Ustekinumab and vedolizumab for the prevention of postoperative recurrence of Crohn's disease: Results from the ENEIDA registry.

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.

• Authors: Míriam Mañosa, Agnès Fernández-Clotet, Pilar Nos, María Dolores Martín-Arranz, Noemí Manceñido, Ana Carbajo, Esther Hinojosa, Alejandro Hernández-Camba, Roser Muñoz-Pérez, Maia Boscá-Watts, Marta Calvo, Mónica Sierra-Ausín, Eugenia Sánchez-Rodríguez, Manuel Barreiro-de Acosta, Alejandro Núñez-Alonso, Yamile Zabana, Lucía Márquez, Javier P Gisbert, Jordi Guardiola, Empar Sáinz, Pedro Delgado-Guillena, David Busquets, Manuel van Domselaar, Eva Girona, Rufo Lorente, Diego Casas-Deza, José M Huguet, Sergio Maestro, M José Cabello, Jesús Castro, Marisa Iborra, Fiorella Cañete, Margalida Calafat, Eugeni Domènech, ENEIDA registry by GETECCU
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 55 Issue 1 Pg. 46-52 (01 2023) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 35948459 (Publication Type: Journal Article)
• Copyright: Copyright © 2022. Published by Elsevier Ltd.

Chemical References

• Ustekinumab
• vedolizumab
• Tumor Necrosis Factor Inhibitors

Topics

• Humans
• Ustekinumab (therapeutic use)
• Crohn Disease (drug therapy, prevention & control, surgery)
• Tumor Necrosis Factor Inhibitors (therapeutic use)
• Registries
• Retrospective Studies
• Treatment Outcome