Pharmacological Prevention of Postoperative Recurrence in Crohn's Disease

Despite increasing use of immunosuppressants and anti-tumor necrosis factor (TNF) agents, approximately half of Crohn's disease (CD) patients still require surgery within 10 years after diagnosis. Surgery is not curative as postoperative relapse is very frequent in the absence of prophylactic treatment. Screening for known risk factors for postoperative recurrence allows patients to be stratified in order to consider appropriate therapy. A subsequent endoscopic evaluation and reassessment of treatment is currently the best strategy. Analyses of pooled data indicate that 5-aminosalicylic acid and thiopurines have only slight efficacy to prevent postoperative recurrence in CD. Nitroimidazole antibiotics are modestly effective, but long-term toxicity limits their use in clinical practice. Recently, anti-TNF agents have demonstrated the best efficacy profile to prevent endoscopic recurrence after surgery. As new treatment algorithms evolve towards increasing use of anti-TNF agents, this drives increased costs of management. However, this may be offset by the more widespread use of biosimilar versions of the anti-TNF agents. The increasing number of patients with previous exposure to numerous immunosuppressants and biologics at the time of surgery is a new challenge in postoperative management of CD, for which further data on new biologics are eagerly awaited.