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Endoscopic Postoperative Recurrence in Crohn's Disease After Curative Ileocecal Resection with Early Prophylaxis by Anti-TNF, Vedolizumab or Ustekinumab: A Real-World Multicentre European Study
H. Yanai, A. Kagramanova, O. Knyazev, J. Sabino, S. Haenen, GJ. Mantzaris, K. Mountaki, A. Armuzzi, D. Pugliese, F. Furfaro, G. Fiorino, D. Drobne, T. Kurent, S. Yassin, N. Maharshak, F. Castiglione, R. de Sire, OM. Nardone, K. Farkas, T. Molnar,...
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu multicentrická studie, časopisecké články
PubMed
35895074
DOI
10.1093/ecco-jcc/jjac100
Knihovny.cz E-zdroje
- MeSH
- biologické přípravky * terapeutické užití MeSH
- Crohnova nemoc * farmakoterapie prevence a kontrola chirurgie MeSH
- dospělí MeSH
- inhibitory TNF terapeutické užití MeSH
- lidé MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- ustekinumab terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: Endoscopic-post-operative-recurrence [ePOR] in Crohn's disease [CD] after ileocecal resection [ICR] is a major concern. We aimed to evaluate the effectiveness of early prophylaxis with biologics and to compare anti-tumour necrosis factor [anti-TNF] therapy to vedolizumab [VDZ] and ustekinumab [UST] in a real-world setting. METHODS: A retrospective multicentre study of CD-adults after curative ICR on early prophylaxis was undertaken. ePOR was defined as a Rutgeerts score [RS] ≥ i2 or colonic-segmental-SES-CD ≥ 6. Multivariable logistic regression was used to evaluate risk factors, and inverse probability treatment weighting [IPTW] was applied to compare the effectiveness between agents. RESULTS: The study included 297 patients (53.9% males, age at diagnosis 24 years [19-32], age at ICR 34 years [26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6% two or more biologics and 17.2% previous surgery). Overall, 224, 39 and 34 patients received anti-TNF, VDZ or UST, respectively. Patients treated with VDZ and UST were more biologic experienced with higher rates of previous surgery. ePOR rates within 1 year were 41.8%. ePOR rates by treatment groups were: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1 year were: past-infliximab (adjusted odds ratio [adj.OR] = 1.73 [95% confidence interval, CI: 1.01-2.97]), past-adalimumab [adj.OR = 2.32 [95% CI: 1.35-4.01] and surgical aspects. After IPTW, the risk of ePOR within 1 year of VDZ vs anti-TNF or UST vs anti-TNF was comparable (OR = 0.55 [95% CI: 0.25-1.19], OR = 1.86 [95% CI: 0.79-4.38]), respectively. CONCLUSION: Prevention of ePOR within 1 year after surgery was successful in ~60% of patients. Patients treated with VDZ or UST consisted of a more refractory group. After controlling for confounders, no differences in ePOR risk were seen between anti-TNF prophylaxis and other groups.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Madrid Spain
Concord Medical Center Clalit Health Services Bnei Brak Israel
Department of Clinical Medicine and Surgery University of Naples Federico 2 Naples Italy
Department of Gastroenterology and Hepatology Kaplan Medical Center Rehovot Israel
Department of Gastroenterology and Liver Diseases Tel Aviv Medical Center Tel Aviv Israel
Department of Gastroenterology Austin Hospital Melbourne VIC Australia
Department of Gastroenterology Faculty of Medicine and Health Örebro University Örebro Sweden
Department of Gastroenterology GHA 'Evaggelismos Ophthalmiatreion Athinon Polykliniki' Athens Greece
Department of Gastroenterology Hepatology and Nutrition University Hospital Centre Zagreb Croatia
Department of Gastroenterology Metaxa Memorial General Hospital Piraeus Greece
Department of Gastroenterology Rambam Health Care Campus Haifa Israel
Department of Gastroenterology Sheba Medical Center Tel Hashomer Israel
Department of Gastroenterology St Vincent's Hospital Melbourne VIC Australia
Department of Gastroenterology University Hospitals of Leuven Leuven Belgium
Department of Gastroenterology University Medical Centre Ljubljana Ljubljana Slovenia
Department of Gastroenterology Venizeleio General Hospital Heraklion Crete Greece
Department of Gastroenterology with IBD Unit Clinical Hospital No 2 Rzeszów Poland
Department of Internal Medicine and Pediatrics Ghent University Ghent Belgium
Department of Internal Medicine Medical Faculty University of Ljubljana Ljubljana Slovenia
Department of Medical Sciences University of Turin Turin Italy
Department of Medicine University of Melbourne Melbourne VIC Australia
Department of Medicine University of Szeged Szeged Hungary
Department of Public Health University of Naples Federico 2 Naples Italy
Digestive Diseases Institute Shaare Zedek Medical Center Jerusalem Israel
Division of Gastroenterology Hospital Beatriz Ângelo Loures Lisbon Portugal
Division of Gastroenterology Hospital da Luz Lisboa Portugal
Division of Gastroenterology Mater Dei Hospital Msida Malta
Division of Gastroenterology Rabin Medical Center Petah Tikva Israel
European Reference Network on Hepatological Diseases San Gerardo Hospital Monza Italy
Faculty of Medicine Hebrew University Jerusalem Israel
Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
Gastroenterology Department Hospital de Bellvitge and IDIBELL L'Hospitalet Spain
Gastroenterology Department University Hospital of Heraklion Crete Greece
Gastroenterology Unit Department of Systems Medicine University of Rome Tor Vergata Italy
Gastroenterology Unit Rho Hospital ASST Rhodense Rho Italy
IBD Center Humanitas Research Hospital IRCCS Milan Italy
IBD Center IRCCS Humanitas Research Hospital Rozzano Milan Italy
IBD unit Department of Gastroenterology University Hospital Ghent Ghent Belgium
Institute of Gastroenterology Meir Hospital Sapir Medical Center Kfar Saba Israel
Irkutsk Scientific Center of Surgery and Traumatology Russia
Moscow Clinical Scientific Centre named after A S Loginov Moscow Russian Federation
Rappaport Faculty of Medicine The Technion Israel Institute of Technology Haifa Israel
Research Institute of Health Organization and Medical Management Moscow Russian Federation
Sackler Faculty of Medicine Tel Aviv University Israel
State Scientific Centre of Coloproctology named after A N Ryzhyh Moscow Russian Federation
Citace poskytuje Crossref.org
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- $a BACKGROUND: Endoscopic-post-operative-recurrence [ePOR] in Crohn's disease [CD] after ileocecal resection [ICR] is a major concern. We aimed to evaluate the effectiveness of early prophylaxis with biologics and to compare anti-tumour necrosis factor [anti-TNF] therapy to vedolizumab [VDZ] and ustekinumab [UST] in a real-world setting. METHODS: A retrospective multicentre study of CD-adults after curative ICR on early prophylaxis was undertaken. ePOR was defined as a Rutgeerts score [RS] ≥ i2 or colonic-segmental-SES-CD ≥ 6. Multivariable logistic regression was used to evaluate risk factors, and inverse probability treatment weighting [IPTW] was applied to compare the effectiveness between agents. RESULTS: The study included 297 patients (53.9% males, age at diagnosis 24 years [19-32], age at ICR 34 years [26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6% two or more biologics and 17.2% previous surgery). Overall, 224, 39 and 34 patients received anti-TNF, VDZ or UST, respectively. Patients treated with VDZ and UST were more biologic experienced with higher rates of previous surgery. ePOR rates within 1 year were 41.8%. ePOR rates by treatment groups were: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1 year were: past-infliximab (adjusted odds ratio [adj.OR] = 1.73 [95% confidence interval, CI: 1.01-2.97]), past-adalimumab [adj.OR = 2.32 [95% CI: 1.35-4.01] and surgical aspects. After IPTW, the risk of ePOR within 1 year of VDZ vs anti-TNF or UST vs anti-TNF was comparable (OR = 0.55 [95% CI: 0.25-1.19], OR = 1.86 [95% CI: 0.79-4.38]), respectively. CONCLUSION: Prevention of ePOR within 1 year after surgery was successful in ~60% of patients. Patients treated with VDZ or UST consisted of a more refractory group. After controlling for confounders, no differences in ePOR risk were seen between anti-TNF prophylaxis and other groups.
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