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Surgical outcomes of patients treated with ustekinumab vs. vedolizumab in inflammatory bowel disease: a matched case analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

The association between preoperative use of monoclonal antibodies in inflammatory bowel disease (IBD) patients and postoperative complications is controversial, especially for the latest approved biologics, ustekinumab and vedolizumab, where data is limited. We hypothesized that ustekinumab-treated patients would have a similar overall postoperative complication rate as vedolizumab-treated patients. The aim of this study was to compare postoperative complications in patients receiving preoperative ustekinumab vs. vedolizumab.

Methods

We queried our IRB-approved prospective database to identify Crohn’s patients who underwent colorectal surgery and pretreatment with ustekinumab or vedolizumab within 12 weeks of surgery. Ustekinumab-treated patients were matched to vedolizumab-treated patients based on sex, age ± 5 years, date of operation ± 3 years, and type of surgery. Paired univariate analysis and conditional logistic regression of the matched pairs were performed. Our primary outcome was the short-term postoperative complication rate. Secondary outcomes included infectious complications, readmission, reoperation, and length of stay.

Results

A total of 103 patients with Crohn’s disease (CD) met the inclusion criteria (mean age 38.7 ± 13.4 years; male 51.2%). Overall, 30 patients received preoperative ustekinumab and 73 vedolizumab. In the univariate analysis, vedolizumab-treated patients had a higher postoperative complication rate (p = 0.009) and ileus rate (p = 0.015). After matching, 26 matched pairs were compared and logistic regression models demonstrated no significant difference in the primary outcome.

Conclusions

For our limited experience, the choice of preoperative biologic treatment between ustekinumab and vedolizumab should not be influenced by fear of surgical complications.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Matteo Novello, Luca Stocchi, Stefan Holubar, Sherief Shawki, Jeremy Lipman, Emre Gorgun, Tracy Hull & Scott R. Steele

Authors
  1. Matteo Novello
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  2. Luca Stocchi
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  3. Stefan Holubar
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  4. Sherief Shawki
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  5. Jeremy Lipman
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  6. Emre Gorgun
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  7. Tracy Hull
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  8. Scott R. Steele
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Corresponding author

Correspondence to Scott R. Steele.

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The authors declare that they have no conflict of interest.

Additional information

It was presented as an E-poster at “The American Society of Colon and Rectal Surgeons 2018 Annual Scientific Meeting” in Nashville, TN, USA, May 19–23, 2018.

What does this paper add to the literature?

The association between preoperative use of ustekinumab and vedolizumab in inflammatory bowel disease patients and postoperative complications is controversial. Considering the little data available in literature and the increasing use of these biologics, we believe it is important to shed light on their preoperative use with respect to postoperative complications.

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Novello, M., Stocchi, L., Holubar, S. et al. Surgical outcomes of patients treated with ustekinumab vs. vedolizumab in inflammatory bowel disease: a matched case analysis. Int J Colorectal Dis 34, 451–457 (2019). https://doi.org/10.1007/s00384-018-3212-6

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  • DOI: https://doi.org/10.1007/s00384-018-3212-6

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