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Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure

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Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure

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Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure
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    Pediatric patients with Crohn's disease who failed anti-TNFα therapy can be re-treated with the same agent for postoperative recurrence.
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    • Overview

      Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure

      Assa A1Bronsky JKolho KLZarubova Kde Meij TLedder OSladek Mvan Biervliet SStrisciuglio CShamir R.

      BACKGROUND:

      The outcome of patients with Crohn's disease who failed anti-tumor necrosis factor alpha (anti-TNFα) therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNFα agent postoperatively.

      METHODS:

      Pediatric patients with Crohn's disease who underwent intestinal resection and were treated with anti-TNFα agents postoperatively were assessed retrospectively. Patients were stratified to those with preoperative anti-TNFα pharmacodynamic failure and those with no preoperative anti-TNFα treatment.

      RESULTS:

      A total of 53 children were included, 18 with pharmacodynamic failure and 35 controls. Median age at intestinal resection was 14.8 years with 23 (43%) girls. The median time from intestinal resection to anti-TNFα initiation was 8 months (interquartile range 4-14 months). At the time of postoperative anti-TNFα initiation, there were no differences in clinical, laboratory, and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNFα treatment after 12 months and at the end of follow-up (1.8 years, interquartile range, 1-2.9 years): 89% versus 88.5% and 83% versus 80% for pharmacodynamic failure patients and controls, respectively; P = 0.9. No significant differences were observed at 14 weeks and 12 months of postoperative anti-TNFα treatment including endoscopic remission rate and fecal calprotectin. Both groups significantly improved all measures during postoperative anti-TNFα treatment.

      CONCLUSIONS:

      Pediatric patients with Crohn's disease who failed anti-TNFα therapy despite adequate drug levels and underwent intestinal resection can be re-treated with the same agent for postoperative recurrence with a high success rate similar to that of anti-TNFα naive patients.

       

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