Laparoscopic Ileocecal Resection Comparable to Anti-TNF's for Crohn's Disease

Toer W. Stevens, MD

As researchers continue to test alternatives to anti-tumor necrosis factor (anti-TNF) treatments for Crohn’s disease, a new option may have emerged.

A team, led by Toer W. Stevens, MD, Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, compared the long-term outcomes of both laparoscopic ileocecal resection and infliximab an anti-TNF treatment, and identified baseline factors linked to the duration of treatment effect in each group.

The LIR!C trial recently showed laparoscopic ileocecal resection could be a cost-effective treatment with similar quality-of-life outcomes to infliximab.

In the retrospective follow-up study, the investigators gathered data from patients who participated in the multicenter, randomized controlled LIR!C trial that compared quality of life following surgical resection compared to infliximab in adult patients with non-structuring and immunomodulator-refractory ileocecal Crohn’s disease.

The investigators collected follow-up data from the time each individual was enrolled in the trial until the last visit at either the gastrointestinal surgeon or gastroenterologist.

The team sought outcomes of interest as the need for surgery or repeat surgery or anti-TNF therapy, duration of treatment effect, and the identification of factors associated with the duration of treatment effect.

They defined the duration of treatment effect as the time without need for additional Crohn’s disease-related treatment, including corticosteroids, immunomodulators, biologics, or surgery.

The investigators collected long-term follow-up data for 134 of the 143 patients from the original LIR!C trial. Of this group, 69 individuals were in the resection group and 65 were in the infliximab group.

The median follow-up was 63.5 months.

In the resection group, 26% (n = 18) of patients started anti-TNF therapy, but no patient required a second resection. Also, for the resection group, 42% (n = 29) of patients did not require additional Crohn’s disease-related medication, while 48% (n = 14) were given prophylactic immunomodulator therapy.

For the infliximab group, 48% (n = 31) of patients had a Crohn’s disease-related resection, with the remaining 34 patients maintain, switching, or escalating their anti-TNF therapy.

The duration of treatment effect was similar in both groups, with a median time without additional Crohn’s disease-related treatment of 33.0 months (95% CI, 15.1-50.9) in the resection group and 34.0 months (95% CI, 0.0-69,3) in the infliximab group (log-rank P = 0.52).

For both treatment arms, therapy with an immunomodulator in combination with the allocated treatment was associated with duration of treatment effect (HR for resection group, 0.34; 95% CI, 0.16-0.69; HR for infliximab group, 0.49; 95% CI, 0.26-0.93).

“These findings further support laparoscopic ileocecal resection as a treatment option in patients with Crohn's disease with limited (affected segment ≤40 cm) and predominantly inflammatory terminal ileitis for whom conventional treatment is not successful,” the authors wrote.

The study, “Laparoscopic ileocecal resection versus infliximab for terminal ileitis in Crohn's disease: retrospective long-term follow-up of the LIR!C trial,” was published online in The Lancet Gastroenterology & Hepatology.