title: Impact of Early Surgery and Immunosuppression on Crohn's Disease Disabling Outcomes.
abstract: The definition of early therapeutic strategies to control Crohn's disease aggressiveness and prevent recurrence is key to improve clinical practice. This study explores the impact of early surgery and immunosuppression onset in the occurrence of disabling outcomes.
  
  
  
  This was a multicentric and retrospective study with 754 patients with Crohn's disease, who were stratified according to the need for an early surgery (group S) or not (group I) and further divided according to the time elapsed from the beginning of the follow-up to the start of immunosuppression therapy.
  
  
  
  The rate of disabling events was similar in both groups (S: 77% versus I: 76%, P = 0.700). The percentage of patients who needed surgery after or during immunosuppression therapy was higher among group S, both for first surgeries after the index event (38% of groups S versus 21% of group I, P < 0.001) and for reoperations (38% of groups S versus 12% of group I, P < 0.001). The time elapsed to reoperation was shorter in group I (HR = 2.340 [1.367-4.005]), stratified for the onset of immunosuppression. Moreover, reoperation was far more common among patients who had a late start of immunosuppression (S36: 50% versus S0-6: 27% and S6-36: 25%, P < 0.001) and (I36: 16% versus I0-6: 5% and I6-36: 7%, P < 0.001).
  
  
  
  Although neither early surgery nor immunosuppression seem to be able to prevent global disabling disease, an early start of immunosuppression by itself is associated with fewer surgeries and should be considered in daily practice as a preventive strategy.
authors.affiliation: 1Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; 2MedInUP-Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal; 3MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; 4CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal; 5Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; 6Gastroenterology Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Portugal; 7Gastroenterology Department, Centro Hospitalar do Porto, Portugal; 8Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Portugal; 9Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Portugal; 10Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal; 11Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal; 12Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital S. Bernardo, Portugal; 13Department of Biomedical Sciences and Medicine, University of Algarve; 14Gastroenterology Department, Hospital de Faro, Portugal; 15Instituto Português de Oncologia de Lisboa; 16Gastroenterology Department, Centro Hospitalar Lisboa Oriental, Portugal; 17Gastroenterology Department, Hospital de Braga, Portugal; 18Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portugal; and 19Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Magro
authors.forename: Cláudia C
authors.initials: CC
authors.lastname: Dias
authors.forename: Rosa
authors.initials: R
authors.lastname: Coelho
authors.forename: Paula M
authors.initials: PM
authors.lastname: Santos
authors.forename: Samuel
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authors.lastname: Fernandes
authors.forename: Cidalina
authors.initials: C
authors.lastname: Caetano
authors.forename: Ângela
authors.initials: Â
authors.lastname: Rodrigues
authors.forename: Francisco
authors.initials: F
authors.lastname: Portela
authors.forename: Ana
authors.initials: A
authors.lastname: Oliveira
authors.forename: Paula
authors.initials: P
authors.lastname: Ministro
authors.forename: Eugénia
authors.initials: E
authors.lastname: Cancela
authors.forename: Ana I
authors.initials: AI
authors.lastname: Vieira
authors.forename: Rita
authors.initials: R
authors.lastname: Barosa
authors.forename: José
authors.initials: J
authors.lastname: Cotter
authors.forename: Pedro
authors.initials: P
authors.lastname: Carvalho
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cremers
authors.forename: Daniel
authors.initials: D
authors.lastname: Trabulo
authors.forename: Paulo
authors.initials: P
authors.lastname: Caldeira
authors.forename: Artur
authors.initials: A
authors.lastname: Antunes
authors.forename: Isadora
authors.initials: I
authors.lastname: Rosa
authors.forename: Joana
authors.initials: J
authors.lastname: Moleiro
authors.forename: Paula
authors.initials: P
authors.lastname: Peixe
authors.forename: Rita
authors.initials: R
authors.lastname: Herculano
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonçalves
authors.forename: Bruno
authors.initials: B
authors.lastname: Gonçalves
authors.forename: Helena
authors.initials: H
authors.lastname: Tavares Sousa
authors.forename: Luís
authors.initials: L
authors.lastname: Contente
authors.forename: Henrique
authors.initials: H
authors.lastname: Morna
authors.forename: Susana
authors.initials: S
authors.lastname: Lopes
mesh_terms: D000368:Aged; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods / Q000706:statistics & numerical data*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents