Contemporary Risk of Surgery in Patients With Ulcerative Colitis and Crohn’s Disease: A Meta-Analysis of Population-Based Cohorts

  • Tsai, Lester
  • Ma, Christopher
  • Dulai, Parambir S.
  • Prokop, Larry J.
  • Eisenstein, Samuel
  • Ramamoorthy, Sonia L.
  • Feagan, Brian G.
  • Jairath, Vipul
  • Sandborn, William J.
  • Singh, Siddharth

  • #Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California

    ||Division of Colorectal Surgery, Department of Surgery, University of California San Diego, La Jolla, California

*Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California

‡Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada

§Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota

Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada

*Reprint requests Address requests for reprints to: Siddharth Singh, MD, MS, Division of Gastroenterology, University of California San Diego, 9452 Medical Center Drive, ACTRI 1W501, La Jolla, California 92093. fax: (858) 657-7259.

E-mail: [email protected]

Conflicts of interest These authors disclose the following: Christopher Ma has received consulting fees from AbbVie, Janssen, Takeda, Pfizer, Roche, and Robarts Clinical Trials, Inc, and speaker's fees from AbbVie, Janssen, Takeda, and Pfizer; Parambir S. Dulai has received research support from Takeda, Pfizer, AbbVie, Janssen, Polymedco, ALPCO, Buhlmann, and Prometheus, and consulting fees from Takeda, Pfizer, AbbVie, and Janssen; Samuel Eisenstein has received consulting fees from Auris Health, Inc; Brian G. Feagan has received grant/research support from Millennium Pharmaceuticals, Merck, Tillotts Pharma AG, AbbVie, Novartis Pharmaceuticals, Centocor, Inc, Elan/Biogen, UCB Pharma, Bristol-Myers Squibb, Genentech, ActoGenix, and Wyeth Pharmaceuticals, Inc, has received consulting fees from Millennium Pharmaceuticals, Merck, Centocor, Inc, Elan/Biogen, Janssen-Ortho, Teva Pharmaceuticals, Bristol-Myers Squibb, Celgene, UCB Pharma, AbbVie, Astra Zeneca, Serono, Genentech, Tillotts Pharma AG, Unity Pharmaceuticals, Albireo Pharma, Given Imaging, Inc, Salix Pharmaceuticals, Novonordisk, GSK, Actogenix, Prometheus Therapeutics and Diagnostics, Athersys, Axcan, Gilead, Pfizer, Shire, Wyeth, Zealand Pharma, Zyngenia, GiCare Pharma, Inc, and Sigmoid Pharma, and speaker’s fees from UCB, AbbVie, and J&J/Janssen; Vipul Jairath has received consulting fees from AbbVie, Eli Lilly, GlaxoSmithKline, Arena Pharmaceuticals, Genetech, Pendopharm, Sandoz, Merck, Takeda, Janssen, Robarts Clinical Trials, Topivert, and Celltrion, and speaker’s fees from Takeda, Janssen, Shire, Ferring, AbbVie, and Pfizer; William J. Sandborn has received research grants from Atlantic Healthcare Limited, Amgen, Genentech, Gilead Sciences, AbbVie, Janssen, Takeda, Lilly, Celgene/Receptos, Pfizer, and Prometheus Laboratories (now Prometheus Biosciences), has received consulting fees from AbbVie, Allergan, Amgen, Arena Pharmaceuticals, Avexegen Therapeutics, BeiGene, Boehringer Ingelheim, Celgene, Celltrion, Conatus, Cosmo, Escalier Biosciences, Ferring, Forbion, Genentech, Gilead Sciences, Gossamer Bio, Incyte, Janssen, Kyowa Kirin Pharmaceutical Research, Landos Biopharma, Lilly, Oppilan Pharma, Otsuka, Pfizer, Progenity, Prometheus Biosciences (merger of Precision IBD and Prometheus Laboratories), Reistone, Ritter Pharmaceuticals, Robarts Clinical Trials (owned by Health Academic Research Trust), Series Therapeutics, Shire, Sienna Biopharmaceuticals, Sigmoid Biotechnologies, Sterna Biologicals, Sublimity Therapeutics, Takeda, Theravance Biopharma, Tigenix, Tillotts Pharma, UCB Pharma, Ventyx Biosciences, Vimalan Biosciences, and Vivelix Pharmaceuticals, and stock or stock options from BeiGene, Escalier Biosciences, Gossamer Bio, Oppilan Pharma, Prometheus Biosciences (merger of Precision IBD and Prometheus Laboratories), Progenity, Ritter Pharmaceuticals, Ventyx Biosciences, and Vimalan Biosciences; and Siddharth Singh has received research grants from AbbVie and Janssen.

Funding Supported by an American Gastroenterological Association Career Development Award (P.S.D.), a National Institute of Diabetes and Digestive and Kidney Diseases–funded San Diego Digestive Diseases Research Center (P30 DK120515) (W.J.S.), National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (K23DK117058), an American College of Gastroenterology Junior Faculty Development Award (144271), and a Crohn’s and Colitis Foundation Career Development Award (404614) (S.S.).

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e103. Learning Objectives: Upon completion of the CME activity, successful learners will be able to: 1. List the changes in risk for surgery in patients with newly diagnosed ulcerative colitis and Crohn’s disease in the biologic era; 2. List the 5- and 10-year risk of repeat surgery in patients with Crohn’s disease; 3. List 3 factors that may have contributed to the observed decrease in risk of surgery in patients diagnosed with IBD after 2000.

Siddharth Singh, Section Editor

Clinical Gastroenterology & Hepatology 19(10):p 2031-2045e11, October 2021. | DOI: 10.1016/j.cgh.2020.10.039

BACKGROUND & AIMS

We conducted a systematic review with meta-analysis to estimate rates and trends of colectomy in patients with ulcerative colitis (UC), and of primary and re-resection in patients with Crohn’s disease (CD), focusing on contemporary risks.

METHODS

Through a systematic review until September 3, 2019, we identified population-based cohort studies that reported patient-level cumulative risk of surgery in patients with UC and CD. We evaluated overall and contemporary risk (after 2000) of surgery and analyzed time trends through mixed-effects meta-regression.

RESULTS

In patients with UC (26 studies), the overall 1-, 5-, and 10-year risks of colectomy was 4.0% (95% CI, 3.3–5.0), 8.8% (95% CI, 7.7–10.0), and 13.3% (95% CI, 11.3–15.5), respectively, with a decrease in risk over time (P< .001). Corresponding contemporary risks were 2.8% (95% CI, 2.0–3.9), 7.0% (95% CI, 5.7–8.6), and 9.6% (95% CI, 6.3–14.2), respectively. In patients with CD (22 studies), the overall 1-, 5-, and 10-year risk of surgery was 18.7% (95% CI, 15.0–23.0), 28.0% (95% CI, 24.0–32.4), and 39.5% (95% CI, 33.3–46.2), respectively, with a decrease in risk over time (P< .001). Corresponding contemporary risks were 12.3% (95% CI, 10.8–14.0), 18.0% (95% CI, 15.4–21.0), and 26.2% (95% CI, 23.4–29.4), respectively. In a meta-analysis of 8 studies in patients with CD with prior resection, the cumulative risk of a second resection at 5 and 10 years after the first resection was 17.7% (95% CI, 13.5–22.9) and 31.3% (95% CI, 24.1–39.6), respectively.

CONCLUSIONS

Patient-level risks of surgery have decreased significantly over time, with a 5-year cumulative risk of surgery of 7.0% in UC and 18.0% in CD in contemporary cohorts. This decrease may be related to early detection and/or better treatment.

GRAPHICAL ABSTRACT

Copyright © 2021Elsevier, Inc.