Factors Affecting Postoperative Recurrence in Japanese Patients With Crohnʼs Disease in The Era of Biologic Therapy: Retrospective Single Center Study

Abstract

Because of the excellent short-term prophylactic effect of infliximab, anti-TNFα monoclonal antibody has been increasingly applied to postoperative patients with Crohn's disease (CD) in Japan. However, such application of biologics should be based on further clinical evidence. We thus investigated factors affecting postoperative recurrence of CD to ascertain longer prophylactic effect of anti-TNFα monoclonal antibody. Postoperative clinical course and endoscopic/radiographic findings of 44 patients with CD, who underwent curative ileal or ileocolonic resection, were retrospectively analyzed. Postoperative recurrence was determined based on endoscopic/radiographic findings, irrespective of clinical symptoms or laboratory data. Recurrence at the anastomotic site was defined by an endoscopic score >i2 of Rutgeerts' score or depiction of small barium flecks indicating erosion or ulceration, thickened mucosal folds, or intestinal narrowing under radiography. Recurrence was also regarded to be positive when active inflammatory lesions were detected outside the anastomotic site. Age, disease duration, history of intestinal resection, disease type, extent of disease, perianal disease, smoking habit, and postoperative treatments were also reviewed, and possible contribution of clinical factors to postoperative recurrence was analyzed. During the mean follow-up period of 29.6 ± 19.2 months, postoperative recurrence was defined to be positive in 23 of 44 patients. Active inflammatory lesions were detected in the anastomotic site in 13 patients, outside the anastomotic site in 6 patients, and both in 4 patients. Postoperatively, 23 patients were treated by scheduled infliximab (5 mg/kg, every 8 weeks) and 2 patients were treated by adalimumab (40 mg, every other week). Univariate analysis using Logrank test revealed that history of intestinal resection (P = 0.017) and current smoking habit (P = 0.007) were more frequent in patients with recurrence than in those without. In addition, recurrence was less frequent in patients with anti-TNFα monoclonal antibody than in those without (P = 0.006). Multivariate analysis using Cox proportional hazards model demonstrated that patients treated with anti-TNFα monoclonal antibody were less likely to recur (RR = 0.09. 95%CI; 0.02-0.34), while patients with history of intestinal resection had an increased risk of recurrence (RR = 8.54, 95%CI; 1.79-60.36). Anti-TNFα monoclonal antibody treatment after intestinal resection obviously improves postoperative clinical course in patients with CD. Postoperative prophylaxis by biologic therapy might be appropriate for patients requiring repeated surgery in consideration of their higher recurrence rate.