Anti-TNF Best at Preventing Postsurgery Relapse in Crohns Postoperative prophylaxis with anti–tumor necrosis factor-α (anti-TNF) monotherapy appears to be the most effective option after surgical resection for Crohns disease (CD). This conclusion is based on moderate- to high-quality evidence from a systemic review, published online September 2014 and in the January 2015 issue of Gastroenterology. 21 trials comparing seven treatment strategies used for 2006 participants were identified of which three randomized control trials compared anti-TNF monotherapy with placebo or other active agents, such as an immunomodulator or mesalamine. Choosing the Best Treatment: Many patients with CD experience endoscopic and clinical relapse after surgical resection. Recurrence is an important problem, and patients are frequently prescribed medical therapy to minimize the risk. Both mesalamine and immunomodulator monotherapy have been shown in randomized clinical trials to prevent relapse after surgically induced remission for CD. The current meta-analysis indicates that immunosuppressive agents, biologic agents, antibiotics, and, to a lesser extent, aminosalicylates decrease the risk for recurrence. In contrast, use of the corticosteroid budesonide was not associated with a reduction of CD recurrence. Biologic agents were the most effective at reducing the risk for disease recurrence. The authors suggest that patients at - high risk for postoperative occurrence be considered for biologic agents, - moderate risk for disease recurrence may be best suited for antibiotics or immunosuppressive medications - low risk for recurrence may find aminosalicylates to be sufficient.
Posted on: Mon, 12 Jan 2015 08:35:41 +0000