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BIOLOGICS AND THEIR IMPACT ON DECREASING PREVALANCE OF SURGICAL INTERVENTION IN INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE ANALYSIS
Taylor E. Messick-Ngo
*1, Kaitlin Boyer
2,11General Surgery, Riverside Community Hospital, Riverside, CA; 2University of Riverside, Riverside, CA
Introduction: Inflammatory bowel disease (IBD) affects more than 2 million patients in the United States (US), with a majority aged 45 years or above. The diagnosis of IBD has the potential to lead to a decreased quality of life, increased hospital admissions, and a weakened immune system with the medical treatment. It is important to evaluate the overall efficacy of biologics to treat these disorders. It is predicted that in the last 10 years, there will be fewer surgical interventions in patients with Crohn’s disease and ulcerative colitis (UC) who are taking biologics, given the advancements in medical therapies.
Methods: This study utilized the TriNetx de-identified administrative database to identify two cohorts of adult patients (ages 18-90) taking biologics in the setting of Crohn’s disease and Ulcerative Colitis between November 2004-November 2014 and November 2014-November 2024. These cohorts were then filtered to determine the number of patients who underwent gastrointestinal surgery on or after the first instance of starting medication, indicating failure of medical therapy. These cohorts were compared to assess medication efficacy in persons with inflammatory bowel disease. Persons with combination treatment (biologics with immunomodulators) were excluded to minimize confounding, and propensity score matching was performed with regard to age, gender, race, diabetes, atherosclerotic cardiovascular disease, obesity, malnutrition, and nicotine dependence.
Results: A total of 11,205 patients were identified with IBD and taking solely biologics between November 2004-2014 (Cohort 1), and 73,779 between November 2014-2024 (Cohort 2). A total of 11,192 patients were then propensity-score matched from each cohort without statistical significance in measurable demographics. The cohorts were analyzed for subsequent surgery occurrence rates and the index age of operation. The average age of index operation was 38.5 in Cohort 1 versus 40.8 in Cohort 2. The total number of patients who received operations was 988 (8.828%) in Cohort versus 582 (5.2%) in Cohort 2. Patients taking biologics between 2004-2014 had a relative risk of 1.698 of needing an operation within the first 5 years of starting biologic therapy (p<0.05).
Conclusion: This study showed that biologics over the last decade have decreased the risk of surgical intervention by 59% in patients with inflammatory bowel disease when compared to the previous decade. This is likely due to the vast advancements in biologics. Decreasing the surgical interventions in IBD patients leads to decreased morbidities and hospital admissions in this population. Overall, the patients taking biologics require less surgical interventions due to their IBD being effectively treated with decreased flares. This data supports biologics as an adequate treatment to promote remission in patients with Crohn’s and UC.
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