Abstract
Background: Most Crohn's disease (CD) patients develop endoscopic recurrence within one year of intestinal resection. The best treatment method to prevent post-operative CD recurrence remains uncertain. Methods: A total of 155 CD patients from 2 referral centres, who were undergoing intestinal resection with ileo-colonic anastomosis (January 2004-January 2015), were included. All subjects received preventive therapy with tumour necrosis factor antagonists (anti-TNFs), thiopurinesor mesalazine. The primary outcome was the rate of endoscopic recurrence (Rutgeerts score ≥i2) in the 3 treatment groups. Results: Patients treated with anti-TNFs were at significantly lower risk of endoscopic recurrence during the follow-up than those receiving thiopurines or mesalazine (incidence rates of 2.2, 3.0 and 4.8 per 100 person-months, respectively, log-rank, p = 0.011). The median time to recurrence was significantly longer in patients treated with anti-TNFs than in those who received thiopurines or mesalazine (37.0, 13.7, and 16.8 months, respectively, log-rank, p = 0.011). Anti-TNFs were more effective than mesalazine (univariable analysis, hazard ratio [HR] 0.45, 95% CI 0.26-0.77, p = 0.004; multivariable analysis, HR 0.45, 95% CI 0.26-0.77, p = 0.004), and non-significantly superior over thiopurines. Conclusion: Anti-TNF therapy was the most effective strategy for the prevention of endoscopic CD recurrence.
Lingua originale | English |
---|---|
pagine (da-a) | 166-172 |
Numero di pagine | 7 |
Rivista | Digestion |
Volume | 96 |
DOI | |
Stato di pubblicazione | Pubblicato - 2017 |
Keywords
- Abdominal surgery
- Adult
- Anti-Inflammatory Agents, Non-Steroidal
- Anti-tumour necrosis factor
- Colectomy
- Colonoscopy
- Crohn Disease
- Crohn’s disease
- Female
- Follow-Up Studies
- Humans
- Immunosuppressive Agents
- Male
- Mercaptopurine
- Mesalamine
- Middle Aged
- Postoperative Period
- Proportional Hazards Models
- Recurrence
- Retrospective Studies
- Secondary Prevention
- Treatment Outcome
- Tumor Necrosis Factor-alpha