Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease

Aliment Pharmacol Ther. 2015 Oct;42(8):977-89. doi: 10.1111/apt.13363. Epub 2015 Aug 14.


Background: The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown.

Aim: To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis.

Methods: Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications.

Results: The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006).

Conclusions: Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adalimumab / administration & dosage
  • Adalimumab / adverse effects
  • Adjuvants, Immunologic / therapeutic use
  • Adult
  • Aged
  • Certolizumab Pegol / administration & dosage
  • Certolizumab Pegol / adverse effects
  • Cohort Studies
  • Crohn Disease / drug therapy*
  • Crohn Disease / epidemiology*
  • Crohn Disease / pathology
  • Crohn Disease / surgery*
  • Digestive System Surgical Procedures / statistics & numerical data*
  • Early Medical Intervention*
  • Female
  • Humans
  • Immunologic Factors / administration & dosage*
  • Immunologic Factors / adverse effects
  • Infliximab / administration & dosage
  • Infliximab / adverse effects
  • Intestines / drug effects*
  • Intestines / pathology
  • Intestines / surgery
  • Male
  • Middle Aged
  • Switzerland / epidemiology
  • Time Factors
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / immunology


  • Adjuvants, Immunologic
  • Immunologic Factors
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab
  • Certolizumab Pegol