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Journal of Gastrointestinal Surgery

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01-07-2017 | Original Article

As Infliximab Use for Ulcerative Colitis Has Increased, so Has the Rate of Surgical Resection

Authors: Cindy Kin, M. Kate Bundorf

Published in: Journal of Gastrointestinal Surgery | Issue 7/2017

Abstract

Background

Infliximab was approved for ulcerative colitis in 2005 after randomized trials showed it reduced the risk of colectomy. Its effect on population-level surgery rates is unknown. Our aim is to assess the impact of infliximab approval for ulcerative colitis on surgical intervention.

Methods

Retrospective review of a private insurance claims database (2002 to 2013) was performed of patients aged 18–64 diagnosed with ulcerative colitis and with 2 years of follow-up. Outcome measures were infliximab treatment and surgical resection. Multivariable logistic regression used independent variables of time period of diagnosis, age, gender, comorbidities, and insurance type.

Results

The cohort included 58,681 patients. Age, gender, and comorbidities were comparable across time periods. Patients diagnosed in the post-infliximab period had greater odds of undergoing infliximab treatment within the first year of diagnosis than those in the pre-infliximab era (OR = 2.88, p < 0.001). However, the odds of undergoing total colectomy or total proctocolectomy were also higher in patients diagnosed in the post-infliximab period (OR 1.5, p < 0.001).

Conclusions

The use of infliximab for ulcerative colitis has, as expected, increased since its approval, but so has the risk of surgery. Thus, the introduction of biologic therapy has not decreased the risk for surgery for this patient population.

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Järnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005; 128(7):1805–1811.CrossRefPubMed

Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005; 353(23):2462–2476.CrossRefPubMed

Aratari A, Papi C, Clemente V, et al. Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis. 2008; 40(10):821–826.CrossRefPubMed

Moore SE, McGrail KM, Peterson S, et al. Infliximab in ulcerative colitis: the impact of preoperative treatment on rates of colectomy and prescribing practices in the province of British Columbia, Canada. Dis Colon Rectum 2014; 57(1):83–90.CrossRefPubMed

Geltzeiler CB, Lu KC, Diggs BS, et al. Initial surgical management of ulcerative colitis in the biologic era. Dis Colon Rectum. 2014; 57(12):1358–1363.CrossRefPubMed

Bikhchandani J, Polites SF, Wagie AE, Habermann EB, Cima RR. National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis. Dis Colon Rectum. 2015; 58(2):199–204.CrossRefPubMed

Bickston SJ, Waters HC, Dabbous O, Tang BI, Rahman M. Administrative claims analysis of all-cause annual costs of care and resource utilization by age category for ulcerative colitis patients. J Manag Care Pharm. 2008; 14(4):352–362.PubMed

Selvaggi F, Pellino G, Canonico S, Sciaudone G. Effect of preoperative biologic drugs on complications and function after restorative proctocolectomy with primary ileal pouch formation: systematic review and meta-analysis. Inflamm Bowel Dis. 2015; 21(1):79–92.CrossRefPubMed

Eshuis EJ, Al Saady RL, Stokkers PC, Ponsioen CY, Tanis PJ, Bemelman WA. Previous infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis. J Crohns Colitis. 2013; 7(2):142–149.CrossRefPubMed

10.

Yang Z, Wu Q, Wu K, Fan D. Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis. Aliment Pharmacol Ther. 2010; 31(4):486–492.CrossRefPubMed

11.

Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH. Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum. 2008; 51(8):1202–1207; discussion 1207-1210.

12.

Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007; 204(5):956–962; discussion 962-953.CrossRefPubMed

13.

Kennedy R, Potter DD, Moir C, Zarroug AE, Faubion W, Tung J. Pediatric chronic ulcerative colitis: does infliximab increase post-ileal pouch anal anastomosis complications? J Pediatr Surg. 2012; 47(1):199–203.CrossRefPubMed

14.

Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg. 2008; 12(10):1730–1736; discussion 1736-1737.CrossRefPubMed

15.

Bordeianou L, Kunitake H, Shellito P, Hodin R. Preoperative infliximab treatment in patients with ulcerative and indeterminate colitis does not increase rate of conversion to emergent and multistep abdominal surgery. Int J Colorectal Dis. 2010; 25(3):401–404.CrossRefPubMed

16.

Zittan E, Milgrom R, Ma GW, et al. Preoperative anti-tumor necrosis factor therapy in patients with ulcerative colitis is not associated with an increased risk of infectious and noninfectious complications after ileal pouch-anal anastomosis. Inflamm Bowel Dis. 2016; 22(10):2442–2447.CrossRefPubMed

17.

Billioud V, Ford AC, Tedesco ED, Colombel JF, Roblin X, Peyrin-Biroulet L. Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis. J Crohns Colitis. 2013; 7(11):853–867.CrossRefPubMed

18.

Kaplan GG, Seow CH, Ghosh S, et al. Decreasing colectomy rates for ulcerative colitis: a population-based time trend study. Am J Gastroenterol. 2012; 107(12):1879–1887.CrossRefPubMed

19.

Lutgens MW, van Oijen MG, van der Heijden GJ, Vleggaar FP, Siersema PD, Oldenburg B. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis. 2013; 19(4):789–799.CrossRefPubMed

Title: As Infliximab Use for Ulcerative Colitis Has Increased, so Has the Rate of Surgical Resection
Authors: Cindy Kin
M. Kate Bundorf
Publication date: 01-07-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 7/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3431-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

As Infliximab Use for Ulcerative Colitis Has Increased, so Has the Rate of Surgical Resection

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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