Safety of anti-TNF therapy prior to surgery in CD

Jan 20, 2015 - E-Mentoring in IBD | Volume 8 • 2015

Issue 01

Clinical Question

For Crohn’s disease (CD) patients, does anti-TNF therapy within 2 months of surgery increase the rate of post-operative complications?

Editor’s Bottom Line

Anti-TNF therapy within 2 months of resection/anastomosis or strictureplasty did not increase post-operative complications.

Editorial Note

A large number of studies, including several metanalysis, have examined post-operative complications with anti-TNF therapy. The results are mixed, likely because of the many variable factors that are associated with a post-operative complication. Nevertheless, no strong signal for an increased risk of post-operative complications with anti-TNF therapy has yet appeared.

Reference

Myrelid P, Marti-Gallostra M, Ashraf S, et al. Complications in surgery for Crohn’s disease after preoperative antitumour necrosis factor therapy. Br J Surg. 2014 Apr;101(5):539–45.
https://www.ncbi.nlm.nih.gov/pubmed/24615529

Synopsis

All CD patients who had surgery with ≥1 intestinal anastomosis (without a covering stoma) and had received biologic therapy were identified using a database comprised of 6 tertiary referral centres. Patients were categorized into a control group (either discontinued anti-TNF therapy >2 months prior to surgery or started it >6 weeks after surgery), or a treatment group (received anti-TNF therapy <2 months prior to surgery). Clinical and patient information was collected as well as surgical procedure, Montreal classification of CD, and medical therapy at time of surgery. Clavien-Dindo classification was used to characterize post-operative complications. Primary study endpoint was post-operative complication within 30 days of surgery.

Of the 298 patients recruited, there were 187 and 111 in the control and treatment groups, respectively. No significant differences between the groups were identified with respect to Montreal classification, surgical history, medications, smoking history, age at time of surgery, or sex. Elective surgeries comprised 85.6% of those analysed; open surgery was performed in 80.9% of the operations. The most common indication was stenosis (61.4%).

Post-operative complications were reported for 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.

Details

Study Design: Retrospective case-control study
Funding: Not reported
Allocation: n/a
Setting: 6 tertiary referral centres, Denmark
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.