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KMID : 0988920180160010075
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Intestinal Research
2018 Volume.16 No. 1 p.75 ~ p.82
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Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease
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Hiraoka Sakiko
Takashima Shiho
Kondo Yoshitaka
Inokuchi Toshihiro
Sugihara Yuusaku
Takahara Masahiro
Kawano Seiji
Harada Keita
Kato Jun
Okada Hiroyuki
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Abstract
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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 naive 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 naive group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than in the anti-TNFα naive 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.
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KEYWORD
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Crohn disease, Anti-tumor necrosis factor α, Surgery
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