Biological therapy (BT) is widely used in the treatment of Crohn’s Disease (CD). However its impact on both the rate and timing of bowel resection (BR) is poorly understood.
Aim: To analyse the rate of, and time to BR in children in pre- and post- BT eras in a tertiary referral hospital according to phenotypic presentation.
Methods: Retrospective review of two consecutive eight-year cohorts of children with CD pre-BT (n=95) and post-BT (n= 169). Exclusion criteria: children diagnosed pre-BT who received BT later in their illness, and children having resection within 6 months of diagnosis. In subgroup analysis phenotype was determined by imaging/endoscopy. Data are presented as mean (SEM). Analysis utilised Student’s t, Fisher’s exact and Kaplan-Meier tests; p<0.05 significant.
Results: Children were diagnosed at a significantly older age post-BT (pre-BT 10.9 (0.3) years vs post-BT 12.4 (0.2) (p<0.0001)). BT was commenced at a median of 1.25 years (IQR 0.7-2.3) after diagnosis. Kaplan-Meier showed no significant difference in the probability of having resection in the pre and post BT era and in children who did and did not receive BTs (Figure 1).
Ileocaecal phenotype in post-BT era. 3-year follow-up: n=60, 4/14 receiving BTs had resection vs 7/46 not receiving BTs (p 0.26). 5-year follow-up: n=30, 6/11 receiving BTs had resection vs 1/19 not receiving BTs (p 0.005).
Colitic phenotype in post-BT era. 3-year follow-up: n=29, 3/12 receiving BTs had resection vs 1/17 not receiving BTs (p 0.28). 5-year follow-up: n=23, 7/16 receiving BTs had resection vs 1/6 not receiving BTs (p 0.35)
Conclusions: The advent of BTs has not demonstrated a long-term reduction in the need for RS in children with ileocaecal and colitic Crohns phenotypes. In ileocaecal CD, requiring BTs significantly increases the risk of resection within 5 years of diagnosis.