Early diagnosis and treatment of postoperative endoscopic recurrence of Crohn's disease: Partial benefit by infiximab - A pilot study

Abstract

Background Current data indicate that infiximab - given immediately after surgery - may be very effective in preventing postsurgical recurrence of Crohn's disease. However, it is unknown whether a similar benefit would result from early diagnosis and treatment, rather than prevention of endoscopic recurrence. Aims The primary outcome of this study was to clarify whether infiximab, given after diagnosis of postoperative endoscopic recurrence of Crohn's diseases (Rutgeerts score ≥ 2) can induce endoscopic remission (score >2) at 54 weeks. The secondary outcomes were improvement in the endoscopic score and clinical recurrence at 54 weeks. Methods In this prospective open label multicenter pilot study 43 patients with ileocolonic Crohn's disease subjected to curative surgery underwent colonoscopy 6 months after surgery. Patients with endoscopic recurrence (Rutgeerts score ≥ 2) were treated with either mesalamine 800 mg tid or infiximab 5 mg/kg bw on a maintenance basis. Colonoscopy was performed after 54 weeks of therapy. Results A total of 24/43 patients were diagnosed with endoscopic recurrence at 6 months. Thirteen were treated with infiximab and 11 with mesalamine. None of the 11 mesalamine-treated patients had endoscopic remission at 54 weeks. Two had clinical recurrence at 8 and 9 months. Fifty-four percent of patients treated with infiximab had endoscopic remission at 54 weeks (P = 0.01) while 69% had an improvement in the endoscopic score. None had clinical recurrence. Conclusions Treatment of postsurgical endoscopic lesions by infiximab appears superior to mesalamine. However, a sizeable proportion of patients did not fully benefit from this strategy. © 2012 Springer Science+Business Media, LLC.