The incidence rate of surgical interventions in patients with Crohn's disease treated with anti-tumour necrosis factor biologics.

BACKGROUND: Anti-tumour necrosis factor alpha drugs (anti-TNF-α) effectively reduce the risk of surgery in Crohn's disease (CD). Unsatisfactory response to anti-TNF-α agents leads to the development of disease complications in a great percentage of patients. Simultaneously, possible predictive factors for ares during biological treatment remain uncertain.

AIMS: To investigate the incidence rate of intestinal resection during biological treatment and search for predicting factors for ares demanding a surgical intervention.

METHODS: A retrospective study of 68 patients qualified for anti-TNF-alpha therapy. The data consisting of demographic details, disease duration and laboratory results before the first drug administration and at the post induction period were collected. The association between these parameters and loss of response (LOR) demanding a surgical intervention was evaluated.

RESULTS: LOR to the anti-TNF-alpha therapy was observed in 10/68 patients (14.7%). Mean disease duration at initiation of therapy was statistically longer in operated patients (8.8 ± 2.04 y vs. 4.93 ± 4.29 y; p < 0.02). That group revealed higher CRP values in post induction period compared to group with sustained response (48.24 ± 61.99 mg/l vs. 7.29 ± 13.43 mg/l; p < 0.05), contrary to hematocrit levels, which were lower in this group at each point of the study (30.58 ± 6.19% vs. 36.69 ± 16.0%; p = 0.04) (18.62 ± 18.19% vs. 40.27 ± 4.72%; p < 0.05) (4.01 ± 0.9 x106/μl; p = 0.009) (40.27 ± 4.72 g/dl vs. 18.62 ± 18.19 g/dl; p < 0.05). CDAI was significantly higher at post induction evaluation in the group with LOR (260.75 ± 98.1 vs. 118.12 ± 4.59; p < 0.05).

CONCLUSION: CRP and CDAI, expressing in ammation severity, RBC, Hgb, Hct and the disease duration may serve as predictive factors for LOR to biological therapy.