Risk factors for recurrence of Crohn's disease requiring surgery in patients receiving post-operative anti-tumor necrosis factor maintenance therapy

Araki, Toshimitsu; Okita, Yoshiki; Kondo, Satoru; Hiro, Junichiro; Toiyama, Yuji; Inoue, Mikihiro; Ohi, Masaki; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

doi:10.23922/jarc.2016-004

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…In our study, as many as 11 patients required additional seton placement repeatedly to control local sepsis despite BIO maintenance therapy, including all 3 smokers and 4 of 5 patients with rectal involvement. Smoking is an independent risk factor associated with postoperative surgical recurrence under BIO maintenance therapy 20) . Active proctitis is not only a risk factor for perianal fistulizing disease but also a predictive factor for refractory, recurrent disease requiring proctectomy eventually 3) .…”

Section: Discussionmentioning

confidence: 99%

A series of seton techniques involving "top-down therapy" for patients with Crohn's disease who initially presented with perianal fistulas

Saigusa¹,

Saigusa

Shinozaki

et al. 2018

J Anus Rectum Colon

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Objectives: We determined the outcomes of seton treatment through a series of techniques using biological agents (BIOs) in 18 patients with Crohn's disease (CD) who initially presented with perianal fistulas. Methods: The patients underwent seton drainage using three seton types: a Penrose tube for fistulas with massive purulent discharge, a vessel loop for a small amount of discharge, and a rubber band for unproductive fistulas. If the distal end of the fistula extended more than 4 cm from the anal orifice, the skin and subcutaneous tissue were dissected along the outer edge of the anal sphincter to divide the fistulous tract into two portions. One seton encircled the sphincter from the primary opening throughout the anal canal (medial seton), and the other was inserted through the distal tract outside the sphincter (lateral seton). A BIO was then introduced immediately. When discharge ceased, the Penrose tube or vessel loop was replaced sequentially with a rubber band, which was tied fittingly and subsequently removed in medial to lateral order. Results: The mean interval between fistula onset and CD diagnosis was 2.1 years, and that between CD diagnosis and introduction of BIOs was 0.5 years. The mean follow-up duration was 4 years. The BIOs currently used were infliximab in 10 patients, adalimumab in 7, and ustekinumab in 1. The overall success rate was 94.4%, including unproductive fistulas in 10 (55.6%) patients and fistula disappearance in 7 (38.9%). Conclusions: Our seton drainage techniques via the "top-down" approach represent a promising avenue for treating perianal fistulas in patients with CD.

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Section: Discussionmentioning

confidence: 99%

A series of seton techniques involving "top-down therapy" for patients with Crohn's disease who initially presented with perianal fistulas

Saigusa¹,

Saigusa

Shinozaki

et al. 2018

J Anus Rectum Colon

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“…A high percentage of CD patients, around 70%-80%, might need to receive intestinal resection during their life [1][2][3]. Furthermore, intestinal resection for CD patients is not curative, and CD patients have remained at risk of relapse after CD-related surgery due to refractoriness to postoperative medical treatments or CD-related complications [4,5]. To improve the quality of life in CD patients, precise biomarkers for predicting surgical relapse might help to identify high-risk patients, improve the follow-up and help determine an appropriate therapy protocol during the postoperative course in CD patients.…”

Section: Introductionmentioning

confidence: 99%

The advanced lung cancer inflammation index predicts outcomes in patients with Crohn’s disease after surgical resection

et al. 2020

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Aim Precise biomarkers for predicting prognosis could help to identify high‐risk Crohn's disease (CD) patients to facilitate better follow‐up during the postoperative course. In this study, the primary aim is the identification of the most reliable nutrition marker that predicts surgical relapse in CD patients. Method We first evaluated the predictive value of various nutrition markers for postoperative surgical relapse in CD patients and identified the advanced lung cancer inflammation index (ALI) as a promising biomarker. Then, we assessed the clinical significance of preoperative ALI in CD patients using two cohorts. Results Preoperative ALI showed the highest correlation with reoperation rate compared with other nutritional parameters in CD patients receiving surgical resection (sensitivity 53%, specificity 86%, area under the curve 0.71). Lower levels of preoperative ALI were significantly correlated with the presence of perianal disease. A lower level of preoperative ALI was an independent prognostic factor for reoperation rate after an intestinal resection (hazard ratio 3.37, 95% CI 1.38–10.12, P = 0.006), and the prognostic impact of preoperative ALI was successfully validated in an independent cohort using the same cut‐off value. Conclusion Preoperative ALI might be useful for postoperative management of CD patients.

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Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease

Gisbert,

Chaparro

2023

Drugs

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Surgery for Crohn’s disease (CD) is not curative, as postoperative recurrence (POR) after ileocolonic resection is the rule in the absence of prophylactic treatment. In the present article, we critically review available data on the role of anti-tumour necrosis factor (TNF) agents and new biologics (including vedolizumab and ustekinumab) in the prevention and treatment of POR after surgery in CD. Several studies (summarised in various meta-analyses) have confirmed the efficacy of anti-TNFs in the prevention of POR. We identified 37 studies, including 1863 CD patients, with mean endoscopic POR at 6–12 months of 29%. Only few randomised controlled trials (RCTs) have directly compared thiopurines and anti-TNFs, with controversial results, although the superiority of the latter is supported by several meta-analyses. Infliximab and adalimumab seem equally effective. The combination of anti-TNFs and immunosuppressives should be considered in patients previously exposed to anti-TNFs. Several studies have shown that anti-TNFs remain an effective option to prevent POR also in patients with anti-TNF failure before surgery. In fact, the use of the same anti-TNF before and after surgery might be effective for the prevention of POR. Prophylactic anti-TNF treatment, once started, should be continued long term. Anti-TNFs are also effective for the treatment of established POR. Retreatment with anti-TNFs for POR is a valid strategy even after their preoperative failure. In six studies (including 156 patients) evaluating vedolizumab, mean endoscopic POR at 6–12 months was 41%. The non-randomised comparison of anti-TNFs and vedolizumab has provided controversial results. One placebo-controlled RCT confirmed that vedolizumab is quite effective in preventing POR in CD patients with increased risk of recurrence. Seven studies (including 162 patients) evaluated ustekinumab, with a mean endoscopic POR at 6–12 months of 41%. The comparative efficacy of ustekinumab and anti-TNFs is still unclear. Ustekinumab and vedolizumab seem to be equally effective, although the experience is very limited. In conclusion, to date, anti-TNFs are the most effective agents in preventing and treating POR in CD. Anti-TNFs remain an effective option to prevent POR also in patients with anti-TNF failure before surgery. Vedolizumab seems to be quite effective in the prevention of POR in patients with increased risk of recurrence. Ustekinumab is probably also effective in the postoperative setting, although the comparative efficacy with anti-TNFs or vedolizumab is still unclear.

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Risk factors for recurrence of Crohn's disease requiring surgery in patients receiving post-operative anti-tumor necrosis factor maintenance therapy

Cited by 3 publications

References 28 publications

A series of seton techniques involving "top-down therapy" for patients with Crohn's disease who initially presented with perianal fistulas

A series of seton techniques involving "top-down therapy" for patients with Crohn's disease who initially presented with perianal fistulas

The advanced lung cancer inflammation index predicts outcomes in patients with Crohn’s disease after surgical resection

Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease

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