Influence of preoperative anti TNF alpha antibody therapy on postoperative recurrence of Crohn’s disease

Anti-TNFα antibodies are effective in controlling intestinal inflammation caused by Crohn's disease. However, many patients undergo surgery due to diminished efficacy of the antibodies during maintenance therapy. Currently, the decision between intensification of TNFα therapy and surgery is difficult to make. The purpose of this study was to determine the effect of preoperative treatment with anti-TNFα antibodies on postoperative recurrence of Crohn's disease. One hundred and fourteen consecutive patients with Crohn's disease who underwent bowel resection with anastomosis between 2009 and 2021 were retrospectively analyzed on the preoperative treatment history and perioperative information. Of the 74 patients who used anti-TNFα antibodies preoperatively, 43 underwent surgery after intensification of therapy following attenuation of anti-TNFα antibody efficacy. Time to postoperative endoscopic recurrence was significantly shorter in the group using anti-TNFα antibodies than in the group not using them (p = 0.0055). We found no difference in time to postoperative endoscopic recurrence between patients who underwent intensified therapy and those who underwent immediate surgery. Patients who received preoperative anti-TNFα antibody had a shorter time to postoperative endoscopic recurrence, but the presence or absence of intensified treatment after weakening of the anti-TNFα antibody effects did not affect the time to postoperative endoscopic recurrence.