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Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 196–203 | Cite as

Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn’s Disease Patients

  • Shirley Cohen-MekelburgEmail author
  • Stephanie Gold
  • Yecheskel Schneider
  • Madison Dennis
  • Clara Oromendia
  • Heather Yeo
  • Fabrizio Michelassi
  • Ellen Scherl
  • Adam Steinlauf
Original Article

Abstract

Background

Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn’s disease recurrence.

Aims

We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients.

Methods

We performed a cohort study of Crohn’s disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively.

Results

A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy.

Conclusions

There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.

Keywords

Inflammatory bowel disease Surgery Preventive care Public payer 

Notes

Acknowledgments

The authors would like to thank Evan Sholle for his IT assistance with capturing the patient cohort.

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Science of the National Institute of Health (UL1TR000457). Clara Oromendia, M.S., was partially supported by the Clinical and Translational Science Center at Weill Cornell Medical College (UL1-TR000457-06).

Compliance with ethical standards

Conflict of interest

Dr. Scherl has received grant/research support from Abbott Laboratories (AbbVie), AstraZeneca, Janssen Research and Development, and Pfizer and serves as a consultant to AbbVie, Janssen Pharmaceutical, and Takeda Pharmaceuticals. The other authors have no relevant conflicts of interest to disclose.

Supplementary material

10620_2018_5159_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 20 kb)

References

  1. 1.
    Sachar DB. Recurrence rates in Crohn’s disease: predicting the future and predicting the past. Gut. 2006;55:1069–1070.CrossRefGoogle Scholar
  2. 2.
    Terdiman JP. Prevention of postoperative recurrence in Crohn’s disease. Clin Gastroenterol Hepatol. 2008;6:616–620.CrossRefGoogle Scholar
  3. 3.
    Morar PS, Faiz O, Hodgkinson JD, et al. Concomitant colonic disease (Montreal L3) and re-resectional surgery are predictors of clinical recurrence following ileocolonic resection for Crohn’s disease. Colorectal Dis. 2015;17:O247–O255.CrossRefGoogle Scholar
  4. 4.
    Aguas M, Bastida G, Cerrillo E, et al. Adalimumab in prevention of postoperative recurrence of Crohn’s disease in high-risk patients. World J Gastroenterol. 2012;18:4391–4398.CrossRefGoogle Scholar
  5. 5.
    De Cruz P, Kamm MA, Hamilton AL, et al. Efficacy of thiopurines and adalimumab in preventing Crohn’s disease recurrence in high-risk patients—a POCER study analysis. Aliment Pharmacol Ther. 2015;42:867–879.CrossRefGoogle Scholar
  6. 6.
    Hanauer SB, Korelitz BI, Rutgeerts P, et al. Postoperative maintenance of Crohn’s disease remission with 6-mercaptopurine, mesalamine, or placebo: a 2-year trial. Gastroenterology. 2004;127:723–729.CrossRefGoogle Scholar
  7. 7.
    Cammà C, Giunta M, Rosselli M, Cottone M. Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology. 1997;113:1465–1473.CrossRefGoogle Scholar
  8. 8.
    Ewe K, Böttger T, Buhr HJ, Ecker KW, Otto HF. Low-dose budesonide treatment for prevention of postoperative recurrence of Crohn’s disease: a multicentre randomized placebo-controlled trial. German Budesonide Study Group. Eur J Gastroenterol Hepatol. 1999;11:277–282.CrossRefGoogle Scholar
  9. 9.
    Ardizzone S, Maconi G, Sampietro GM, et al. Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn’s disease. Gastroenterology. 2004;127:730–740.CrossRefGoogle Scholar
  10. 10.
    Peyrin-Biroulet L, Deltenre P, Ardizzone S, et al. Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn’s disease: a meta-analysis. Am J Gastroenterol. 2009;104:2089–2096.CrossRefGoogle Scholar
  11. 11.
    Sorrentino D, Terrosu G, Avellini C, Beltrami CA, Bresadola V, Toso F. Prevention of postoperative recurrence of Crohn’s disease by infliximab. Eur J Gastroenterol Hepatol. 2006;18:457–459.CrossRefGoogle Scholar
  12. 12.
    Regueiro M, Schraut W, Baidoo L, et al. Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology 2009;136:441–50.e1; quiz 716.Google Scholar
  13. 13.
    Regueiro M, Feagan BG, Zou B, et al. Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after ileocolonic resection. Gastroenterology. 2016;150:1568–1578.CrossRefGoogle Scholar
  14. 14.
    Sorrentino D. State-of-the-art medical prevention of postoperative recurrence of Crohn’s disease. Nat Rev Gastroenterol Hepatol. 2013;10:413–422.CrossRefGoogle Scholar
  15. 15.
    Sorrentino D, Terrosu G, Paviotti A, et al. Early diagnosis and treatment of postoperative endoscopic recurrence of Crohn’s disease: partial benefit by infliximab—a pilot study. Dig Dis Sci. 2012;57:1341–1348.  https://doi.org/10.1007/s10620-011-2025-z.CrossRefPubMedGoogle Scholar
  16. 16.
    Yamamoto T, Umegae S, Matsumoto K. Impact of infliximab therapy after early endoscopic recurrence following ileocolonic resection of Crohn’s disease: a prospective pilot study. Inflamm Bowel Dis. 2009;15:1460–1466.CrossRefGoogle Scholar
  17. 17.
    Nguyen GC, Loftus EV, Hirano I, et al. American Gastroenterological Association Institute Guideline on the management of Crohn’s disease after surgical resection. Gastroenterology. 2017;152:271–275.CrossRefGoogle Scholar
  18. 18.
    Regueiro M, Velayos F, Greer JB, et al. American Gastroenterological Association Institute Technical Review on the management of Crohn’s disease after surgical resection. Gastroenterology. 2017;152:277–295.e3.CrossRefGoogle Scholar
  19. 19.
    Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease. Br J Surg. 2000;87:1697–1701.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Shirley Cohen-Mekelburg
    • 1
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  • Stephanie Gold
    • 2
  • Yecheskel Schneider
    • 1
  • Madison Dennis
    • 2
  • Clara Oromendia
    • 3
  • Heather Yeo
    • 4
  • Fabrizio Michelassi
    • 4
  • Ellen Scherl
    • 1
  • Adam Steinlauf
    • 1
  1. 1.Division of Gastroenterology and HepatologyNew York Presbyterian Weill Cornell Medical CenterNew YorkUSA
  2. 2.Department of MedicineNew York Presbyterian Weill Cornell Medical CenterNew YorkUSA
  3. 3.Division of Healthcare Policy and ResearchNew York Presbyterian Weill Cornell Medical CenterNew YorkUSA
  4. 4.Department of SurgeryNew York Presbyterian Weill Cornell Medical CenterNew YorkUSA

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