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      저자 : Wakayama Medical University (검색결과 1 건)
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        Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn’s disease

        Sakiko Hiraoka,Shiho Takashima,Yoshitaka Kondo,Toshihiro Inokuchi,Yuusaku Sugihara,Masahiro Takahara,Seiji Kawano,Keita Harada,Wakayama Medical University,Hiroyuki Okada 대한장연구학회 2018 Intestinal Research Vol.16 No.1

        Background/Aims: The efficacy of anti-tumor necrosis factor α (anti-TNFα) antibodies for postoperative Crohn’s disease(CD) in patients who were treated with these agents prior to surgery is largely unknown. Methods: CD patients who underwentintestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence orabsence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα naïve group. Endoscopic recurrence aftersurgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery. Results: Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti-TNFα naïve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than inthe anti-TNFα naïve group (68% vs. 14% , P <0.001). Multivariate analysis revealed the following significant risk factors of endoscopicrecurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10; 95% CI, 3.08−722.00), age at diagnosis <23 years(OR, 24.30; 95% CI, 1.67−1,312.00), serum albumin concentration at surgery <3.3 g/dL (OR, 34.10; 95% CI, 1.72–2,804.00), andpresence of inflammation outside of the surgical site (OR, 21.40; 95% CI, 1.02−2,150.00). Treatment intensification for patientswith endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopicremission. Conclusions: The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatmentintensification or a change to different classes of biologics should be considered for those patients.

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