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Safety of anti-TNF therapy before surgery in Crohn’s disease
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- Decreasing incidence of colectomy in ulcerative colitis 0%
- Prevention of venous thromboembolism in patients with IBD 0%
- Rate of repeat intestinal resection in Crohn’s disease 0%
- Safety of anti-TNF therapy before surgery in Crohn’s disease 0%
- Vaccination of IBD patients before treatment 0%
- Vedolizumab therapy for Crohn’s disease 0%
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1. Question
A retrospective case-control study of 298 patients with Crohn’s disease at 6 centres in Denmark compared the risk of complications after resection/anastomosis or strictureplasty in patients treated with anti-TNF agents within 2 months preoperatively with the risk among patients not treated with anti-TNF agents. The study found no significant difference between the two groups.
Correct
Postoperative complications were reported in 30.9%. The use of biologics within 2 months before an operation with anastomosis or strictureplasty did not alter the rate or severity of complication. (E-Mentoring in IBD Volume 8 Issue 1)
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Postoperative complications were reported in 30.9%. The use of biologics within 2 months before an operation with anastomosis or strictureplasty did not alter the rate or severity of complication. (E-Mentoring in IBD Volume 8 Issue 1)
Prevention of venous thromboembolism in patients with IBD
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- Prevention of venous thromboembolism in patients with IBD 0%
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1. Question
Although patients with IBD have a 3-fold increase in the rate of venous thromboembolism (VTE) compared with individuals without IBD, not all patients with IBD require thromboprophylaxis. A recent CAG consensus statement recommended anticoagulant prophylaxis in patients with IBD flare who had a history of VTE, and in the following situations:
Correct
Good evidence supports use of anticoagulant thromboprophylaxis for IBD patients in the following circumstances:
• Major surgery, including abdominal and caesarean procedures
• Hospitalization for an IBD flare or for non-flare reasons
• IBD flare in patients with a history of VTE.
• (E-Mentoring in IBD Volume 8 Issue 3)Incorrect
Good evidence supports use of anticoagulant thromboprophylaxis for IBD patients in the following circumstances:
• Major surgery, including abdominal and caesarean procedures
• Hospitalization for an IBD flare or for non-flare reasons
• IBD flare in patients with a history of VTE.
• (E-Mentoring in IBD Volume 8 Issue 3)
Rate of repeat intestinal resection in Crohn’s disease
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A systematic review and meta-analysis reviewed 11 population-based studies and 1 abstract to establish the risk of a second abdominal surgery in patients with Crohn’s disease among those who had a previous surgery. The analysis found the overall risk of a second surgery was
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For all population-based studies, the overall risk of second surgery was 28.7% (22.6–36.6%). The 5-year risk of second surgery was 24.2% (22.3–26.4%). The 10-year risk of second surgery was 35.0% (31.8–38.6%). The 10-year risk of second surgery significantly decreased for studies conducted after 1980 (33.2%, 31.2–35.4%) compared with those before 1980 (44.6%, 37.7–52.7%). (E-Mentoring in IBD Volume 8 Issue 7)
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For all population-based studies, the overall risk of second surgery was 28.7% (22.6–36.6%). The 5-year risk of second surgery was 24.2% (22.3–26.4%). The 10-year risk of second surgery was 35.0% (31.8–38.6%). The 10-year risk of second surgery significantly decreased for studies conducted after 1980 (33.2%, 31.2–35.4%) compared with those before 1980 (44.6%, 37.7–52.7%). (E-Mentoring in IBD Volume 8 Issue 7)
Decreasing incidence of colectomy in ulcerative colitis
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1. Question
A retrospective observational cohort study used the discharge databases of 4 hospitals in Edmonton, Alberta to identify 481 adults diagnosed with UC who underwent colectomy for medically refractory disease (1998–2011). A comparison of colectomy rates before and after introduction of anti-TNF agents found increasing use of anti-TNF agents resulted in an annual reduction of colectomy rates of approximately 12%, to an annual incidence of 0.9 per 100 UC patients in 2011.
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Before introduction of anti-TNFs (1998–2005), the annual colectomy rate did not change. After introduction of anti-TNFs (2005–2011) the colectomy rate decreased by 16.1% annually, in parallel with the increasing use of anti-TNFs, to an annual colectomy incidence of 0.9 per 100 UC patients in 2011. The annual urgent colectomy rate declined more sharply (-18.6%) than the elective colectomy rate (-14.9%). (E-Mentoring in IBD Volume 8 Issue 9)
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Before introduction of anti-TNFs (1998–2005), the annual colectomy rate did not change. After introduction of anti-TNFs (2005–2011) the colectomy rate decreased by 16.1% annually, in parallel with the increasing use of anti-TNFs, to an annual colectomy incidence of 0.9 per 100 UC patients in 2011. The annual urgent colectomy rate declined more sharply (-18.6%) than the elective colectomy rate (-14.9%). (E-Mentoring in IBD Volume 8 Issue 9)
Vedolizumab therapy for Crohn’s disease
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1. Question
A randomized controlled trial compared the rates of clinical remission after induction with vedolizumab or placebo at 6 and 10 weeks in 315 patients who had experienced anti-TNF therapy failure. The study found no difference between vedolizumab and placebo at 6 weeks among patients with anti-TNF failure, but a significant effect at 10 weeks.
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Among patients with anti-TNF failure, 15.2% of those given vedolizumab and 12.1% of those given placebo were in remission at week 6 (P=.433). At week 10, a greater proportion of patients given vedolizumab was in remission (26.6%) than those given placebo (12.1%) (nominal P=.001; relative risk, 2.2; 95% confidence interval, 1.3–3.6). (E-Mentoring in IBD Volume 8 Issue 13)Incorrect
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Among patients with anti-TNF failure, 15.2% of those given vedolizumab and 12.1% of those given placebo were in remission at week 6 (P=.433). At week 10, a greater proportion of patients given vedolizumab was in remission (26.6%) than those given placebo (12.1%) (nominal P=.001; relative risk, 2.2; 95% confidence interval, 1.3–3.6). (E-Mentoring in IBD Volume 8 Issue 13)
Vaccination of IBD patients before treatment
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A meta-analysis of 9 prospective case series evaluated the impact of immunosuppressive monotherapy, biologic monotherapy, and combination therapy on seroprotection after routine vaccination. The pooled analysis found that immunosuppressive therapy reduced the chance of achieving adequate seroprotection after vaccination by:
Correct
The chances of achieving adequate seroprotection, compared with patients not receiving any immunosuppressive therapy, were as follows:
• 60% lower for patients receiving combination therapy (OR 0.41, 95% CI 0.30, 0.55, P<.001) • 40% lower for patients receiving immunomodulator monotherapy (OR 0.63, 95% CI 0.42, 0.95, P=.03). • 70% lower for patients receiving anti-TNF monotherapy (OR 0.32, 95% CI 0.21, 0.49, P<.001). • 65% lower for patients receiving ≥2 immunosuppressive therapies Patients receiving immunomodulator monotherapy had a 2-fold greater chance of achieving an adequate immune response than patients receiving anti-TNF monotherapy (OR 1.92, 95 % CI 1.30, 2.84). (E-Mentoring in IBD Volume 8 Issue 20)Incorrect
The chances of achieving adequate seroprotection, compared with patients not receiving any immunosuppressive therapy, were as follows:
• 60% lower for patients receiving combination therapy (OR 0.41, 95% CI 0.30, 0.55, P<.001) • 40% lower for patients receiving immunomodulator monotherapy (OR 0.63, 95% CI 0.42, 0.95, P=.03). • 70% lower for patients receiving anti-TNF monotherapy (OR 0.32, 95% CI 0.21, 0.49, P<.001). • 65% lower for patients receiving ≥2 immunosuppressive therapies Patients receiving immunomodulator monotherapy had a 2-fold greater chance of achieving an adequate immune response than patients receiving anti-TNF monotherapy (OR 1.92, 95 % CI 1.30, 2.84). (E-Mentoring in IBD Volume 8 Issue 20)