P393 Investigation of Crohn’s disease patients receiving anti-TNF α therapy after surgery for intestinal stenosis
T. Kuriyama*, B. Iizuka, H. Kashiwagi, T. Hara, A. Ito, T. Omori, M. Yonezawa, K. Tokushige
Tokyo Women’s Medical University, Gastroenterology, Tokyo, Japan
Since Crohn’s disease (CD) is characterised by repeated relapse and remission over a long period, many patients require surgery or repeat surgery because of relapse. Anti-TNF α therapy is changing the natural history of CD both at an early stage after diagnosis and after surgery. We retrospectively investigated the efficacy of anti-TNF α therapy in CD patients who underwent surgery for intestinal stenosis.
The subjects were 23 patients with CD (18 males and 5 females aged 27–59 years [mean age: 41.9 ± 9.2 years]) who started anti-TNF α therapy after surgery for intestinal stenosis during the period from January 2009 to January 2015 and could be followed at our hospital until November 2015. Their clinical characteristics, treatment, and clinical outcome were investigated. In the group with relapse, we also investigated differences (changes of CDAI, CRP, and Alb) from the group without relapse. We defined relapse as stenosis requiring endoscopic balloon dilatation (EBD) or further surgery, as well as the need for intensified treatment (including a change/dose increase of anti-TNF α therapy or immunosuppressants for secondary failure). The observation period was 22.6–82.7 months after surgery (mean: 56.4 ± 21.7 months).
In the study, 16 patients had combined small intestinal and colorectal CD; 6 patients had the small intestinal type; and 1 patient had the colorectal type. The duration of disease was 3–31 years (mean 14.2 ± 7.6 years). Infliximab (IFX) was used by 21 patients, and adalimumab (ADA) was used by 4 patients. IFX was switched to ADA because of infusion reactions in 2 patients. The interval between surgery and the start of anti-TNF α therapy was 12–183 days (mean 67.9 ± 42.5 days). With regards to the outcome, 16 out of 23 patients (70%) did not require a change or intensification of treatment, EBD, or repeat surgery after initiation of anti-TNF α therapy. Anti-TNF α therapy was introduced earlier in the postoperative period for patients without relapse compared with relapse patients. Further, the CDAI, CRP, and Alb levels at 1 year after surgery showed no significant differences between the 2 groups. Relapse was treated as follows: increase of IFX (3 patients), increase of IFX + addition of azathioprine (AZA) + further surgery (2 patients), increase of IFX + EBD (1 patient), or addition of AZA (1 patient).
Anti-TNF α therapy was effective for CD patients after intestinal resection. It is probable that earlier introduction of anti-TNF α therapy after surgery will contribute to improving the prognosis, provided that infection does not occur.