HealingWell
Search Close Search
☰

interesting study on UC surgery pre-biologic era vs. now

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 1/25/2019 1:19 PM (GMT -5)
https://www.gastroendonews.com/in-the-news/article/01-19/study-shines-light-on-surgical-morbidity-in-ulcerative-colitis/53845?

I hope you don't have to sign up to read this, I get it by email. Let me know and I'll copy and paste if needed.

My synopsis: UC people having surgery to manage their disease have had more problems (multiple surgeries required, etc) since biologics have been introduced than the pre-biologic era. The researchers have no definitive conclusions but they guess that people needing surgery now have worse disease since they have not responded to biologics.

This sounds like a plausible conclusion but I'm wondering if fewer surgeries are being done now than pre-biologic era. If the same # or more surgeries are being done then biologics haven't really taken more people out of surgery-required cohort.
Posted 1/25/2019 2:53 PM (GMT -5)
I read that the % of people who end up needing surgery hasn't declined because of biologics, but that may have been old information.
Posted 1/25/2019 2:59 PM (GMT -5)
I asked my dr about this a few weeks ago, i.e. are biologics preventing or just delaying surgery, he said the evidence is that the number of surgeries is coming down (as is the number of people who do not respond to medication). Although the biologics are still only a ??20 year experiment, i guess it needs more time to draw firm conclusions.
Posted 1/25/2019 3:32 PM (GMT -5)
Here's a good one for you.

onlinelibrary.wiley.com said...
In CD and UC, anti-TNF biologics are efficacious in reducing the odds of
hospitalization by half and surgery by 33–77%. Azathioprine and vedolizumab were not associated with a similar improvement, but robust conclusions may be limited due to paucity of RCTs.

(2016) Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn’s disease and ulcerative colitis
E. J. Mao*, G. S. Hazlewood

Source: https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.13847

And another:

said...
Anti-tumour necrosis factor (TNF)-α therapy has revolutionized inflammatory bowel disease (IBD) treatment. Infliximab and adalimumab either as monotherapy or in combination with an immunomodulator are able to induce clinical and biological remission in patients with moderate and severe Crohn’s disease (CD) and ulcerative colitis (UC). These new therapies have led to a shift in the goals of IBD management from just controlling clinical symptoms to preventing disease progression. However, despite these advances in medical therapy, surgery is still required in 30%-40% of patients with CD and 20%-30% of patients with UC at some point during their lifetime.

(2016) Inflammatory bowel disease surgery in the biologic era
Linda Ferrari, Mukta K Krane, and Alessandro Fichera

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4872064/

However the last bit of that last one makes me wonder "surgery for 20%-30% of patients with UC at some point during their lifetime". Isn't that the same as old studies...
Posted 1/25/2019 3:40 PM (GMT -5)
That's what I've seen too John, but I am sure there may be more current info with all the newer treatments that have come available. Unfortunately, It does seem like there's a certain group that is refractory, maybe that's a consistent %.
Posted 1/25/2019 3:54 PM (GMT -5)
I think the key phrase is "at some point"
Posted 1/25/2019 4:08 PM (GMT -5)

poopydoop said...
I think the key phrase is "at some point"

And maybe therein lays the reason why. Initially, biologics reduce the need for hospitalization and surgery (first citation). However, if you're talking over the course of a lifetime (second citation) there is still a persistent 20-ish percent that ultimately require a surgery. And that has always been a golden rule of UC, that there is a persistent group in that ballpark that ultimately require a surgery. Not sure how lifetime is determined, if biologics have only been around for 20-years. Not sure if they are relying on pre-biologic data or projecting forward within their methodology...
✚ New Topic ✚ Reply