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Anti-TNF-alpha agents do not increase post-operative risks in Crohn's

A study published ahead of print in the Alimentary Pharmacology & Therapeutics investigates the pre-operative use of anti-TNF-α agents, and the risk of post-operative complications in patients with Crohn's disease.

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A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-α) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated.
 
Dr Nørgård and colleagues from Denmark examined the impact of pre-operative anti-TNF-α agents on post-operative outcomes 30 and 60 days after CD surgery in a nationwide Danish cohort.

Outcomes were death, reoperation, anastomosis leakage, intra-abdominal abscess and bacteremia.
 
The research team identified all patients having surgical procedures from2000 to 2010.

Patients were classified according to use of anti-TNF-α agents within 12 weeks before surgery (exposed) or not (unexposed).

Outcomes were obtained from nationwide registries and a bacteremia registry.

Sub-analyses were performed for bacteremia and for impact of pre-operative timing of anti-TNF-α agents.
 
Among surgical procedures for Crohn's disease, the team found that 214 were exposed and 2079 were not.

The research team found no increased relative risks of death or abscess drainage 30 or 60 days after follow-up.

The team observed that among exposed, 8% had a reoperation within 30 days vs 9% among unexposed.

Among exposed, 4% had an anastomosis leakage within 30 days after surgery vs 3% among unexposed.

No further cases of anastomosis leakages appeared within 60 days.

On performing sub-analyses, the team noted no increased risk of bacteremia after 30 days, and no increased risks when anti-TNF-α agents were given 14 days or less before surgery.
 
Dr Nørgård's team concludes, "We found no significantly increased relative risks of post-operative complications after use of anti-TNF-α agents either 12 weeks or 14 days or less before surgery for Crohn's disease."

Aliment Pharmacol Ther 2012: DOI: 10.1111/apt.12159
04 December 2012

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