title: Type and Quantity of Pharmacologic Therapy for Crohn's Disease before Eventual Surgical Treatment.
abstract: Treatment of Crohn's disease (CD) relies on medical therapy with surgery reserved for medically refractory cases. This study measured pharmaceutical therapies that CD patients receive before surgery. Prospective data were collected on 558 patients undergoing surgery for medically refractory CD from November 1999 through June 2014. Patient demographics and preoperative medical therapies were tabulated, including types and number of doses of aminosalicylic acid, corticosteroids, immunomodulators, and biologic therapies. Most patients had been treated with preoperative aminosalicylic acid (72%), steroids (77%), or immunomodulators (69%). Forty-two per cent of patients were treated with a biologic before surgery with a mean number of 20 doses (range, 1-130). In 29 per cent of patients, all therapeutic modalities were used before surgery. Biologic therapy was more common in the last seven years of the study compared with the first eight years (64% vs 35%; P < 0.01). More patients had been treated with all therapeutic modalities before surgery in the second half of the study period (37% vs 19%; P < 0.01). CD patients undergoing surgery have had extensive pharmaceutical treatment. In the current era, more patients have been placed on biologic therapies and more than one third of them failed all available classes of medications before surgical intervention.
authors: Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Jan P
authors: JP
authors: Kamiński
authors: Emily
authors: E
authors: Miraflor
authors: Karen
authors: K
authors: Zaghiyan
authors: Phillip
authors: P
authors: Fleshner
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001688:Biological Products / Q000008:administration & dosage; D002648:Child; D015331:Cohort Studies; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008239:Lysine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products; D007166:Immunosuppressive Agents; C404803:lysine- salycilate; D008239:Lysine