Use of Infliximab within 3 Months of Ileocolonic Resection is Associated with Adverse Postoperative Outcomes in Crohn’s Patients
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Few studies have evaluated preoperative infliximab use and postoperative outcomes in Crohn’s patients. Our aim was to evaluate 30-day postoperative outcomes for Crohn’s patients treated with infliximab within 3 months prior to ileocolonic resection.
The study is a retrospective evaluation of data for patients undergoing ileocolonic resection after 1998 from a prospective Crohn’s disease database. Patient characteristics and 30-day complications were compared for patients treated with infliximab within 3 months before surgery and an infliximab naïve group. The infliximab group was also compared with non-infliximab patients undergoing ileocolonic surgery before 1998.
Sixty of 389 Crohn’s patients undergoing ileocolonic resection received infliximab. The infliximab and non-infliximab groups had similar characteristics, preoperative risk factors, and surgical procedure. However, steroid use was higher (p < 0.05) in the non-infliximab group while concurrent immunosuppressive use was higher (p < 0.001) in the infliximab group. Multivariate analysis showed infliximab use to be associated with 30-day postoperative readmission (p = 0.045), sepsis (p = 0.027), and intraabdominal abscess (p = 0.005). The presence of diverting stoma (n = 17) in the infliximab group was associated with lower risk of sepsis (0% vs. 27.9%, p = 0.013). Similar results were noted when the infliximab group was compared to the pre-infliximab patients.
Infliximab use within 3 months before surgery is associated with increased postoperative sepsis, abscess, and readmissions in Crohn’s patients. Diverting stoma may protect against these complications.
- van Hogezand RA. Medical management of patients with difficult-to-treat inflammatory bowel disease. Neth J Med. 1994;45(2):55–59.
- Rasenack J, Kreisel W. Conservative therapy of ulcerative colitis and Crohn disease. Fortschr Med. 1991;109(11):245–247.
- Hanauer SB. Medical therapy for Crohn’s disease. Curr Opin Gastroenterol. 1999;15(4):308–314. doi:10.1097/00001574-199907000-00006 CrossRef
- Hanauer SB. Clinical perspectives in Crohn’s disease. Turning traditional treatment strategies on their heads: current evidence for “step-up” versus “top-down”. Rev Gastroenterol Disord. 2007;7(Suppl 2):S17–22.
- Oldenburg B, Hommes D. Biological therapies in inflammatory bowel disease: top-down or bottom-up? Curr Opin Gastroenterol. 2007;23(4):395–399. doi:10.1097/MOG.0b013e32815b601b CrossRef
- Frikker MJ, Segall MM. The resectional reoperation rate for Crohn’s disease in a general community hospital. Dis Colon Rectum. 1983;26(5):305–309. doi:10.1007/BF02561704 CrossRef
- Polle SW, Slors JF, Weverling GJ, Gouma DJ, Hommes DW, Bemelman WA. Recurrence after segmental resection for colonic Crohn’s disease. Br J Surg. 2005;92(9):1143–1149. doi:10.1002/bjs.5050 CrossRef
- Sachar DB. Maintenance strategies in Crohn’s disease. Hospital Practice (1995) 1996;31(1):99–106.
- Murray JJ, Schoetz DJ Jr, Nugent FW, Coller JA, Veidenheimer MC. Surgical management of Crohn’s disease involving the duodenum. Am J Surg. 1984;147(1):58–65. doi:10.1016/0002-9610(84)90035-7 CrossRef
- Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T. et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337(15):1029–1035. doi:10.1056/NEJM199710093371502 CrossRef
- Kornbluth A. Infliximab approved for use in Crohn’s disease: a report on the FDA GI Advisory Committee conference. Inflamm Bowel Dis. 1998;4(4):328–329. doi:10.1002/ibd.3780040415 CrossRef
- Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF. et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359(9317):1541–1549. doi:10.1016/S0140-6736(02)08512-4 CrossRef
- Feagan BG, Yan S, Bala M, Bao W, Lichtenstein GR. The effects of infliximab maintenance therapy on health-related quality of life. Am J Gastroenterol. 2003;98(10):2232–2238. doi:10.1111/j.1572-0241.2003.07674.x CrossRef
- Andus T, Stange EF, Hoffler D, Keller-Stanislawski B. Suspected cases of severe side effects after infliximab (Remicade) in Germany. Med Klin (Munich). 2003;98(8):429–436. doi:10.1007/s00063-003-1282-9 CrossRef
- Hansen RA, Gartlehner G, Powell GE, Sandler RS. Serious adverse events with infliximab: analysis of spontaneously reported adverse events. Clin Gastroenterol Hepatol. 2007;5(6):729–735. doi:10.1016/j.cgh.2007.02.016 CrossRef
- Byrne CM, Solomon MJ, Young JM, Selby W, Harrison JD. Patient preferences between surgical and medical treatment in Crohn’s disease. Dis Colon Rectum. 2007;50(5):586–597. doi:10.1007/s10350-006-0847-0 CrossRef
- Chang J, Girgis L. Clinical use of anti-TNF-alpha biological agents-a guide for GPs. Aust Fam Physician. 2007;36(12):1035–1038.
- Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS. 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. doi:10.1016/j.jamcollsurg.2006.12.044 CrossRef
- 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. CrossRef
- Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T. et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99(5):878–883. doi:10.1111/j.1572-0241.2004.04148.x CrossRef
- Marchal L, D’Haens G, Van Assche G, Vermeire S, Noman M, Ferrante M. et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther. 2004;19(7):749–754. doi:10.1111/j.1365-2036.2004.01904.x CrossRef
- Cornillie F, Shealy D, D’Haens G, Geboes K, Van Assche G, Ceuppens J. et al. Infliximab induces potent anti-inflammatory and local immunomodulatory activity but no systemic immune suppression in patients with Crohn’s disease. Aliment Pharmacol Ther. 2001;15(4):463–473. doi:10.1046/j.1365-2036.2001.00956.x CrossRef
- Bratcher JM, Korelitz BI. Toxicity of infliximab in the course of treatment of Crohn’s disease. Expert Opin Drug Saf. 2006;5(1):9–16. doi:10.1517/147403220.127.116.11 CrossRef
- Reddy JG, Loftus EV Jr. Safety of infliximab and other biologic agents in the inflammatory bowel diseases. Gastroenterol Clin North Am. 2006;35(4):837–855. doi:10.1016/j.gtc.2006.09.008 CrossRef
- Weston-Petrides GK, Lovegrove RE, Tilney HS, Heriot AG, Nicholls RJ, Mortensen NJ. et al. Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg. 2008;143(4):406–412. doi:10.1001/archsurg.143.4.406 CrossRef
- Hochberg MC, Lebwohl MG, Plevy SE, Hobbs KF, Yocum DE. The benefit/risk profile of TNF-blocking agents: findings of a consensus panel. Semin Arthritis Rheum. 2005;34(6):819–836. doi:10.1016/j.semarthrit.2004.11.006 CrossRef
- Kalkay MN, Cordoba I, Plevy D. The nonreflux determinant of esophagitis. Am J Gastroenterol. 1975;63(2):135–146.
- Plevy SE, Landers CJ, Prehn J, Carramanzana NM, Deem RL, Shealy D. et al. A role for TNF-alpha and mucosal T helper-1 cytokines in the pathogenesis of Crohn’s disease. J Immunol. 1997;159(12):6276–6282.
- Use of Infliximab within 3 Months of Ileocolonic Resection is Associated with Adverse Postoperative Outcomes in Crohn’s Patients
Journal of Gastrointestinal Surgery
Volume 12, Issue 10 , pp 1738-1744
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- Crohn’s disease
- Ileocolonic resection
- Postoperative complications
- Anastomotic leak
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