Continued Postoperative Use of Tumor Necrosis Factor-alpha Inhibitors for the Prevention of Crohn's Disease Recurrence

Abstract

Background/Aims: Many patients with Crohn's disease (CD) undergo intestinal resection dur -ing the disease course. Despite surgery, postoperative recurrence (POR) commonly occurs. Al-though postoperative use of tumor necrosis factor alpha (TNF-alpha) inhibitors is known to be effective in preventing POR, few studies have evaluated the effectiveness of continuing the same TNF-alpha inhibitors postoperatively in patients who received TNF-alpha inhibitors before surgery. Methods: This retrospective observational study was performed in a single tertiary medical cen-ter. We retrospectively reviewed patients who had undergone the first intestinal resection due to CD and divided them into two groups: TNF-alpha inhibitor users in both the preoperative and post-operative periods, and TNF-alpha inhibitor users in only the preoperative period. We compared the clinical outcomes between these two groups. Results: In total, 45 patients who used TNF-alpha inhibitors preoperatively were recruited. Among them, TNF-alpha inhibitors were used postoperatively in 20 patients (44.4%). The baseline character-istics except age at diagnosis were similar in both groups. The rates of surgical and endoscopic recurrence were not different between the two groups, but the cumulative clinical recurrence rate was significantly lower in the postoperative TNF-alpha inhibitors group (log-rank p=0.003). In multivariate Cox regression analysis, postoperative TNF-alpha inhibitors use was significantly associ-ated with a decreased risk of clinical recurrence (adjusted hazard ratio, 0.204; 95% confidence interval, 0.060 to 0.691; p=0.011). Conclusions: Continuing TNF-alpha inhibitors postoperatively in patients who were receiving TNF-alpha inhibitors before surgery significantly reduced the rate of clinical recurrence. For patients with CD who received TNF-alpha inhibitors preoperatively, continuing their use after surgery could be recom-mended. (Gut Liver, Published online August 24, 2021)