Are the New Biologics Effective in the Management of Postoperative Crohn’s Disease?

Author:

Mourad Fadi H1ORCID,Maalouf Rami G1,Aoun Roni1,Gustavo Kotze Paulo2,Hashash Jana G13ORCID

Affiliation:

1. Division of Gastroenterology and Hepatology, American University of Beirut , Beirut , Lebanon

2. Colorectal Surgery Unit, Catholic University of Paraná , Curitiba , Brazil

3. Division of Gastroenterology and Hepatology, Mayo Clinic , Florida , USA

Abstract

AbstractBackgroundDespite the growing therapeutic armamentarium, at least half of the patients with Crohn’s disease will require surgery during their lifetime. Current evidence for the prevention and treatment of postoperative Crohn’s disease supports the use of anti-tumor necrosis factor agents with limited data about the use of the newer biologics, vedolizumab and ustekinumab.MethodsWe performed a systematic review of available data to determine the efficacy of the newer biologics in the management of postoperative Crohn’s disease. We included noncomparative and comparative studies. The main outcomes of interest were clinical and endoscopic postoperative recurrence rates.ResultsThe search strategy identified 1231 citations, with 32 eligible for review. Several studies showed that the postoperative Crohn’s disease recurrence rates with the use of the newer biologics were comparable to previously published results with the use of anti-tumor necrosis factor agents, while other studies failed to show their efficacy. It is important to note that the studies were heterogeneous and included a relatively small sample size, making it difficult to draw a definite conclusion about the efficacy of the newer biologics in the management of postoperative Crohn’s disease.ConclusionThe newer biologics do play a role in the management of postoperative Crohn’s disease. After our review, we proposed an updated algorithm on the role of newer biologics in the approach to patients with postoperative Crohn’s disease. Yet, until we have better-designed studies, their definite positioning remains to be determined.

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology,Immunology and Allergy

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