0.32 (95% CI 0.13–0.74). Immunomodulators did not decrease the risk of initial intestinal surgery. Conclusions: Anti-TNF therapy can decrease the risk of intestinal surgery among patients with inflammatory-type CD at the initial diagnosis. Further studies should be necessary to determine the additive effect of immunomodulators on the risk of intestinal surgery.

Original languageEnglish
Pages (from-to)330-338
Number of pages9
JournalJournal of gastroenterology
Volume54
Issue number4
DOIs
Publication statusPublished - Apr 1 2019

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Crohn Disease
Tumor Necrosis Factor-alpha
Immunologic Factors
Therapeutics
Propensity Score
Proportional Hazards Models
Cohort Studies
Necrosis
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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Anti-tumor necrosis factor therapy decreases the risk of initial intestinal surgery after diagnosis of Crohn’s disease of inflammatory type. / Nagata, Yutaka; Esaki, Motohiro; Tomohiko, Moriyama; Hirano, Atsushi; Umeno, Junji; Maehata, Yuji; torisu, takehiro; Matsumoto, Takayuki; Kitazono, Takanari.

In: Journal of gastroenterology, Vol. 54, No. 4, 01.04.2019, p. 330-338.

Research output: Contribution to journalArticle

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abstract = "Background: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn’s disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. Methods: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. Results: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P < 0.0001). The hazard ratio in the TNF group was 0.32 (95{\%} CI 0.13–0.74). Immunomodulators did not decrease the risk of initial intestinal surgery. Conclusions: Anti-TNF therapy can decrease the risk of intestinal surgery among patients with inflammatory-type CD at the initial diagnosis. Further studies should be necessary to determine the additive effect of immunomodulators on the risk of intestinal surgery.",
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T1 - Anti-tumor necrosis factor therapy decreases the risk of initial intestinal surgery after diagnosis of Crohn’s disease of inflammatory type

AU - Nagata, Yutaka

AU - Esaki, Motohiro

AU - Tomohiko, Moriyama

AU - Hirano, Atsushi

AU - Umeno, Junji

AU - Maehata, Yuji

AU - torisu, takehiro

AU - Matsumoto, Takayuki

AU - Kitazono, Takanari

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N2 - Background: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn’s disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. Methods: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. Results: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P < 0.0001). The hazard ratio in the TNF group was 0.32 (95% CI 0.13–0.74). Immunomodulators did not decrease the risk of initial intestinal surgery. Conclusions: Anti-TNF therapy can decrease the risk of intestinal surgery among patients with inflammatory-type CD at the initial diagnosis. Further studies should be necessary to determine the additive effect of immunomodulators on the risk of intestinal surgery.

AB - Background: Anti-tumor necrosis factor (TNF) therapy induces and maintains clinical remission in patients with Crohn’s disease (CD). However, the effect of anti-TNF therapy on the natural course of CD remains controversial. We aimed to investigate the effect of anti-TNF therapy on the initial intestinal surgery for CD. Methods: In this single-center retrospective cohort study, clinical course of 199 CD patients of inflammatory type at the initial diagnosis (the period between 1973 and 2014) was precisely reviewed until the end of 2016. Patients were divided into TNF and non-TNF groups based on anti-TNF agent use. After comparisons of clinical characteristics and medical treatments, propensity scores were calculated for covariates. Risk of intestinal surgery was compared by a Cox proportional hazards model using the propensity scores. The effect of immunomodulators on initial intestinal surgery was assessed in the TNF group. Results: During the study period, 108 patients received anti-TNF therapy. The patients in the TNF group were diagnosed more recently, and more frequently had isolated colonic involvement, and perianal disease. Immunomodulators were more frequently used in the TNF group. Cumulative probability of initial intestinal surgery was significantly lower in the TNF group (P < 0.0001). The hazard ratio in the TNF group was 0.32 (95% CI 0.13–0.74). Immunomodulators did not decrease the risk of initial intestinal surgery. Conclusions: Anti-TNF therapy can decrease the risk of intestinal surgery among patients with inflammatory-type CD at the initial diagnosis. Further studies should be necessary to determine the additive effect of immunomodulators on the risk of intestinal surgery.

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