Immunoprophylaxis ‘does not seem superior’ to prevent postoperative Crohn’s recurrence
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CHICAGO — Immediate immunoprophylaxis after curative ileo-colonic resection did not reduce the rate of early recurrence among patients with Crohn’s disease who only had one risk factor for postoperative recurrence.
“As we all know, approximately half of our patients with Crohn’s disease will need at least one intestinal resection during their lifetime,” Gabriele Dragoni, MD, PhD, from the University Hospital of Florence in Italy, said at Digestive Disease Week. “And 65% to 90% of patients may develop endoscopic postoperative recurrence at 1 year.”
Dragoni continued: “Even when treated correctly, we know that 15% to 20% of our patients may need another resection.”
In a multicenter retrospective study, Dragoni and colleagues enrolled 195 patients with CD who had only one risk factor for postoperative recurrence, which included previous intestinal resection, extensive small intestine resection, fistulizing phenotype, history of perianal disease or active smoking.
Following curative ileo-colonic resection, patients received either prophylactic immunosuppression (31.3% at a median time of 32 days) or immunosuppression was guided by endoscopy. Primary endpoints included the rate of any endoscopic recurrence and severe endoscopic recurrence within 12 months following surgery, while secondary endpoints were clinical recurrence rates at 6, 12 and 24 months.
Researchers performed an initial colonoscopy exam at a median time of 8 months after surgery and observed no difference in endoscopic recurrence between the immunoprophylaxis or endoscopy-driven groups (36.1% vs. 45.5%, respectively; P = .1) or severe endoscopic recurrence (9.8% vs. 15.7%; P = .15). Researchers further noted similar rates of recurrence among a subset of 32 patients who underwent a secondary colonoscopy at a median time of 30.5 months after surgery (P = .055 and P = .43).
Early clinical recurrence occurred among 23.4% and 31.5% (P = .43) at 6 months with similar rates at 12 (17.9% vs. 34.8%; P = .09) and 24 (17.9% vs. 24.1%; P = .63) months.
“We can reasonably conclude that, according to our data, systematic immunoprophylaxis does not seem superior to an endoscopy-driven approach in Crohn’s disease patients to prevent postoperative recurrence,” Dragoni said.
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Dragoni G, et al. Abstract 12: Comparison of two strategies for the management of postoperative recurrence in Crohn’s disease patients with one clinical risk factor: A multicenter Italian study. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago, (hybrid).
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