Skip to main content
SpringerLink
Log in

Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn’s Disease Patients

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn’s disease recurrence.

Aims

We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients.

Methods

We performed a cohort study of Crohn’s disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively.

Results

A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy.

Conclusions

There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sachar DB. Recurrence rates in Crohn’s disease: predicting the future and predicting the past. Gut. 2006;55:1069–1070.

    Article  CAS  Google Scholar 

  2. Terdiman JP. Prevention of postoperative recurrence in Crohn’s disease. Clin Gastroenterol Hepatol. 2008;6:616–620.

    Article  Google Scholar 

  3. Morar PS, Faiz O, Hodgkinson JD, et al. Concomitant colonic disease (Montreal L3) and re-resectional surgery are predictors of clinical recurrence following ileocolonic resection for Crohn’s disease. Colorectal Dis. 2015;17:O247–O255.

    Article  CAS  Google Scholar 

  4. Aguas M, Bastida G, Cerrillo E, et al. Adalimumab in prevention of postoperative recurrence of Crohn’s disease in high-risk patients. World J Gastroenterol. 2012;18:4391–4398.

    Article  CAS  Google Scholar 

  5. De Cruz P, Kamm MA, Hamilton AL, et al. Efficacy of thiopurines and adalimumab in preventing Crohn’s disease recurrence in high-risk patients—a POCER study analysis. Aliment Pharmacol Ther. 2015;42:867–879.

    Article  Google Scholar 

  6. Hanauer SB, Korelitz BI, Rutgeerts P, et al. Postoperative maintenance of Crohn’s disease remission with 6-mercaptopurine, mesalamine, or placebo: a 2-year trial. Gastroenterology. 2004;127:723–729.

    Article  CAS  Google Scholar 

  7. Cammà C, Giunta M, Rosselli M, Cottone M. Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology. 1997;113:1465–1473.

    Article  Google Scholar 

  8. Ewe K, Böttger T, Buhr HJ, Ecker KW, Otto HF. Low-dose budesonide treatment for prevention of postoperative recurrence of Crohn’s disease: a multicentre randomized placebo-controlled trial. German Budesonide Study Group. Eur J Gastroenterol Hepatol. 1999;11:277–282.

    Article  CAS  Google Scholar 

  9. Ardizzone S, Maconi G, Sampietro GM, et al. Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn’s disease. Gastroenterology. 2004;127:730–740.

    Article  CAS  Google Scholar 

  10. Peyrin-Biroulet L, Deltenre P, Ardizzone S, et al. Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn’s disease: a meta-analysis. Am J Gastroenterol. 2009;104:2089–2096.

    Article  CAS  Google Scholar 

  11. Sorrentino D, Terrosu G, Avellini C, Beltrami CA, Bresadola V, Toso F. Prevention of postoperative recurrence of Crohn’s disease by infliximab. Eur J Gastroenterol Hepatol. 2006;18:457–459.

    Article  Google Scholar 

  12. Regueiro M, Schraut W, Baidoo L, et al. Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology 2009;136:441–50.e1; quiz 716.

  13. Regueiro M, Feagan BG, Zou B, et al. Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after ileocolonic resection. Gastroenterology. 2016;150:1568–1578.

    Article  CAS  Google Scholar 

  14. Sorrentino D. State-of-the-art medical prevention of postoperative recurrence of Crohn’s disease. Nat Rev Gastroenterol Hepatol. 2013;10:413–422.

    Article  CAS  Google Scholar 

  15. Sorrentino D, Terrosu G, Paviotti A, et al. Early diagnosis and treatment of postoperative endoscopic recurrence of Crohn’s disease: partial benefit by infliximab—a pilot study. Dig Dis Sci. 2012;57:1341–1348. https://doi.org/10.1007/s10620-011-2025-z.

    Article  CAS  PubMed  Google Scholar 

  16. Yamamoto T, Umegae S, Matsumoto K. Impact of infliximab therapy after early endoscopic recurrence following ileocolonic resection of Crohn’s disease: a prospective pilot study. Inflamm Bowel Dis. 2009;15:1460–1466.

    Article  Google Scholar 

  17. Nguyen GC, Loftus EV, Hirano I, et al. American Gastroenterological Association Institute Guideline on the management of Crohn’s disease after surgical resection. Gastroenterology. 2017;152:271–275.

    Article  Google Scholar 

  18. Regueiro M, Velayos F, Greer JB, et al. American Gastroenterological Association Institute Technical Review on the management of Crohn’s disease after surgical resection. Gastroenterology. 2017;152:277–295.e3.

    Article  Google Scholar 

  19. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease. Br J Surg. 2000;87:1697–1701.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Evan Sholle for his IT assistance with capturing the patient cohort.

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Science of the National Institute of Health (UL1TR000457). Clara Oromendia, M.S., was partially supported by the Clinical and Translational Science Center at Weill Cornell Medical College (UL1-TR000457-06).

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA

    Shirley Cohen-Mekelburg, Yecheskel Schneider, Ellen Scherl & Adam Steinlauf

  2. Department of Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA

    Stephanie Gold & Madison Dennis

  3. Division of Healthcare Policy and Research, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA

    Clara Oromendia

  4. Department of Surgery, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA

    Heather Yeo & Fabrizio Michelassi

Authors
  1. Shirley Cohen-Mekelburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yecheskel Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Madison Dennis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clara Oromendia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heather Yeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fabrizio Michelassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ellen Scherl
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Adam Steinlauf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shirley Cohen-Mekelburg.

Ethics declarations

Conflict of interest

Dr. Scherl has received grant/research support from Abbott Laboratories (AbbVie), AstraZeneca, Janssen Research and Development, and Pfizer and serves as a consultant to AbbVie, Janssen Pharmaceutical, and Takeda Pharmaceuticals. The other authors have no relevant conflicts of interest to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cohen-Mekelburg, S., Gold, S., Schneider, Y. et al. Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn’s Disease Patients. Dig Dis Sci 64, 196–203 (2019). https://doi.org/10.1007/s10620-018-5159-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5159-4

Keywords

Search

Navigation