title: Previous Exposure to Multiple Anti-TNF Is Associated with Decreased Efficiency in Preventing Postoperative Crohn's Disease Recurrence.
abstract: OBJECTIVE
  Infliximab and adalimumab are increasingly used to prevent postoperative recurrence in Crohn's disease patients. The impact of previous exposure to one or more anti-tumour necrosis factor [TNF] agents before surgery on the efficacy of anti-TNF therapy on postoperative recurrence is unknown.
  
  
  METHODS
  We performed a retrospective analysis of Crohn's disease patients who underwent surgical bowel resection with anastomosis and prophylactic treatment with anti-TNF therapy between January 2005 and June 2013.
  
  
  RESULTS
  A total of 57 consecutive Crohn's disease patients with bowel resection and anastomosis followed by prophylactic treatment with anti-TNF were included; 21 [37%] and 24 [42%] patients had a previous exposure to one and more than one anti-TNF agents, respectively; 39 patients [68%] had a surveillance colonoscopy. Cumulative rates of postoperative endoscopic recurrence at 2 years were 45.5% [26.6-69.6%] in patients exposed to two or more anti-TNFα as compared with 29.1% [11.5-48.1%] in patients exposed to one or to zero anti-TNFα before surgery [p = 0.07]. Cumulative rates of clinical recurrence at 1 year were 21.6% [9.6-44.4%] in patients exposed to two or more anti-TNFα as compared with 6.9% [1.8-25.1%] in patients exposed to zero or one anti-TNFα before surgery [p = 0.02]. Multivariable analysis identified smoking and previous exposure to two or more anti-TNFα as risk factors for Crohn's disease clinical or endoscopic postoperative recurrence (hazard ratio [HR] = 3.17; 95% confidence interval [CI]: 1.3-7.8, p = 0.01 and HR = 4.2; 95% CI: 1.8-10.2, p = 0.001, respectively).
  
  
  CONCLUSIONS
  Previous exposure to two or more anti-TNF agents was associated with a higher risk of postoperative recurrence in Crohn's disease patients.
authors: Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.|Gastroenterology Department, Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France.
authors: Michael
authors: M
authors: Collins
authors: Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France.
authors: Hélène
authors: H
authors: Sarter
authors: Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France.
authors: Corinne
authors: C
authors: Gower-Rousseau
authors: Colorectal Surgery Department, Lille University Hospital, Lille, France.
authors: Dine
authors: D
authors: Koriche
authors: Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.
authors: Louise
authors: L
authors: Libier
authors: Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.
authors: Maria
authors: M
authors: Nachury
authors: Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.
authors: Antoine
authors: A
authors: Cortot
authors: Colorectal Surgery Department, Lille University Hospital, Lille, France.
authors: Philippe
authors: P
authors: Zerbib
authors: Gastroenterology and Hepatology Department, Montpellier University Hospital, Montpellier, France.
authors: Pierre
authors: P
authors: Blanc
authors: Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.|Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France.
authors: Pierre
authors: P
authors: Desreumaux
authors: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Jean-Frédéric
authors: JF
authors: Colombel
authors: Gastroenterology Department, Nancy University Hospital, Lorraine University, Vandoeuvre, France.
authors: Laurent
authors: L
authors: Peyrin-Biroulet
authors: Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.|Gastroenterology and Hepatology Department, Montpellier University Hospital, Montpellier, France.
authors: Guillaume
authors: G
authors: Pineton de Chambrun
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D003113:Colonoscopy; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D011184:Postoperative Period; D057234:Preoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012907:Smoking / Q000009:adverse effects; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn’s disease; anti-TNFα; postoperative recurrence