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.

CEMAD IBD UNIT Unità Operativa Complessa di Medicina Interna e Gastroenterologia Dipartimento di Scienze Mediche e Chirurgiche Fondazione Policlinico Universitario 'A Gemelli' IRCCS Rome Italy

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Madrid Spain

Clinical and Research Centre for Inflammatory Bowel Disease ISCARE Clinical Centre Prague Czech Republic

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 Hepatology University Hospital of Santiago de Compostela Santiago de Compostela Spain

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 Hospital Universitario de La Princesa Instituto de Investigación Sanitaria Princesa Spain

Department of Gastroenterology Lyon Sud hospital Hospices Civils de Lyon Lyon and INSERM U1111 CIRI Lyon France

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 The Northern Care Alliance NHS Foundation Trust Manchester Academic Health Sciences University of Manchester Manchester UK

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

Department of Surgical Oncological and Gastroenterological Sciences Gastroenterology Unit Padua University Padua Italy

Digestive Diseases Institute Shaare Zedek Medical Center Jerusalem Israel

Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and Surgery University of Milano Bicocca Monza Italy

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 and Endoscopy IRCCS Ospedale San Raffaele and Vita Salute San Raffaele University Milan Italy

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

Imelda GI clinical Research Center Department of Gastroenterology Imelda General Hospital Bonheiden Belgium

Inflammatory Bowel Disease Center Department of Gastroenterology Radboud University Medical Center Nijmegen The Netherlands and Division of Gastroenterology Department of Medicine University of Alberta Edmonton Canada

Institute of Gastroenterology Meir Hospital Sapir Medical Center Kfar Saba Israel

Institute of Medical Biochemistry and Laboratory Medicine General University Hospital and 1st Faculty of Medicine Charles University Prague Czech Republic

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

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