Adalimumab Is More Effective Than Azathioprine and Mesalamine at Preventing Postoperative Recurrence of Crohn's Disease: A Randomized Controlled Trial

Savarino, Edoardo; Bodini, Giorgia; Dulbecco, Pietro; Assandri, Lorenzo; Bruzzone, Linda; Mazza, Fabrizio; Frigo, Anna Chiara; Fazio, Valentina; Marabotto, Elisa; Savarino, Vincenzo

doi:10.1038/ajg.2013.287

Cited by 190 publications

(88 citation statements)

References 43 publications

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“…Infliximab therapy significantly improved endoscopic inflammation and reduced the risk of subsequent clinical recurrence. In contrast, recent randomized controlled trials (RCTs) found that anti-TNF therapy with infliximab or adalimumab initiated soon after surgery was useful in preventing postoperative recurrence in CD [9][10][11]. Should we start anti-TNF therapy soon after surgery or after confirming early endoscopic recurrence?…”

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confidence: 75%

Prevention of Postoperative Recurrence in Crohn’s Disease

Yamamoto

2014

Drugs

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confidence: 75%

Prevention of Postoperative Recurrence in Crohn’s Disease

Yamamoto

2014

Drugs

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“…In another prospective trial from Italy, Saverino et al 23 compared the role of ADA with that of azathioprine and mesalamine after resection. The authors concluded that the PER rates after ileocolic resection in the 18 patients treated with ADA (6.3%) were significantly lower than those in the 17 patients treated with azathioprine (64.7%) and in the 16 patients treated with mesalamine (83.3%) after 2 years of follow-up (P=0.0017) (Fig.…”

Section: Adalimumab In the Prevention Of Postoperative Endoscopic Recmentioning

confidence: 99%

Biological Therapy for the Prevention and Treatment of Postoperative Endoscopic Recurrence in Crohn's Disease: Time for Acceptance?

Kotze

Saad-Hossne

2013

Intest Res

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wide, even with the currently available best medical therapy.Postoperative endoscopic recurrence (PER) after abdominal resection for CD occurs in nearly 75% of patients 1 year after the surgical procedure. 4,5 It develops earlier than clinical recurrence and, most commonly, years before the need for a repeated resection. Several studies have demonstrated the effect of different medications aimed at reducing PER rates. Probiotics and aminosalicylates have not been effective in this scenario.6 Metronidazole and ornidazole were more effective than placebo in 2 randomized controlled trials, but only in a 3-month period.7 Azathioprine was also more effective than placebo and aminosalicylates in preventing PER. 6,8 However, even with these therapies, a significant number of patients developed recurrence and disease progression over time.Biological agents seem proportionally more effective than conventional therapy in preventing PER in various studies. Since the initial trial published in 2009 by Regueiro et al.,9 various authors have studied the effect of both infliximab (IFX) and adalimumab (ADA) in reducing PER rates or treating

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“…24 There are not yet comparative effectiveness data for thiopurines and TNF antagonists for the indication of prevention of post-operative recurrence, but early data suggest a very large effect size for TNF antagonists. 25,26 If TNF antagonists had a similar low cost as generic thiopurines, there would likely be little debate regarding an evolution towards treatment of CD with TNF antagonists, either as monotherapy or ideally as combination therapy. Unfortunately, this is not the world that we live in.…”

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confidence: 99%