A study published in the Journal of Crohn’s and Colitis found that 65% of patients with Crohn disease (CD) were adherent to treatment and that prophylactic medication use decreased risk for recurrence.
Patients (N=213) with CD undergoing ileocolonic resection (ICR) were enrolled at 14 sites between 2017 and 2021. A standard postoperative management algorithm was created, which stratified patients as low or high risk for postoperative recurrence. High risk was defined as the presence of active smoking, penetrating disease, and/or previous ICR. Patients who were found to be high risk received prophylactic immunomodulator and/or biological therapy. The primary endpoint was endoscopic recurrence at 6 months following ICR.
The patients had a median age of 34.5 (IQR, 25.8-51.1) years at ICR, 65.3% were women, BMI was 23.8 (IQR, 21.3-25.9) kg/m2, 76.1% had not undergone a previous resection, and the resected segment was 24 (IQR, 23-26) cm in length.
Patients were stratified into low (n=93) and high (n=120) risk for recurrence. Adherence rates to postoperative treatment were 81.7% among the low-risk cohort and 50.8% among the high-risk cohort.
At 6 months, 16.0% of the low-risk and 25.5% of the high-risk groups had a recurrence.
Risk for recurrence was associated with disease localization at ICR (odds ratio [OR], 3.39; 95% CI, 1.59-7.26; P =.002) and postoperative prophylactic medication (OR, 0.34; 95% CI, 0.16-0.72; P =.005).
Predictors for recurrence included clinical risk factors (area under the curve [AUC], 0.70), European Crohn’s and Colitis Organization risk factors and clinical risk factors (AUC, 0.71), transmural inflammation and clinical risk factors (AUC, 0.71), and Tandon score and clinical risk factors (AUC, 0.73).
This study may have been limited by the fact that the decision to prescribe medications to patients was left to the treating physician discretion.
The study authors concluded, “This study shows that prophylactic medication reduces the risk of endoscopic recurrence after ICR in both low-risk and high-risk patients with CD. Clinical risk stratification including the prescription of prophylaxis has an acceptable predictive value with a limited improvement after incorporation of histologic assessment. Further refinement of risk stratification is required for patients considered at low risk to optimize individualized treatment.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Arkenbosch JHC, Beelen EMJ, Dijkstra G, et al. Prophylactic medication for the prevention of endoscopic recurrence in Crohn’s disease: a prospective study based on clinical risk stratification. J Crohns Colitis. Published online September 12, 2022. doi:10.1093/ecco-jcc/jjac128