TY - JOUR
T1 - Retreatment with anti-tumor necrosis factor therapy in combination with an immunomodulator for recurrence of Crohn's disease after ileocecal resection results in prolonged continuation as compared to anti-tumor necrosis factor monotherapy
AU - Ten Bokkel Huinink, Sebastiaan
AU - Beelen, Evelien M J
AU - Ten Bokkel Huinink, Thomas
AU - Hoentjen, Frank
AU - G L Bodelier, Alexander
AU - Dijkstra, Gerard
AU - Romberg-Camps, Marielle
AU - de Boer, Nanne K
AU - Stassen, Laurents P S
AU - van der Meulen, Andrea E
AU - West, Rachel
AU - van Ruler, Oddeke
AU - van der Woude, C Janneke
AU - de Vries, Annemarie C
AU - Dutch Initiative on Crohn and Colitis (ICC)
N1 - Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - BACKGROUND: A considerable proportion of Crohn's disease patients that undergo ileocecal resection (ICR) have failed anti-tumor necrosis factor (TNF) therapy preoperatively. This study aimed to assess the effectiveness of retreatment of anti-TNF therapy in patients with postoperative recurrence.METHODS: A real-world cohort study was performed on Crohn's disease patients who underwent primary ICR after anti-TNF therapy failure, and who were retreated with anti-TNF therapy for postoperative symptomatic Crohn's disease. The primary outcome was treatment failure (the need for (re)introduction of corticosteroids, immunosuppressants, or biologicals or the need for re-resection). Sub-analyses were performed on the nature of preoperative anti-TNF failure (primary non-response, secondary loss of response, intolerance), indication for ICR (refractory, stricturing, penetrating disease), combination therapy with immunomodulators, retreatment with the same anti-TNF agent and preoperative exposure to 1 vs. >1 anti-TNF agents.RESULTS: In total, 66 of 364 patients retreated with anti-TNF therapy following ICR. Cumulative rates of treatment failure at 1 and 2 years were 28% and 47%. Treatment failure rate at 2 years was significantly lower in patients receiving combination therapy as compared to anti-TNF monotherapy (30% vs. 49%, P = 0.02). No difference in treatment failure was found with regards to the nature of preoperative anti-TNF failure (P = 0.76), indication for ICR (P = 0.88) switch of anti-TNF agent (P = 0.55) agent, and preoperative exposure to 1 vs. >1 anti-TNF agents (P = 0.88).CONCLUSION: Retreatment with anti-TNF therapy for postoperative Crohn's disease recurrence is a valid strategy after preoperative failure. Combination therapy is associated with a lower rate of treatment failure.
AB - BACKGROUND: A considerable proportion of Crohn's disease patients that undergo ileocecal resection (ICR) have failed anti-tumor necrosis factor (TNF) therapy preoperatively. This study aimed to assess the effectiveness of retreatment of anti-TNF therapy in patients with postoperative recurrence.METHODS: A real-world cohort study was performed on Crohn's disease patients who underwent primary ICR after anti-TNF therapy failure, and who were retreated with anti-TNF therapy for postoperative symptomatic Crohn's disease. The primary outcome was treatment failure (the need for (re)introduction of corticosteroids, immunosuppressants, or biologicals or the need for re-resection). Sub-analyses were performed on the nature of preoperative anti-TNF failure (primary non-response, secondary loss of response, intolerance), indication for ICR (refractory, stricturing, penetrating disease), combination therapy with immunomodulators, retreatment with the same anti-TNF agent and preoperative exposure to 1 vs. >1 anti-TNF agents.RESULTS: In total, 66 of 364 patients retreated with anti-TNF therapy following ICR. Cumulative rates of treatment failure at 1 and 2 years were 28% and 47%. Treatment failure rate at 2 years was significantly lower in patients receiving combination therapy as compared to anti-TNF monotherapy (30% vs. 49%, P = 0.02). No difference in treatment failure was found with regards to the nature of preoperative anti-TNF failure (P = 0.76), indication for ICR (P = 0.88) switch of anti-TNF agent (P = 0.55) agent, and preoperative exposure to 1 vs. >1 anti-TNF agents (P = 0.88).CONCLUSION: Retreatment with anti-TNF therapy for postoperative Crohn's disease recurrence is a valid strategy after preoperative failure. Combination therapy is associated with a lower rate of treatment failure.
KW - Humans
KW - Crohn Disease/diagnosis
KW - Cohort Studies
KW - Tumor Necrosis Factor Inhibitors/adverse effects
KW - Immunologic Factors/therapeutic use
KW - Tumor Necrosis Factor-alpha
KW - Retreatment
KW - Necrosis
U2 - 10.1097/MEG.0000000000002474
DO - 10.1097/MEG.0000000000002474
M3 - Article
C2 - 36468568
SN - 0954-691X
VL - 35
SP - 45
EP - 51
JO - European Journal of Gastroenterology & Hepatology
JF - European Journal of Gastroenterology & Hepatology
IS - 1
ER -