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- W2191991897 abstract "We appreciate the study by Safroneeva et al. highlighting the impact of early treatment with immunodulators on surgery in Crohn's disease (CD).1 In our meta-analysis on this topic we identified several studies that support a role for immunomodulators in reducing the risk of first intestinal surgery, although the impact of early therapy was unclear.2 This meta-analysis included our own large national population-based study of adult onset CD in which duration, rather than time of onset, of immunomodulator therapy was associated with reduced risk of first intestinal surgery,3 and we also found this to be the case for perianal surgery.4 We would be interested to know if Safroneeva et al. analysed their data set to assess the impact of duration of therapy and adjusted for this variable in their analysis of the impact of early therapy on surgical outcomes? In our most recent study, we reported the benefit of early immunomodulator therapy in reducing the risk of surgery in children and young adults,5 akin to the findings of Markowitz et al.6 Were the authors able to identify a differential effect of IMs between younger and older onset CD in their cohort? Our recent findings support the notion that patients presenting with CD at a young age are more likely to gain benefit from early immunomodulator usage, with an associated reduced surgical risk. Possible biologically plausible reasons for this are firstly this group frequently have a more aggressive disease behaviour, and secondly the natural history of disease is more likely to be in the early stages before onset of a stricturing or penetrating phenotype. Declaration of personal and funding interests: None." @default.
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- W2191991897 date "2015-12-14" @default.
- W2191991897 modified "2023-10-16" @default.
- W2191991897 title "Letter: early use of immunomodulators and surgery in Crohn's disease" @default.
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- W2191991897 doi "https://doi.org/10.1111/apt.13464" @default.
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