|Title||Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients.|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Authors||Cohen-Mekelburg S, Gold S, Schneider Y, Dennis M, Oromendia C, Yeo H, Michelassi F, Scherl E, Steinlauf A|
|Journal||Dig Dis Sci|
|Date Published||2019 01|
|Keywords||Adalimumab, 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|
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.
|Alternate Journal||Dig Dis Sci|
|Grant List||UL1TR000457 / / 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
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