Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/136151
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Conference item |
Title: | Strategic timing of anti-TNF therapy in postoperative Crohn's disease: Comparison of routine use immediately postoperatively with selective use after demonstrated recurrence at 6 month endoscopy. Results from POCER |
Author: | De Cruz, P. Kamm, M. Hamilton, A. Ritchie, K. Krejany, S. Gorelik, A. Liew, D. Prideaux, L. Lawrance, I. Andrews, J. Bampton, P. Sparrow, M. Florin, T. Gibson, P. Debinksi, H. Gearry, R. Macrae, F. Leong, R. Kronborg, I. Radford-Smith, G. et al. |
Citation: | Journal of Gastroenterology and Hepatology, 2013, vol.28, iss.Suppl. 2, pp.92-92 |
Publisher: | Wiley |
Issue Date: | 2013 |
ISSN: | 1440-1746 |
Conference Name: | Australian Gastroenterology Week (AGW) (7 Oct 2013 - 9 Oct 2013 : Melbourne, Australia) |
Statement of Responsibility: | P De Cruz ... J Andrews ... et al. |
Abstract: | Introduction: Recent data suggest that anti-TNF therapy prevents post-operative recurrence of Crohn’s disease. Routine postoperative use is costly and may lead to overtreatment; an alternative may be selective use for early endoscopic recurrence. These strategies have been compared with mucosal healing as the goal in this “treat to target” study. Methods: In the Post Operative Crohn’s Endoscopic Recurrence, “POCER” study, after resection patients were stratified for risk of recurrence as high (smoker, perforating disease,≥2nd operation) or low risk. All patients received 3 months metronidazole 400 mg bd. High risk patients also received daily azathioprine 2 mg/kg or 6 mercaptopurine 1.5 mg/kg, or adalimumab 40 mg fortnightly if thiopurine intolerant. Patients were randomised to endoscopy at 6 months or no endoscopy; endoscopic remission defined as Rutgeerts score i0 or i1 & recurrence as≥i2. For endoscopic recurrence at 6 months high risk patients on thiopurine stepped up to adalimumab 40 mg fortnightly, & high risk thiopurine-intolerant patients stepped up to weekly adalimumab. All patients were colonoscoped at 18months: the primary endpoint endoscopic recurrence. In this intent-to-treat sub-analysis we compared the 18 month outcomes of high risk patients in the endoscopy arm on immediate postoperative adalimumab to those initially on thiopurine who stepped-up to combined adalimumab+thiopurine for recurrence at 6 months. Results: Endoscopic recurrence at 18 months occurred in 12/28 (43%)patients on adalimumab immediately postoperatively compared to19/32 (59%) patients initially on thiopurine who stepped up to adalimumab+thiopurine at 6 months; P=0.20. Complete mucosal normality (i0) occurred in 9/28 (32%) v 7/32 (22%); P=0.37. Severe disease(i3 & i4) occurred in 3/28 (11%) v 3/32 (9%); P=NS. Conclusions: Recurrence did not differ significantly between immediate postoperative adalimumab & step-up adalimumab at 6 months for endoscopic recurrence, although the former tended to be more effective. There was minimal difference in rates of severe disease recurrence between the two strategies. Step-up with anti-TNF therapy based on endoscopic findings is a viable postoperative strategy in patients at high risk of recurrence. |
Rights: | © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd |
DOI: | 10.1111/jgh.12365_6 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.