Stemming the tide with ileocecal Crohn’s disease: when is pharmacotherapy enough?

ABSTRACT

Introduction

Crohn’s disease (CD) mostly affects the terminal ileum and ileocecal region and up to 80% of patients end up requiring surgery. Previously reserved for complicated or refractory forms, surgery is now considered as an alternative to medical treatment in localized ileocecal disease.

Areas covered

This review examines factors associated with response to medical treatment and those associated with the need for surgery in ileocecal CD to identify the patients' profile for whom pharmacotherapy might be enough. Factors associated with the recurrence and the postoperative complications are also reviewed to help the clinician identify patients for whom medical therapy might be preferred.

Expert’s opinion

LIR!C study long-term follow-up data show that 38% of infliximab-treated patients were still treated with infliximab at the end of their follow-up, while 14% had switched to another biologic or had received immunomodulator or corticosteroid and 48% had CD-related surgery. Only the combination with an immunomodulator was associated with a greater likelihood of continuing infliximab. Patients with ileocecal CD for whom pharmacotherapy might be sufficient are probably those with no risk factors for CD-related surgery.

In addition, patients with high risk of recurrence or of post-operative complications may benefit more from medical treatment than from surgery.

KEYWORDS:

• Crohn’s disease
• Ileocecal CD
• pharmacotherapy
• surgery
• postoperative reccurence

Declaration of interest

L Peyrin-Biroulet declares: personal fees from Galapagos, AbbVie, Janssen, Genentech, Ferring, Tillots, Pharmacosmos, Celltrion, Takeda, Boehringer Ingelheim, Pfizer, Index Pharmaceuticals, Sandoz, Celgene, Biogen, Samsung Bioepis, Alma, Sterna, Nestle, Inotrem, Enterome, Allergan, MSD, Roche, Arena, Gilead, Hikma, Amgen, BMS, Vifor, Norgine, Mylan, Lilly, Fresenius Kabi, Oppilan Pharma, Sublimity Therapeutics, Applied Molecular Transport, OSE Immunotherapeutics, Enthera, Theravance, Pandion Therapeutics; grants form AbbVie, MSD, Takeda, Fresenius Kabi; stock options from CTMA. P G Kotze declares: consultant and speaker for AbbVie, Ferring, Janssen, Pfizer, Novartis and Takeda; scientific grants from Pfizer and Takeda. E Louis declares: research grants from Janssen, Pfizer, Ferring, Dr Falk Pharma, AbbVie and Takeda; educational grants from AbbVie, Janssen, Fresenius Kabi and Takeda; speakers fees from AbbVie, Dr Falk Pharma, Ferring, Janssen, Pfizer, Galapagos, and Takeda; advisory board membership for AbbVie, Celgene, Ferring, Janssen, BMS, Pfizer, Takeda, Galapagos, Gilead Sciences, Arena Pharmaceuticals, and Eli Lilly; consultant for AbbVie. S Danese declares: speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Como Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson & Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma, and Vifor.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

S Vieujean was financially supported by the National Fund for Scientific Research (F. R. S. – FNRS) (grant number 40001034).