Abstract
Background
Anti-TNF agents are the only effective biological agents for the prevention of postoperative
recurrence (POR) in Crohn's disease (CD). However, they are contraindicated or have
been shown to fail in some patients. Although ustekinumab and vedolizumab were licensed
for CD some years ago, data in this setting are scarce.
Methods
All CD patients in whom ustekinumab or vedolizumab was prescribed for the prevention
of POR within three months of ileocolonic resection with anastomosis were identified
from the ENEIDA registry. The development of endoscopic, clinical and surgical POR
was registered.
Results
Forty patients were treated for the prevention of POR with ustekinumab and 25 were
treated with vedolizumab. Eighty per cent had at least one risk factor for POR (prior
resections, active smoking, perianal disease or penetrating disease behaviour). All
the patients had been exposed to anti-TNF therapy. After a median follow-up of 17
and 26 months, the cumulative probability of clinical POR at 12 months after surgery
was 32% and 30% for ustekinumab and vedolizumab, respectively. Endoscopic assessment
within the first 18 months after surgery was available for 80% of the patients on
ustekinumab and 70% for those on vedolizumab. The rate of endoscopic POR was 42% for
ustekinumab and 40% for vedolizumab. One patient treated with ustekinumab and two
with vedolizumab underwent a new intestinal resection.
Conclusions
Ustekinumab and vedolizumab seem to be effective in the prevention of POR in patients
at high risk. Our results warrant controlled trials comparing these drugs with conventional
therapies.
Keywords
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Article info
Publication history
Published online: August 07, 2022
Accepted:
July 19,
2022
Received:
April 6,
2022
Editor: Roberto de FranchisIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
