Introduction Anti-TNF (a-TNF) prescription is tightly controlled by NICE guidelines and reserved for severe or resistant Crohn’s disease in the UK, with annual review of ongoing prescription required and discontinuation for patients in remission.
Methods Retrospective review of 135 patients with Crohn’s disease who have received anti-TNF at UHNS.
Results 135 patients received a-TNF; 51 male, 84 female with a mean age of 29 at diagnosis. 28% of patients smoke. Table 1 shows most advanced stage of disease at diagnosis and when a-TNF started.
58% of patients had already had surgery for CD prior to commencement of a-TNF, 13% had major abdominal surgery after a-TNF. The number of patients with stricturing disease had doubled from diagnosis to the time of a-TNF commencement. 7/23 (30%) required surgery in less than 6 months of commencement of anti-TNF, 10/23 (43%) in under 12 months.
Conclusion a-TNF is being commenced late in the disease process, with significant accumulated damage and 73% of ongoing surgical requirements occurring in less than 1 year after commencing a-TNF. This may be a reflection of current prescription prohibition. What remains to be demonstrated is whether earlier intervention could have prevented the large amount of intra-abdominal surgery in these high risk cohorts.
Disclosure of Interest None Declared.
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