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- 저자 : Konstantin Umanskiy (검색결과 1 건)
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Anthony Buisson,Lisa Cannon,Konstantin Umanskiy,Roger D. Hurst,Neil H. Hyman,Atsushi Sakuraba,Joel Pekow,Sushila Dalal,Russell D. Cohen,Bruno Pereira,David T. Rubin 대한장연구학회 2022 Intestinal Research Vol.20 No.3
Background/Aims: We assessed the effectiveness of anti-TNF agents and its associated factors to prevent endoscopic and clinical postoperative recurrence (POR) in Crohn’s disease (CD). Methods: From a prospectively-maintained database, we retrieved 316 CD patients who underwent intestinal resection (2011–2017). Endoscopic (Rutgeerts index ≥ i2 at 6 months) and clinical (recurrence of symptoms leading to hospitalization or therapeutic escalation) POR were assessed. Results: In 117 anti-TNF-naïve patients, anti-TNF therapy was more effective than immunosuppressive agents (odds ratio [OR], 8.8; 95% confidence interval [CI], 1.8–43.9; <i>P</i>= 0.008) and no medication/5-aminosalicylates (OR, 5.2; 95% CI, 1.0–27.9; <i>P</i>= 0.05) to prevent endoscopic POR. In 199 patients exposed to anti-TNF prior to the surgery, combination with anti-TNF and immunosuppressive agents was more effective than anti-TNF monotherapy (OR, 2.32; 95% CI, 1.02–5.31; <i>P</i>= 0.046) to prevent endoscopic POR. Primary failure to anti-TNF agent prior to surgery was predictive of anti-TNF failure to prevent endoscopic POR (OR, 2.41; 95% CI, 1.10–5.32; <i>P</i>= 0.03). When endoscopic POR despite anti-TNF prophylactic medication (n = 55), optimizing anti-TNF and adding an immunosuppressive drug was the most effective option to prevent clinical POR (hazard ratio, 7.38; 95% CI, 1.54–35.30; <i>P</i>= 0.012). Anti-TNF therapy was the best option to prevent clinical POR (hazard ratio, 3.10; 95% CI, 1.09–8.83; <i>P</i>= 0.034) in patients with endoscopic POR who did not receive any biologic to prevent endoscopic POR (n = 55). Conclusions: Anti-TNF was the most effective medication to prevent endoscopic and clinical POR. Combination with anti-TNF and immunosuppressive agents should be considered in patients previously exposed to anti-TNF.
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