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Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients.

TitleDelays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients.
Publication TypeJournal Article
Year of Publication2019
AuthorsCohen-Mekelburg S, Gold S, Schneider Y, Dennis M, Oromendia C, Yeo H, Michelassi F, Scherl E, Steinlauf A
JournalDig Dis Sci
Volume64
Issue1
Pagination196-203
Date Published2019 01
ISSN1573-2568
KeywordsAdalimumab, Adult, Antibodies, Monoclonal, Humanized, Biological Products, Cecum, Certolizumab Pegol, Cohort Studies, Colectomy, Crohn Disease, Digestive System Surgical Procedures, Female, Humans, Ileum, Infliximab, Insurance, Health, Intestine, Small, Logistic Models, Male, Medicaid, Medicare, Middle Aged, Multivariate Analysis, Postoperative Care, Preoperative Care, Retrospective Studies, Risk Factors, Secondary Prevention, Time-to-Treatment, United States
Abstract

BACKGROUND: Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence.

AIMS: We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients.

METHODS: We performed a cohort study of Crohn's disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively.

RESULTS: A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy.

CONCLUSIONS: There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.

DOI10.1007/s10620-018-5159-4
Alternate JournalDig Dis Sci
PubMed ID29876778
Grant ListUL1TR000457 / / National Center for Advancing Translational Science of the National Institute of Health / International
UL1-TR000457-06 / / Clinical and Translational Science Center at Weill Cornell Medical / International