Long-term outcome data support laparoscopic ileocecal resection as a treatment option for patients with Crohn disease (CD) with limited, predominantly inflammatory terminal ileitis who have not had success with conventional treatment.
“The LIR!C trial showed that laparoscopic ileocecal resection is a cost-effective treatment that has similar quality-of-life outcomes to treatment with infliximab, an anti-tumor necrosis factor (TNF) drug,” the researchers wrote.
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In a retrospective follow-up study, the researchers compared the long-term outcomes of both interventions by analyzing data on 134 participants in the LIR!C trial, which included adults with with nonstricturing and immunomodulator-refractory ileocecal CD.
Over a median follow-up of 63.5 months, 26% of the 69 participants in the resection group initiated anti-TNF therapy, and none needed a second resection. Approximately 42% of patients in the resection group did not require additional medication for CD, but 48% of them did receive prophylactic immunomodulator therapy.
In comparison, 48% of the 65 participants in the infliximab group needed a CD-related resection over the course of follow-up. The 34 other participants in the group maintained, switched, or escalated their anti-TNF therapy.
The duration of treatment effect was defined as the time without need for additional CD-related treatment, including corticosteroids, immunomodulators, biologics, or surgery. Among both groups, the duration of treatment effect was similar. The median time without additional CD-related treatment was 33 months for the resection group and 34 months for the infliximab group.
Therapy with an immunomodulator, in addition to the allocated treatment, was linked with duration of treatment effect in both groups.
Stevens TW, Haasnoot ML, D’Haens GR, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: retrospective long-term follow-up of the LIR!C trial. The Lancet Gastroenterol Hepatol. 2020;5(10):900-907. https://doi.org/10.1016/S2468-1253(20)30117-5