Intestinal Research  
Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn’s disease
Sakiko Hiraoka1, Shiho Takashima1, Yoshitaka Kondo2, Toshihiro Inokuchi1, Yuusaku Sugihara1, Masahiro Takahara1, Seiji Kawano1, Keita Harada1, Jun Kato3, Hiroyuki Okada1
Departments of 1Gastroenterology and Hepatology and 2Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 3Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
Correspondence to: Sakiko Hiraoka, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Tel: +81-86-235-7219, Fax: +81-86-225-5991, E-mail: sakikoh@cc.okayama-u.ac.jp
Received: July 6, 2017; Revised: August 6, 2017; Accepted: August 8, 2017; Published online: September 28, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: The efficacy of anti-tumor necrosis factor α (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], 28.1; 95% confidence interval [CI], 3.08−722), age at diagnosis 〈23 years (OR, 24.3; 95% CI, 1.67−1312), serum albumin concentration at surgery 〈3.3 g/dL (OR, 34.1; 95% CI, 1.72–2804), and presence of inflammation outside of the surgical site (OR, 21. 4; 95% CI, 1.02−2151). 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.
Keywords: Crohn disease; Anti-tumor necrosis factor α; Surgery


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