eP259 - Switching Between Disease Modifying Drug Class Following Resection for Refractory Crohn's Disease Is Associated with Increased Risk for Re-Intervention

Purpose/Background: Disease modifying drugs (DMDs), such as infliximab, have altered the natural history of Crohn’s Disease (CD). However, guidance regarding adjustment of these medications perioperatively—specifically, if switching DMDs (or class of DMDs) following surgery impacts the likelihood of re-intervention for refractory disease—is currently lacking.Methods/Interventions: MarketScan® database (2005-2021) was employed to identify patients over 18 who received a DMD both within 6 months prior to, and 3 months following surgical resection for refractory CD. Kruskal-Wallis analysis was used to determine if differences existed between patients who switched or did not switch DMDs before vs after surgery. Landmark analysis with Kaplan-Meier curves were employed to estimate cumulative incidence of re-intervention (reoperation or endoscopic intervention) beginning 90 days after surgery. Multivariate Cox regression was used to evaluate the effect of switching between DMDs or DMD classes, after controlling for patient characteristics and CD severity, to estimate hazard ratios for re-intervention.Results/Outcomes: We identified 2111 patients with the aforementioned inclusion criteria, with mean follow up time of 2.8 years. 286 (13.5%) patients switched DMDs within 3 months of discharge from their index surgery. Of these individuals, 158 switched between anti-TNF agents, while 103 switched between anti-TNF agents or non-anti-TNF-agents. A previously published CD severity index did not differ between those who switched and those who did not switch (10.8 (7.33) vs 11.3 (7.59) p = 0.351). Logistic regression revealed that year of surgery, comorbidity index, and length of stay were associated with switching DMDs. With each year, there were 9% higher odds of switching (OR = 1.09; 95% CI: 1.05-1.13), while every 1-point increase in comorbidity index was associated with 17% lower odds of switching (OR = 0.83; 95% CI: 0.72-0.96).134 (6.3%) patients underwent re-intervention (72 underwent reoperation, while 62 underwent endoscopic intervention). Cox regression model demonstrates that while switching between DMDs was not associated with re-intervention, switching between DMD class (anti-TNF to non-anti-TNF, or vice versa) was significantly associated with a two-times increased risk of re-intervention, (HR = 2.06 (95% CI:1.01-4.20), p = 0.048). Age at surgery, sex, comorbidity index, and CD severity index were not associated with significant risk for re-intervention (p > 0.13 for all cases).Conclusion/

Discussion: Switching DMD class is associated with increased risk of re-intervention for refractory CD, though switching between DMDs of the same class is not, nor is it associated with increased CD severity. This highlights the need for further investigation into DMD selection in the perioperative setting and the consequences thereof.Cumulative incidence curves for re-intervention by whether or not a patient switched DMD class following index surgery