Intest Res.  2018 Jan;16(1):75-82. 10.5217/ir.2018.16.1.75.

Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease

• Hiraoka S
• Takashima
• Kondo Y
• Inokuchi T
• Sugihara Y
• Takahara M
• Kawano S
• Harada K
• Kato J
• Okada H

• KMID: 2402650
• DOI: http://doi.org/10.5217/ir.2018.16.1.75

Abstract

BACKGROUND/AIMS
The efficacy of anti-tumor necrosis factor α (anti-TNFα) antibodies for postoperative Crohn's disease (CD) in patients who were treated with these agents prior to surgery is largely unknown.
METHODS
CD patients who underwent intestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence or absence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα naïve group. Endoscopic recurrence after surgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery.
RESULTS
Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti-TNFα naïve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than in the anti-TNFα naïve group (68% vs. 14%, P < 0.001). Multivariate analysis revealed the following significant risk factors of endoscopic recurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10; 95% CI, 3.08-722.00), age at diagnosis < 23 years (OR, 24.30; 95% CI, 1.67-1,312.00), serum albumin concentration at surgery < 3.3 g/dL (OR, 34.10; 95% CI, 1.72-2,804.00), and presence of inflammation outside of the surgical site (OR, 21.40; 95% CI, 1.02-2,150.00). Treatment intensification for patients with endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopic remission.
CONCLUSIONS
The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatment intensification or a change to different classes of biologics should be considered for those patients.

Keyword

Crohn disease; Anti-tumor necrosis factor α; Surgery

MeSH Terms

Antibodies
Biological Products
Crohn Disease*
Diagnosis
Humans
Inflammation
Multivariate Analysis
Necrosis*
Recurrence
Risk Factors
Serum Albumin
Antibodies
Biological Products
Serum Albumin

Figure

• 

  Fig. 1 Flow chart of the present study. TNF, tumor necrosis factor.

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