treatment initiation

Early Treatment Initiation Improves Outcomes in Patients With Crohn Disease

12/29/2022

Individuals with Crohn disease (CD) who began treatment with biologic therapies earlier after diagnosis had a lower risk of surgery and disease progression when compared with individuals who started biologics later after diagnosis, according to the results of the 5-year Longitudinal Observational Study of Patients Undergoing Therapy for Inflammatory Bowel Disease (TARGET-IBD).

The researchers included patients with IBD who were being treated at one of 34 academic or community centers in the United States between June 2016 and February 2022. A total of 611 patients with CD of the 4474 adults participating in TARGET-IBD were included in this analysis.

Patients must have initiated one of the following biologic therapies during the retrospective or prospective study periods to be included: adalimumab, infliximab, certolizumab pegol, vedolizumab, or ustekinumab. Patients were excluded from this analysis if they had a total colectomy before treatment initiation, a diagnosis of ulcerative colitis, if the earliest clinical assessment was done before the retrospective period, of if they were consistently categorized as IBD-unclassified.

The results indicated that the risk of surgery or procedures was significantly higher in individuals who began treatment 2 to 5 years after diagnosis. Of these patients, 30% required surgery within 20 months of diagnosis.

The risk of disease progression decreased with earlier biologic initiation, with the lowest risk (15%) among those who began biologics within 1 month of diagnosis. In individuals who began treatment 2 to 5 years after diagnosis, about 50% had disease progression by 20 months after diagnosis. Approximately 60% of patients who had later initiation had evidence of disease progression by 60 months after diagnosis.

 

—Leigh Precopio

 

Reference:

Long M, Dubinsky M, Requeim M, et al. The impact of early vs late biologic initiation among real-world patient’s with crohn’s disease in TARGET-IBD. Am J Gastroenterol. 2022;117:S8. doi:10.14309/01.ajg.0000897632.64570.56.