P474 Anti-TNFα treatment efficacy in prevention of postoperative recurrence in Crohn's disease depends on previous exposure to anti-TNFα agents
M. Collins*1, H. Sarter2, C. Gower-Rousseau3, D. Koriche4, M. Nachury5, L. Libier5, A. Cortot6, P. Zerbib4, J.-F. Colombel7, L. Peyrin-Biroulet8, P. Desreumaux5, G. Pineton de Chambrun9
1APHP Paris Sud University , Gastroenterology, Le Kremlin Bicêtre, France, 2University and Hospital, Epidemiology, Lille, France, 3Lille University Hospital, North of France University, Epidemiology, Lille, France, 4Lille University Hospital, Colorectal Surgery Department , Lille, France, 5CHU de Lille, Department of Gastroenterology, Lille, France, 6Lille University Hospital, North of France University, Gastroenterology, Lille, France, 7Mount Sinai Hospital, Gastroenterology, New-York, United States, 8Nancy University Hospital, Université de Lorraine, Gastroenterology and Hepatology, Vandoeuvre-les-Nancy, France, 9Montpellier 1 University, Gastroenterology and Hepatology, Montpellier, France
Almost 50% of Crohn's disease (CD) patients will need surgical resection during their follow-up. Infliximab and adalimumab are effective to prevent postoperative recurrence in CD patient naïve from anti-TNFα antibodies (anti-TNF). The effect of previous exposure to one or more anti-TNF before surgery on prevention of post-operative recurrence by these agents is still unknown. The aim of our study was to investigate the efficacy of anti-TNF to prevent CD post-operative recurrence according to previous exposure to these drugs.
We performed a retrospective analysis of CD patients, followed in a tertiary referral centre, who underwent surgical bowel resection and prophylactic treatment with anti-TNF between January 2005 and June 2012. Infliximab, adalimumab and certolizumab pegol were considered as prophylactic treatments if started within three months after surgery. Endoscopic recurrence, defined as a Rutgeerts score ≥ i2 and clinical recurrence, defined as physician judgment were evaluated one year after surgery and also during the follow-up.
Fifty-seven consecutive CD patients with bowel resection, anastomosis and prophylactic treatment with anti-TNF were included in the study. Twenty two patients (39%) had prior intestinal resection for CD and a majority (45, 79%) were treated with at least one anti-TNF before surgery. Twenty-four (42%) received two or more anti-TNF before surgery and 12 (21%) patients were naïve from anti-TNF. Thirty-nine (67%) patients had a surveillance colonoscopy one year after surgery. At one year, the global endoscopic and clinical postoperative recurrence rates were 42% (17/39) and 19% (11/57), respectively. According to previous exposure to anti-TNF, patients with two or more anti-TNF before surgery had a higher one-year endoscopic recurrence rate compared with patients that received one and zero anti-TNF before surgery (62%, n=13/21 vs. 31%, n=4/13 vs. 20%, n=1/5). Also, patients with two or more anti-TNF before surgery had a higher rate of clinical recurrence compared with patients receiving less than two anti-TNF before surgery (37%, n=9/24 vs. 12%, n=4/33, p=0.05). In multivariate analysis, smoking (HR=3.2; IC 95%: 1.2-7.8) and previous exposure to two or more anti-TNF (HR=4.3; IC 95%: 1.3-14.0) were significantly associated to the risk of clinical postoperative recurrence in CD patients.
Previous exposure to two or more anti-TNF agents was associated to a higher risk of postoperative recurrence in CD patients receiving prophylactic treatment with anti-TNF. This study suggested that previous exposure to anti-TNF should be taken into account when managing prevention of post-operative recurrence in CD patients.