Chunjie Zhang, Juan Wu, Zhaoxiu Liu, Leilei Luo, Wen Tang, Jing Sun, Fenfen Wang, Yan Chen, Yanjun Chen, Wei Han, Meijiao Lu, Zhaolian Bian, Cuihua Lu, Naizhong Hu, Lanxiang Zhu, Xiujun Liao, Yi Li
IMPORTANCE: In Crohn's disease (CD) patients treated with biologics preoperatively, the optimal strategy for postoperative biologic management remains unclear. DESIGN: This was a retrospective multicenter study involving CD patients with ileocolonic anastomosis from 9 medical centers. Patients were divided into "the consistent group" (postoperative biologic previously used before surgery) and "the switched group" (postoperative biologic not used preoperatively). The primary endpoint was postoperative endoscopic recurrence (ER), which was defined as the first endoscopy performed between 6 and 18 months after surgery. Propensity score matching (PSM) was used to minimize baseline differences between groups, and conditional logistic regression was applied to identify factors associated with ER. RESULTS: In total, 227 patients were included in the study, of whom 177 were in the consistent group. No significant difference was observed in the rate of ER between the switched group and the consistent group (30.0% vs 40.7%, P = .170). In patients with ≤2 risk factors defined by established guidelines, the switched group showed a lower ER rate (20.6% vs 40.0%, P = .038). After 1:1 PSM, the switched group had a lower ER rate (29.4% vs 61.8%, P = .027). Conditional logistic regression analysis revealed that switching biologics was associated with a lower risk of ER (odds ratio = 0.31, 95% confidence interval, 0.11-0.85, P = .023). CONCLUSIONS: In CD patients with preoperative biologic exposure, both continuing and switching biologic therapy postoperatively were effective in preventing ER, with switching showing improved endoscopic outcomes after adjustment for confounders.