Are the New Biologics Effective in the Management of Postoperative Crohn's Disease?

Lay Summary Review of the literature showed some encouraging results on the effectiveness of vedolizumab and ustekinumab in the prevention and treatment of postoperative Crohn's disease. However, more controlled studies comparing the new biologic agents with anti-tumor necrosis factor agents are needed. Background Despite the growing therapeutic armamentarium, at least half of the patients with Crohn's disease will require surgery during their lifetime. Current evidence for the prevention and treatment of postoperative Crohn's disease supports the use of anti-tumor necrosis factor agents with limited data about the use of the newer biologics, vedolizumab and ustekinumab. Methods We performed a systematic review of available data to determine the efficacy of the newer biologics in the management of postoperative Crohn's disease. We included noncomparative and comparative studies. The main outcomes of interest were clinical and endoscopic postoperative recurrence rates. Results The search strategy identified 1231 citations, with 32 eligible for review. Several studies showed that the postoperative Crohn's disease recurrence rates with the use of the newer biologics were comparable to previously published results with the use of anti-tumor necrosis factor agents, while other studies failed to show their efficacy. It is important to note that the studies were heterogeneous and included a relatively small sample size, making it difficult to draw a definite conclusion about the efficacy of the newer biologics in the management of postoperative Crohn's disease. Conclusion The newer biologics do play a role in the management of postoperative Crohn's disease. After our review, we proposed an updated algorithm on the role of newer biologics in the approach to patients with postoperative Crohn's disease. Yet, until we have better-designed studies, their definite positioning remains to be determined.

Automated summary

A review of the literature found promising results regarding the use of vedolizumab and ustekinumab in preventing and treating postoperative Crohn's disease. However, additional controlled studies comparing these new biologics with anti-tumor necrosis factor agents are necessary.