Adalimumab or Infliximab for the Prevention of Early Postoperative Recurrence of Crohn Disease: Results From the ENEIDA Registry

Abstract

Background Anti–tumor necrosis factor agents (anti-TNFs) are efficacious at preventing the postoperative recurrence (POR) of Crohn disease, as demonstrated in 2 randomized controlled trials. However, real-life data for infliximab or adalimumab in this setting are scarce. Our aim was to assess both the efficiency of anti-TNFs at preventing early POR of Crohn disease in clinical practice and the associated risk factors for POR. Methods Patients in whom anti-TNFs were prescribed for the prevention of POR within 3 months after ileocolonic resection and who had an endoscopic assessment within 18 months were identified from the ENEIDA registry. Clinical and endoscopic features were collected within 18 months after surgery. Results In total, 152 patients were included (55 treated with infliximab, 97 with adalimumab, and 39% with concomitant immunosuppressants). Anti-TNF treatment was started after a median time of 29 days (IQR 13–44) after surgery. Eighty-two percent of patients had at least one risk factor for POR, and 82% had been exposed to anti-TNFs before the index surgery. Overall, 34% had endoscopic POR (as defined using a Rutgeerts endoscopic score > i1); 14% had advanced endoscopic POR (>i2); and 20% had clinical POR, with no differences between infliximab and adalimumab. In the multivariate analysis, only perianal disease (odds ratio 2.73, 95% confidence interval [CI] 1.26–5.91) and rectal involvement (odds ratio 2.79, 95% CI 1.09–7.14) were independent predictors of endoscopic POR. Conclusions In clinical practice, anti-TNFs for the prevention of POR of Crohn disease are frequently used in patients experienced with anti-TNFs and with concomitant immunosuppressants. The efficacy of infliximab and adalimumab for POR prevention is similar and in accordance with the results obtained in randomized controlled trials.

Tumour necrosis factor inhibitors in inflammatory bowel disease: the story continues

“… 160 Findings from this registry demonstrate that infliximab and adalimumab have similar efficacy for the prevention of postoperative recurrence, and that findings were consistent with results obtained in randomized controlled trials. 160 …”

Quantifying the rate of recurrence of postoperative Crohn's disease with biological therapy. A meta‐analysis

“…In our meta‐analysis, most of the included studies used infliximab (n = 9), while six used adalimumab and eight used both infliximab and adalimumab. While there was a significant difference in the rate of recurrence, one study reported real life observational data on the efficacy of anti‐TNF‐α agents at preventing the POR of CD and did not find significant differences in endoscopic POR between patients treated with infliximab or adalimumab at 18 months (40% vs 30%, P = 0.2) 24 . Similar observations have been made on the MULTIPER 28 database ( P = 0.815).…”

“…Altogether 87 articles were selected for detailed evaluation, among which 24 articles were included (Figure 1). Generally, articles originated from Europe, 21‐36 Japan, 28,37‐41 the United States 42,43 and Oceania, 44 comprising 11 RCTs, 23,26,29,32,34,36,38,39,41,43,44 and 13 cohort or case‐control studies 21,22,24,25,27,28,30,31,33,35,37,40,42 . Most of the articles prescribed anti‐TNF‐α therapy, either with infliximab or adalimumab, with one article using vedolizumab.…”

Continued Postoperative Use of Tumor Necrosis Factor-α Inhibitors for the Prevention of Crohn’s Disease Recurrence

“… 15 , 16 However, most studies have focused on the preventive effects of TNF-α inhibitors for POR. 17 , 18 Additionally, due to the concerns about immediate postoperative complications of TNF-α inhibitors, they are usually discontinued few weeks before elective surgery. 19 - 23 After discontinuing TNF-α inhibitors before surgery, the decision to restart or discontinue them depend on each clinician’s assessment, due to the lack of evidence.…”