Patients receiving adalimumab after intestinal resection demonstrated a significantly lower likelihood of endoscopic and clinical recurrence of Crohn’s disease, according to recent study results.
“Our study provides strong evidence that ADA [adalimumab] is much more effective than the traditional medications (AZA [azathioprine] or mesalamine) in preventing endoscopic and clinical postoperative recurrence of CD [Crohn’s disease] and provides a rationale for aggressive postoperative chemoprevention with biologic therapy,” the researchers concluded.
The prospective, three-armed, controlled study randomly assigned 51 CD patients who had undergone ileocolonic resection to begin one of three treatments after surgery for 2 years. Group 1 received 160 mg ADA at baseline, 80 mg at 2 weeks and then 40 mg every 2 weeks; group 2 received 2 mg/kg AZA daily; and group 3 received 3 g mesalamine daily.
After 2 years of follow-up, endoscopic recurrence — which predicts the likelihood of complications and the potential need for reoperation — was seen at a significantly lower rate in the ADA group (6.3%) than with the AZA (64.7%; OR=0.036; 95% CI, 0.004-0.347) or mesalamine groups (83.3%; OR=0.013; 95% CI, 0.001-0.143).
Clinical recurrence in group 1 was 12.5% vs. 64.7% in group 2 (OR=0.078; 95% CI, 0.013-0.464) and 50% in group 3 (OR=0.143; 95% CI, 0.025-0.819).
Quality of life as measured by an IBD evaluation also was higher in the ADA group (202) than in the AZA (90; OR=0.028; 95% CI, 0.004-0.196) or mesalamine groups (98; OR=0.015; 95% CI, 0.002-0.134).
“To our knowledge, this is the first randomized controlled trial in which ADA has been successfully used to prevent postoperative CD recurrence, an event considered almost mandatory in the natural history of this disorder,” the researchers concluded.