Colon to Rectum
Clin Gastroenterol Hepatol. 2022;20(11):2607–18.e14
Earlier anti-TNF initiation leads to long-term lower health care utilization in Crohn’s disease but not in ulcerative colitis
Background and aims: The timing of initiating biologic therapy in persons with Crohn’s disease (CD) and ulcerative colitis (UC) is an area of ongoing controversy. In particular, there is concern that delaying the initiation of biologic therapy may lead to more treatment-resistant disease, which can result in more complications and hospitalizations.
Methods: The authors used health administrative data from Manitoba, Canada, to identify all persons with a new diagnosis of inflammatory bowel disease (IBD) between 2001 and 2018 who received tumor necrosis factor antagonists (anti-TNF) therapy and had at least 1 year of post-anti-TNF initiation follow-up. They measured the rates of hospitalization, surgery, and outpatient visits, prior to and for up to 5 years following anti-TNF initiation. They compared the rates of these health care utilization outcomes between persons receiving anti-TNFs within 2 years following diagnosis and those receiving anti-TNFs more than 2 years following IBD diagnosis. They used inverse probability treatment weighting to adjust for baseline differences in risk between the 2 groups.
Results: Among 742 persons with CD, early anti-TNF initiators had fewer IBD-specific and overall hospitalizations over the 5 years following the start of therapy. Incidence of resective surgery was also lower in earlier anti-TNF initiators with CD if the first year following initiation was excluded from the analysis. In 318 cases of UC, there was no impact of the timing of anti-TNF therapy on the rates of hospitalization and surgery.
Conclusions: Earlier administration of tumor necrosis factor antagonist therapy is associated with reduced downstream health care resource utilization in Crohn’s disease, though these impacts are not evident in ulcerative colitis.