Antitumor Necrosis Factor Agents to Treat Endoscopic Postoperative Recurrence of Crohn’s Disease: A Nationwide Study With Propensity-Matched Score Analysis
Cañete, Fiorella1,2,3; Mañosa, Míriam1,2; Pérez-Martínez, Isabel4; Barreiro-de Acosta, Manuel5; González-Sueyro, Ramiro C.6; Nos, Pilar2,7; Iglesias-Flores, Eva8; Gutiérrez, Ana9; Bujanda, Luis2,10; Gordillo, Jordi11; Ríos León, Raquel12; Casanova, María José2,13; Villoria, Albert2,3,14; Rodríguez-Lago, Iago15,16; López Serrano, Pilar17; García-Herola, Antonio18; Ramírez-de la Piscina, Patricia19; Navarro-Llavat, Mercè20; Taxonera, Carlos21,22; Barrio, Jesús23; Ramos, Laura24; Navarro, Pablo25; Benítez-Leiva, Olga26; Calafat, Margalida1,3; Domènech, Eugeni MD, PhD1,2, on behalf of the INFLIRECU study
1Gastroentorology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;
2CIBERehd, Madrid, Spain;
3Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain;
4Gastroentorology Department, Hospital Universitario Central de Asturias, Oviedo, Spain;
5Gastroentorology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain;
6Gastroentorology Department, Hospital Universitari Clínic, Barcelona, Spain;
7Gastroentorology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain;
8UGC Digestivo, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain;
9Gastroentorology Department, Hospital General Universitario de Alicante, Alicante, Spain;
10Gastroentorology Department, Hospital Universitario de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain;
11Gastroentorology Department, Hospital de La Santa Creu i Sant Pau, Barcelona, Spain;
12Gastroentorology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain;
13Gastroentorology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain;
14Gastroentorology Department, Hospital Parc Taulí, Sabadell, Spain;
15Gastroentorology Department, Hospital de Galdakao, Galdakao, Spain;
16Gastroentorology Department, Biocruces Health Research Institute, Barakaldo, Vizcaya, Spain;
17Gastroentorology Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain;
18Gastroentorology Department, Hospital Marina Baixa de Villajoyosa, Alicante, Spain;
19Gastroentorology Department, Hospital Universitario Araba, Vitoria, Spain;
20Gastroentorology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain;
21Gastroentorology Department, Hospital Clínico San Carlos, Madrid, Spain;
22Gastroentorology Department, Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain;
23Gastroentorology Department, Hospital Universitario Río Hortega, Valladolid, Spain;
24Gastroentorology Department, Hospital Universitario de Canarias, La Laguna, Spain;
25Gastroentorology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain;
26Gastroentorology Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
Correspondence: Eugeni Domènech, MD, PhD. E-mail: eugenidomenech@gmail.com.
INTRODUCTION:
Patients with Crohn’s disease experiencing endoscopic postoperative recurrence (POR) may benefit from antitumor necrosis factor (TNF) agents but scarce data on this are available. Our aim was to assess the efficacy of anti-TNF in improving mucosal lesions in patients with endoscopic POR.
METHODS:
Multicenter, retrospective, study of patients with Crohn’s disease who underwent therapy with anti-TNF agents for endoscopic POR (Rutgeerts score > i1). Treatment outcomes were assessed by the findings in the last ileocolonoscopy performed after anti-TNF therapy was initiated. Endoscopic improvement and remission were defined as any reduction in the baseline Rutgeerts score and by a Rutgeerts score < i2, respectively.
RESULTS:
A total of 179 patients were included, 83 were treated with infliximab and 96 with adalimumab. Median time on anti-TNF therapy at the last endoscopic assessment was 31 months (interquartile range, 13–54). Endoscopic improvement was observed in 61%, including 42% who achieved endoscopic remission. Concomitant use of thiopurines and treatment with infliximab were associated with endoscopic improvement (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.04–4.46; P = 0.03, and OR 2.34, 95% CI 1.18–4.62; P < 0.01, respectively) and endoscopic remission (OR 3.16, 95% CI 1.65–6.05; P < 0.01, and OR 2.01, 95% CI 1.05–3.88; P = 0.04, respectively) in the multivariable logistic regression analysis. These results were confirmed in a propensity-matched score analysis.
DISCUSSION:
In patients with endoscopic POR, anti-TNF agents improve mucosal lesions in almost two-thirds of the patients. In this setting, concomitant use of thiopurines and use of infliximab seem to be more effective in improving mucosal lesions.
FUENTE:
https://journals.lww.com/ctg/Fulltext/2020/08000/Antitumor_Necrosis_Factor_Agents_to_Treat.3.aspx
