P663 Primary prevention of post-operative recurrence of Crohn’s disease with anti-TNF agents in real life. Preliminary data from the Spanish ENEIDA registry

Anti-TNF and thiopurines are the only drugs that demonstrated efficacy in preventing postoperative recurrence (POR) in Crohn’s disease (CD). There are only two large RCTs in this setting assessing the efficacy of infliximab (IFX) or adalimumab (ADM), and real-life experience has been scarcely reported. All CD patients in whom anti-TNF agents were prescribed for primary prevention of POR within the first 3 months after ileocecal or ileocolonic resection with anastomosis were identified from the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD –GETECCU-). Epidemiological, clinical, biological and endoscopic features were collected before and within 18 months after surgery. Endoscopic POR was defined by a Rutgeerts score >i1 and advanced endoscopic POR by >i2. A total of 126 patients were included, 46 treated with IFX and 80 with ADM, after a median time of 29 days (IIQ13–48). Concomitant use of immunosuppressants was prescribed in 39% of which 80% thiopurines and 20% methotrexate. 39% received an additional 3-month course of metronidazole after surgery. Regarding risk factors for POR: 24% were active smokers, 50% had prior resections, 42% had penetrating CD behaviour, and 23% had a history of perianal disease. In total, 31 (25%) had none, 46 (37%) had only 1, and 49 (39%) had >1 risk factor for POR. 81% had been exposed to anti-TNF prior to the index surgery (74% within the last 6 months). Median time of follow-up on anti-TNF was 29 months (IQR 13–48). All patients had at least one endoscopic assessment within 18 months after surgery: 33% had endoscopic POR and 14% advanced endoscopic POR. Additionally, 28% presented clinical POR at the discretion of the treating physician and 3% developed surgical POR, with no differences between infliximab and adalimumab. In the multivariate logistic regression analysis only the penetrating behaviour was associated with endoscopic POR. Use of anti-TNF agents for the prevention of POR in real practice is markedly different from RCTs: they are more frequently used in combination with immunosuppressants and/or a 3-month course of metronidazole, a great proportion is anti-TNF experienced, and meet high-risk criteria for POR. In this setting, although anti-TNFs prevent POR in a large proportion of patients (particularly advanced endoscopic lesions), still one third of patients develop early endoscopic lesions.