Factors associated with anti-tumor necrosis factor effectiveness to prevent postoperative recurrence in Crohn's disease

Background/Aims: We assessed the effectiveness of anti-TNF agents and its associated factors to prevent endoscopic and clinical postoperative recurrence (POR) in Crohn's disease (CD). Methods: From a prospectively-maintained database, we retrieved 316 CD patients who underwent intestinal resection (2011-2017). Endoscopic (Rutgeerts index >= i2 at 6 months) and clinical (recurrence of symptoms leading to hospitalization or therapeutic escalation) POR were assessed. Results: In 117 anti-TNF-naive patients, anti-TNF therapy was more effective than immunosuppressive agents (odds ratio [OR], 8.8; 95% confidence interval [CI], 1.8-43.9; P=0.008) and no medication/5-aminosalicylates (OR, 5.2; 95% CI, 1.0-27.9; P=0.05) to prevent endoscopic POR. In 199 patients exposed to anti-TNF prior to the surgery, combination with anti-TNF and immunosuppressive agents was more effective than anti-TNF monotherapy (OR, 2.32; 95% CI, 1.02-5.31; P=0.046) to prevent endoscopic POR. Primary failure to anti-TNF agent prior to surgery was predictive of anti-TNF failure to prevent endoscopic POR (OR, 2.41; 95% CI, 1.10-5.32; P=0.03). When endoscopic POR despite anti-TNF prophylactic medication (n=55), optimizing anti-TNF and adding an immunosuppressive drug was the most effective option to prevent clinical POR (hazard ratio, 7.38; 95% CI, 1.54-35.30; P=0.012). Anti-TNF therapy was the best option to prevent clinical POR (hazard ratio, 3.10; 95% CI, 1.09-8.83; P=0.034) in patients with endoscopic POR who did not receive any biologic to prevent endoscopic POR (n=55). Conclusions: Anti-TNF was the most effective medication to prevent endoscopic and clinical POR. Combination with anti-TNF and immunosuppressive agents should be considered in patients previously exposed to anti-TNF.

Automated summary

Anti-TNF therapy was found to be the most effective medication in preventing endoscopic and clinical postoperative recurrence (POR) in Crohn's disease (CD). Combination therapy with anti-TNF agents and immunosuppressive drugs should be considered for patients previously exposed to anti-TNF before surgery.