Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn’s disease

다국어 초록 (Multilingual Abstract)

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.

참고문헌 (Reference)

1 Ainsworth MA, "Tumor necrosis factor-alpha binding capacity and anti-infliximab antibodies measured by fluid-phase radioimmunoassays as predictors of clinical efficacy of infliximab in Crohn's disease" 103 : 944-948, 2008

2 Dignass A, "The second European evidence-based consensus on the diagnosis and management of Crohn's disease: current management" 4 : 28-62, 2010

3 Ding NS, "Systematic review: predicting and optimizing response to anti-TNF therapy in Crohn's disease: algorithm for practical management" 43 : 30-51, 2016

4 Wils P, "Subcutaneous ustekinumab provides clinical benefit for two-thirds of patients with Crohn's disease refractory to anti-tumor necrosis factor agents" 14 : 242-250.e2, 2016

5 Thia KT, "Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort" 139 : 1147-1155, 2010

6 Rutgeerts P, "Review article: recurrence of Crohn's disease after surgery-the need for treatment of new lesions" 24 (24): 29-32, 2006

7 Allez M, "Report of the ECCO pathogenesis workshop on anti-TNF therapy failures in inflammatory bowel diseases: definitions, frequency and pharmacological aspects" 4 : 355-366, 2010

8 Steinhart AH, "Reliability of a Crohn's disease clinical classification scheme based on disease behavior" 4 : 228-234, 1998

9 Beaugerie L, "Predictors of Crohn's disease" 130 : 650-656, 2006

10 Rutgeerts P, "Predictability of the postoperative course of Crohn's disease" 99 : 956-963, 1990

11 Dotan I, "Patient factors that increase infliximab clearance and shorten half-life in inflammatory bowel disease: a population pharmacokinetic study" 20 : 2247-2259, 2014

12 Lichtenstein GR, "Management of Crohn's disease in adults" 104 : 465-483, 2009

13 Amiot A, "Long-term outcome of enterocutaneous fistula in patients with Crohn's disease treated with anti-TNF therapy: a cohort study from the GETAID" 109 : 1443-1449, 2014

14 Mowat C, "Guidelines for the management of inflammatory bowel disease in adults" 60 : 571-607, 2011

15 Yaari S, "Factors associated with surgery in patients with intra-abdominal fistulizing Crohn's disease" 22 : 10380-10387, 2016

16 Paulo Gustavo Kotze, "Endoscopic Postoperative Recurrence Rates in Crohn’s Disease in Korea: The Beginning of a New Approach?" 대한장연구학회 12 (12): 258-259, 2014

17 Sands BE, "Effects of vedolizumab induction therapy for patients with Crohn's disease in whom tumor necrosis factor antagonist treatment failed" 147 : 618-627.e3, 2014

18 Frolkis AD, "Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies" 109 : 1739-1748, 2014

19 Paulo Gustavo Kotze, "Conventional Versus Biological Therapy for Prevention of Postoperative Endoscopic Recurrence in Patients With Crohn’s Disease: an International, Multicenter, and Observational Study" 대한장연구학회 13 (13): 259-265, 2015

20 Singh S, "Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn's disease after surgery: a systematic review and network meta-analysis" 148 : 64-76, 2015