Reutilization of biologics for postoperative Crohn's disease recurrence prevention is effective.

BACKGROUND: Biologic prophylaxis is used to prevent postoperative recurrence (POR) of Crohn's disease (CD) in high-risk patients who have undergone ileocolonic resection (ICR). There are limited data to guide clinicians' choice of prophylactic biologic class to prevent POR in patients previously exposed to biologics. We aimed to determine if reutilizing a prophylactic biologic class is associated with lower risk of POR in patients preoperatively exposed to biologics. METHODS: Adult CD patients who underwent ICR between 2009 and 2020 and were ever preoperatively exposed to biologics were included. Composite POR, including endoscopic (Rutgeerts ≥ i2b) and/or radiographic recurrence, was compared between patients who: received no prophylaxis, reutilized prophylaxis, or received a new class of prophylaxis (≤3 months from ICR) using Kaplan-Meier analysis. A multivariate Cox proportional hazards regression model was utilized to compare the 3 groups along with clinically established risk factors. RESULTS: A total of 635 biologic-exposed patients (≥2 biologics: 46%) who postoperatively received no prophylactic biologic (63.8%), who reutilized prophylactic biologic (30.7%), or who received a new class of prophylactic biologic (5.5%) were included. On multivariable analysis, no biologic prophylaxis was associated with a higher risk of recurrence (adjusted hazard ratio, 1.33; 95% confidence interval, 1.01-1.74; P = .04), and new biologic prophylaxis (adjusted hazard ratio, 1.50; 95% confidence interval, 0.89-2.53; P = .13) was associated with a similar risk of recurrence when compared with reutilization. Recurrence-free survival was similar among the 3 groups (P = .08); however, in patients undergoing their first ICR (P = .026) and in patients previously exposed only to anti-tumor necrosis factor agents (P = .051), the reutilization group demonstrated longer recurrence-free survival. CONCLUSIONS: Reutilization of biologic classes can be a valid strategy to prevent postoperative CD recurrence.