Prophylactic Versus Endoscopy-driven Treatment of Crohn's Postoperative Recurrence: A Retrospective, Multicentric, European Study [PORCSE Study].
J Crohns Colitis
; 18(8): 1202-1214, 2024 Aug 14.
Article
de En
| MEDLINE
| ID: mdl-38243807
ABSTRACT
BACKGROUND AND AIMS:
No consensus exists on optimal strategy to prevent postoperative recurrence [POR] after ileocaecal resection [ICR] for Crohn's disease [CD]. We compared early medical prophylaxis versus expectant management with treatment driven by findings at elective endoscopy 6-12 months after ICR.METHODS:
A retrospective, multicentric, observational study was performed. CD patients undergoing first ICR were assigned to Cohort 1 if a biologic or immunomodulator was [re]started prophylactically after ICR, or to Cohort 2 if no postoperative prophylaxis was given and treatment was started as reaction to elective endoscopic findings. Primary endpoint was rate of endoscopic POR [Rutgeerts >i1]. Secondary endpoints were severe endoscopic POR [Rutgeerts i3/i4], clinical POR, surgical POR, and treatment burden during follow-up.RESULTS:
Of 346 included patients, 47.4% received prophylactic postoperative treatment [proactive/Cohort 1] and 52.6% did not [reactive/Cohort 2]. Endoscopic POR [Rutgeertsâ >i1] rate was significantly higher in Cohort 2 [41.5% vs 53.8%, OR 1.81, pâ =â 0.039] at endoscopy 6-12 months after surgery. No significant difference in severe endoscopic POR was found [OR 1.29, pâ =â 0.517]. Cohort 2 had significantly higher clinical POR rates [17.7% vs 35.7%, OR 3.05, pâ =â 0.002] and numerically higher surgical recurrence rates [6.7% vs 13.2%, OR 2.59, pâ =â 0.051]. Cox proportional hazards regression analysis showed no significant difference in time to surgical POR of proactive versus expectant/reactive approach [HR 2.50, pâ =â 0.057]. Quasi-Poisson regression revealed a significantly lower treatment burden for immunomodulator use in Cohort 2 [mean ratio 0.53, pâ =â 0.002], but no difference in burden of biologics or combination treatment.CONCLUSIONS:
The PORCSE study showed lower rates of endoscopic POR with early postoperative medical treatment compared with expectant management after first ileocaecal resection for Crohn's disease.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Maladie de Crohn
/
Prévention secondaire
Type d'étude:
Clinical_trials
/
Observational_studies
Limites:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Pays/Région comme sujet:
Europa
Langue:
En
Journal:
J Crohns Colitis
/
J. crohns. colitis
/
Journal of Crohn's and colitis (Online)
Sujet du journal:
GASTROENTEROLOGIA
Année:
2024
Type de document:
Article
Pays d'affiliation:
Belgique
Pays de publication:
Royaume-Uni