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Adalimumab or Infliximab for the Prevention of Early Postoperative Recurrence of Crohn Disease: Results From the ENEIDA Registry

2019; Oxford University Press; Volume: 25; Issue: 11 Linguagem: Inglês

10.1093/ibd/izz084

1536-4844

Fiorella Cañete, Míriam Mañosa, María José Casanova, Ramiro C. Gonzalez Sueyro, Jesús Barrio, Fernando Bermejo, Pilar Nos, E Iglesias-Flores, Esther García-Planella, José Lázaro Pérez‐Calle, Raquel Vicente, Maribel Vera, Laura Ramos, Montserrat Rivero, Ruth de Francisco, Antònia Montserrat, Olga Benítez, Pablo Navarro, Carlos Taxonera, Esther Hinojosa, Lucía Márquez, Mercè Navarro-Llavat, Patricia Ramírez-de la Piscina, Fernando Gomollón, Lorena Rodríguez‐Alonso, Alejandro Núñez-Alonso, Luís Fernández-Salazar, Pedro Almela, Raquel Ríos León, Luisa de Castro, Javier P. Gisbert, Elena Ricart, Eduard Cabré, Eugeni Domènech,

Autoimmune and Inflammatory Disorders

Abstract Background Anti–tumor necrosis factor agents (anti-TNFs) are efficacious at preventing the postoperative recurrence (POR) of Crohn disease, as demonstrated in 2 randomized controlled trials. However, real-life data for infliximab or adalimumab in this setting are scarce. Our aim was to assess both the efficiency of anti-TNFs at preventing early POR of Crohn disease in clinical practice and the associated risk factors for POR. Methods Patients in whom anti-TNFs were prescribed for the prevention of POR within 3 months after ileocolonic resection and who had an endoscopic assessment within 18 months were identified from the ENEIDA registry. Clinical and endoscopic features were collected within 18 months after surgery. Results In total, 152 patients were included (55 treated with infliximab, 97 with adalimumab, and 39% with concomitant immunosuppressants). Anti-TNF treatment was started after a median time of 29 days (IQR 13–44) after surgery. Eighty-two percent of patients had at least one risk factor for POR, and 82% had been exposed to anti-TNFs before the index surgery. Overall, 34% had endoscopic POR (as defined using a Rutgeerts endoscopic score > i1); 14% had advanced endoscopic POR (>i2); and 20% had clinical POR, with no differences between infliximab and adalimumab. In the multivariate analysis, only perianal disease (odds ratio 2.73, 95% confidence interval [CI] 1.26–5.91) and rectal involvement (odds ratio 2.79, 95% CI 1.09–7.14) were independent predictors of endoscopic POR. Conclusions In clinical practice, anti-TNFs for the prevention of POR of Crohn disease are frequently used in patients experienced with anti-TNFs and with concomitant immunosuppressants. The efficacy of infliximab and adalimumab for POR prevention is similar and in accordance with the results obtained in randomized controlled trials.