COMPARATIVE REAL-WORLD EFFECTIVENESS OF BIOLOGIC THERAPIES FOR PREVENTING POSTOPERATIVE ENDOSCOPIC RECURRENCE OF CROHN’S DISEASE

BACKGROUND: Postoperative recurrence is common after ileocolonic resection for Crohn's disease (CD). Comparative effectiveness data for advanced treatments for preventing recurrence is limited. METHODS: We conducted a population-based retrospective cohort study of adults with CD undergoing ileocolonic resection with primary anastomosis in the Calgary Health Zone, Canada (2016-2020). The primary outcome was endoscopic recurrence within 18 months, assessed using the modified Rutgeerts score as an ordinal endpoint. High-risk recurrence (modified Rutgeerts score ≥i2b) was evaluated as a secondary outcome. Propensity scores were estimated using established clinical risk factors and inverse probability of treatment weighting (IPTW) targeting the average treatment effect among treated patients was applied to ordinal and logistic regression models. Treatment effects were expressed as adjusted odds ratios (aOR) with 95% CI. RESULTS: Among 231 patients, 126 (54.5%) received biologic prophylaxis and 92 (39.8%) received no treatment; endoscopy was performed in 217 patients. High-risk endoscopic recurrence occurred in 42.3% (36/85) of untreated patients compared with 9.4% (6/64) receiving TNF antagonists, 27.8% (10/36) receiving ustekinumab, and 10.0% (2/20) receiving vedolizumab. After weighting for established risk factors for recurrence, all biologic strategies were associated with reduced odds of endoscopic recurrence compared to no treatment (aOR 0.15-0.31, all p<0.05). Vedolizumab was associated with lower odds of recurrence compared with ustekinumab (aOR 0.24 [0.06-0.92], p=0.04) but not TNF antagonists (aOR 0.43 [0.10-1.87], p=0.26). CONCLUSIONS: In this real-world cohort, biologic prophylaxis is associated with reduced endoscopic recurrence in CD. Both ustekinumab and vedolizumab are effective options, including after prior TNF exposure.