Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease

Sakiko Hiraoka, Shiho Takashima, Yoshitaka Kondo, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Seiji Kawano, Keita Harada, Jun Kato, Hiroyuki Okada

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background/Aims: The efficacy of anti-tumor necrosis factor a (anti-TNFα) antibodies for postoperative Crohn's disease (CD) in patients who were treated with these agents prior to surgery is largely unknown. Methods: CD patients who underwent intestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence or absence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα naïve group. Endoscopic recurrence after surgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery. Results: Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti- TNFα naïve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than in the anti-TNFα naïve group (68% vs. 14%, P < 0.001). Multivariate analysis revealed the following significant risk factors of endoscopic recurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10; 95% CI, 3.08-722.00), age at diagnosis < 23 years (OR, 24.30; 95% CI, 1.67-1,312.00), serum albumin concentration at surgery < 3.3 g/dL (OR, 34.10; 95% CI, 1.72-2,804.00), and presence of inflammation outside of the surgical site (OR, 21.40; 95% CI, 1.02-2,150.00). Treatment intensification for patients with endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopic remission. Conclusions: The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatment intensification or a change to different classes of biologics should be considered for those patients.

Original languageEnglish
Pages (from-to)75-82
Number of pages8
JournalIntestinal Research
Volume16
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Crohn Disease
Tumor Necrosis Factor-alpha
Odds Ratio
Recurrence
Antibodies
Therapeutics
Biological Products
Serum Albumin
Multivariate Analysis
Inflammation

Keywords

  • Anti-tumor necrosis factor α
  • Crohn disease
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease. / Hiraoka, Sakiko; Takashima, Shiho; Kondo, Yoshitaka; Inokuchi, Toshihiro; Sugihara, Yuusaku; Takahara, Masahiro; Kawano, Seiji; Harada, Keita; Kato, Jun; Okada, Hiroyuki.

In: Intestinal Research, Vol. 16, No. 1, 01.01.2018, p. 75-82.

Research output: Contribution to journalArticle

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abstract = "Background/Aims: The efficacy of anti-tumor necrosis factor a (anti-TNFα) antibodies for postoperative Crohn's disease (CD) in patients who were treated with these agents prior to surgery is largely unknown. Methods: CD patients who underwent intestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence or absence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα na{\"i}ve group. Endoscopic recurrence after surgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery. Results: Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti- TNFα na{\"i}ve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than in the anti-TNFα na{\"i}ve group (68{\%} vs. 14{\%}, P < 0.001). Multivariate analysis revealed the following significant risk factors of endoscopic recurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10; 95{\%} CI, 3.08-722.00), age at diagnosis < 23 years (OR, 24.30; 95{\%} CI, 1.67-1,312.00), serum albumin concentration at surgery < 3.3 g/dL (OR, 34.10; 95{\%} CI, 1.72-2,804.00), and presence of inflammation outside of the surgical site (OR, 21.40; 95{\%} CI, 1.02-2,150.00). Treatment intensification for patients with endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopic remission. Conclusions: The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatment intensification or a change to different classes of biologics should be considered for those patients.",
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AU - Hiraoka, Sakiko

AU - Takashima, Shiho

AU - Kondo, Yoshitaka

AU - Inokuchi, Toshihiro

AU - Sugihara, Yuusaku

AU - Takahara, Masahiro

AU - Kawano, Seiji

AU - Harada, Keita

AU - Kato, Jun

AU - Okada, Hiroyuki

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