P326. Prevention of recurrence after surgery of Crohn's disease: Efficacy of adalimumab
M. Aguas1, E. Cerrillo2, G. Bastida1, B. Beltrán1, M. Iborra1, F. Muñoz3, J. Barrio Andres4, S. Riestra5, P. Nos1
1La Fe Hospital, Gastroenterology. Ciberehd, Valencia, Spain; 2La Fe Hospital, Gastroenterology, Valencia, Spain; 3Complejo Asistencial De Leon, Leon, Spain; 4Hospital Universitario Río Hortega, Valldolid, Spain; 5Hospital Universitario Central De Asturias, Inflammatory Bowel Disease Unit, Oviedo, Spain
Background: Crohn's disease (CD) commonly recurs after intestinal surgical resection, but the optimal strategy to prevent postoperative recurrence remains unclear. Biologic drugs are one of the most effective therapies in the management of CD, however the efficacy of adalimumab (ADA) in postoperative setting has not yet been assessed.
Aims: Efficacy of ADA (proportion of patients with biological, endoscopic or radiologic recurrence) at 12 months after intestinal resection for CD was evaluated.
Methods: A multicenter prospective observational study was conducted (June 2009-June 2010). We included consecutively selected patients with high risk for disease recurrence who undergone an intestinal resection and were treated with ADA to prevent postoperative recurrence. It was used the Montreal definitions for CD classification. Demographic data, smoking status, previous and concomitant treatments and reason, type and number of previous resections were registered. ADA was administered to all patients, 4 weeks (±2 weeks) after intestinal resection, dose of 40 mg eow, with or without an initial induction dose of 160/80 mg at weeks 0 and 2. Biological status (C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin) was assessed at months 0, 6 and 12. One year (±3 months) after surgery an ileocolonoscopy and/or magnetic resonance enterography (MRE) was performed. Endoscopic recurrence was defined as a Rutgeerts score ≥ i2 [1]. Radiological recurrence was based on MR score ≥ MR1 [2].
Results: Twenty-nine patients (55.2% males, 13.8% smokers), mean age 42.3 years, mean duration of the disease 13.8 years and a mean of 1.76 (range:1–4) resections previous to ADA administration were included in the study. Inmunomodulators were concomitantly given to 65.5% of patients. One patient had an adverse event. 7/29 (24.1%) developed biological recurrence, 6/29 (20.7%) endoscopic recurrence and 8/19 (42.1%) radiologic recurrence after 12 months. Correlation between biological-endoscopic, biological-radiologic, and endoscopic-radiologic recurrences were found (p-value <0.0001, <0.002 and <0.0001, respectively).
Conclusions: ADA was well tolerated and seems to be effective in preventing postoperative biological and endoscopic recurrence, in a selected group of patients undergone an intestinal resection for their CD.
1. Rutgeerts P (1990), Predictability of the postoperative course of Crohn's disease. Gastroenterology, 956–63, 99.
2. Sailer J (2008), Anastomotic recurrence of Crohn's disease after ileocolic resection: comparison of MR enteroclysis with endoscopy. European Radiology, 2512–21, 18.