Can Ileocaecal Resection Cut Corticosteroid Use in Crohn’s?

TOPLINE:

Patients with Crohn’s disease who underwent primary ileocaecal resection and had preoperative corticosteroid use of ≥ 1000 mg had reduced corticosteroid use in the 5 years following surgery. Corticosteroid use in the 90 days before surgery was associated with an increased risk for re-resection and postoperative steroid use.

METHODOLOGY:

• Researchers conducted an observational cohort study to assess postoperative treatment following primary ileocaecal resection in patients with Crohn’s disease and to evaluate the impact of preoperative corticosteroid use on re-resection and postoperative steroid use.
• They included 1565 patients with Crohn’s disease (median age at the first inflammatory bowel disease diagnosis, 28.9 years; 49% women) who underwent primary ileocaecal resection (median age at surgery, 37.0 years) in Sweden between 2006 and 2019, using nationwide registries.
• Systemic corticosteroid prescriptions over the 5 years before surgery were summed to calculate the mean annual use per patient, and patients were categorised as low (< 1000 mg; n = 1275), intermediate (1000 to < 2000 mg; n = 193), or high (≥ 2000 mg; n = 97) corticosteroid users on the basis of annual prednisolone equivalent use.
• The change in corticosteroid use post-surgery was assessed, with a median follow-up duration of 6.8 years.
• A subgroup analysis included 1618 patients and examined the impact of oral corticosteroid use within 90 days before surgery on the risk for ileocolic re-resection. Among the patients, 400 had corticosteroid exposure in the 90 days preoperatively, while 1218 did not.

TAKEAWAY:

• Corticosteroid use was significantly declined among intermediate and high users, with a combined mean reduction of 1354 mg per patient per year, from 1847 mg preoperatively to 493 mg postoperatively. Within 5 years post-surgery, 88% of intermediate users and 80% of high users transitioned to low use.
• Patients with high preoperative corticosteroid use experienced a mean reduction of 2280 mg prednisolone equivalents per year after ileocaecal resection.
• Patients with corticosteroid exposure 90 days before surgery had an increased incidence of stoma formation (P < .001) and a decreased median time to stoma closure during follow-up (P = .044).
• Exposure to systemic corticosteroids within 90 days before ileocaecal resection was associated with an increased risk for ileocolic re-resection (adjusted hazard ratio, 1.64; P = .036) and postoperative steroid use (adjusted odds ratio, 1.57; P = .030).

IN PRACTICE:

“Considering the substantial drop in CS [corticosteroid] use among high users after surgery, our study highlights the potential clinical gains of surgical intervention in this patient group,” the authors wrote. “Earlier surgical intervention among patients with ileocaecal CD [Crohn’s disease] who have repeated CS demanding disease flares may prove beneficial,” they added.

SOURCE:

The study was led by Vilhelm Hjalte, Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden. It was published online on March 10, 2025, in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

The study lacked a comparison group of patients with ileocaecal Crohn’s disease who did not undergo surgery. Reliance on registry data may have led to missing relevant clinical details, including disease activity or symptoms, and may have resulted in residual confounding. The inability to precisely extract information on resection length, disease extent, or disease behaviour from the registers introduced potential bias.

DISCLOSURES:

This study was supported by the Regional Council of Region Östergötland, Sweden. Some authors disclosed receiving honoraria or financial support from or serving as consultants, speakers, or advisory board members for several pharmaceutical companies. One author reported being employed by and owning shares in AstraZeneca.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.