P-116 Infliximab and Adalimumab are Equally Effective in Prevention of Postoperative Endoscopic Recurrence in Crohnʼs Disease

Abstract

BACKGROUND: Anti-TNF therapy plays an important role in prevention of endoscopic recurrence in Crohn's disease (CD) patients submitted to surgical resections. Prospective studies had demonstrated the significant efficacy of this agents as compared to conventional treatment with thiopurines and 5-ASA. There is lack of data comparing directly the efficacy of Infliximab (IFX) and Adalimumab (ADA) in this setting. The aim of this study was to compare the rates of endoscopic recurrence after ileocolectomies for CD between patients that were treated with IFX and ADA. METHODS: Multicenter retrospective observational study, with CD patients that were submitted to ileocecal resections, were treated with anti-TNF therapy after the procedures and had endoscopic follow-up to analyze recurrence. Studied variables: demographic data, Montreal classification, surgical characteristics, pre and postoperative medication and recurrence according to the Rutgeerts score. Endoscopic recurrence was defined as Rutgeerts score i2 to i-4. Patients were classified in (Graph presented) 2 groups according to the type of anti-TNF used (IFX or ADA). Endoscopic recurrence rates on the first postoperative colonoscopy were analyzed and compared between the groups. Statistical analysis: student t test or Mann-Whitney analysis were used for quantitative variables and Fischer test was used for qualitative variables, with P < 0.05 considered significant. RESULTS: From an initial cohort of 85 patients, from 4 referral centres, 56 patients with anti-TNF therapy after the ileocecal resections were included, 28 on IFX and 28 on ADA group. The groups were completely homogeneous in all variables analyzed, including demographic data, Montreal Classification, CD duration at surgery, pre and postoperative medication and all surgical aspects. Median time for the first colonoscopy after the operations was 12.8 months (3-120). Endoscopic recurrence was detected in 9/28 patients on the IFX group (32,14%) and 8/28 patients on the ADA group (28,57%), with P = 1.000. CONCLUSIONS: There was no significant difference between the type of anti-TNF agent used after ileocecal resection for CD in terms of endoscopic recurrence. IFA and ADA seem to be equally effective in this setting. Prospective randomized headto- head trials are still needed to better define the role of each agent in the postoperative prevention of recurrence.