Endoscopic Postoperative Recurrence in Crohn's Disease After Curative Ileocecal Resection with Early Prophylaxis by Anti-TNF, Vedolizumab or Ustekinumab: A Real-World Multicentre European Study.
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Yanai Henit, Kagramanova Anna, Knyazev Oleg, Sabino João, Haenen Shana, Mantzaris Gerassimos J, Mountaki Katerina, Armuzzi Alessandro, Pugliese Daniela, Furfaro Federica, Fiorino Gionata, Drobne David, Kurent Tina, Yassin Sharif, Maharshak Nitsan, Castiglione Fabiana, de Sire Roberto, Nardone Olga Maria, Farkas Klaudia, Molnar Tamas, Krznaric Zeljko, Brinar Marko, Chashkova Elena, Livne Margolin Moran, Kopylov Uri, Bezzio Cristina, Bar-Gil Shitrit Ariella, Lukas Milan, Chaparro María, Truyens Marie, Nancey Stéphane, Lobaton Triana, Gisbert Javier P, Saibeni Simone, Bacsúr Péter, Bossuyt Peter, Schulberg Julien, Hoentjen Frank, Viganò Chiara, Palermo Andrea, Torres Joana, Revés Joana, Karmiris Konstantinos, Velegraki Magdalini, Savarino Edoardo, Markopoulos Panagiotis, Tsironi Eftychia, Ellul Pierre, Calviño Suárez Cristina, Weisshof Roni, Ben-Hur Dana, Naftali Timna, Eriksson Carl, Koutroubakis Ioannis E, Foteinogiannopoulou Kalliopi, Limdi Jimmy K, Liu Eleanor, Surís Gerard, Calabrese Emma, Zorzi Francesca, Filip Rafał, Ribaldone Davide Giuseppe, Snir Yifat, Goren Idan, Banai-Eran Hagar, Broytman Yelena, Amir Barak Hadar, Avni-Biron Irit, Ollech Jacob E, Dotan Iris, Aharoni Golan Maya
Аннотация
METHODS: A retrospective multicentre study of CD-adults after curative ICR on early prophylaxis was undertaken. ePOR was defined as a Rutgeerts score [RS] ≥ i2 or colonic-segmental-SES-CD ≥ 6. Multivariable logistic regression was used to evaluate risk factors, and inverse probability treatment weighting [IPTW] was applied to compare the effectiveness between agents.
RESULTS: The study included 297 patients (53.9% males, age at diagnosis 24 years [19-32], age at ICR 34 years [26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6% two or more biologics and 17.2% previous surgery). Overall, 224, 39 and 34 patients received anti-TNF, VDZ or UST, respectively. Patients treated with VDZ and UST were more biologic experienced with higher rates of previous surgery. ePOR rates within 1 year were 41.8%. ePOR rates by treatment groups were: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1 year were: past-infliximab (adjusted odds ratio [adj.OR] = 1.73 [95% confidence interval, CI: 1.01-2.97]), past-adalimumab [adj.OR = 2.32 [95% CI: 1.35-4.01] and surgical aspects. After IPTW, the risk of ePOR within 1 year of VDZ vs anti-TNF or UST vs anti-TNF was comparable (OR = 0.55 [95% CI: 0.25-1.19], OR = 1.86 [95% CI: 0.79-4.38]), respectively.
CONCLUSION: Prevention of ePOR within 1 year after surgery was successful in ~60% of patients. Patients treated with VDZ or UST consisted of a more refractory group. After controlling for confounders, no differences in ePOR risk were seen between anti-TNF prophylaxis and other groups.