TNF-Antagonist Therapy Linked to Better Outcomes for Post-Operative Crohn’s Disease

May 23, 2022
Kenny Walter

Kenny Walter is an editor with HCPLive. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with R&D Magazine. He graduated with a degree in journalism from Temple University in 2008 and began his career as a local reporter for a chain of weekly newspapers based on the Jersey shore. When not working, he enjoys going to the beach and enjoying the shore in the summer and watching North Carolina Tar Heel basketball in the winter.

Patients treated with TNF- antagonists had a higher deep remission rate compared to patients treated with ustekinumab.

Tumor necrosis factor (TNF)-antagonist treatment does result in better outcomes for post-operative Crohn's disease patients (POCDP).

A team, led by Waseem Ahmed, Weill Cornell Medicine, compared the efficacy of biologics in post-operative patients with Crohn’s disease, controlling for recurrent risk factos and prior TNF-antagonist exposure in data presented at the Digestive Disease Week (DDW) 2022 Annual Meeting in San Diego.

A Lack of Data

There currently is a lack of comparative efficacy data on biologics in post-operative patients with Crohn’s disease and how prior anti-TNF treatment exposure impacts outcomes.

In the study, the investigators collected data on 186 patients with Crohn’s disease following their first post-operative biologic treatment using data from prospectively maintained single-center biobanks.

The investigators sought primary outcomes of comparing deep remission (HBI < 5, CD-PRO2 < 8, or remission stated) and objective (endoscopic (SES-CD < 3, Rutgeert’s i2a, or absence of ulcers) or biochemical (FCP < 150 µg/g or CRP < 1mg/dL) remission if endoscopy unavailable) between TNF-antagonists and ustekinumab (UST) at < 12 months post-treatment.

They also sought secondary outcomes of comparing clinical and objective remission.

The Analysis

The investigators repeated analyses by prior TNF-antagonist exposure, in patients treated < 6 months post-operatively, and in patients with documentation of objective recurrence at treatment baseline and performed multivariable analysis for the primary outcome analyzing factors associated with deep remission.

Overall, patients treated with TNF-antagonists had a higher deep remission rate compared to patients treated with ustekinumab (45% vs. 22%; P <0.01), with conclusions identifcal in patients with prior-TNF antagonist exposure (TNF: 44% vs. UST:19%; P = 0.02).

The rates of objective (72% vs. 53%; P = 0.03) and clinical (63% vs. 43%, p = 0.03) remission were also higher with TNF-antagonists compared to ustekinumab.

Outcomes

After conducting the multivariable analysis, the investigators found current TNF-antagonist use was the only factor linked to deep remnission (OR, 4.0; 95% CI, 1.7-9.6; P <0.01).

Outcomes also additionally favored the patients treated with TNF-antagonist in both patients with treatment initiation < 6 months post-operatively (TNF:48% vs. UST:29%, P = 0.1) and in patients treated after documentation of post-operative recurrence (TNF:44% vs. UST:16%, P <0.01).

“In the largest study on ustekinumab in POCD, TNF-antagonists were associated with improved outcomes compared to ustekinumab,” the authors wrote. “This reinforces the use of TNF antagonists as the primary therapy in POCD.”

The study, “Su1502: EFFICACY OF TUMOR NECROSIS FACTOR ANTAGONISTS AND USTEKINUMAB IN POST-OPERATIVE CROHN'S DISEASE,” was published online by DDW 2022.


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