TY - JOUR
T1 - Prophylactic Medication for the Prevention of Endoscopic Recurrence in Crohn's Disease
T2 - a Prospective Study Based on Clinical Risk Stratification
AU - Arkenbosch, Jeanine H. C.
AU - Beelen, Evelien M. J.
AU - Dijkstra, Gerard
AU - Romberg-Camps, Mariëlle
AU - Duijvestein, Marjolijn
AU - Hoentjen, Frank
AU - van der Marel, Sander
AU - Maljaars, P. W. Jeroen
AU - Jansen, Sita
AU - de Boer, Nanne K. H.
AU - West, Rachel L.
AU - Horjus, Carmen S.
AU - Stassen, Laurents P. S.
AU - van Schaik, Fiona D. M.
AU - van Ruler, Oddeke
AU - Jharap, Bindia J. H.
AU - Visschedijk, Marijn
AU - Janssen, Alfred
AU - Erler, Nicole S.
AU - Doukas, Michail
AU - Ooms, Ariadne H. A. G.
AU - Kats-Ugurlu, Gursah
AU - van der Woude, Christien Janneke
AU - de Vries, Annemarie C.
N1 - Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of European Crohn's and Colitis Organisation.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - BACKGROUND: To prevent recurrence after ileocolonic resection [ICR] in Crohn's disease [CD], postoperative prophylaxis based on risk stratification is recommended in international guidelines. This study aimed to evaluate postoperative CD recurrence after implementation of a clinical management algorithm and to determine the predictive value of clinical and histological risk factors [RFs]. METHODS: In this multicentre, prospective cohort study, CD patients [≥16 years] scheduled for ICR were included. The algorithm advised no postoperative medication for low-risk patients, and treatment with prophylaxis [immunosuppressant/biological] for high-risk patients [≥1 RF: active smoking, penetrating disease, prior ICR]. Clinical and histological RFs [active inflammation, granulomas, plexitis in resection margins] for endoscopic recurrence [Rutgeerts' score ≥i2b at 6 months] were assessed using logistic regression and ROC curves based on predicted probabilities. RESULTS: In total, 213 CD patients after ICR were included [age 34.5 years; 65% women] (93 [44%] low-risk; 120 [56%] high-risk: 45 [38%] smoking; 51 [43%] penetrating disease; 51 [43%] prior ICR). Adherence to the algorithm was 82% in low-risk [no prophylaxis] and 51% in high-risk patients [prophylaxis]. Endoscopic recurrence was higher in patients treated without prophylaxis than with prophylaxis in both low [45% vs 16%, p = 0.012] and high-risk patients [49% vs 26%, p = 0.019]. Clinical risk stratification including the prescription of prophylaxis corresponded to an area under the curve [AUC] of 0.70 (95% confidence interval [CI] 0.61-0.79). Clinical RFs combined with histological RFs increased the AUC to 0.73 [95% CI 0.64-0.81]. CONCLUSION: Adherence to this management algorithm is 65%. Prophylactic medication after ICR prevents endoscopic recurrence in low- and high-risk patients. Clinical risk stratification has an acceptable predictive value, but further refinement is needed.
AB - BACKGROUND: To prevent recurrence after ileocolonic resection [ICR] in Crohn's disease [CD], postoperative prophylaxis based on risk stratification is recommended in international guidelines. This study aimed to evaluate postoperative CD recurrence after implementation of a clinical management algorithm and to determine the predictive value of clinical and histological risk factors [RFs]. METHODS: In this multicentre, prospective cohort study, CD patients [≥16 years] scheduled for ICR were included. The algorithm advised no postoperative medication for low-risk patients, and treatment with prophylaxis [immunosuppressant/biological] for high-risk patients [≥1 RF: active smoking, penetrating disease, prior ICR]. Clinical and histological RFs [active inflammation, granulomas, plexitis in resection margins] for endoscopic recurrence [Rutgeerts' score ≥i2b at 6 months] were assessed using logistic regression and ROC curves based on predicted probabilities. RESULTS: In total, 213 CD patients after ICR were included [age 34.5 years; 65% women] (93 [44%] low-risk; 120 [56%] high-risk: 45 [38%] smoking; 51 [43%] penetrating disease; 51 [43%] prior ICR). Adherence to the algorithm was 82% in low-risk [no prophylaxis] and 51% in high-risk patients [prophylaxis]. Endoscopic recurrence was higher in patients treated without prophylaxis than with prophylaxis in both low [45% vs 16%, p = 0.012] and high-risk patients [49% vs 26%, p = 0.019]. Clinical risk stratification including the prescription of prophylaxis corresponded to an area under the curve [AUC] of 0.70 (95% confidence interval [CI] 0.61-0.79). Clinical RFs combined with histological RFs increased the AUC to 0.73 [95% CI 0.64-0.81]. CONCLUSION: Adherence to this management algorithm is 65%. Prophylactic medication after ICR prevents endoscopic recurrence in low- and high-risk patients. Clinical risk stratification has an acceptable predictive value, but further refinement is needed.
KW - Crohn's disease
KW - Ileocecal resection
KW - postoperative recurrence
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85150665772&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36094558
UR - http://www.scopus.com/inward/record.url?scp=85150665772&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ecco-jcc/jjac128
DO - https://doi.org/10.1093/ecco-jcc/jjac128
M3 - Article
C2 - 36094558
SN - 1873-9946
VL - 17
SP - 221
EP - 230
JO - Journal of Crohn's & Colitis
JF - Journal of Crohn's & Colitis
IS - 2
ER -