Early Treatment Initiation Improves Outcomes in Patients With Crohn Disease
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.
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.