© Springer International Publishing AG 2018 59
A.S. Cheifetz, J.D. Feuerstein (eds.), Treatment of Inflammatory
Bowel Disease with Biologics, https://doi.org/10.1007/978-3-319-60276-9_5
Chapter 5
Use of Biologics in the Postoperative
Management of Crohn’s Disease
Benjamin H. Click and Miguel Regueiro
Burden of Postoperative Recurrence
Prior to the routine use of immune-modifying therapies for Crohn’s disease (CD),
the majority of patients required surgery with clinical postoperative recurrence
(POR) rates as high as 30–60% [ 1 ]. Subsequent endoscopic evaluations demon-
strated that as many as 70–90% CD patients who underwent surgical resection
developed endoscopic disease within 1 year. Symptoms will recur in this 30–60% of
patients within 3–5 years [ 2 – 4 ]. With the advent and routine use of biologic agents
such as the antitumor necrosis factor (aTNF) agents, the need for surgical interven-
tion has been reduced, but not eliminated. Biologic era studies have shown the
cumulative risk of surgery at 1, 5, and 10 years from diagnosis is 16.3%, 33.3%, and
46.6% [ 5 ]. Furthermore, 50% of patients will require repeat surgery within 5 years
of first surgery. Thus, POR poses a significant threat to patient health and
well-being.
Clinically, POR is often silent. In one study of postoperative CD patients,
Rutgeerts et al. observed that 72% (21/29) had endoscopic recurrence within 1 year;
however, the majority of these patients had no clinical symptoms [ 6 ]. Additionally,
following 89 patients after resection, only 20% were symptomatic at 1 year and
34% at 3 years despite endoscopic disease in 73% and 85%, respectively [ 3 ]. In the
initial study of infliximab for prevention of POR, Regueiro et al. observed a low
kappa coefficient (0.12) between patient’s endoscopic score and their clinical
B.H. Click • M. Regueiro (*)
Division of Gastroenterology, Hepatology and Nutrition, UPMC Presbyterian Hospital,
Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA
e-mail: [email protected]; [email protected]