Infliximab may prevent Crohn's disease recurrence after surgery

Last Updated: 2009-02-09 13:20:46 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Treatment with infliximab may help prevent endoscopic and histologic recurrence of Crohn's disease following ileal resection, according to a report in the February issue of Gastroenterology.

The results provide "a rationale for aggressive postoperative chemoprevention with biologic therapy," lead author Dr. Miguel Regueiro, from the University of Pittsburgh Medical Center, said in a statement. "We are encouraged by our findings," he added, "which warrant future study of the duration of post-operative infliximab maintenance and appropriate endoscopic follow-up."

The study featured 24 patients who were randomized to receive infliximab (5 mg/kg IV) or placebo after ileal resection, starting within 4 weeks of surgery and continued for 1 year. The main endpoint was the proportion of patients with endoscopic recurrence at 1 year.

Just 1 of 11 patients (9.1%) in the infliximab group had endoscopic recurrence, compared with 11 of 13 patients (84.6%) in the control group, the authors found (p = 0.0006).

The histologic recurrence rate at 1 year was also lower in the infliximab group: 27.3% vs. 84.6% (p = 0.01). The clinical remission rate was non-significantly higher in the infliximab group: 80.0% vs. 53.8%.

Rates of adverse events did not differ between the study groups, the authors note.

"In our practice, we now consider patients with a high risk for postoperative recurrence of Crohn's disease, such as ileal penetrating disease and recurrent resective surgery, for postoperative infliximab prophylaxis," the investigators conclude.

Gastroenterology 2009;136:441-450.