TY - JOUR
T1 - Prophylactic medication for the prevention of endoscopic recurrence in Crohn's disease
T2 - a prospective study based on clinical risk stratification
AU - Arkenbosch, Jeanine H C
AU - Beelen, Evelien M J
AU - Dijkstra, Gerard
AU - Romberg-Camps, Mariëlle
AU - Duijvestein, Marjolijn
AU - Hoentjen, Frank
AU - van der Marel, Sander
AU - Maljaars, P W Jeroen
AU - Jansen, Sita
AU - de Boer, Nanne K H
AU - West, Rachel L
AU - Horjus, Carmen S
AU - Stassen, Laurents P S
AU - van Schaik, Fiona D M
AU - van Ruler, Oddeke
AU - Jharap, Bindia J H
AU - Visschedijk, Marijn
AU - Janssen, Alfred
AU - Erler, Nicole S
AU - Doukas, Michail
AU - Ooms, Ariadne H A G
AU - Kats-Ugurlu, Gursah
AU - van der Woude, C Janneke
AU - de Vries, Annemarie C
AU - Dutch Initiative on Crohn's and Colitis (ICC)
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation.
PY - 2022/9/12
Y1 - 2022/9/12
N2 - BACKGROUND: To prevent recurrence after ileocolonic resection (ICR) in Crohn's disease (CD), postoperative prophylaxis based on risk stratification is recommended in international guidelines. This study aimed to evaluate postoperative CD recurrence after implementation of a clinical management algorithm and determine the predictive value of clinical and histological risk factors (RF).METHODS: In this multicenter, prospective cohort study, CD patients (≥16 years) scheduled for ICR were included. The algorithm advised no postoperative medication for low-risk patients, and treatment with prophylaxis (immunosuppressant/biological) for high-risk patients (≥1 RF: active smoking, penetrating disease, prior ICR). Clinical and histologic RF (active inflammation, granulomas, plexitis in resection margins) for endoscopic recurrence (Rutgeerts' score ≥i2b at 6 months) were assessed using logistic regression and ROC curves based on predicted probabilities.RESULTS: 213 CD patients after ICR were included (age 34.5 years; 65% women) (93[44%] low-risk; 120[56%] high-risk [45[38%] smoking; 51[43%] penetrating disease; 51[43%] prior ICR]). Adherence to the algorithm was 82% in low-risk (no prophylaxis) and 51% in high-risk patients (prophylaxis). Endoscopic recurrence was higher in patients treated without prophylaxis than with prophylaxis in both low (45% vs 16%, p=.012) and high-risk (49% vs 26%, p=.019). Clinical risk stratification including the prescription of prophylaxis corresponded with an area under the curve (AUC) of 0.70 (95%CI 0.61-0.79). Clinical RF combined with histological RF increased the AUC to 0.73 (95%CI 0.64-0.81).CONCLUSION: Adherence to this management algorithm is 65%. Prophylactic medication after ICR prevents endoscopic recurrence in low and high-risk patients. Clinical risk stratification has an acceptable predictive value, but further refinement is needed.
AB - BACKGROUND: To prevent recurrence after ileocolonic resection (ICR) in Crohn's disease (CD), postoperative prophylaxis based on risk stratification is recommended in international guidelines. This study aimed to evaluate postoperative CD recurrence after implementation of a clinical management algorithm and determine the predictive value of clinical and histological risk factors (RF).METHODS: In this multicenter, prospective cohort study, CD patients (≥16 years) scheduled for ICR were included. The algorithm advised no postoperative medication for low-risk patients, and treatment with prophylaxis (immunosuppressant/biological) for high-risk patients (≥1 RF: active smoking, penetrating disease, prior ICR). Clinical and histologic RF (active inflammation, granulomas, plexitis in resection margins) for endoscopic recurrence (Rutgeerts' score ≥i2b at 6 months) were assessed using logistic regression and ROC curves based on predicted probabilities.RESULTS: 213 CD patients after ICR were included (age 34.5 years; 65% women) (93[44%] low-risk; 120[56%] high-risk [45[38%] smoking; 51[43%] penetrating disease; 51[43%] prior ICR]). Adherence to the algorithm was 82% in low-risk (no prophylaxis) and 51% in high-risk patients (prophylaxis). Endoscopic recurrence was higher in patients treated without prophylaxis than with prophylaxis in both low (45% vs 16%, p=.012) and high-risk (49% vs 26%, p=.019). Clinical risk stratification including the prescription of prophylaxis corresponded with an area under the curve (AUC) of 0.70 (95%CI 0.61-0.79). Clinical RF combined with histological RF increased the AUC to 0.73 (95%CI 0.64-0.81).CONCLUSION: Adherence to this management algorithm is 65%. Prophylactic medication after ICR prevents endoscopic recurrence in low and high-risk patients. Clinical risk stratification has an acceptable predictive value, but further refinement is needed.
U2 - 10.1093/ecco-jcc/jjac128
DO - 10.1093/ecco-jcc/jjac128
M3 - Article
C2 - 36094558
SN - 1873-9946
JO - Journal of Crohn's & Colitis
JF - Journal of Crohn's & Colitis
ER -