Quantifying the Rate of Recurrence of Post-Operative Crohn's Disease with Biological Therapy. A Meta-Analysis.

Jain, Sneha Rajiv; Ow, Zachariah Gene Wing; Chin, Yip Han; Lim, Wen Hui; Kong, Gwyneth; Tham, Hui Yu; Wong, Neng Wei; Chong, Choon Seng; Foo, Fung Joon; Chan, Webber Pak Wo

BACKGROUND Prevention of post-operative recurrence of Crohn's disease poses a significant challenge to clinicians. With the advent of biologics, reduction of recurrence after surgery has been observed in various studies. Hence, we performed a systematic review and meta-analysis to identify the rate of post-operative recurrence at different timepoints in the era of anti-TNF-α therapy biologics use. METHODS We performed a literature search using Medline and Embase databases for studies investigating biologics in preventing post-operative recurrence of Crohn's disease. Data were extracted, and a single arm meta-analysis with generalized linear mixed model and Clopper-Pearson method for confidence interval was performed to identify the endoscopic, clinical, and surgical recurrence rates at six-months, one-, two- and five-years post-operatively. RESULTS 24 articles were included in the meta-analysis. The endoscopic, clinical, and surgical postoperative recurrence rate with the use of anti-TNF-α agents at one-year was 21.72% (95%CI: 16.28% - 28.37%), 13.06% (95%CI: 8.18% - 18.92%) and 3.76% (95%CI: 1.37% - 9.91%) respectively. The five-year recurrence rate was 84.21% (95%CI: 72.35% - 91.57%) and 17.49% (95%CI: 9.17% - 30.80%) for endoscopic and surgical recurrence respectively. Subgroup analysis at one-year for type of anti-TNF-α agent or timing of initiation after surgery showed no significant difference in endoscopic, clinical and surgical recurrence rate. CONCLUSION Anti-TNF-α agents are effective at preventing clinical, endoscopic, and surgical postoperative Crohn's disease recurrence. The timing of initiating biological therapy after surgery has no significant effect on the rate of postoperative recurrence. The efficacy of infliximab and adalimumab for postoperative recurrence prevention is similar.