Most people with Crohn’s disease receive surgery, yet the disease comes back a short time later. A study in the July issue of Clinical Gastroenterology and Hepatology reports that giving patients low doses of infliximab immediately after surgery prevents disease recurrence over long time periods.
Dario Sorrentino et al. began giving 12 patients with Crohn’s disease 5 mg/Kg infliximab (an inhibitor of tumor necrosis factor (TNF)-a within 2 weeks after surgery—they found no clinical or endoscopic evidence of disease recurrence after 3 years of treatment. However, when therapy with infliximab was discontinued, the disease recurred in 10 patients within 4 months. Sorrentino et al. then gave these patients 3 mg/Kg infliximab every 8 weeks and their symptoms disappeared again for an entire year (1 or 2 mg/Kg were not effective).
So should all patients who undergo surgery for Crohn’s disease immediately receive infliximab? The disease does not recur in 20%–30% of patients after surgery and infliximab increases risks for infections and lymphoma. This study did not include a placebo group, so it is not clear how many of the patients would have remained disease free without the drug. Nonetheless, 7 of the patients in this study were considered to be at high risk of relapsing—3 had previous surgeries and 4 had penetrating disease. Better markers are needed to identify patients at greatest risk for Crohn’s recurrence; Sorrentino et al. observed that levels of fecal calprotectin correlated with mucosal healing.
There might be simpler, less expensive alternatives to anti-TNF therapy to reduce post-operative recurrence. 5-ASA, metronidazole, azathioprine, and ornidazole have shown different levels of efficacy against Crohn’s disease. Different dosing schedules than those tested in this study might also be more safe and effective for long-term maintenance of recovery. Additional clinical trials are required to determine the best way to prevent recurrence of this autoimmune disorder.
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Sorrentino D, Paviotti A, Terrosu G, et al. Low-dose maintenance therapy with infliximab prevents postsurgical recurrence of Crohn’s disease. Clin Gastroenterol and Hepatol 2010; 8: 591–599.
Watch Dr. Sorrentino discuss this study in his video abstract.
Read the article online at CGH.
Read the accompanying free editorial.
Bernstein CN. Anti–tumor necrosis factor therapy in Crohn’s disease: more information and more questions about the long term. Clin Gastroenterol and Hepatol 2010; 8:556–558.