Alimentary Pharmacology and Therapeutics
Letter to the Editor Letter: early use of immunomodulators and surgery in Crohn’s disease R. Pollok*, V. Chhaya* & S. Saxena† *Department of Gastroenterology, St George’s Hospital, NHS Healthcare Trust, London, UK. † Imperial College London, Primary Care and Public Health, London, UK. E-mail: [email protected]
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.
doi:10.1111/apt.13464
ACKNOWLEDGEMENT SIRS, 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
Declaration of personal and funding interests: None.
REFERENCES 1. Safroneeva E, Vavrick SR, Fournier N, et al. Impact of the early use of immunomodulators or TNF agonists on bowel damage and surgery in Crohn’s disease. Aliment Pharmacol Ther 2015; 42: 977–89. 2. Chatu S, Subramanian V, Saxena S, et al. The role of thiopurines in reducing the need for surgical resection in Crohn’s disease: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 23–34. 3. Chatu S, Saxena S, Subramanian V, et al. The impact of timing and duration of thiopurine treatment on first intestinal resection in Crohn’s disease: national UK population-based study 19892010. Am J Gastroenterol 2014; 109: 409–16. 4. Chhaya V, Saxena S, Cecil E, et al. Impact of timing and duration of thiopurine treatment on first perianal surgery in Crohn’s disease: UK population-based study (1995-2009). Inflamm Bowel Dis 2015; 21: 385–91. 5. Chhaya V, Pollok RC, Cecil E, et al. Impact of early thiopurines on surgery in 2770 children and young people diagnosed with inflammatory bowel disease: a national population-based study. Aliment Pharmacol Ther 2015; 42: 990–9. 6. Markowitz J, Grancher K, Kohn N, et al. A multicentre trial of 6-mercaptopurine and prednisolone in children with newly diagnosed Crohn’s disease. Gastroenterology 2000; 119: 895–902.
AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 500 words, may contain one table or figure, and should have no more than 10 references. It should be submitted electronically to the Editors via http://mc.manuscriptcentral.com/apt.
ª 2015 John Wiley & Sons Ltd
313
Letter to the Editor Letter: early use of immunomodulators and surgery in Crohn’s disease R. Pollok*, V. Chhaya* & S. Saxena† *Department of Gastroenterology, St George’s Hospital, NHS Healthcare Trust, London, UK. † Imperial College London, Primary Care and Public Health, London, UK. E-mail: [email protected]
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.
doi:10.1111/apt.13464
ACKNOWLEDGEMENT SIRS, 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
Declaration of personal and funding interests: None.
REFERENCES 1. Safroneeva E, Vavrick SR, Fournier N, et al. Impact of the early use of immunomodulators or TNF agonists on bowel damage and surgery in Crohn’s disease. Aliment Pharmacol Ther 2015; 42: 977–89. 2. Chatu S, Subramanian V, Saxena S, et al. The role of thiopurines in reducing the need for surgical resection in Crohn’s disease: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 23–34. 3. Chatu S, Saxena S, Subramanian V, et al. The impact of timing and duration of thiopurine treatment on first intestinal resection in Crohn’s disease: national UK population-based study 19892010. Am J Gastroenterol 2014; 109: 409–16. 4. Chhaya V, Saxena S, Cecil E, et al. Impact of timing and duration of thiopurine treatment on first perianal surgery in Crohn’s disease: UK population-based study (1995-2009). Inflamm Bowel Dis 2015; 21: 385–91. 5. Chhaya V, Pollok RC, Cecil E, et al. Impact of early thiopurines on surgery in 2770 children and young people diagnosed with inflammatory bowel disease: a national population-based study. Aliment Pharmacol Ther 2015; 42: 990–9. 6. Markowitz J, Grancher K, Kohn N, et al. A multicentre trial of 6-mercaptopurine and prednisolone in children with newly diagnosed Crohn’s disease. Gastroenterology 2000; 119: 895–902.
AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 500 words, may contain one table or figure, and should have no more than 10 references. It should be submitted electronically to the Editors via http://mc.manuscriptcentral.com/apt.
ª 2015 John Wiley & Sons Ltd
313
