Tu1337 Anti-TNFα Treatment Efficacy in Prevention of Postoperative Recurrence in Crohn's Disease Depends on Previous Exposure to Anti-TNFα Agents

Abstract

Background Almost 50% of Crohn's disease (CD) patients will need surgical resection during their follow-up. Infliximab and adalimumab are effective to prevent postoperative recurrence in CD patient naive from anti-TNFα antibodies (anti-TNF). The effect of previous exposure to one or more anti-TNF before surgery on prevention of post-operative recurrence by these agents is still unknown. The aim of our study was to investigate the efficacy of anti-TNF to prevent CD post-operative recurrence according to previous exposure to these drugs. Methods: We performed a retrospective analysis of CD patients, followed in a tertiary referral centre, who underwent surgical bowel resection and prophylactic treatment with anti-TNF between January 2005 and June 2012. Infliximab, adalimumab and certolizumab pegol were considered as prophylactic treatments if started within threemonths after surgery. Endoscopic recurrence, defined as a Rutgeerts score ≥ i2 and clinical recurrence, defined as physician judgment were evaluated one year after surgery and also during the follow-up. Results: Fifty-seven consecutive CD patients with bowel resection, anastomosis and prophylactic treatment with anti-TNF were included in the study. Twenty two patients (39%) had prior intestinal resection for CD and a majority (45, 79%) were treated with at least one antiTNF before surgery. Twenty-four (42%) received two or more anti-TNF before surgery and 12 (21%) patients were naive from anti-TNF. Thirty-nine (67%) patients had a surveillance colonoscopy one year after surgery. At one year, the global endoscopic and clinical postoperative recurrence rates were 42% (17/39) and 19% (11/57), respectively. According to previous exposure to anti-TNF, patients with two or more anti-TNF before surgery had a higher oneyear endoscopic recurrence rate compared with patients that received one and zero antiTNF before surgery (62%, n=13/21 vs. 31%, n=4/13 vs. 20%, n=1/5). Also, patients with two or more anti-TNF before surgery had a higher rate of clinical recurrence compared with patients receiving less than two anti-TNF before surgery (37%, n=9/24 vs. 12%, n=4/33, p=0.05). In multivariate analysis, smoking (HR=3.2; IC 95%: 1.2-7.8) and previous exposure to two or more anti-TNF (HR=4.3; IC 95%: 1.3-14.0) were significantly associated to the risk of clinical postoperative recurrence in CD patients. Conclusion: Previous exposure to two or more anti-TNF agents was associated to a higher risk of postoperative recurrence in CD patients receiving prophylactic treatment with anti-TNF. This study suggested that previous exposure to anti-TNF should be taken into account when managing prevention of post-operative recurrence in CD patients.