title: Adalimumab in prevention of postoperative recurrence of Crohn's disease in high-risk patients.
abstract: OBJECTIVE
  To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn's disease in high-risk patients.
  
  
  METHODS
  A multicenter, prospective, observational study was conducted from June 2009 until June 2010. We consecutively included high-risk Crohn's disease patients who had undergone an ileal/ileocolonic resection. High-risk patients were defined as two or more criteria: smokers, penetrating pattern, one or more previous surgical resections or prior extensive resection. Subcutaneous adalimumab was administered 2 wk (± 5 d) after surgery at a dose of 40 mg eow, with an initial induction dose of 160/80 mg at weeks 0 and 2. Demographic data, previous and concomitant treatments (antibiotics, 5-aminosalicylates, corticosteroids, immunomodulators or biologic therapies), smoking status at the time of diagnosis and after the index operation and number of previous resections (type and reason for surgery) were all recorded. Biological status was assessed with C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin. One year (± 3 mo) after surgery, an ileocolonoscopy and/or magnetic resonance enterography was performed. Endoscopic recurrence was defined as Rutgeerts score ≥ i2. Morphological recurrence was based on magnetic resonance (MR) score ≥ MR1.
  
  
  RESULTS
  Twenty-nine patients (55.2% males, 48.3% smokers at diagnosis and 13.8% after the index operation), mean age 42.3 years and mean duration of the disease 13.8 years were included in the study. A mean of 1.76 (range: 1-4) resections previous to adalimumab administration and in 37.9% was considered extensive resection. 51.7% had previously received infliximab. Immunomodulators were given concomitantly to 17.2% of patients. Four of the 29 (13.7%) developed clinical recurrence, 6/29 (20.7%) endoscopic recurrence and 7/19 (36.8%) morphological recurrence after 1-year. All patients with clinical recurrence showed endoscopic and morphological recurrence. A high degree of concordance was found between clinical-endoscopic recurrence (κ = 0.76, P < 0.001) and clinical-morphological recurrence (κ = 0.63, P = 0.003). Correlation between endoscopic and radiological findings was good (comparing the 5-point Rutgeerts score with the 4-point MR score, a score of i4 was classified as MR3, i3 as MR2, and i2-i1 as MR1) (P < 0.001, r(s) = 0.825). During follow-up, five (17.2%) patients needed adalimumab dose intensification (40 mg/wk); Mean time to intensification after the introduction of adalimumab treatment was 8 mo (range: 5 to 11 mo). In three cases (10.3%), a biological change was needed due to a worsening of the disease after the dose intensification to 40 mg/wk. One patient suffered an adverse event.
  
  
  CONCLUSIONS
  Adalimumab seems to be effective and safe in preventing postoperative recurrence in a selected group of patients who had undergone an intestinal resection for their CD.
authors.affiliation: Department of Digestive Disease, Networked Biomedical Research Center for Hepatic and Digestive Diseases, La Fe University and Politechnic Hospital, 46026 Valencia, Spain. aguas_mar@gva.es
authors.forename: Mariam
authors.initials: M
authors.lastname: Aguas
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bastida
authors.forename: Elena
authors.initials: E
authors.lastname: Cerrillo
authors.forename: Belén
authors.initials: B
authors.lastname: Beltrán
authors.forename: Marisa
authors.initials: M
authors.lastname: Iborra
authors.forename: Cristina
authors.initials: C
authors.lastname: Sánchez-Montes
authors.forename: Fernando
authors.initials: F
authors.lastname: Muñoz
authors.forename: Jesús
authors.initials: J
authors.lastname: Barrio
authors.forename: Sabino
authors.initials: S
authors.lastname: Riestra
authors.forename: Pilar
authors.initials: P
authors.lastname: Nos
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D003106:Colon / Q000601:surgery; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis / Q000517:prevention & control* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab