Inflamm Bowel Dis.2024 Nov 14:izae272. doi: 10.1093/ibd/izae272. Online ahead of print.

Maya Fischman ¹, Lihi Godny ^2 3, Adi Friedenberg ^2 3, Revital Barkan ^2 3, Ian White ^3 4, Nir Wasserberg ^3 4, Keren Rabinowitz ⁵, Irit Avni-Biron ², Hagar Banai ², Yifat Snir ², Yelena Broitman ², Henit Yanai ^2 3, Iris Dotan ^2 3, Jacob E Ollech ^2 3

Author information

¹Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

²Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.

³Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.

⁴Division of Surgery, Rabin Medical Center, Petah-Tikva, Israel.

⁵Felsenstein Medical Research Center, Rabin Medical Center, Tel Aviv University, Petah-Tikva, Israel.

Abstract

Background: Patients with ulcerative colitis (UC) undergoing proctocolectomy and ileal pouch-anal anastomosis (IPAA) may eventually require biologic therapy. Factors associated with biologic therapy after IPAA have not been previously studied.

Methods: All patients with UC after total proctocolectomy and IPAA who were followed at Rabin Medical Center comprehensive pouch clinic and who consented to prospective observational follow-up were included. The primary outcome was the initiation of biologic therapy after IPAA. Cox proportional hazard models were used to evaluate potential associations.

Results: Out of 400 patients receiving their care at the pouch clinic, 148 patients consented to prospective observational follow-up and constituted the study cohort. The median age at diagnosis was 21 years and the age at IPAA was 30 years. Median time-to-biologic therapy initiation post-IPAA was 9.2 years, with 34 patients (23%) initiating biologic therapy: Associated factors for initiating biologic therapy post-IPAA were preoperative treatment with biologic therapy and immunomodulatory therapy (hazard ratio [HR] 6.1 and 3.6, respectively, P < .001); Arab descent (HR 5.3, P < .001); heterozygosity of NOD2 variant rs2066845 (HR 5.1, P = .03); past smoking status (HR 2.3, P = .03); 3-stage IPAA (HR 2.3, P = .02); immediate postoperative complications (HR 2.1, P = .033); and pediatric-onset UC (HR 2.1, P = .03). None of the patients undergoing IPAA due to dysplasia (n = 27) required biologic therapy.

Conclusions: Several demographic, disease-related, surgery-related, and genetic factors associated with post-IPAA biologic therapy were identified. Physicians treating patients with UC undergoing colectomy should incorporate these factors into their decision-making process. These patients may benefit from closer postoperative follow-up, and earlier initiation of biologic therapy should be considered.