Early ileocecal resection vs infliximab: later biologic need

What is known

• LIR!C long-term follow-up (94% retention, ~63.5 mo): 26% of resection patients started anti-TNF and none needed re-resection, vs 48% of infliximab patients later requiring resection. ¹
• LIR!C is an open-label multicentre RCT comparing laparoscopic ileocecal resection with infliximab for terminal ileitis, powered on quality of life. ²
• A real-world biologic-naive cohort found no significant difference in crossover between surgery-first and biologic-first strategies (36% vs 40%, p=0.60). ³

What is unknown / caveats

• Real-world cohort shows comparable crossover between strategies ³; LIR!C shows a surgery advantage in later anti-TNF use ¹
• Median time free of additional CD-related treatment was similar between arms (~33 vs 34 mo) ¹
• LIR!C primary endpoint was quality of life, not cumulative biologic need
• The single RCT was not powered on cumulative biologic exposure, and the supporting cohort data are retrospective and conflicting.

References

1. Maruyama BY, Ma C, Panaccione R, Kotze PG. Early Laparoscopic Ileal Resection for Localized Ileocecal Crohn's Disease: Hard Sell or a Revolutionary New Norm?. Inflamm Intest Dis. 2022;7(1):13-20. PMID: 35224013.

2. Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, Warusavitarne J, Buskens CJ, van Bodegraven AA, Brink MA, Consten ECJ, van Wagensveld BA, Rijk MCM, Crolla RMPH, Noomen CG, Houdijk APJ, Mallant RC, Boom M, Marsman WA, Stockmann HB, Mol B, de Groof AJ, Stokkers PC, D'Haens GR, Bemelman WA, LIR!C study G. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol. 2017;2(11):785-792. PMID: 28838644.

3. [No authors listed]. Which first? Surgery or biologic therapy for ileocolic Crohn's disease in the real world. Expert Rev Gastroenterol Hepatol. 2025;19(7):817-824. PMID: 40498697.

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