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Endoscopic Postoperative Recurrence in Crohn's Disease After Curative Ileocecal Resection

Endoscopic Postoperative Recurrence in Crohn's Disease After Curative Ileocecal Resection with Early Prophylaxis by Anti-TNF, Vedolizumab or Ustekinumab: A Real-World Multicentre European Study.

Henit Yanai, Anna Kagramanova, Oleg Knyazev, João Sabino, Shana Haenen, Gerassimos J Mantzaris, Katerina Mountaki, Alessandro Armuzzi, Daniela Pugliese, Federica Furfaro, Gionata Fiorino, David Drobne, Tina Kurent, Sharif Yassin, Nitsan Maharshak, Fabiana Castiglione, Roberto de Sire, Olga Maria Nardone, Klaudia Farkas, Tamas Molnar, Zeljko Krznaric, Marko Brinar, Elena Chashkova, Moran Livne Margolin, Uri Kopylov , Cristina Bezzio, Ariella Bar-Gil Shitrit, Milan Lukas, María Chaparro, Marie Truyens, Stéphane Nancey, Triana Lobaton, Javier P Gisbert, Simone Saibeni, Péter Bacsúr, Peter Bossuyt Julien Schulberg, Frank Hoentjen, Chiara Viganò, Andrea Palermo, Joana Torres , Joana Revés, Konstantinos Karmiris, Magdalini Velegraki, Edoardo Savarino, Panagiotis Markopoulos, Eftychia Tsironi, Pierre Ellul, Cristina Calviño Suárez, Roni Weisshof , Dana Ben-Hur, Timna Naftali, Carl Eriksson, Ioannis E Koutroubakis, Kalliopi Foteinogiannopoulou, Jimmy K Limdi, Eleanor Liu, Gerard Surís, Emma Calabrese, Francesca Zorzi, Rafał Filip, Davide Giuseppe Ribaldone, Yifat Snir, Idan Goren, Hagar Banai-Eran, Yelena Broytman, Hadar Amir Barak, Irit Avni-Biron, Jacob E Ollech, Iris Dotan, Maya Aharoni Golan

Published in Jul 2022, Journal of Crohn's & colitis.


Abstract

Background

Endoscopic-post-operative-recurrence [ePOR] in Crohn's disease [CD] after ileocecal resection [ICR] is a major concern. We aimed to evaluate the effectiveness of early prophylaxis with biologics and to compare anti-tumour necrosis factor [anti-TNF] therapy to vedolizumab [VDZ] and ustekinumab [UST] in a real-world setting.

Methods

A retrospective multicentre study of CD-adults after curative ICR on early prophylaxis was undertaken. ePOR was defined as a Rutgeerts score [RS] ≥ i2 or colonic-segmental-SES-CD ≥ 6. Multivariable logistic regression was used to evaluate risk factors, and inverse probability treatment weighting [IPTW] was applied to compare the effectiveness between agents.

Results

The study included 297 patients (53.9% males, age at diagnosis 24 years [19-32], age at ICR 34 years [26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6% two or more biologics and 17.2% previous surgery). Overall, 224, 39 and 34 patients received anti-TNF, VDZ or UST, respectively. Patients treated with VDZ and UST were more biologic experienced with higher rates of previous surgery. ePOR rates within 1 year were 41.8%. ePOR rates by treatment groups were: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1 year were: past-infliximab (adjusted odds ratio [adj.OR] = 1.73 [95% confidence interval, CI: 1.01-2.97]), past-adalimumab [adj.OR = 2.32 [95% CI: 1.35-4.01] and surgical aspects. After IPTW, the risk of ePOR within 1 year of VDZ vs anti-TNF or UST vs anti-TNF was comparable (OR = 0.55 [95% CI: 0.25-1.19], OR = 1.86 [95% CI: 0.79-4.38]), respectively.

Conclusion

Prevention of ePOR within 1 year after surgery was successful in ~60% of patients. Patients treated with VDZ or UST consisted of a more refractory group. After controlling for confounders, no differences in ePOR risk were seen between anti-TNF prophylaxis and other groups.



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