Twenty Years of Disease-Modifying Anti-IBD Drug Use Preceding Colectomy for Refractory IBD-Associated Colitis

BACKGROUND: Disease-modifying anti-IBD drugs such as infliximab have altered the treatment of IBD. Despite the increasing availability of disease-modifying anti-IBD drugs, many individuals with IBD still require surgical resection, and the role of disease-modifying anti-IBD drugs in delaying colectomy is limited. OBJECTIVE: To assess use patterns of disease-modifying anti-IBD drug use preceding colectomy for refractory IBD. DESIGN: Retrospective analysis of institutional data. SETTING: Academic tertiary medical center from 2003 to 2022. PATIENTS: Patients with Crohn’s disease or ulcerative colitis who underwent total abdominal colectomy or proctocolectomy for medically refractory disease were included. MAIN OUTCOME MEASURES: Number and type of disease-modifying anti-IBD drugs used before colectomy and use of disease-modifying anti-IBD drugs over time. RESULTS: A total of 487 patients met inclusion criteria. Most patients had ulcerative colitis (77.8%) and were men (57.1%), with a mean age at diagnosis of 32.1 years. Two hundred eighty patients’ first disease-modifying anti-IBD drug was an anti-tumor necrosis factor agent. We found no significant difference in time from diagnosis to colectomy when comparing those who initially received an anti-tumor necrosis factor versus a non–anti-tumor necrosis agent (8.29 vs 8.86 years, p = 0.39). Linear regression demonstrated that, with each decade, patients used about 1.5 additional disease-modifying anti-IBD drugs (p < 0.01) before surgery. The mean time between diagnosis and colectomy was 8.6 years. Accelerated failure time modeling demonstrated each additional disease-modifying anti-IBD drug was associated with a nonsignificant 5% increase in time between diagnosis and colectomy (1.05 [0.96–1.13], p = 0.25). LIMITATIONS: Single-center, retrospective. CONCLUSIONS: During a 20-year period, patients with IBD-associated colitis who ultimately required colectomy received increasing numbers of disease-modifying anti-IBD drugs; however, each additional disease-modifying anti-IBD drug used did not significantly delay time to colectomy, nor did initial non-anti-tumor necrosis factor agent choice. These data suggest that a subset of patients are using increasing numbers of disease-modifying anti-IBD drugs that do not afford them meaningful time in delaying colectomy.