Surgical rates in the era of biological therapy: Up, down or unchanged?

Pablo Olivera, Antonino Spinelli, Corinne Gower-Rousseau, Silvio Danese, Laurent Peyrin-Biroulet

Research output: Contribution to journalReview article

Abstract

Purpose of review The aim of this review is to summarize data regarding surgical trends in inflammatory bowel disease in the prebiologic and biologic era, with a focus on population-based studies and randomized controlled trials (RCTs). Recent findings There is paucity of data in RCTs regarding surgical rates, with only a few clinical trials reporting them. From the available data, meta-analyses of RCTs have concluded that antitumor necrosis α agents (anti-TNF) reduce surgical rates in ulcerative colitis and Crohn's disease. A large body of evidence from population-based studies from different regions of the world is available to evaluate surgical trends before and after the introduction of anti-TNF agents. The risk of surgery decreased significantly over the past six decades; these decreasing trends continued in the biologic era, which might indicate a potential beneficial disease-modifying effect of biologics. There is lack of data with nonanti-TNF biologics (i.e. anti-integrins and ustekinumab) regarding the risk of surgery. Summary Although data from population-based studies and available RCTs suggest a protective effect from surgery of anti-TNF agents, definitive conclusions should be drawn only when more disease-modifying trials with different biologics and treatment strategies become available.

Original languageEnglish
Pages (from-to)246-253
Number of pages8
JournalCurrent Opinion in Gastroenterology
Volume33
Issue number4
DOIs
Publication statusPublished - Jul 1 2017

Keywords

  • biologics
  • colectomy
  • inflammatory bowel disease
  • surgery

ASJC Scopus subject areas

  • Gastroenterology

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