Immunomodulators Are Associated With a Lower Risk of First Surgery Among Patients With Non-Penetrating Non-Stricturing Crohn's Disease

OBJECTIVES: Early immunomodulator therapy may alter the natural history of Crohn's disease in certain patients. We determined whether immunomodulator use was associated with a lower risk of first surgery among patients with non-stricturing non-penetrating Crohn's disease. METHODS: A total of 159 consecutive patients with non-penetrating non-stricturing Crohn's disease from 1994 to 2005 were retrospectively identified and followed from diagnosis to either first surgery (surgery group) or last clinic follow-up (medication group) in a historical cohort analysis. Immunomodulator use, duration, disease location, age at diagnosis, smoking, family history, and decade of diagnosis were compared. Cox proportional hazards models were adjusted for propensity score to determine whether immunomodulator use lasting > 6 months decreased the risk of first surgery and whether duration of therapy affected risk. RESULTS: The median duration of follow-up was similar (6.0 vs. 5.5 years), age at diagnosis 10 years earlier, and isolated colonic disease three times less common (18 vs. 49%) in the surgery group as compared with the medication group. Immunomodulator use increased with time but overall was less common in the surgical group (24 vs. 48%). In the multivariate Cox proportional hazards model immunomodulator use was associated with a lower risk of surgery (hazard ratio, 0.41; 95% confidence interval 0.21-0.81) after adjustment for propensity score. Similarly, risk of surgery declined with duration of use. CONCLUSIONS: Immunomodulator use is associated with a decreased risk of first surgery among patients with non-stricturing non-penetrating CD. Early immunomodulator therapy may be beneficial in preventing first surgery in this population that has yet to develop penetrating or fistulizing complications.