Early Diagnosis and Treatment of Postoperative Endoscopic Recurrence of Crohn's Disease: Partial Benefit by Infliximab-A Pilot Study

Goals: Primary outcome of this study was to clarify whether infliximab, given after diagnosis of post operative endoscopic recurrence of Crohn’s diseases, can heal mucosal lesions (score <2) at 54 weeks. The secondary outcomes were improvement in the endoscopic score and clinical recurrence at 54 weeks. Background: Current data indicate that infliximab - given immediately after surgery – may be very effective in preventing postsurgical recurrence of Crohn’s disease. However, it is unknown whether a similar benefit would result from early diagnosis and treatment, rather then prevention, of endoscopic recurrence. Study: In this prospective open label multicenter pilot study 43 patients with ileocolonic Crohn’s disease subjected to curative surgery underwent colonoscopy 6 months after surgery. Patients with endoscopic recurrence (Rutgeerts score ≥ 2) were treated with either mesalamine 800 mg tid or infliximab 5 mg/Kg bw on a maintenance basis. Colonoscopy was performed after 54 weeks of therapy. Results: A total of 24/43 patients were diagnosed with endoscopic recurrence at 6 months. Thirteen were treated with infliximab and eleven with mesalamine. None of the 11 mesalamine treated patients had mucosal healing at 54 weeks. Two had clinical recurrence at 8 and 9 months. Fifty-four percent of patients treated with infliximab had mucosal healing at 54 weeks (p=0.01) while 69% had an improvement in the endoscopic score. None had clinical recurrence. Conclusions: Treatment of postsurgical endoscopic lesions by infliximab appears superior to mesalamine. However a sizeable proportion of patients did not fully benefit from this strategy.