Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure

Amit Assa, Jiri Bronsky, Kaija-Leena Kolho, Kristyna Zarubova, Tim de Meij, Oren Ledder, Margaret Sladek, Stephanie van Biervliet, Caterina Strisciuglio, Raanan Shamir

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BACKGROUND: The outcome of patients with Crohn's disease who failed anti-tumor necrosis factor alpha (anti-TNFα) therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNFα agent postoperatively.

METHODS: Pediatric patients with Crohn's disease who underwent intestinal resection and were treated with anti-TNFα agents postoperatively were assessed retrospectively. Patients were stratified to those with preoperative anti-TNFα pharmacodynamic failure and those with no preoperative anti-TNFα treatment.

RESULTS: A total of 53 children were included, 18 with pharmacodynamic failure and 35 controls. Median age at intestinal resection was 14.8 years with 23 (43%) girls. The median time from intestinal resection to anti-TNFα initiation was 8 months (interquartile range 4-14 months). At the time of postoperative anti-TNFα initiation there were no differences in clinical, laboratory, and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNFα treatment after 12 months and at the end of follow-up (1.8 years, interquartile range, 1-2.9 years): 89% versus 88.5% and 83% versus 80% for pharmacodynamic failure patients and controls, respectively; P = 0.9. No significant differences were observed at 14 weeks and 12 months of postoperative anti-TNFα treatment including endoscopic remission rate and fecal calprotectin. Both groups significantly improved all measures during postoperative anti-TNFα treatment.

CONCLUSIONS: Pediatric patients with Crohn's disease who failed anti-TNFα therapy despite adequate drug levels and underwent intestinal resection can be re-treated with the same agent for postoperative recurrence with high success rate similar to that of anti-TNFα naive patients.

Original languageEnglish
Pages (from-to)791-797
Number of pages7
JournalInflammatory Bowel Diseases
Issue number5
Publication statusPublished - May 2017


  • Adolescent
  • Colectomy
  • Combined Modality Therapy
  • Crohn Disease
  • Female
  • Gastrointestinal Agents
  • Humans
  • Journal Article
  • Male
  • Postoperative Period
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha

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