Use of biologic agents in Inflammatory Bowel Disease and Risk of Surgery
Does Infliximab increase the risk of surgery in children with Ulcerative Colitis?
A nice study by Kennedy, et al from Mayo Clinic Rochester attempted to answer this question. Only 11 patients were examined in the study, so caution must be used in drawing conclusions. The authors found that the 11 children who received Infliximab (a biologic agent) had nearly twice as many post-operative complications than the 27 children who did not receive the drug. The infliximab patients may have been sicker then the other group, however. Moveover, more of these patient were also on thiopurines (91% vs 41%). Most of the complications were early after surgery. Late complications were similar.
The authors concluded by stating their current practice is to limit the first operation to a subtotal colectomy and end ileostomy, and delay the Ileal pouch anal anastomosis (IPAA) in patients who have received infliximab within 8 weeks of surgery.
Kennedy RK, Potter DD, Moir C, Zarroug A, Faubion W, Tung J. Pediatric Chronic Ulcerative Colitis: Does Infliximab increase post-IPAA complications? Presented at 42nd APSA Meeting, May 23, 2011 in Palm Desert, CA
Ulcerative colitis in children: Surgical Considerations