Combination therapy of thiopurines and anti–tumor necrosis factor alpha (TNF-α) antibodies is the most effective medical treatment of Crohn's disease (CD). Data on thiopurines and anti-TNF-α antibodies in preventing surgical recurrence (need for re-resection) of CD are scarce. Therefore, we analyzed which factors were involved in surgical recurrence of CD in a large cohort of patients with CD operated in a regional and a university hospital.
This is a retrospective cohort study of 567 patients who underwent surgery for CD. Clinical data and risk factors for surgical recurrence were analyzed, focusing on medical therapy and hospital type.
Overall, 237 (41.8%) patients developed a surgical recurrence, after a median of 70 (2–482) months. Before surgical recurrence, 235 patients (41.4%) and 116 patients (20.5%) used thiopurines and anti-TNF-α antibodies, respectively. Multivariate analysis identified 3 independent risk factors associated with surgical recurrence of CD. A higher risk was seen in patients with colonic disease compared with patients with ileal disease (hazard ratio, 1.56; 95% confidence interval, 1.10–2.21; P = 0.012) and in patients using multiple types of medication (hazard ratio, 1.38; 95% confidence interval, 1.25–1.54; P < 0.001). However, a lower risk was seen in patients using thiopurines (hazard ratio, 0.51; 95% confidence interval, 0.34–0.77; P = 0.001).
Thiopurines are effective in preventing surgical recurrence of CD. The role of anti-TNF-α antibodies seems promising as well. Combination therapy of thiopurines and anti-TNF-α antibodies for prevention of surgical recurrence of CD should be studied in a randomized trial.
Article first published online 1 November 2013
*Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands;
†Department of Surgery, Scheper Ziekenhuis, Emmen, the Netherlands;
‡Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands;
§Wenckebach Institute, Post Graduate School of Medicine, University Medical Center Groningen, Groningen, the Netherlands;
Departments of ‖Surgery, and
¶Gastroenterology, Medical Center Leeuwarden, Leeuwarden, the Netherlands; and
**Department of Surgery, Isala Klinieken, Zwolle, the Netherlands.
Reprints: Ellen S. van Loo, MD, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, PO BOX 30.001, Groningen 9700 RB, the Netherlands (e-mail: email@example.com).
The authors have no conflicts of interest to disclose.
G. Dijkstra and V. B. Nieuwenhuijs contributed equally to this study.
Received September 17, 2013
Accepted September 17, 2013