Adalimumab or Infliximab for the Prevention of Early Postoperative Recurrence of Crohn Disease: Results From the ENEIDA Registry. Issue 11 (22nd April 2019)

• Record Type: Journal Article
• Authors: Cañete, Fiorella; Mañosa, Míriam; Casanova, María José; González-Sueyro, Ramiro C; Barrio, Jesús; Bermejo, Fernando; Nos, Pilar; Iglesias-Flores, Eva; García-Planella, Esther; Pérez-Calle, José Lázaro; Vicente, Raquel; Vera, Maribel; Ramos, Laura; Rivero, Montserrat; De Francisco, Ruth; Montserrat, Antonia; Benítez, Olga; Navarro, Pablo; Taxonera, Carlos; Hinojosa, Esther; Márquez-Mosquera, Lucía; Navarro-Llavat, Mercé; Ramírez-de la Piscina, Patricia; Gomollón, Fernando; Rodríguez-Alonso, Lorena; Núñez-Alonso, Alejandro; Fernández-Salazar, Luis; Almela, Pedro; Ríos León, Raquel; De Castro, Luisa; Gisbert, Javier P; Ricart, Elena; Cabré, Eduard; Domènech, Eugeni;
• Is Part Of: Inflammatory bowel diseases. Volume 25:Issue 11(2019)
• Page Start: 1862
• Page End: 1870
• Publication Date: 2019-04-22
• Subjects: postoperative recurrence -- Crohn disease -- anti-TNFs; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izz084
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: Anti–tumor necrosis factor agents (anti-TNFs) are efficacious at preventing the postoperative recurrence (POR) of Crohn disease, as demonstrated in 2 randomized controlled trials. However, real-life data for infliximab or adalimumab in this setting are scarce. Our aim was to assess both the efficiency of anti-TNFs at preventing early POR of Crohn disease in clinical practice and the associated risk factors for POR. Methods: Patients in whom anti-TNFs were prescribed for the prevention of POR within 3 months after ileocolonic resection and who had an endoscopic assessment within 18 months were identified from the ENEIDA registry. Clinical and endoscopic features were collected within 18 months after surgery. Results: In total, 152 patients were included (55 treated with infliximab, 97 with adalimumab, and 39% with concomitant immunosuppressants). Anti-TNF treatment was started after a median time of 29 days (IQR 13–44) after surgery. Eighty-two percent of patients had at least one risk factor for POR, and 82% had been exposed to anti-TNFs before the index surgery. Overall, 34% had endoscopic POR (as defined using a Rutgeerts endoscopic score > i1); 14% had advanced endoscopic POR (>i2); and 20% had clinical POR, with no differences between infliximab and adalimumab. In the multivariate analysis, only perianal disease (odds ratio 2.73, 95% confidence interval [CI] 1.26–5.91) and rectal involvement (odds ratio 2.79, 95% CI 1.09–7.14) were independent predictors of endoscopic POR. Conclusions: In clinical practice, anti-TNFs for the prevention of POR of Crohn disease are frequently used in patients experienced with anti-TNFs and with concomitant immunosuppressants. The efficacy of infliximab and adalimumab for POR prevention is similar and in accordance with the results obtained in randomized controlled trials. Video Abstract: Abstract : This is the largest series assessing the use of anti-TNF agents for POR prevention in clinical practice. The efficacy of infliximab and adalimumab for POR prevention is similar and are in accordance with the results obtained in RCTs. Perianal disease and rectal involvement were independent predictors of endoscopic POR.