title: Benefit of Earlier Anti-TNF Treatment on IBD Disease Complications?
abstract: BACKGROUND
  Anti-tumour necrosis factor [anti-TNF] treatment was demonstrated to have disease-modifying abilities in inflammatory bowel disease [IBD]. In this study, we aimed to determine the effect of anti-TNF treatment timing on IBD disease complications and mucosal healing [MH].
  
  
  METHODS
  The following IBD-related complications were tested in relation to timing of anti-TNF therapy start in newly diagnosed IBD patients [n = 413]: fistula formation, abscess formation, extra-intestinal manifestations [EIM], surgery, referral to academic centre, and MH.
  
  
  RESULTS
  A total of 85 patients [21%] received anti-TNF (66 Crohn's disease [CD], 16 ulcerative colitis [UC], 3 inflammatory bowel disease unclassified [IBDU]) of whom 57% [48 patients] were treated < 16 months after diagnosis. Patients receiving anti-TNF early [< 16 months] did not differ from patients receiving anti-TNF late [> 16 months] regarding gender, age, smoking status, and familial IBD. More importantly, patients receiving anti-TNF early did not suffer less IBD-related complications during follow-up as compared with patients started on anti-TNF late, nor was more MH observed. Similar results were obtained when anti-TNF treated patient were stratified more stringently, ie < 12 months [40 patients] vs >2 4 months [24 patients]. Cox regression analysis showed no beneficial correlations between anti-TNF timing and IBD-related complications. Anti-TNF treated patients achieving MH were 11 times less likely to develop EIMs compared with patients who did not achieved MH while on anti-TNF.
  
  
  CONCLUSIONS
  This study was unable to confirm a benefit of earlier anti-TNF treatment on IBD disease complications. This could be explained by more aggressive treatment earlier in disease, resulting in fewer IBD complications. However, it seems more likely that inappropriate selection of patients for therapy leads to suboptimal treatment and subsequently suboptimal outcome.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands v.nuij@erasmusmc.nl.
authors.forename: Veerle
authors.initials: V
authors.lastname: Nuij
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Gwenny M
authors.initials: GM
authors.lastname: Fuhler
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Annemarie J
authors.initials: AJ
authors.lastname: Edel
authors.affiliation: Department of Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, The Netherlands.
authors.forename: Rob J T
authors.initials: RJ
authors.lastname: Ouwendijk
authors.affiliation: Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands.
authors.forename: Marno C M
authors.initials: MC
authors.lastname: Rijk
authors.affiliation: Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
authors.forename: Ruud
authors.initials: R
authors.lastname: Beukers
authors.affiliation: Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, The Netherlands.
authors.forename: Rutger
authors.initials: R
authors.lastname: Quispel
authors.affiliation: Department of Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors.forename: Antonie J P
authors.initials: AJ
authors.lastname: van Tilburg
authors.affiliation: Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
authors.forename: Thjon J
authors.initials: TJ
authors.lastname: Tang
authors.affiliation: Department of Internal Medicine, Lievensberg Hospital, Bergen op Zoom, The Netherlands.
authors.forename: Hermen
authors.initials: H
authors.lastname: Smalbraak
authors.affiliation: Department of Gastroenterology and Hepatology, Tweesteden Hospital, Tilburg, The Netherlands.
authors.forename: Karlien F
authors.initials: KF
authors.lastname: Bruin
authors.affiliation: Department of Gastroenterology and Hepatology, Franciscus Hospital, Roosendaal, The Netherlands.
authors.forename: Flordeliz
authors.initials: F
authors.lastname: Lindenburg
authors.affiliation: Department of Gastroenterology and Hepatology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-les-Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: C Janneke
authors.initials: CJ
authors.lastname: van der Woude
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy* / Q000601:surgery; D000069285:Infliximab / Q000008:administration & dosage* / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D000069285:Infliximab; D000068879:Adalimumab
keywords: Inflammatory bowel disease; anti-TNF; disease complications