Effectiveness of Mesalazine, Thiopurines and Tumour Necrosis Factor Antagonists in Preventing Post-Operative Crohn's Disease Recurrence in a Real-Life Setting

Alfredo Papa, Alessandro Armuzzi, Silvio Danese, Mariangela Allocca, Stefanos Bonovas, Gionata Fiorino, Antonino Spinelli, Federica Furfaro, Laurent Peyrin-Biroulet

Risultato della ricerca: Contributo in rivistaArticolo in rivista

9 Citazioni (Scopus)

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 originaleEnglish
pagine (da-a)166-172
Numero di pagine7
RivistaDigestion
Volume96
DOI
Stato di pubblicazionePubblicato - 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

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