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Postoperative therapy with infliximab prevents long-term Crohn’s disease recurrence

A study in the latest Clinical Gastroenterology & Hepatology evaluated recurrence of Crohn’s disease, on the basis of endoscopic examination and/or the need for additional surgical resection, beyond the first postoperative year.

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A previous randomized, placebo-controlled study showed that infliximab maintenance therapy prevented recurrence of Crohn’s disease 1 year after an ileocolonic resection.

Dr Miguel Regueiro and colleagues from Pennsylvania, USA evaluated recurrence of Crohn’s disease, on the basis of endoscopic examination and/or the need for additional surgical resection, beyond the first postoperative year.

In a prospective, open-label, long-term follow-up study, 24 patients previously randomly assigned to receive infliximab for 1 year after an ileocolonic resection were given the option to continue, stop, or start infliximab therapy.

The team's primary end point was the time to recurrence of Crohn’s disease, on the basis of endoscopic evidence (endoscopic recurrence), from the initial assignment to postoperative infliximab or placebo.

Crohn’s recurrence occurred 22% of patients who received long-term infliximab
Clinical Gastroenterology & Hepatology

Secondary end points were rate of endoscopic recurrence, time to reoperation, and rate of surgical recurrence in relation to the total time on infliximab.

All patients were followed for at least 5 years after surgery.

The research team found that patients assigned to the infliximab group in the first year after surgery had a longer mean time to first endoscopic recurrence than patients originally assigned to the placebo group.

Colonoscopies identified Crohn’s disease recurrence in 22% of patients who received long-term infliximab, and in 94% of those not on infliximab.

Compared with no infliximab, the team found that adjusted rate ratio for being in endoscopic remission while on infliximab was 14.

Patients originally assigned to the infliximab group had a mean longer time to surgery than patients originally assigned to the placebo group.

The team noted that the rate of surgical recurrence was significantly lower among patients who received infliximab for most of the follow-up period than patients who received it for shorter periods.

Dr Regueiro's team concludes, "Postoperative infliximab maintenance beyond 1 year prevents recurrence of Crohn’s disease."

Clin Gastroenterol Hepatol 2014: 12(9): 1494–1502.e1
04 September 2014

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