title: Comparable outcomes of the consistent use versus switched use of anti- tumor necrosis factor agents in postoperative recurrent Crohn's disease following ileocolonic resection.
abstract: OBJECTIVE
  There are no published data or guidelines on whether the same anti-tumor-necrosis factor (TNF) agents used preoperatively or different anti-TNF agents are preferable to treat postoperative recurrence. Our aim was to compare the efficacy of the consistent vs. switched anti-TNF approaches in patients with recurrent Crohn's disease (CD) after their inception ileocolonic resection (ICR).
  
  
  METHODS
  Patients with CD receiving anti-TNF agents before the inception ICR who were treated for clinical recurrence with the same or different anti-TNF agents after surgical resection were included in the study. The outcome of the study was the need for the subsequent resection of ileocolonic anastomosis (ICA) as calculated with survival curves.
  
  
  RESULTS
  Eighty-five patients were included in the study. The mean age of the whole cohort at the inception ICR was 35.1 ± 13.5 years. The whole cohort consisted 42 (49.4 %) in the consistent group and 43 (50.6 %) in the switched group. No significant differences were observed in demographic and clinical variables between the two groups. During the median follow-up of 1.5 (interquartile range, 0.8-3.1) years, seven (16.7 %) patients in the consistent group and eight (18.6 %) in the switched group required the repeat resection of ICA. Similar results were found in terms of the subsequent resection of ICA-free survival (hazard ratio = 1.36, 95 % confidence interval 0.49-3.76, P = 0.54) between the consistent and switched groups.
  
  
  CONCLUSIONS
  The adherence to the same anti-TNF agent appeared to be as effective as the switching approach to different anti-TNF agent in treating postoperative recurrent CD after the inception ICR.
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Luca
authors.initials: L
authors.lastname: Stocchi
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Yuanyi
authors.initials: Y
authors.lastname: Rui
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.affiliation: Department of Gastroenterology/Hepatology, Desk A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. shenb@ccf.org.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D011184:Postoperative Period; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF; Crohn’s disease; Ileocolonic resection; Recurrence; Surgery