P391 The availability of anti-TNF agents is associated with reduced early surgical requirements in Crohn’s disease but not in ulcerative colitis. A nationwide study from the Eneida registry

Abstract

Background: It has been suggested that biological therapies might change the natural history of IBD, avoiding surgery in a proportion of patients. Retrospective series show controversial results and include small samples sizes. Methods: To assess the impact of the availability of anti-TNF agents on the need for early surgery (within the first 5 years from IBD diagnosis) in both CD and UC, all those incident patients who were diagnosed in two different periods (before and after anti-TNF availability) were identified from the ENEIDA Registry (a large, prospectively maintained database of the Spanish Working Group in IBD-GETECCU-). Incident cohorts included the time periods 1990-1995 and 2007-2012 for CD, and 1995-2000 and 2007-2012 for UC. Patients lacking dates of IBD diagnosis or surgery, as well as those with a follow-up <6 months in the absence of intestinal resection, were excluded. Surgery-free survival curves were compared between incident cohorts by means of log-rank test. Results: A total of 7496 CD patients and 8.028 UC patients were included. In the cohorts post-anti-TNF approval, 1964 (37%) CD patients were exposed to anti-TNF within the first 5 years and 862 of them (44%) were operated on thereafter; 777 (15%) UC patients were exposed to anti-TNFs within the first 5 years and 203 of them (26%) were colectomized. Table 1 shows the number of included patients in each incident cohort and the cumulative probability of resectional surgery within the first 5 years since disease diagnosis for the total cohorts and in those subgroups at higher risk for surgery (ileal disease in CD, extensive UC). Conclusions: Availability of anti-TNF agents is associated with a reduction of early intestinal resection in CD but not in UC (even in extensive UC). Timely and/or improved use of biological therapies might have a deeper impact on surgical requirements in IBD.