Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates

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Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates

Eberhardson, Michael (författare): Karolinska Institutet,Linköpings universitet,Linköping University,Karolinska Institute,Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Mag- tarmmedicinska kliniken,Karolinska Inst, Sweden

Myrelid, Pär (författare): Linköpings universitet,Linköping University,Division of Surgery, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Surgery, University Hospital, Linköping, Sweden,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US

Söderling, Jonas K. (författare): Karolinska Institutet,Karolinska Institute,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Karolinska Inst, Sweden

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Ekbom, Anders (författare): Karolinska Institutet,Karolinska Institute,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Karolinska Inst, Sweden

Everhov, Åsa H. (författare): Karolinska Institutet,Karolinska Institute,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Karolinska Inst, Sweden; Karolinska Inst, Sweden

Hedin, Charlotte R.H. (författare): Karolinska Institutet,Karolinska Institute,Department of Medicine Solna, Karolinska Institutet, Stockholm, Swede; Division of Gastroenterology, Medical Unit Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden

Neovius, Martin (författare): Karolinska Institutet,Karolinska Institute,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Karolinska Inst, Sweden

Ludvigsson, Jonas F., 1969- (författare): Karolinska Institutet,Örebro universitet,Karolinska Institute,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA,Columbia University,Institutionen för medicinska vetenskaper,Region Örebro län,Karolinska Inst, Sweden; Orebro Univ Hosp, Sweden; Univ Nottingham, England; Columbia Univ Coll Phys & Surg, NY USA

Olén, Ola (författare): Karolinska Institutet,Karolinska Institute,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Karolinska Inst, Sweden; Karolinska Inst, Sweden

Strid, Hans (creator_code:cre_t)

Hjortswang, Henrik (creator_code:cre_t)

Olsson, Malin (creator_code:cre_t)

Björk, Jan (creator_code:cre_t)

Bengtsson, Jonas L. (creator_code:cre_t)

Halfvarson, Jonas (creator_code:cre_t)

Andersson, Marie A. (creator_code:cre_t)

Karling, Pontus (creator_code:cre_t)

Rejler, Martin (creator_code:cre_t)

Jäghult, Susanna (creator_code:cre_t)

Fagerberg, Ulrika L. (creator_code:cre_t)

Grip, Olof (creator_code:cre_t): Lund University,Lunds universitet,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Internal Medicine - Epidemiology,Lund University Research Groups

Nordenvall, Caroline (creator_code:cre_t)

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(creator_code:org_t)

2022-01-22
2022
Engelska.
Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 24:4, s. 470-483

Relaterad länk:: http://dx.doi.org/10... (free); visa fler...; https://onlinelibrar...; https://doi.org/10.1...; https://liu.diva-por... (primary) (Raw object); https://lup.lub.lu.s...; https://doi.org/10.1...; https://urn.kb.se/re...; https://urn.kb.se/re...; http://kipublication...; visa färre...

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Aim: Surgery is an important therapeutic option for Crohn's disease. The need for first bowel surgery seems to have decreased with the introduction of tumour necrosis factor inhibitors (TNFi; adalimumab or infliximab). However, the impact of TNFi on the need for intestinal surgery in Crohn's disease patients irrespective of prior bowel resection is not known. The aim of this work is to compare the incidence of bowel surgery in Crohn's disease patients who remain on TNFi treatment versus those who discontinue it. Method: We performed a nationwide register-based observational cohort study in Sweden of all incident and prevalent cases of Crohn's disease who started first-line TNFi treatment between 2006 and 2017. Patients were categorized according to TNFi treatment retention less than or beyond 1 year. The study cohort was evaluated with regard to incidence of bowel surgery from 12 months after the first ever TNFi dispensation. Results: We identified 5003 Crohn's disease patients with TNFi exposure: 3748 surgery naïve and 1255 with bowel surgery prior to TNFi initiation. Of these patients, 7% (n = 353) were subjected to abdominal surgery during the first 12 months after the start of TNFi and were subsequently excluded from the main analysis. A majority (62%) continued TNFi for 12 months or more. Treatment with TNFi for less than 12 months was associated with a significantly higher surgery rate compared with patients who continued on TNFi for 12 months or more (hazard ratio 1.26, 95% CI 1.09–1.46; p = 0.002). Conclusion: Treatment with TNFi for less than 12 months was associated with a higher risk of bowel surgery in Crohn's disease patients compared with those who continued TNFi for 12 months or more.

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Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates

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