Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease
Background Early bowel resection (EBR) in ileocolonic Crohn’s disease (CD) may be associated with more durable remission compared with initial medical therapy (IMT) even when biologic therapy is included. Aim To compare the efficacy of EBR versus IMT for ileocolonic CD Methods A systematic search wa...
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| Veröffentlicht in: | International journal of colorectal disease 2020-03, Vol.35 (3), p.501-512 |
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| container_title | International journal of colorectal disease |
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| creator | Ryan, Éanna J. Orsi, Gabriel Boland, Michael R. Syed, Adeel Zafar Creavin, Ben Kelly, Michael E. Sheahan, Kieran Neary, Paul C. Kavanagh, Dara O. McNamara, Deirdre Winter, Des C. O’Riordan, James M. |
| description | Background
Early bowel resection (EBR) in ileocolonic Crohn’s disease (CD) may be associated with more durable remission compared with initial medical therapy (IMT) even when biologic therapy is included.
Aim
To compare the efficacy of EBR versus IMT for ileocolonic CD
Methods
A systematic search was performed to identify studies that compared EBR (performed |
| doi_str_mv | 10.1007/s00384-019-03479-9 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2335179129</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714487858</galeid><sourcerecordid>A714487858</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-be7c1b4e74e05612880b05d75791423cdaa41b347a07392d16e332871df7a7433</originalsourceid><addsrcrecordid>eNp9kU1rHDEMhk1paTZp_0APxdBDc5nEX7OeOYalX5CSS3o2Ho8m6-C1t5YnYf99vZm0UCjFB2HpeYWkl5B3nF1wxvQlMiY71TDeN0wq3Tf9C7LiSoqGi7V4SVaM1yTv2-6EnCLes_pfa_WanEje87bv1Irgdyi2sdGGA3qkaaJgczjQIT1CoBkQXPEp0gfIOCP10RdvA93B6F2NZQvZ7g81T_e2eIjlI9JHX7bUB0guhRS9o5uctrEWRo9gEd6QV5MNCG-f4xn58fnT7eZrc33z5dvm6rpxiqvSDKAdHxRoBaxdc9F1bGDtqFvdcyWkG61VfKiLW6ZlL0a-BilFp_k4aauVlGfkfOm7z-nnDFjMzqODEGyENKMRUrb1Qlz0Ff2woHc2gPFxSiVbd8TNleZKdbpru0pd_IOqb4SddynCVLf-WyAWgcsJMcNk9tnvbD4YzszRQ7N4aKqH5slDc5zl_fPY81Dv_Efy27QKyAXAWop3kM19mnO1EP_X9hcyg6Za</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2335179129</pqid></control><display><type>article</type><title>Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease</title><source>SpringerLink Journals - AutoHoldings</source><creator>Ryan, Éanna J. ; Orsi, Gabriel ; Boland, Michael R. ; Syed, Adeel Zafar ; Creavin, Ben ; Kelly, Michael E. ; Sheahan, Kieran ; Neary, Paul C. ; Kavanagh, Dara O. ; McNamara, Deirdre ; Winter, Des C. ; O’Riordan, James M.</creator><creatorcontrib>Ryan, Éanna J. ; Orsi, Gabriel ; Boland, Michael R. ; Syed, Adeel Zafar ; Creavin, Ben ; Kelly, Michael E. ; Sheahan, Kieran ; Neary, Paul C. ; Kavanagh, Dara O. ; McNamara, Deirdre ; Winter, Des C. ; O’Riordan, James M.</creatorcontrib><description>Background
Early bowel resection (EBR) in ileocolonic Crohn’s disease (CD) may be associated with more durable remission compared with initial medical therapy (IMT) even when biologic therapy is included.
Aim
To compare the efficacy of EBR versus IMT for ileocolonic CD
Methods
A systematic search was performed to identify studies that compared EBR (performed < 1 year from initial diagnosis) or IMT for the management of ileocolonic CD. Log hazard ratios (InHR) for relapse-free survival (RFS) and their standard errors were calculated from Kaplan-Meier plots and pooled using the inverse-variance method. Dichotomous variables were pooled as odds ratios (OR). Quality assessment of the included studies was performed using the Newcastle-Ottawa (NOS) and Jadad scales.
Results
A total of 7 studies with 1863 CD patients (EBR
n
= 581, 31.2%; IMT
n
= 1282, 68.8%) were eligible for inclusion. There was a moderate-to-high risk of bias. The median NOS was 8 (range 7–9). There was a reduced likelihood of overall (OR, 0.53; 95% confidence interval (95% CI), 0.34, 0.83;
p
= 0.005) and surgical (OR, 0.47; 95% CI, 0.24, 0.91;
p
= 0.03) relapse with EBR. There was also a less requirement for maintenance biologic therapy (OR, 0.24; 95% CI, 0.14, 0.42;
p
< 0.0001). Patients who underwent EBR had a significantly improved RFS than those who underwent IMT (HR, 0.62; 95% CI, 0.52, 0.73;
p
< 0.001). There was no difference in morbidity (OR, 1.67; 95% CI, 0.44, 6.36;
p
= 0.45) between the groups.
Conclusion
EBR may be associated with less relapse and need for maintenance biologic therapy than IMT. ‘Upfront’ or early resection may represent a reasonable and cost-effective alternative to biologic therapy, especially in biologic-resistant subpopulations.
Trial registration</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-019-03479-9</identifier><identifier>PMID: 31915984</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Comparative analysis ; Gastroenterology ; Hepatology ; Internal Medicine ; Medical colleges ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Original Article ; Proctology ; Surgery</subject><ispartof>International journal of colorectal disease, 2020-03, Vol.35 (3), p.501-512</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>COPYRIGHT 2020 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-be7c1b4e74e05612880b05d75791423cdaa41b347a07392d16e332871df7a7433</citedby><cites>FETCH-LOGICAL-c414t-be7c1b4e74e05612880b05d75791423cdaa41b347a07392d16e332871df7a7433</cites><orcidid>0000-0003-2609-0836</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-019-03479-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-019-03479-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31915984$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ryan, Éanna J.</creatorcontrib><creatorcontrib>Orsi, Gabriel</creatorcontrib><creatorcontrib>Boland, Michael R.</creatorcontrib><creatorcontrib>Syed, Adeel Zafar</creatorcontrib><creatorcontrib>Creavin, Ben</creatorcontrib><creatorcontrib>Kelly, Michael E.</creatorcontrib><creatorcontrib>Sheahan, Kieran</creatorcontrib><creatorcontrib>Neary, Paul C.</creatorcontrib><creatorcontrib>Kavanagh, Dara O.</creatorcontrib><creatorcontrib>McNamara, Deirdre</creatorcontrib><creatorcontrib>Winter, Des C.</creatorcontrib><creatorcontrib>O’Riordan, James M.</creatorcontrib><title>Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Background
Early bowel resection (EBR) in ileocolonic Crohn’s disease (CD) may be associated with more durable remission compared with initial medical therapy (IMT) even when biologic therapy is included.
Aim
To compare the efficacy of EBR versus IMT for ileocolonic CD
Methods
A systematic search was performed to identify studies that compared EBR (performed < 1 year from initial diagnosis) or IMT for the management of ileocolonic CD. Log hazard ratios (InHR) for relapse-free survival (RFS) and their standard errors were calculated from Kaplan-Meier plots and pooled using the inverse-variance method. Dichotomous variables were pooled as odds ratios (OR). Quality assessment of the included studies was performed using the Newcastle-Ottawa (NOS) and Jadad scales.
Results
A total of 7 studies with 1863 CD patients (EBR
n
= 581, 31.2%; IMT
n
= 1282, 68.8%) were eligible for inclusion. There was a moderate-to-high risk of bias. The median NOS was 8 (range 7–9). There was a reduced likelihood of overall (OR, 0.53; 95% confidence interval (95% CI), 0.34, 0.83;
p
= 0.005) and surgical (OR, 0.47; 95% CI, 0.24, 0.91;
p
= 0.03) relapse with EBR. There was also a less requirement for maintenance biologic therapy (OR, 0.24; 95% CI, 0.14, 0.42;
p
< 0.0001). Patients who underwent EBR had a significantly improved RFS than those who underwent IMT (HR, 0.62; 95% CI, 0.52, 0.73;
p
< 0.001). There was no difference in morbidity (OR, 1.67; 95% CI, 0.44, 6.36;
p
= 0.45) between the groups.
Conclusion
EBR may be associated with less relapse and need for maintenance biologic therapy than IMT. ‘Upfront’ or early resection may represent a reasonable and cost-effective alternative to biologic therapy, especially in biologic-resistant subpopulations.
Trial registration</description><subject>Comparative analysis</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Internal Medicine</subject><subject>Medical colleges</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Original Article</subject><subject>Proctology</subject><subject>Surgery</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kU1rHDEMhk1paTZp_0APxdBDc5nEX7OeOYalX5CSS3o2Ho8m6-C1t5YnYf99vZm0UCjFB2HpeYWkl5B3nF1wxvQlMiY71TDeN0wq3Tf9C7LiSoqGi7V4SVaM1yTv2-6EnCLes_pfa_WanEje87bv1Irgdyi2sdGGA3qkaaJgczjQIT1CoBkQXPEp0gfIOCP10RdvA93B6F2NZQvZ7g81T_e2eIjlI9JHX7bUB0guhRS9o5uctrEWRo9gEd6QV5MNCG-f4xn58fnT7eZrc33z5dvm6rpxiqvSDKAdHxRoBaxdc9F1bGDtqFvdcyWkG61VfKiLW6ZlL0a-BilFp_k4aauVlGfkfOm7z-nnDFjMzqODEGyENKMRUrb1Qlz0Ff2woHc2gPFxSiVbd8TNleZKdbpru0pd_IOqb4SddynCVLf-WyAWgcsJMcNk9tnvbD4YzszRQ7N4aKqH5slDc5zl_fPY81Dv_Efy27QKyAXAWop3kM19mnO1EP_X9hcyg6Za</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Ryan, Éanna J.</creator><creator>Orsi, Gabriel</creator><creator>Boland, Michael R.</creator><creator>Syed, Adeel Zafar</creator><creator>Creavin, Ben</creator><creator>Kelly, Michael E.</creator><creator>Sheahan, Kieran</creator><creator>Neary, Paul C.</creator><creator>Kavanagh, Dara O.</creator><creator>McNamara, Deirdre</creator><creator>Winter, Des C.</creator><creator>O’Riordan, James M.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2609-0836</orcidid></search><sort><creationdate>20200301</creationdate><title>Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease</title><author>Ryan, Éanna J. ; Orsi, Gabriel ; Boland, Michael R. ; Syed, Adeel Zafar ; Creavin, Ben ; Kelly, Michael E. ; Sheahan, Kieran ; Neary, Paul C. ; Kavanagh, Dara O. ; McNamara, Deirdre ; Winter, Des C. ; O’Riordan, James M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-be7c1b4e74e05612880b05d75791423cdaa41b347a07392d16e332871df7a7433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Comparative analysis</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Internal Medicine</topic><topic>Medical colleges</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Original Article</topic><topic>Proctology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ryan, Éanna J.</creatorcontrib><creatorcontrib>Orsi, Gabriel</creatorcontrib><creatorcontrib>Boland, Michael R.</creatorcontrib><creatorcontrib>Syed, Adeel Zafar</creatorcontrib><creatorcontrib>Creavin, Ben</creatorcontrib><creatorcontrib>Kelly, Michael E.</creatorcontrib><creatorcontrib>Sheahan, Kieran</creatorcontrib><creatorcontrib>Neary, Paul C.</creatorcontrib><creatorcontrib>Kavanagh, Dara O.</creatorcontrib><creatorcontrib>McNamara, Deirdre</creatorcontrib><creatorcontrib>Winter, Des C.</creatorcontrib><creatorcontrib>O’Riordan, James M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ryan, Éanna J.</au><au>Orsi, Gabriel</au><au>Boland, Michael R.</au><au>Syed, Adeel Zafar</au><au>Creavin, Ben</au><au>Kelly, Michael E.</au><au>Sheahan, Kieran</au><au>Neary, Paul C.</au><au>Kavanagh, Dara O.</au><au>McNamara, Deirdre</au><au>Winter, Des C.</au><au>O’Riordan, James M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>35</volume><issue>3</issue><spage>501</spage><epage>512</epage><pages>501-512</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Background
Early bowel resection (EBR) in ileocolonic Crohn’s disease (CD) may be associated with more durable remission compared with initial medical therapy (IMT) even when biologic therapy is included.
Aim
To compare the efficacy of EBR versus IMT for ileocolonic CD
Methods
A systematic search was performed to identify studies that compared EBR (performed < 1 year from initial diagnosis) or IMT for the management of ileocolonic CD. Log hazard ratios (InHR) for relapse-free survival (RFS) and their standard errors were calculated from Kaplan-Meier plots and pooled using the inverse-variance method. Dichotomous variables were pooled as odds ratios (OR). Quality assessment of the included studies was performed using the Newcastle-Ottawa (NOS) and Jadad scales.
Results
A total of 7 studies with 1863 CD patients (EBR
n
= 581, 31.2%; IMT
n
= 1282, 68.8%) were eligible for inclusion. There was a moderate-to-high risk of bias. The median NOS was 8 (range 7–9). There was a reduced likelihood of overall (OR, 0.53; 95% confidence interval (95% CI), 0.34, 0.83;
p
= 0.005) and surgical (OR, 0.47; 95% CI, 0.24, 0.91;
p
= 0.03) relapse with EBR. There was also a less requirement for maintenance biologic therapy (OR, 0.24; 95% CI, 0.14, 0.42;
p
< 0.0001). Patients who underwent EBR had a significantly improved RFS than those who underwent IMT (HR, 0.62; 95% CI, 0.52, 0.73;
p
< 0.001). There was no difference in morbidity (OR, 1.67; 95% CI, 0.44, 6.36;
p
= 0.45) between the groups.
Conclusion
EBR may be associated with less relapse and need for maintenance biologic therapy than IMT. ‘Upfront’ or early resection may represent a reasonable and cost-effective alternative to biologic therapy, especially in biologic-resistant subpopulations.
Trial registration</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31915984</pmid><doi>10.1007/s00384-019-03479-9</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-2609-0836</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-1958 |
| ispartof | International journal of colorectal disease, 2020-03, Vol.35 (3), p.501-512 |
| issn | 0179-1958 1432-1262 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Comparative analysis Gastroenterology Hepatology Internal Medicine Medical colleges Medical research Medicine Medicine & Public Health Medicine, Experimental Original Article Proctology Surgery |
| title | Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease |
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