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P519. Direct retrospective comparison of adalimumab and infliximab in preventing early postoperative endoscopic recurrence after ileocecal resection for Crohn's disease: results from the MULTIPER database

P.G. Kotze1, Y. Suzuki2, T. Yamamoto3, S. Danese4, R. Saad-Hossne5, F. Teixeira6, I. Albuquerque7, R. Silva1, I. Barcelos1, A. Yamada2, L. Kotze8, M. Sacchi9, M. Olandoski10, A. Spinelli9,11, 1Cajuru University Hospital - Catholic University of Parana, Colorectal Surgery Unit, Curitiba, Brazil, 2Toho University - Sakura Medical Center, Internal Medicine, Chiba, Japan, 3Yokkaichi Social Insurance Hospital, IBD Unit, Yokkaichi, Japan, 4Humanitas Research Hospital, IBD Unit - Gastroenterology, Milano, Italy, 5São Paulo State University, Digestive Surgery Department, Botucatu, Brazil, 6Gastrosaude, Colorectal Surgery, Marilia, Brazil, 7Heliopolis Hospital, IBD unit, São Paulo, Brazil, 8Cajuru University Hospital - Catholic University of Parana, Gastroenterology, Curitiba, Brazil, 9Humanitas Research Hospital, Medical Biotechnologies and Translational Medicine, Milano, Italy, 10Catholic University of Paraná, Statistics, Curitiba, Brazil, 11Humanitas Research Hospital, IBD Surgery Unit, Milano, Italy

Background

Adalimumab (ADA) and Infliximab (IFX) both seem to reduce the rates of early postoperative endoscopic recurrence (EPER) after ileocecal resections in Crohn's disease (CD) patients, in comparison with conventional therapy. There is lack of data with direct comparison between the two agents in the postoperative prevention of recurrence scenario. The aim of this study was to compare the rates of EPER in patients treated with ADA and IFX after ileocecal resections for CD.

Methods

The MULTIPER (Multicenter International Postoperative Endoscopic Recurrence) database is a retrospective analysis of EPER rates in CD patients after ileocecal resection, from 7 referral centres from 3 different countries. All consecutive patients submitted to ileocecal resections between 2008 and 2012 that had colonoscopies performed up to 12 months after surgery were included in the analysis. Patients with conventional therapy after surgery were excluded. Recurrence was defined as Rutgeerts' score equal or greater than i2. The patients under postoperative biological therapy were allocated, according to treatment, in two groups: ADA and IFX. The EPER rates were compared between the two groups. Statystical analysis was performed by Fischer and chi-square tests (qualitative variables), and by Student's t test and Mann–Whitney test (quantitavive variables), with p < 0.05 considered significant.

Results

Initially, 231 patients were analyzed (63 excluded, for missing data and for having the first postoperative colonoscopy longer than 12 months). From the 168 patients included in the database, 96 used anti-TNF agents after resection (37 in the ADA and 59 on the IFX group) and were included in this comparative study. The groups were completely homogeneous in all baseline characteristics, mainly age (p = 0.282), gender (p = 0.521), previous resections (p = 0.392), perianal CD (p = 0.262) and mono or combination therapy (p = 0.521). EPER was identified in 9/37 (24.32%) in the ADA group versus 16/59 (27.12%) in the IFX group (p = 0.815).

Conclusion

In this retropective direct comparison between ADA and IFX therapy after ileocecal resections, from an international multicenter database, there was no significant difference between the two anti-TNF agents in terms of EPER rates. Prospective randomized studies are needed to confirm these data and better define the role of each agent in the prevention of PER.