Adalimumab and azathioprine in the prevention of postoperative crohn’s disease recurrence

Introduction. Despite improvements in earlier diagnosis and the development of conservative therapy for Crohn’s disease (CD), approximately 70%–80% of patients undergo surgical treatment for complications. Surgical treatment is not a cure for this disease. The question of choosing therapy as a prevention of postoperative relapse of CD is still open. AIM. To compare the effectiveness of immunosuppressive and biological therapy as a postoperative preventive therapy.Materials and methods. The retrospective study included 125 patients with CD who underwent surgery in terms from 2010 to 2017. After the operation, patients were divided into 3 groups. Patients from the first group received azathioprine, from the second - adalimumab, and patients from the third group were prescribed combined therapy with azathioprine and adalimumab. Clinical, endoscopic, and laboratory data for analysis of disease activity was collected 3, 6, and 12 months after surgery.Results. During the year of therapy in all three groups relapses occurred in only 22 patients (22/125 17.6%). There were no statistically significant differences between the groups at any of the assessment stages. There was also no statistically significant correlation between the presence of risk factors and relapses.Conclusion. Our research has shown that the choice of anti-relapse therapy depending on risk factors is controversial. However, active endoscopic monitoring is important regardless of the treatment strategy. Also, our data allow us to conclude that the frequency of relapses of CD during the postoperative preventive therapy does not depend on the specific drug chosen, as well as on demographic and anamnestic parameters.

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THE EFFICIENCY OF POSTOPERATIVE PREVENTIVE TREATMENT BY ADALIMUMAB AND AZATHIOPRINE IN CROHN'S DISEASE

Koloproktologia ◽

10.33878/2073-7556-2018-0-2-73-77 ◽

2018 ◽

pp. 73-77

Author(s):

A. V. Poletova ◽

M. V. Shapina ◽

I. L. Khalif ◽

A. V. Vardanyan

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Biological Therapy ◽

Preventive Treatment ◽

Preventive Therapy ◽

Laboratory Assessment ◽

Scientific Center ◽

Appropriate Therapy ◽

One Year

INTRODUCTION. About 75% of patients with Crohn's disease (CD) required surgery due to the complications of CD. Surgical treatment does not cure this disease. The question of appropriate therapy for the prevention of postoperative reccurence of CD remains open until now. The purpose of this study was to compare immunosuppressive and biological therapy as a postoperative preventive therapy. MATERIALS AND METHODS. 91 patients with CD who underwent surgery in the A.N. Ryzhykh State Scientific Center for Coloproctology of the Ministry of Health of Russian Federation from 2010 to 2017 were included in the study. Patients who had inflammation in the remaining areas of the intestine in the outcome of surgical treatment were excludedfrom the study. After surgery, patients were randomized into 3 groups. In the first group preventive therapy was carried out with azathioprine, in the second group with adalimumab, in the third group, patients received combination therapy with azathioprine and adalimumab. Clinical, endoscopical and laboratory assessment of disease activity was conducted at 3, 6 and 12 month after the surgery. RESULTS. During one year of preventive therapy with azathioprine, adalimumab, or a combination of this medications, relapse occurred in 17 patients (17/83, 20%). There were no statistically significant differences between the groups in any of the stages of evaluation. CONCLUSION: The data obtained in the study allow to conclude that the frequency of relapses of CD on postoperative preventive therapy does not depend on the specific drug, as well as on demographic and anamnestic parameters.

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P400 Incidence and risk factors associated to Crohn’s disease recurrence after total proctocolectomy with definitive ileostomy: A long-term single-centre experience

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx180.527 ◽

2018 ◽

Vol 12 (supplement_1) ◽

pp. S307-S307

Author(s):

M Calvo ◽

I Alonso ◽

K Villa ◽

V Matallana ◽

Y González Lama ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Recurrence ◽

Total Proctocolectomy ◽

Single Centre ◽

Factors Associated ◽

Single Centre Experience

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Sa1760 – Risk Factors for Post-Operative Crohn's Disease Recurrence. A Prospective Cohort Study

Gastroenterology ◽

10.1016/s0016-5085(19)37827-8 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-391

Author(s):

Giuseppina Vincoli ◽

Enrico Corazziari ◽

Patrizio Pezzotti ◽

Maurizio Giovannone ◽

Danilo Badiali ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Disease Recurrence

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The Occurrence of Postoperative Complications in Patients Undergoing Surgery due to Complications from Crohn's Disease: A Case Report

Acta Facultatis Medicae Naissensis ◽

10.2478/afmnai-2018-0008 ◽

2018 ◽

Vol 35 (1) ◽

pp. 73-80

Author(s):

Vladimir Joksimović ◽

Nikola Jankulovski ◽

Svetozar Antović ◽

Marija Joksimović ◽

Ljubinka Mančeva

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Surgical Treatment ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Resection Margins ◽

Chronic Inflammatory Condition ◽

Positive Resection Margins ◽

Low Levels ◽

Emergent Case

Summary Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can give rise to strictures, inflammatory masses, fistulas, abscesses, hemorrhage, and cancer. This disease commonly affects the small bowel, colon, rectum or anus. Less commonly, it affects the stomach, esophagus and mouth. Often, the disease affects multiple areas of the gastrointestinal tract. The cause of CD is not known and there is no curative treatment. The current medical and surgical treatment is effective in controlling the disease, but even with optimal treatment, recurrences and relapses are frequent. Various risk factors specific for the patients with conditions related to the CD can influence the outcome of the surgical treatment in the postoperative period. Those risk factors can be preoperative laboratory inflammatory markers such as WBC and CRP values, phlegmona of the anterior abdominal wall and preoperative interintestinal abscess, positive resection margins. Here we present a case of a patient who was surgically treated as an emergent case because of the complication due to Crohn's disease. At presentation, the patient had leukocytosis, elevated CRP, anemia, low levels of total proteins, and albumin.

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Montreal classification of patient operated for Crohn's disease and identification of surgical recurrence predictors

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015002006 ◽

2015 ◽

Vol 42 (2) ◽

pp. 97-104 ◽

Cited By ~ 5

Author(s):

Cristiane de Souza Bechara ◽

Antonio Lacerda Filho ◽

Maria de Lourdes Abreu Ferrari ◽

Déborah Almeida Roquette Andrade ◽

Magda Maria Profeta da Luz ◽

...

Keyword(s):

Crohn’S Disease ◽

Retrospective Study ◽

Surgical Treatment ◽

Crohn's Disease ◽

Median Time ◽

Disease Recurrence ◽

Surgical Recurrence ◽

Increased Risk

OBJECTIVE: to evaluate Crohn's disease recurrence and its possible predictors in patients undergoing surgical treatment. METHODS: We conducted a retrospective study with Crohn's disease (CD) patients undergoing surgical treatment between January 1992 and January 2012, and regularly monitored at the Bowel Clinic of the Hospital das Clínicas of the UFMG. RESULTS: we evaluated 125 patients, 50.4% female, with a mean age of 46.12 years, the majority (63.2%) diagnosed between 17 and 40 years of age. The ileum was involved in 58.4%, whereas stenotic behavior was observed in 44.8%, and penetrating, in 45.6%. We observed perianal disease in 26.4% of cases. The follow-up average was 152.40 months. Surgical relapse occurred in 29.6%, with a median time of 68 months from the first operation. CONCLUSION: The ileocolic location, penetrating behavior and perianal involvement (L3B3p) were associated with increased risk of surgical recurrence.

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Fecal Diversion in Perirectal Fistulizing Crohn's Disease is an Underutilized and Potentially Temporary Means of Successful Treatment

The American Surgeon ◽

10.1177/000313480907500814 ◽

2009 ◽

Vol 75 (8) ◽

pp. 715-718 ◽

Cited By ~ 15

Author(s):

Kellee L. Rehg ◽

Jaime E. Sanchez ◽

Beth R. Krieger ◽

Jorge E. Marcet

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Complete Resolution ◽

Disease Recurrence ◽

Fecal Diversion ◽

The Other ◽

Intestinal Continuity ◽

Disease Free ◽

Viable Treatment

The purpose of this study was to determine the outcome of patients treated with fecal diversion for perirectal fistulizing Crohn's disease. Thirty-nine patients were identified and followed for an average of 60 months. Patients were divided into two groups based on surgical treatment: local surgical treatment only and fecal diversion in addition to local surgical therapy. Thirteen patients (33%) underwent fecal diversion due to the severity of their disease. Eleven of these patients (85%) had complete resolution of their fistulas and only two (15%) required proctectomy. In contrast, only five out of 26 patients (19%) who underwent local surgical procedures alone had complete perirectal disease resolution. Intestinal continuity was restored in six patients (46%) and three of these patients (50%) remained disease free. The remaining three patients had disease recurrence, which required additional local procedures in one patient (17%), but with eventual resolution; the other two patients (33%) necessitated rediversion. Our data suggest that fecal diversion is a viable treatment option for severe perirectal fistulizing Crohn's disease and may be associated with a higher rate of resolution than local surgical treatment alone. In addition, we demonstrate a higher rate of successful intestinal continuity restoration than is typically reported.

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Tailored Medical Management of the Complex Postoperative Crohn's Disease Patient

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0039-1683853 ◽

2019 ◽

Vol 32 (04) ◽

pp. 225-230 ◽

Cited By ~ 1

Author(s):

Jean-Paul Achkar

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Residual Disease ◽

Disease Patient ◽

Intestinal Resection ◽

Disease Recurrence ◽

Recurrence Rates ◽

Patient Risk ◽

Necrosis Factor

AbstractDespite advancements in medical therapy, many patients with Crohn's disease continue to require surgery for intestinal resection and/or management of perianal disease at some point in their disease course. Unfortunately, in this complex group of patients, postoperative disease recurrence rates are high. Medical prophylaxis can be used to prevent Crohn's disease recurrence or manage residual disease after surgery, but the ideal timing to start medications after surgery varies based on patient risk factors and patient preference for medication use. Currently, the largest medical treatment effects are seen with thiopurines and antitumor necrosis factor antibodies, but there are continually expanding options as new medical therapies are developed. A proposed algorithm stratified based on patient risk factors is provided.

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