Interventions for prevention of post-operative recurrence of Crohn's disease

Abstract

There are insufficient randomised controlled trials of infliximab, budesonide, tenovil and interleukin-10 to draw conclusions. Nitro-imidazole antibiotics, mesalamine and immunosuppressive therapy with azathioprine/6-MP or infliximab all appear to be superior to placebo for the prevention of post-operative recurrence of Crohn's disease. The cost, toxicity and tolerability of these approaches require careful consideration to determine the optimal approach for post-operative prophylaxis.

Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease

“…In addition, we found no association between steroid treatment and the need for surgery. The lack of an association between the duration of treatment with 5-aminosalicylates and the risk for surgery is in agreement with previous reports 23 24…”

Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease

“…In addition, we found no association between steroid treatment and the need for surgery. The lack of an association between the duration of treatment with 5-aminosalicylates and the risk for surgery is in agreement with previous reports 23 24…”

Ustekinumab is more effective than azathioprine to prevent endoscopic postoperative recurrence in Crohn's disease

“…Even though azathioprine remains an option, its efficacy remains limited as preventive medication after surgery in CD. 3,[6][7][8]16 The rate of endoscopic POR in our patients treated with azathioprine (58.1%) was comparable to the data from the medical literature ranging from 21% to 63%. 16 D'Haens et al 32 reported a rate of endoscopic POR of 55% in patients with concomitant use of metronidazole.…”

Optimizing clinical use of mesalazine (5-aminosalicylic acid) in inflammatory bowel disease

“…In the only study in which the objective endpoint of endoscopic recurrence was assessed [Caprilli et al 1994], 5-ASA significantly reduced CD recurrence at 6, 12, and 24 months postoperatively, suggesting that this drug can maintain mucosal healing. The modest magnitude of clinical efficacy of 5-ASA in postoperative prevention of CD demonstrated in the systematic review and meta-analysis by Ford and colleagues is largely in agreement with a recent Cochrane Collaboration Review [Doherty et al 2009]. Although the apparent clinical benefit of 5-ASA for the prevention of postoperative recurrence of CD is modest, a recent head-to-head comparison of 5-ASA and azathioprine sheds some light on the practical use of 5-ASA in this setting.…”

Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease

“…In addition, we found no association between steroid treatment and the need for surgery. The lack of an association between the duration of treatment with 5-aminosalicylates and the risk for surgery is in agreement with previous reports 23 24…”

Ustekinumab is more effective than azathioprine to prevent endoscopic postoperative recurrence in Crohn's disease

“…Even though azathioprine remains an option, its efficacy remains limited as preventive medication after surgery in CD. 3,[6][7][8]16 The rate of endoscopic POR in our patients treated with azathioprine (58.1%) was comparable to the data from the medical literature ranging from 21% to 63%. 16 D'Haens et al 32 reported a rate of endoscopic POR of 55% in patients with concomitant use of metronidazole.…”

Optimizing clinical use of mesalazine (5-aminosalicylic acid) in inflammatory bowel disease

“…In the only study in which the objective endpoint of endoscopic recurrence was assessed [Caprilli et al 1994], 5-ASA significantly reduced CD recurrence at 6, 12, and 24 months postoperatively, suggesting that this drug can maintain mucosal healing. The modest magnitude of clinical efficacy of 5-ASA in postoperative prevention of CD demonstrated in the systematic review and meta-analysis by Ford and colleagues is largely in agreement with a recent Cochrane Collaboration Review [Doherty et al 2009]. Although the apparent clinical benefit of 5-ASA for the prevention of postoperative recurrence of CD is modest, a recent head-to-head comparison of 5-ASA and azathioprine sheds some light on the practical use of 5-ASA in this setting.…”

Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease

“…In addition, we found no association between steroid treatment and the need for surgery. The lack of an association between the duration of treatment with 5-aminosalicylates and the risk for surgery is in agreement with previous reports 23 24…”

Ustekinumab is more effective than azathioprine to prevent endoscopic postoperative recurrence in Crohn's disease

“…Even though azathioprine remains an option, its efficacy remains limited as preventive medication after surgery in CD. 3,[6][7][8]16 The rate of endoscopic POR in our patients treated with azathioprine (58.1%) was comparable to the data from the medical literature ranging from 21% to 63%. 16 D'Haens et al 32 reported a rate of endoscopic POR of 55% in patients with concomitant use of metronidazole.…”

Optimizing clinical use of mesalazine (5-aminosalicylic acid) in inflammatory bowel disease

“…In the only study in which the objective endpoint of endoscopic recurrence was assessed [Caprilli et al 1994], 5-ASA significantly reduced CD recurrence at 6, 12, and 24 months postoperatively, suggesting that this drug can maintain mucosal healing. The modest magnitude of clinical efficacy of 5-ASA in postoperative prevention of CD demonstrated in the systematic review and meta-analysis by Ford and colleagues is largely in agreement with a recent Cochrane Collaboration Review [Doherty et al 2009]. Although the apparent clinical benefit of 5-ASA for the prevention of postoperative recurrence of CD is modest, a recent head-to-head comparison of 5-ASA and azathioprine sheds some light on the practical use of 5-ASA in this setting.…”