术后给予英夫利西单抗治疗预防克罗恩病的复发

BACKGROUND & AIMS: A previous randomized, placebo-controlled study showed that infliximab maintenance therapy prevented recurrence of Crohn's disease 1 year after an ileo-colonic resection. We evaluated recurrence of Crohn's disease, based on endoscopic examination and/or the need for additional surgical resection, beyond the first postoperative year.

METHODS: In a prospective, open-label, long-term follow-up study, 24 patients, previously randomly assigned to receive infliximab for 1 year after an ileocolonic resection, were given the option to continue, stop, or start infliximab therapy. The primary endpoint was the time to recurrence of Crohn's disease, based on endoscopic evidence (endoscopic recurrence), from the initial assignment to postoperative infliximab or placebo. Secondary endpoints were rate of endoscopic recurrence, time to reoperation, and rate of surgical recurrence in relation to the total time on infliximab.

RESULTS: All patients were followed for at least 5 years after surgery. Patients assigned to the infliximab group in the first year after surgery had a longer mean time to first endoscopic recurrence (1231±747 days) than patients originally assigned to the placebo group (460±121 days, P=.003). Colonoscopies identified Crohn's disease recurrence in 22.2% in patients who received long-term infliximab and 93.9% in those not on infliximab (P <.0001). Compared to no infliximab, the adjusted rate ratio for being in endoscopic remission while on infliximab was 13.47 (95% confidence interval, 3.52-61.53, P=.0001). Patients originally assigned to the infliximab group had a mean longer time to surgery (1798±359 days) than patients originally assigned to the placebo group (1058±529 days, P=0.04). The rate of surgical recurrence (required additional surgical resection,) was significantly lower among patients who received infliximab for most of the follow-up period than patients who received it for shorter periods (20.0% vs 64.3%, P=.047).

CONCLUSIONS: Postoperative infliximab maintenance, beyond 1 year, prevents recurrence of Crohn's disease.

结论：术后给予英夫利西单抗维持治疗一年可预防克罗恩病的复发。