Has the need for colectomy changed with the increasing use of more potent medical therapies for ulcerative colitis (UC)? One article gives some insight into this question (Inflamm Bowel Dis 2012; 18: 1641-46).
This French study followed 151 patients with newly diagnosed UC from 2000-2008; median followup was 58 months. During this time, 21 patients (14%) underwent colectomy. 1.3% required colectomy in the first year following diagnosis.
Looking closer at their study, 55% of patients had pancolitis. Cyclosporin usage, typically given in refractory cases, was the only medication determined to be a predictive factor for surgery.
Medication usage during study period:
- 68% oral mesalamine products
- 72% systemic corticosteroids
- 7% methotrexate
- 49% azathioprine
- 9% cyclosporin
- 30% had received at least one anti-TNF agent
The authors concede several limitations, including the evolving nature of UC treatment. Yet, they conclude that colectomy still is frequently needed and the use of IBD medications, including anti-TNF, “does not appear to reduce the long-term need for surgery in UC.”
I take issue with the last sentence. Whether anti-TNF agents prove to be a disease-modifying treatment over the long-term is not known. In this particular cohort, only 30% were even exposed to these agents. My conclusion: we need a study designed to answer the question. This would require larger numbers of patients followed prospectively for many years.
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