TNF-Antagonist Therapy Linked to Better Outcomes for Post-Operative Crohn’s Disease

Patients treated with TNF- antagonists had a higher deep remission rate compared to patients treated with ustekinumab.

Tumor necrosis factor (TNF)-antagonist treatment does result in better outcomes for post-operative Crohn's disease patients (POCDP).

A team, led by Waseem Ahmed, Weill Cornell Medicine, compared the efficacy of biologics in post-operative patients with Crohn’s disease, controlling for recurrent risk factos and prior TNF-antagonist exposure in data presented at the Digestive Disease Week (DDW) 2022 Annual Meeting in San Diego.

A Lack of Data

There currently is a lack of comparative efficacy data on biologics in post-operative patients with Crohn’s disease and how prior anti-TNF treatment exposure impacts outcomes.

In the study, the investigators collected data on 186 patients with Crohn’s disease following their first post-operative biologic treatment using data from prospectively maintained single-center biobanks.

The investigators sought primary outcomes of comparing deep remission (HBI < 5, CD-PRO2 < 8, or remission stated) and objective (endoscopic (SES-CD < 3, Rutgeert’s i2a, or absence of ulcers) or biochemical (FCP < 150 µg/g or CRP < 1mg/dL) remission if endoscopy unavailable) between TNF-antagonists and ustekinumab (UST) at < 12 months post-treatment.

They also sought secondary outcomes of comparing clinical and objective remission.

The Analysis

The investigators repeated analyses by prior TNF-antagonist exposure, in patients treated < 6 months post-operatively, and in patients with documentation of objective recurrence at treatment baseline and performed multivariable analysis for the primary outcome analyzing factors associated with deep remission.

Overall, patients treated with TNF-antagonists had a higher deep remission rate compared to patients treated with ustekinumab (45% vs. 22%; P <0.01), with conclusions identifcal in patients with prior-TNF antagonist exposure (TNF: 44% vs. UST:19%; P = 0.02).

The rates of objective (72% vs. 53%; P = 0.03) and clinical (63% vs. 43%, p = 0.03) remission were also higher with TNF-antagonists compared to ustekinumab.

Outcomes

After conducting the multivariable analysis, the investigators found current TNF-antagonist use was the only factor linked to deep remnission (OR, 4.0; 95% CI, 1.7-9.6; P <0.01).

Outcomes also additionally favored the patients treated with TNF-antagonist in both patients with treatment initiation < 6 months post-operatively (TNF:48% vs. UST:29%, P = 0.1) and in patients treated after documentation of post-operative recurrence (TNF:44% vs. UST:16%, P <0.01).

“In the largest study on ustekinumab in POCD, TNF-antagonists were associated with improved outcomes compared to ustekinumab,” the authors wrote. “This reinforces the use of TNF antagonists as the primary therapy in POCD.”

The study, “Su1502: EFFICACY OF TUMOR NECROSIS FACTOR ANTAGONISTS AND USTEKINUMAB IN POST-OPERATIVE CROHN'S DISEASE,” was published online by DDW 2022.