Addition of mesalazine for subclinical post‐surgical endoscopic recurrence of <scp>C</scp>rohn's disease despite preventive thiopurine therapy: A case–control study

Zabana, Yamile; Mañosa, Míriam; Cabré, Eduard; Bernal, Isabel; Marín, Laura; Lorenzo-Zúñiga, Vicente; Moreno, V.; Boix, Jaume; Domènech, Eugeni

doi:10.1111/jgh.12579

Cited by 6 publications

(2 citation statements)

References 28 publications

(63 reference statements)

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“…Beyond the early postoperative management of CD, it is a fact that approximately half of these patients develop early mucosal lesions that put them at risk of clinical POR. Mesalazine has demonstrated a very limited efficacy in this setting ( 14 – 16 , 22 ). Thiopurines, although useful ( 14 ), are hampered by a high rate of intolerance and their slow active mechanism, and they may not be the most suitable option in patients with already existing clinical POR.…”

Section: Discussionmentioning

confidence: 99%

Antitumor Necrosis Factor Agents to Treat Endoscopic Postoperative Recurrence of Crohn's Disease: A Nationwide Study With Propensity-Matched Score Analysis

Cañete

Mañosa

Pérez-Martínez

et al. 2020

Clin Transl Gastroenterol

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INTRODUCTION: Patients with Crohn's disease experiencing endoscopic postoperative recurrence (POR) may benefit from antitumor necrosis factor (TNF) agents but scarce data on this are available. Our aim was to assess the efficacy of anti-TNF in improving mucosal lesions in patients with endoscopic POR. METHODS: Multicenter, retrospective, study of patients with Crohn's disease who underwent therapy with anti-TNF agents for endoscopic POR (Rutgeerts score > i1). Treatment outcomes were assessed by the findings in the last ileocolonoscopy performed after anti-TNF therapy was initiated. Endoscopic improvement and remission were defined as any reduction in the baseline Rutgeerts score and by a Rutgeerts score < i2, respectively. RESULTS: A total of 179 patients were included, 83 were treated with infliximab and 96 with adalimumab. Median time on anti-TNF therapy at the last endoscopic assessment was 31 months (interquartile range, 13–54). Endoscopic improvement was observed in 61%, including 42% who achieved endoscopic remission. Concomitant use of thiopurines and treatment with infliximab were associated with endoscopic improvement (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.04–4.46; P = 0.03, and OR 2.34, 95% CI 1.18–4.62; P < 0.01, respectively) and endoscopic remission (OR 3.16, 95% CI 1.65–6.05; P < 0.01, and OR 2.01, 95% CI 1.05–3.88; P = 0.04, respectively) in the multivariable logistic regression analysis. These results were confirmed in a propensity-matched score analysis. DISCUSSION: In patients with endoscopic POR, anti-TNF agents improve mucosal lesions in almost two-thirds of the patients. In this setting, concomitant use of thiopurines and use of infliximab seem to be more effective in improving mucosal lesions.

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Section: Discussionmentioning

confidence: 99%

Antitumor Necrosis Factor Agents to Treat Endoscopic Postoperative Recurrence of Crohn's Disease: A Nationwide Study With Propensity-Matched Score Analysis

Cañete

Mañosa

Pérez-Martínez

et al. 2020

Clin Transl Gastroenterol

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“…Additionally, mesalazine-treated patients exhibited less frequent endoscopic improvement after one year compared to their AZA counterparts (RS reduction 8–34% vs. 36–63%, respectively). Furthermore, a small case-control study failed to demonstrate any benefit from the addition of mesalazine in patients with subclinical endoscopic recurrence who were already receiving thiopurine therapy [ 124 ].…”

Section: Medical Treatment Of Postoperative Recurrencementioning

confidence: 99%

The Management of Postoperative Recurrence in Crohn’s Disease

Fasulo,

D’Amico,

Osorio

et al. 2023

JCM

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Crohn’s disease (CD) is a chronic inflammatory bowel disease with different phenotypes of presentation, inflammatory, penetrating, or stricturing disease, that significantly impacts patient well-being and quality of life. Despite advances in medical therapy, surgery sometimes represents the only treatment to address complications, such as strictures, fistulas, or abscesses. Minimizing postoperative recurrence (POR) remains a major challenge for both clinicians and patients; consequently, various therapeutic strategies have been developed to prevent or delay POR. The current review outlines an updated overview of POR management. We focused on diagnostic assessment, which included endoscopic examination, biochemical analyses, and cross-sectional imaging techniques, all crucial tools used to accurately diagnose this condition. Additionally, we delved into the associated risk factors contributing to POR development. Furthermore, we examined recent advances in the prophylaxis and treatment of POR in CD.

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Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the monitoring, prevention and treatment of post-operative recurrence in Crohn's disease

Domènech

López-Sanromán

Nos

et al. 2017

Gastroenterología y Hepatología (English Edition)

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Addition of mesalazine for subclinical post‐surgical endoscopic recurrence of Crohn's disease despite preventive thiopurine therapy: A case–control study

Abstract: The addition of mesalazine seems to be of no benefit in patients with subclinical endoscopic recurrence while on thiopurine prevention. Moderate endoscopic postsurgical recurrence while on thiopurines may even revert with no additional therapy in some patients.

Cited by 6 publications

References 28 publications

Antitumor Necrosis Factor Agents to Treat Endoscopic Postoperative Recurrence of Crohn's Disease: A Nationwide Study With Propensity-Matched Score Analysis

Antitumor Necrosis Factor Agents to Treat Endoscopic Postoperative Recurrence of Crohn's Disease: A Nationwide Study With Propensity-Matched Score Analysis

The Management of Postoperative Recurrence in Crohn’s Disease

Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the monitoring, prevention and treatment of post-operative recurrence in Crohn's disease

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