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Endoscopic Postoperative Recurrence In Crohn's Disease After Curative Ileocecal Resection With Early Prophylaxis By Anti-Tnf, Vedolizumab Or Ustekinumab: A Real-World Multicenter European Study
Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.ORCID iD: 0000-0002-1046-383x
Department of Gastroenterology and Hepatology, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Concord Medical Center, Clalit Health Services, Bnei Brak, Israel.
Number of Authors: 692022 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 16, no 12, p. 1882-1892Article in journal (Refereed) Published
Abstract [en]

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-TNF therapy to vedolizumab (VDZ) and ustekinumab (UST) in a real-world setting.

METHODS: A retrospective multicenter study of CD-adults after curative ICR on early prophylaxis. 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: Included 297 patients (53.9% males, age at diagnosis 24y[19-32], age at ICR-34y[26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6%≥2 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: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1-year: past-infliximab (adj.OR=1.73[95%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.

Place, publisher, year, edition, pages
Oxford University Press, 2022. Vol. 16, no 12, p. 1882-1892
Keywords [en]
Biologics, Crohn’s disease, Post-operative recurrence
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-100612DOI: 10.1093/ecco-jcc/jjac100ISI: 000844745800001PubMedID: 35895074Scopus ID: 2-s2.0-85139393261OAI: oai:DiVA.org:oru-100612DiVA, id: diva2:1688769
Available from: 2022-08-19 Created: 2022-08-19 Last updated: 2023-12-08Bibliographically approved

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