Issue 09

Clinical Question

Does anti-TNF therapy prevent early post-op recurrence in Crohn’s disease (CD)?

Editor’s Bottom Line

Adalimumab and infliximab performed similarly as post-surgical prophylaxis but recurrence remained too common. Additional strategies are needed.

Reference

Cañete F, Mañosa M, Casanova MJ, et al. Adalimumab or Infliximab for the Prevention of Early Postoperative Recurrence of Crohn Disease: Results From the ENEIDA Registry. Inflamm Bowel Dis. E-pub April 22, 2019; https://doi.org/10.1093/ibd/izz084

Synopsis

Spanish researchers documented rates of endoscopic or clinical recurrence in 152 CD patients included in that country’s national, prospective ENEIDA Registry, within 18 months of colonic resection and ileocolonic anastomosis. Fifty-five patients had received post-operative infliximab and 97 were administered adalimumab post-operatively. They initiated treatment a median of 29 days after surgery (Interquartile range: 13–44 days). Roughly 40% of patients also received concomitant immunosuppressants and 82% of patients had a history of prior anti-TNF use.

Data showed that 34% of patients experienced endoscopic post-operative recurrence within 18 months, which the researchers defined according to the Rutgeerts endoscopic score, and 20% experienced clinical recurrence during the 18-month post-operative period. There were no differences in recurrence rates between the infliximab and adalimumab groups.

While 82% of all patients had at least one known risk factor for post-operative recurrence, such as active smoking after surgery, previous intestinal resection or penetrating disease, in multivariate analyses only a history of perianal disease (Odds Ratio [OR]: 2.73; 95% Confidence Interval [CI], 1.26–5.91) and rectal disease (OR: 2.79; 95% CI, 1.09–7.14) (P<0.05 for both) were significant predictors of early endoscopic post-operative recurrence. The authors noted that 34% of patients did not follow the established induction protocol for infliximab or adalimumab.

Details

Study Design: Retrospective observational
Funding: The ENEIDA Registry is supported by AbbVie, Takeda, Pfizer, Kern Pharmaceuticals and MSD.
Allocation: Not applicable
Setting: National database
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.